If taken ill traveling in New York or Texas, or any other of the 50 states, odds are you would not question the basic competence of the medical professionals who treated you there. But consult that same doctor over Skype from within Virginia and state licensing laws might get in the way.
A bill introduced to the 2019 General Assembly, pending now in both the House and the Senate, would eliminate that basic barrier by in effect allowing Virginians to use telemedicine on a national basis, removing the requirement for a Virginia license if the physician or other provider is in good standing where he or she works.
Senate Bill 1221 was introduced by Senator Ben Chafin and House Bill 1970 by Delegate Terry Kilgore. Both Republicans represent deep southwest Virginia, known to have a shortage of medical services, a shortage that may be worsened by higher demand created under Virginia’s expanding Medicaid program.
Two conservative activist groups which opposed Medicaid expansion are promoting this idea, in part because of those supply and demand concerns. “Frankly, Virginia needs doctors! Demand for healthcare consumption is increasing as Medicaid Expansion takes hold, but supply remains unchanged (at best),” wrote Caleb Taylor of the Virginia Institute for Public Policy. Americans for Prosperity is the other group pushing the idea.
Current Virginia law permits a doctor from another state with an office less than fifty miles from the Virginia border to engage in telemedicine. That picks up some urban centers near under-served rural Virginia, as well as Washington, D.C. and its environs. This bill would expand that nationwide, with Virginia relying on the other states to police their providers.
A 2017 bill made it somewhat easier to prescribe medications through telemedicine, within Virginia.
The right to consult a physician in another state, or to have them monitor your treatment, is only one element of the bill. It goes to the heart of the matter by requiring that health insurance cover that patient monitoring service and calls for the Department of Medical Assistance Services (DMAS) to expand the opportunity for telemedicine within the Medicaid program.
It also makes an important tweak to the code by defining the location of a medical practice as where the doctor is located, not where the patient is located.
There is no mention in the legislation or the talking points Taylor shared of efforts already underway to accomplish this through an interstate licence compact, or a telemedicine compact seventeen states (not including Virginia) have joined already. The multi-state license process may be a response intended to maintain tighter requirements than the proponents of this bill want to see. As you can see here, none of the states is willing to part with its licensing fee.
These cross-border access issues always combine good arguments for state oversight with naked turf protection, preventing competition for economic benefit. There is also a debate going on about access to interstate health insurance options. But getting at the cost of these services is vital and the technology is making this harder to resist.
Objections to the idea are bound to surface when the bills come up for discussion, both in subcommittees of the two health committees. There no shortage of lobbying muscle on the part of the Medical Society of Virginia and related practitioner associations, and the health insurance industry is bound to have opinions.
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