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Bills to regulate telehealth pending in Senate, House

By MARY SELL, Alabama Daily News

Bills to regulate medical care provided through telehealth are pending in the Alabama Legislature but debate remains about the proposed rules, including how often physicians must see patients in person.

The COVID-19 pandemic quickly expanded the use of technology to allow Alabamians to see their care providers without going into crowded offices, but rules haven’t kept up, bill sponsors say.

“Today, telehealth is being done, but there are no guidelines, there is no foundation in the state of Alabama,” House sponsor Paul Lee, R-Dothan, said last week in the House Health Committee he chairs. “It’s basically the wild, wild west.”

Lee’s House Bill 423 was approved in the House Health Committee and awaits a House vote. Senate Bill 272, by Sen. Dan Roberts, R-Mountain Brook, is awaiting a vote in that chamber.

Lee said he wants to make sure telehealth options offer the same quality of care as in-person visits.The bills authorize the Alabama Board of Medical Examiners and the Medical Licensure Commission to adopt rules for using technology to deliver remote care.

Currently, the bill says that if a doctor sees a patient four or more times within a year, there must be an in-person visit. That requirement has drawn some opposition. Claudia Tucker, senior vice president for New York-based virtual care provider Teledoc Health, said “90% of the bill is great.”

“The other 10% is not good and it will set access to care for all Alabama residents backward and it doesn’t have to,” she said in a public hearing on the bill.

Specifically, Tucker said the mandate for in-person visits is out of line with what other states do. Using herself as an example, Tucker said a healthy person living in a rural area shouldn’t have to drive to a medical office because she gets poison ivy five times per year.

It should be up to doctors to decide when a patient should be seen in person, Tucker said.

“If a person needs to be seen in person, then a doctor will do that,” she said.

The Medical Association of the State of Alabama disagrees.

“You have to lay hands, you have to lay eyes on a patient periodically,” Niko Corley, director of government relations for MASA, told the committee.

Bill sponsors in the House and Senate are adamant that physicians need to occasionally be in the same room as their patients.

“That’s just good medicine,” Roberts said.

He said telemedicine can augment and expand traditional in-person care.

The bill also says a controlled substance can only be prescribed via telehealth if, “the physician or another physician in the same practice or group, within the preceding 12 months, has had at least one in-person encounter with the patient and established a legitimate medical purpose for issuing the prescription.”

Prior to early 2020, providers said telehealth was limited in the state by a lack of access to high-speed Internet in several areas and a lack of insurance coverage for the remote visits.

In response to the virus in March 2020, Blue Cross and Blue Shield of Alabama, the state’s largest insurer, expanded its coverage of telehealth services. That coverage remains in place.

Roberts in 2020 sponsored legislation to require insurers in Alabama to provide coverage for telemedicine services. The bill did not get approved. This year’s legislation does not have a coverage requirement.

Asked about the bills, a BCBS spokesperson said the insurer strongly supports the use of telemedicine. 

“At the onset of the pandemic, Blue Cross expanded telehealth coverage for our members allowing physicians, physician assistants, nurse practitioners and behavioral health practitioners to provide medically necessary services via telephone consultation,” Sophie Martin said in an emailed statement. “Telemedicine ensures our customers have increased access to the quality care they need and the strong potential to decrease the cost of care.

“Telemedicine is an effective option for care but shouldn’t replace needed in-person visits to primary care physicians. Preventive care visits and certain symptom diagnosis made in-person allows physicians to accurately diagnose their patients resulting in better health outcomes.”

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