Definitions of telemedicine and telehealth vary across jurisdictions. SAMHSA uses the federal Medicaid definition of telemedicine:
“Telemedicine seeks to improve a patient's health by permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment... [Medicaid] does not recognize telemedicine as a distinct service.”
By contrast, telehealth is usually used as a broader term. Telehealth typically includes not only telemedicine but also other forms of telecommunication, including asynchronous or “store and forward” systems, which transfer a patient’s data or images for a physician or practitioner at another site to access at a later time. With these systems, the patient and provider do not have to be present at the same time.
Fundamental Telehealth/Telemedicine Considerations
All CCBHCs should consider the following issues, regardless of their state:
- What type of telehealth/telemedicine/telecommunications are reimbursable by the state (for example, interactive audio-visual, asynchronous, store and forward, remote patient monitoring)?
- For what services does the state permit telehealth/telemedicine delivery?
- Which providers does the state permit to deliver services via telehealth/telemedicine?
- Does the state limit where the consumer must be physically located and where the distant provider must be physically located?
- Are there state licensure restrictions related to the distant provider?
- Are there state or other credentialing restrictions related to the distant provider?
- Does the state permit facility, transmission, and/or other fees to be reimbursed?
- Does the state require someone to be in attendance at the originating site and, if so, is it reimbursed?
- Are there any prior authorization or other utilization controls that restrict telehealth/telemedicine use?
- What security and confidentiality restrictions does the state place specifically on telehealth/telemedicine?