For states with large rural and/or underserved populations, telehealth has developed as a cost-effective alternative to traditional face-to-face consultations or examinations between a provider and a patient. According to the National Conference of State Legislatures (NCSL), the most common path being taken by states is to cover telehealth services in the Medicaid program. In fact, 43 states and the District of Columbia now provide some form of Medicaid reimbursement for telehealth services. States also are evaluating whether to require private insurance plans to cover telehealth services. According to NCSL, 19 states and the District of Columbia now require private insurance plans to cover telehealth services.
Although most states provide some form of Medicaid reimbursement for telemedicine or telehealth, many states have not yet begun to explore teledentistry as a way to tackle the growing oral health needs in their communities. Below are some examples of state legislation related to teledentistry.
A.B. 318 has been introduced by Assembly Member Dan Logue (R-CA). The bill provides that, to the extent that federal financial participation is available, face-to-face contact between a health care provider and a patient shall not be required under the Medi-Cal program (California’s Medicaid program) for teledentistry by store and forward. The bill defines “store and forward” as an asynchronous transmission (1) of dental information to be reviewed at a later time by a licensed dentist at a distant site, where the dentist at the distant site reviews the dental information without the patient being present in real time. The bill would also provide that dentist participation in services provided at an intermittent clinic shall be considered a billable encounter under Medi-Cal. Additionally, the bill requires that on or before January 1, 2017, the State Department of Health Care Services must report to the Legislature regarding the number and type of services provided, and the payments made related to the application of teledentistry.
H.C.R. 2014 16 and a similar resolution, S.C.R. 2014 14, have been introduced. Both resolutions note the following:
This new care delivery model [teledentistry] can provide a much needed community-based “virtual dental home” for the state’s most vulnerable and underserved populations, who will access dental services in their own communities. It also will remove some of the barriers to receiving care in a traditional dental office setting. This model allows dentists and dental hygienists working in community sites to connect with a dental home in private dentist offices and in public health settings;
The State of Hawaii has a unique geographic topography that includes five main islands, where the majority of oral health professionals, including specialists, reside and work on the island of Oahu; and
Teledentistry can be an effective way to improve access to oral health care.
The resolutions request that the Department of Health establish a task force to study the potential benefits of teledentistry for the vulnerable and underserved populations, such as access to dental care and cost efficiencies, and to identify the barriers to the practice of teledentistry in Hawaii. The resolutions have been introduced on behalf of the governor. On February 26, the House Committee on Health recommended that H.C.R. 2014 16 be passed as amended by a vote of 7-0. To date, the amendment language has not been released to the public.
H.B. 2411 and its companion bill, S.B. 2469, have also been introduced in Hawaii. Both bills require reimbursement for services provided through telehealth to be equivalent to reimbursement for the same services provided via face-to-face contact between a health care provider and a patient. The bills also clarify that a health care provider of telehealth includes primary care providers, mental health providers and oral health providers, such as dentists. H.B. 2411 is currently moving through the committee process. On March 4, S.B. 2469 passed the Senate by a 23-0 vote with an amendment changing the effective date and making some nonsubstantive changes to the bill. S.B. 2469 has been transmitted to the House for further consideration.
Sen. Richard H. Black (R-VA) has introduced S.B. 647. The bill defines teledentistry as the delivery of dental services through the use of interactive audio, video or other electronic media used for the purpose of diagnosis, consultation or treatment. Teledentistry does not include audio-only telephone, email or facsimile transmission. Specifically the bill requires the Department of Medical Assistance Services (DMAS) to establish a pilot program providing dental services to school-age children who are eligible to receive pediatric dental services through the Smiles for Children program. Dentists participating in the program must provide supervision to licensed dental hygienists through teledentistry. Additionally, the bill requires DMAS to enter into a memorandum of understanding with the Virginia Dental Association to establish protocols for the administration of the program. Further, DMAS, in consultation with stakeholders including the Virginia Dental Association, the Virginia Dental Hygienists' Association, the Virginia Association of School Nurses, the Mid-Atlantic Telehealth Association and the Virginia Oral Health Coalition, must develop metrics to be used to evaluate the plan.
The bill also directs DMAS to report to the Secretary of Health and Human Services and the Chairmen of the House Appropriations and Senate finance committees on the benefits of teledentistry by November 1, 2016. On February 7, the bill passed the full Senate 40-0 and was transmitted to the House. On February 27, the bill passed the House Committee on Health, Welfare and Institutions with amendments by a vote of 22-0. S.B. 647 has been referred to the House Committee on Appropriations for further consideration.
1. The U.S. Centers for Medicare and Medicaid Services defines asynchronous or store and forward as follows: The transfer of data from one site to another through the use of a camera or similar device that records (stores) an image that is sent (forwarded) via telecommunication to another site for consultation. Asynchronous or store and forward applications would not be considered telemedicine but may be utilized to deliver services.