Title PageI. IntroductionTelemedicine definedII. An Overview of TelemedicineIII. Barriers to the Diffusion of TelemedicineIV. Telemedicine in MichiganExemplar Projects TableRecommendationsVI. Summary of RecommendationsVII. ConclusionReferencesTable 1. Roster of The Working GroupTable 2. Telemedicine-Related State Licensure LawsTable 3. States that Adopted the Interstate Nurse Licensure CompactTable 4. States Where Medicaid Reimbursement of Services Utilizing Telemedicine is Available.Table 5. Additional State Laws Addressing TelemedicineTelemedicine in Michigan: A Policy Report Addressing Legal and Regulatory Barriers Prepared by: Pamela Whitten, Ph.D. In Cooperation with the State Telehealth Working group Michigan State University Acknowledgements: This report is made possible by State of Michigan funding allocated to Michigan State University's Institute for Public Policy and Social Research (IPPSR) for applied public policy research projects.1 Contents I. Introduction……………………………………………………………………….4 A. Rationale for this Project……………..………………………………………5 II. An Overview of Telemedicine……………………………………………………6 III. Barriers to Diffusion of Telemedicine……………………………………………9 A. Licensure, Credentials and Certification……………………………………10 1. Physician Licensure……….……………………………………………...11 2. Nursing Licensure………………………….……………………………..13 3. Credentialing and Privileging…………….………………………………14 4. Certification……………………….………………………………………14 B. Payment and Reimbursement…………………………………………………16 C. Safety, Standards of Care and Liability……………………………………….19 1. Practice Guidelines………..………………………………………………19 2. Technical Standards…………………………………………..…………...21 3. Liability Insurance……………..………………………………………….21 D. Infrastructure…………………………………………………………………..23 E. Privacy, Security, and Confidentiality…………………………………………26 1. HIPAA……………………………………………………………………….26 IV. Telemedicine in Michigan…………………………………………………………29 V. Recommendations to Advance Telemedicine in Michigan…………………...…...33 A. Coordination Mechanism………………………...……………………………..332B. Licensure, Credentials and Certification……………………………………...34 1. Issues Presented…………………..……………………………………….34 2. Recommendations………..………….…………………………………….35 C. Payment and Reimbursement………………………………………………...37 1. Issues Presented…………………….……….………………………….....37 2. Recommendations…………………………….…………………………...37 D. Liability……………………………..……………………………………….39 1. Issues Presented………………….….…..…………….………………….39 2. Recommendations…………………...………..…………………………..40 E. Infrastructure………………………………………………………………..42 1. Issues Presented…………………………………….…………………….42 2. Recommendations………………………..………………………………..42 F. Privacy, Security and Confidentiality……….……………………………….44 1. Issues Presented………………….…………………….…………………..44 2. Recommendations…………..…………………..…………..……………...44 VI. Summary ……………………………………………………………………..…46 VII. Conclusion……………………………………………………………………...47 References ……………………………………………………………………..493Tables and Appendix Table 1 Roster of the Working Group on Telemedicine Policy for Michigan ………..52 Table 2 Telemedicine-Related State Licensure Laws………………………………....53 Table 3 States that Adopted the Interstate Nurse Licensure Compact………………..57 Table 4 States Where Medicaid Reimbursement of Services Utilizing Telemedicine is Available………………………………………………58 Table 5 Additional State Laws addressing Telemedicine……………………………64 Appendix 1 Sample Professional Liability Application………………………………..…664Telemedicine in Michigan: A Policy Report To Address Legal and Regulatory Barriers I. Introduction The Office for the Advancement of Telehealth (OAT) defines “telehealth” as: “ …the use of electronic information and telecommunications technologies to support long-distance clinical care, patient and professional health-related education, public health and health administration.” Emergence of the Internet and diffusion of high-bandwidth telecommunications technologies are just beginning to enable telehealth applications to address the burgeoning needs of our society for greater access to healthcare services at a lower cost. Michigan, however, is falling behind other states in its efforts to promote the advancement of telehealth applications. For instance, while Michigan has not yet addressed issues pertaining to licensure of providers who practice telemedicine across state lines, Alabama and other states have passed legislation recognizing (for telemedicine only) the license a practitioner holds in another jurisdiction. Whereas Michigan lacks the infrastructure to make available broadband access beyond a T-1 line in most parts of the state, Arizona has been able to attain OC-12 bandwidth (About 400x greater than T-1) within 10 miles of 90% of its population. Medicaid providers in Michigan are not eligible for reimbursement for telemedicine