April 2020 has been crucial for the development of telehealth services in Arizona. The COVID-19 outbreak forced the officials to act fast and try to remodel the inefficient health system that took a massive hit in the time of the pandemic. The past mistakes are becoming painfully evident as the medical professionals are struggling to rise to the task of fighting the coronavirus.

Many experts deem telemedicine to be the solution to a number of problems the healthcare system is facing these days. They lament over the chances we had and lost to improve the effectiveness and availability of medical treatments.

The telemedicine laws received a fantastic upgrade in Arizona, and the practitioners have a much clearer picture in terms of both practice and reimbursement. It is not the right time to despair, so congratulations to the Grand Canyon State for this swift reaction even though it may be long overdue We can only hope that some other states will follow this excellent example.

The Benefits of Telemedicine

Arizona does not have an unusual definition of telemedicine. The term is described as healthcare provision via digital communication channels or other technologies between a practitioner and a patient who are in different locations. 

The location of the doctor is called the distant site, and the location of the patient is called the originating site. Telemedicine uses different advantages of modern technology for communication, depending on the type of service required. As you can see, there are many different telemedicine services, and they can be used as an additional tool in the traditional practice, but also on its own. Depending on the needs of a specific community, remote care can bring many positive changes to healthcare. Some of the primary goals of telemedicine are:

• Allowing more patients to receive necessary care
• Reducing the costs of healthcare
• Improving the quality of service and patient satisfaction

The idea is to offer affordable, efficient services that enable medical professionals to deliver maximum results by providing better care, both in terms of treatment and disease prevention.

Telemedicine vs. Telehealth

The State of Arizona does not make a specific distinction between these two terms, so they often overlap in official documents. Some other states do offer separate definitions of telemedicine and telehealth. 

Telemedicine usually refers to strictly clinical practices delivered through a variety of digital communication tools. Telehealth is a broader term that incorporates non-clinical activities, such as education and prevention. With the development of remote care services, the need for differentiation may force the authorities to provide definitions of these two terms on a federal level.

In Arizona, telemedicine/telehealth is defined as the practice of healthcare (diagnosis, consultation, and treatment) and the transfer of medical data through interactive video, audio, and data communications, occurring in the physical presence of the patient. Audio and video communication sent to a provider for treatment or diagnostic consultation are included in the definition.

Arizona law offers a separate definition of telepractice. This term refers to interactive digital communication between a behavioral health professional and the client and is restricted to behavioral health services.

Arizona Telemedicine Rules and Regulations

Although it seems to be the leader in technological innovation, Arizona is a little behind in the development of telehealth. This does not mean that the practice was not available, but it implies that it was limited in many ways.

Arizona followed the usual guidelines that apply on the federal level when it comes to regulating telehealth services and focused primarily on keeping the standards as high as in traditional practice. All practitioners have to comply with medical retention rules, confidentiality and privacy policies, and HIPAA.

The Arizona Medical Board gives clear recommendations on the following topics:

• Licensure
• Standard of care
• Informed patient consent
• Prescriptions
• Medical records
• Location restrictions

Licensing

Arizona officials consider the originating site the place of the visit. All telehealth providers who want to practice telemedicine in Arizona must have a valid medical license for the Grand Canyon State, regardless of their residence.

If you are a telemedicine practitioner based in Arizona, you must make sure that you have the right to practice in the state. These licensing requirements used to be a challenge for many healthcare providers. The good news is that Arizona joined the Interstate Medical Licensure Compact, which aims to make cross-state licensing easier.

Standard of Care

Telehealth providers must follow the rules and regulations applicable to traditional, in-person practice when it comes to the standard of care. All requirements and restrictions are the same in terms of responsibilities and ethics, while the patient’s well-being must be the priority of every treatment.

Doctors are required to evaluate the patient and decide whether telemedicine is appropriate for diagnosis and treatment. Since this practice has its limitations, the practitioner must refer the patient to other institutions if their condition exceeds the expertise of the doctor or the limits of telehealth.

Emergency backup plans must exist in case the patient receiving telemedicine services needs hospitalization or any other form of traditional care. The patient must get information about these emergency protocols from the practitioner at the beginning of the treatment.

Informed Patient Consent

In the State of Arizona, telemedicine providers must obtain oral or written consent from the patient before the visit. If you're not sure what information should be on the consent form, we suggest you follow the guidelines of the American Telemedicine Association:

1. Information about the rights of the patient, including the right to stop or refuse the telehealth treatment
2. The explanation of the responsibilities of the patient during the telemedicine treatment
3. A formal complaint form if any issues occur during the treatment
4. A list of all the potential benefits but also risks and limitations of telehealth
5. The contingency plan that is set in motion in case of equipment failure or a need to refer the patient to another practitioner or institution because of a sudden change in their condition
6. A description of the technology used during the treatment, as well as of patient privacy and data protection

Prescriptions

According to Arizona law, practitioners cannot prescribe medication without performing a physical or mental health examination of the patient. 

Online questionnaires, text messages, or emails are not considered appropriate communication channels for prescribing medication or for establishing a doctor-patient relationship. 

If the examination has been performed the doctor can prescribe drugs online. They should not recommend specific pharmacies, and they should use e-Prescription systems to ensure patient safety and prevent errors.

Medical Records

Telemedicine providers in Arizona must keep transparent, comprehensive, and updated medical records on all patients they see. The records should be available to patients at all times.

Since electronic health records (EHRs) became a standard in both traditional and remote healthcare, it is vital to keep them up-to-date and precise. They should include the patient's medical history with all test results, scans, instructions, prescriptions, as well as the entire doctor-patient communication. 

It is essential to use the technology and software that integrates with various EHRs to avoid manual and double entry. Your staff will have more time for direct patient care if the administration is not overly demanding. Curogram integrates with all the popular EHRs, which makes it an excellent solution for setting up a telemedicine practice.

Location Restrictions

The biggest challenge when practicing telemedicine in Arizona are the location restrictions.The limitations apply to:

1. The area in which the patient lives
2. The type of facility where the telemedicine appointment takes place

State Region Limitations

Practicing telehealth is allowed only in rural areas of the Grand Canyon State. Any place with less than 900,000 people is considered a rural area. Arizona recognized the need for healthcare availability improvements for the particular demographic and focused on making diagnosis and treatment more accessible to them. 

Type of Facilities Qualifying as the Originating Site

The patient has to be at a specific type of facility to be able to receive telemedicine treatment. The eligible sites include:

• IHS clinic
• Hospital
• Practitioner's office 
• Urban clinic for Native Americans
• 638 facility which is tribally governed
• Federally Qualified Health Center (FQHC)

These restrictions imply that the patient should receive telehealth services only in controlled circumstances and under the supervision of other medical professionals. These are usually appointments with specialists that are unavailable in a particular region while the general physician is present at the originating site.

Arizona Telemedicine Laws During the COVID-19 National Emergency

It is clear that Arizona was not using the full potential of telehealth and imposing restrictions on the locations suitable for appointments. Although it may seem like a reasonable decision, the COVID-19 pandemic proved that limiting the scope of telemedicine services needs to be reconsidered.

The healthcare system was on the verge of breaking, and all it needed was a little push to collapse. With the lack of medical professionals, many states, Arizona included, failed to tend to all the patients.

It is not surprising that the State Governor Doug Ducey issued an Executive Order that requires all insurance companies to expand the coverage for telehealth services to match that of in-person ones during the national health emergency. For many Arizona residents in self-isolation or quarantine, this means easier and safer access to primary and special care. It will also help take some of the pressure off hospitals and health centers that have been overcrowded for weeks. Medical staff will also be safer and at a lower risk of getting infected.

Elderly and chronic patients are at the highest risk during the pandemic. The officials realized that the outbreak could cause the rise in fatalities not necessarily from COVID-19.

The most important points of Ducey's Executive Order are:

1. The insurers must not charge more for telemedicine than for in-person visits.
2. Arizona Health Care Cost Containment System (AHCCCS), which is the Arizona Medicaid agency, can cover all telemedicine services for its beneficiaries.
3. All electronic communication channels can be used for telehealth appointments.
4. The patient's home becomes an approved originating site for telemedicine services.
5. Physicians are not required to conduct an in-person visit to issue prescriptions.

The Governor has been an advocate for telemedicine for quite a while, pointing out that the remodeling of healthcare is long overdue. He signed the progressive SB 1089 bill in March 2019, enabling the above points to become legal as of 2021. The Executive Order accelerated the process, as the pandemic required prompt reaction.

Inhabitants of rural regions in Arizona have been struggling with receiving primary care for years even though the state has the fourth highest economic growth rate in the country. Some officials warned about the critical shortage of physicians in certain areas that could cause serious problems for the population's health.

Digital health platforms can be helpful during these difficult times. For practitioners looking for ways to establish their COVID-19 testing sites, we at Curogram can automate the entire process by providing end-to-end solutions for patient registration, scheduling, testing coordination, and payment.

The Potential Challenges of Practicing Telemedicine in Arizona

The critics of SB 1089 say that the Bill does not adequately address the general lack of broadband resources. They are concerned that the programs will not be successful in the areas where the Internet connection is poor, which are mostly rural regions that need remote medical care the most.

Practitioners should be careful about choosing a reliable platform that features a fully HIPAA compliant communication channel, as well as a user-friendly interface and ease of access for both medical personnel and patients. Curogram can help you improve your practice with two-way texting and various other useful features.

Telemedicine reimbursement in Arizona

The partial parity law left a lot to interpretation, and some providers were reluctant to engage in remote patient care because of the intricate red tape and vague legislation.

The parity law that should kick off in 2021 is great news for providers. Telehealth providers will get reimbursement for all services in the same way they do for traditional practice.

The partial parity law left a lot to interpretation, and some providers were reluctant to engage in remote patient care because of the intricate red tape and vague legislation.

With SB 1089 in place, both private payers and Medicaid covers for telehealth services even outside rural areas. Store-and-forward services and home health monitoring are added to the list of covered services.

The Grand Canyon State lifted many restrictions regarding the types of services and eligible providers for telehealth, and the results of their work should soon be palpable. We can only hope that the rest of the country will jump on the bandwagon because telehealth is an opportunity to deliver better care to all requesting patients.

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.