Texas is making access to health care much more convenient for the parents of children enrolled in the state’s Medicaid program. Through new legislation effective September 1, 2015, providers will be able to bill the program for telemedicine appointments after “seeing” the patients over video chats during school hours, with the help of the school nurse. If a diagnosis is made, parents will be able to pick up a prescription later that day.
State Representative Jodie Laubenberg (R-89) authored the legislation in an effort to increase access to health care while limiting work and school disruptions for parents and students. Laubenberg pointed to programs like the one organized by Children’s Health(SM), which provides 27 grade schools in the Dallas-Fort Worth area with electronic access to a doctor and two nurse practitioners. A local school nurse (who may or may not have a nursing degree) examines the child, and then schedules an appointment with Children’s if a problem is observed. Due to the success of the program, Children’s will deploy to an additional 30 schools. This program was limited to five years of funding through a Medicaid 1115 waiver, so the new law is vital to continuing to provide this type of access. The Texas program follows similar laws in Georgia and New Mexico.
Although some point out that the vast majority of things seen in a pediatric clinic, like sports injuries, strep throat, and mental illnesses, can be handled via telemedicine, others have raised concerns about these programs. Even those who find health intervention in school “effective” are concerned about equity and access for children who get sick in school but are not enrolled in Medicaid. Others pointed out that these busy doctors may not have a full picture of the child’s health, and children cannot be expected to understand risks and report allergies and medical histories appropriately.
The Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) incorporates telemedicine in several sections, paving the way for the increased use of this method of providing care. For example, section 3021 of the ACA created the Center for Medicare and Medicaid Innovation (CMMI) in an effort to test new payment models, including ways of using telehealth services to treat behavioral health issues (see Are we there yet? Telehealth, telemedicine, and the ACA, Health Reform WK-EDGE, April 22, 2015). As states embrace new ways of delivering care and explore payment strategies, the ACA can serve as a guide for reform.