When it comes to health coverage and reimbursement policies for telehealth services, there are significant differences between states. In some states, inadequate coverage has made it difficult for telemedicine to be adopted on a broad scale (Thomas & Capistrant, 2016). One state of particular interest is Alaska. Because Alaska is the largest state in the country and one of the most rural, telemedicine could significantly expand the accessibility of health care for many Alaskans. However, while telemedicine coverage under Alaska’s Medicaid program is excellent, coverage for Alaskans with private insurance and the state employee health plan are lacking. This represents a major gap in Alaska’s current coverage and reimbursement system.
The main reason why there is such a significant gap between telemedicine coverage for Alaskans with Medicaid and Alaskans with other insurance is that Alaska has no parity law (Thomas & Capistrant, 2016). A full parity law is one that guarantees that coverage for telemedicine services is comparable to coverage for in-person health care services (Thomas & Capistrant, 2016). Currently, there are twenty-eight states with full parity laws, and one state has a partial parity law (Thomas & Capistrant, 2016). This indicates that, in terms of parity, Alaska lags far behind most other states. Passing a parity law will be essential in order to ensure that all Alaskans, not just those who qualify for Medicaid, have adequate coverage for telemedicine services.

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There are also a few gaps within the Medicaid service coverage and conditions of payment in Alaska. Most of the coverage is excellent. In fact, it is ranked the highest of all states for Medicaid coverage of various telemedicine technologies, as it covers interactive audio-video, store-and forward, remote-patient monitoring, and audio conferencing (Thomas & Capistrant, 2016). It is also ranked the highest for coverage of telemedicine services under Medicaid’s home health benefit (Thomas & Capistrant, 2016). Another highlight of Alaska’s Medicaid program covers telemedicine services from a wide range of providers, including podiatrists and nonmedical, mental / behavioral health service providers (Thomas & Capistrant). Still, the variety of providers covered under Alaska’s Medicaid program is not as extensive as in some other states, so it could be improved in the future.

The most problematic gap in Alaska’s telemedicine coverage program under Medicaid is the telepresenter requirement. Along with twenty other states, Alaskans with Medicaid must have a telepresenter or another health care provider to be on the premises during a telemedicine encounter in order to receive reimbursement (Thomas & Capistrant, 2016). Technically, this is not directly required by the Medicaid program itself, but it is required by Alaska’s state Medical Board (Thomas & Capistrant, 2016). This represents one way in which requirements for telemedicine are more stringent than for in-person health care services in Alaska.

Right now, it does not appear that Alaska is looking to address the gap in telemedicine coverage between Medicaid recipients and Alaskans with other types of health care coverage. In 2017, the Alaska State Legislature amended a section of AAC 40 to define the guiding principles for the practice of telemedicine (State of Alaska, 2017), but this did not include the addition of a parity law. Instead, the amendment adopted the treatment standards set forth by the American Medical Association and the Federation of State Medical Boards (FSMB) (State of Alaska, 2017). While this may improve the quality of care that Alaskans receive through telemedicine, it will not increase access. Alaskans who do not qualify for Medicaid do not stand to benefit from this amendment. Therefore, in the future, it will be essential for the state of Alaska to implement a parity law in order to ensure that telemedicine services are available and affordable for all of the Alaskans who need it.

    References
  • Notice of proposed changes relating to the practice of medicine in the regulations of the State Medical Board. (2017). State of Alaska. Retrieved from https://aws.state.ak.us/OnlinePublicNotices/Notices/View.aspx?id=185025
  • Professional regulations. (2017). State of Alaska. Retrieved from https://www.commerce.alaska.gov/web/portals/5/pub/MED-0317.pdf
  • Thomas, L. & Capistrant, G. (2016). State telemedicine gaps analysis: Coverage and reimbursement. American Telemedicine Association.