Telemedicine utilization continues to progress across the U.S., increasingly underscoring the service as an affordable and effective way to universally widen access to healthcare—especially for individuals living in rural and underserved areas.

Yet, access to telemedicine services and reimbursement varies greatly depending on which state a person lives in. As outlined in the American Telemedicine Association (ATA) annual report card, some states are making more progress than others.

This week we will take a closer look at recent developments in select states, specifically, tighter regulations proposed in Montana, despite widespread use of telemedicine among its residents, while Indiana looks to expand services to the state’s Medicaid patients.

New bill in Montana looking for tighter telemedicine regulation stalled

The geographic composite of Montana alone makes the state an ideal candidate for telemedicine’s broad reach. Montana is ruralresidents face great distances between cities as well as weather conditions that can often make travel by road problematic. These and other factors considerably limit access to healthcare for its residents and play a big role in why many patients in Montana utilize telemedicine to interact with care providers remotely.

Despite its wide use, or perhaps because of it, Rep. Kirk Wagoner, R-Montana City, proposed a new bill aiming to put tighter regulations on the state’s telemedicine practice. “The bill would require doctors practicing telemedicine to first establish a relationship with their patients through video chat or in person,” reported the Great Falls Tribune. Once that relationship has been established, patient and provider are free to move forward by solely-audio means if desired.

Yet the bill has drawn mixed reactions. The Montana Medical Association supported the bill feeling that it would help maintain high standards of care for those utilizing telemedicine, while telehealth provider Teladoc claimed it was “not technology neutral enough.”

However, ultimately what may seal the bill’s fate is the state’s unreliable access to sufficient broadband to support the video consults that the bill is mandating. According to mHealth Intelligence, the bill was shot down in the Senate, despite an earlier favorable vote in the House.

Politico reported that state senators became disenchanted with the bill because of its focus on audio-visual telemedicinebanning phone-based consults to establish a doctor-patient relationship, despite the fact that more than half of the state’s residents don’t have access to sufficient broadband to support video consults.

It’s evident why states with large rural populations would benefit greatly from telemedicine, yet limited and unreliable broadband capability and other infrastructure roadblocks continue to present challengesnot just in Montana but for other rural states as well. As a result, access to telemedicine programs are limited for the people who would benefit from them the most, making phone-based doctor-patient interaction all the more valuable.

Indiana looks to expand telemedicine services to Medicaid patients

MobiHealth news reported last week that House lawmakers sent a bill to Indiana’s governor that would expand telemedicine services across the state to Medicaid patients. At the request of psychiatrists, reports Indiana Public Media, the proposed bill would also remove a ban on prescribing controlled substances via telemedicine, such as Ritalin and Adderall.

Although the bill requires patients to be examined in-person by a healthcare provider before receiving a prescription via telemedicine, removing the ban has some legislators worried. Indianapolis Rep. Ed DeLaney voiced that he’s “very concerned that this would allow somebody out-of-state to prescribe a controlled substance in this state to someone they’ve never laid eyes on.”

However, psychiatrists feel the measure would fill a gap for those who need mental health care but aren’t able to access it because of where they live. In addition to extreme shortages of primary care providers and specialists, behavioral healthcare is no exception. Particularly for Americans in rural communities who run into the same challenges trying to access mental health services in areas where often there is none offered or realistically accessible.

On Wednesday, the bill was signed by the Speaker.

As telemedicine use grows, states navigate changing landscape

As we continue to look for viable answers to address some of the big issues impacting healthcarea crippling opioid epidemic, a growing number of Americans facing mental health issues and a nationwide physician shortage, one that’s hitting rural areas especially hard, it will be critical to factor telemedicine into the solution. State’s need to consider the unique challenges and current healthcare climates impacting their citizens when integrating telemedicine practices and legislation.

For example, Montana’s rural geography and lack of broadband infrastructure makes audio capability a key component to successful telemedicine implementation.

Indiana, who was recently ranked as one of the worst states in the country in regards to access to mental health services for its citizens, could greatly benefit from telemedicine services. According to the American Telemedicine Association, studies have shown that telemedicine’s use in mental health delivers greater outcomes and patient satisfaction than traditional, in-person consultations.

Telemedicine works to fill many of the gaps in care that result from an inability to access quality healthcare services due to a myriad of circumstances. State lawmakers will need to work cohesively and thoughtfully in order to develop telemedicine legislation that meets their citizens most critical needs and leverages telemedicine’s benefits to the full extent.