The turning point for telemedicine in Colorado came in 2017. The state officials passed the complete parity law obliging private payers, employee health plan users, and Medicaid beneficiaries to cover for remote care services in the same way they do for in-person treatment. The new law lifted the location restrictions and other limitations, allowing access to telehealth services to all Centennial State residents.

Colorado has one of the most progressive telemedicine laws in the country, and the practice is proving to be helpful in releasing the pressure off the struggling healthcare system. The coronavirus outbreak shed light on all the inadequacies of patient care in the U.S. It seems that the states with properly regulated telehealth have a much better response to the crisis.

Colorado authorities continue to develop and support telemedicine, setting an excellent example for the rest of the U.S. The COVID-19 pandemic showed that we need to be flexible and react promptly to new and unpredictable challenges. A rigid approach to healthcare can have dire consequences and cause the system to collapse in the time of emergency.

The benefits of telehealth in Colorado

Telemedicine has many upsides, and some would even call it the future of healthcare. The truth is that patient care is going through a significant transformation that requires new models in providing treatment and diagnosis.

Digital technology revolutionized medicine in many ways, but it was not until recently that it offered an alternative to the traditional doctor's appointment. Telemedicine enabled the interaction between the physician and the requesting patient via telecommunication channels. The parties can interact from remote locations, which makes access to primary and specialist care much easier.

The benefits go beyond just meeting the two. The passing of all relevant medical information is quicker as all parties can use various communication tools such as emails, text messages, or phone calls to forward crucial data almost in real-time.

Colorado officials realized that the advantages of this model could help in modernizing and democratizing the healthcare system. Telehealth can potentially:

1. Allow better access to medical care for more patients
2. Upgrade patient experience by reducing the travel time and waiting hours
3. Improve the overall health of the population

With many of its residents living in rural regions, Colorado focused primarily on making healthcare available to them. Outside the cities, the lack of medical personnel is an ongoing issue, and remote care is an excellent way to bridge the gap between the providers and the recipients.

In 2017, the Centennial State officials decided to lift the location restrictions and allow access to telemedicine to residents of urban areas. It proved to be a smart move because it took the pressure off the hospitals that were struggling to admit all the requesting patients.

Although telehealth cannot replace the traditional practice entirely, it allows the doctors to remotely treat the patients that do not require in-person appointments or hospitalization. This leaves more space to provide for people who need acute or emergency care.

Telehealth and COVID-19 

Taking another step in the right direction, Colorado instructed all the insurers to allow telemedicine services free of charge during the COVID-19 pandemic. With self-isolation and movement restrictions in place, many people are reluctant to seek medical help in clinics and hospitals. The danger of failing to see and advise patients with other conditions is quite high during the pandemic.

Telemedicine enables the patients to seek advice or treatment without exposure to contagion in public places. Practitioners are also at a lower risk of catching the virus because they do not have to see many patients in-person. 

Even people who have the COVID-19 symptoms benefit immensely from this decision as they can consult with their doctors on what to do next without the risk of passing the virus to someone else in a crowded waiting room.

Colorado telemedicine providers report that the number of virtual visits has significantly increased since the outbreak. They also praise the decision of the government because it allows better care and treatment to both COVID-19 and other patients.

For many American states struggling to hold the situation under control, the Centennial State should serve as an example. A conservative approach to healthcare may have devastating circumstances in the time of crisis. That’s why we need to think in advance, with patients’ best interests in mind.

Telemedicine vs. Telehealth in Colorado

There is no clear and precise distinction between these two terms on the federal level. It is common to use telemedicine for strictly clinical services. Telehealth usually includes non-clinical activities, such as health education and prevention.

The state of Colorado does not differentiate between telemedicine and telehealth. They can be used as synonyms and refer to the same service. The official definition of telehealth in Colorado says that it is a mode of delivery of healthcare services by the use of telecommunication systems (information, communication, and electronic technologies included) to facilitate the diagnosis, treatment, consultation, education, and assessment while the covered person is at an originating site, and the provides on a distant site.

In this definition, the originating site is the location of the patient, and the distant site is the location of the doctor. According to Colorado officials, telehealth or telemedicine includes not only live, two-way interaction, but the store-and-forward model as well.  

Colorado Telemedicine Rules and Regulations

The Centennial State law imposes strict rules the providers must comply with to practice telehealth. The main concern is to keep the standard of care on the same level as in traditional practice. 

The Colorado Medical Board (CMB) provides comprehensive and precise guidelines for telehealth providers. Following issues have been at the center of attention:

1. Licensing
2. Doctor-patient relationship
3. Evaluation
4. Prescribing medication
5. Informed patient consent
6. Data protection and privacy
7. Medical records
8. Standard of care

Licensing

All providers offering services to Colorado residents must have a valid medical license for the State of Colorado. Out-of-state physicians will only be allowed to practice once they obtain the appropriate Colorado permits. 

The providers based in Colorado who are treating the patients from other states or countries must have appropriate permits for those jurisdictions. Since the Centennial State joined the Interstate Medical Licensure Compact in 2016, getting cross-state medical licenses became easier.

There are several exceptions to the licensing rule:

• An unlicensed physician can conduct peer-to-peer consultations with a practitioner with a valid Colorado medical license
• If a doctor has a license from a bordering state, they are allowed to practice in Colorado
• The physicians can provide follow-ups to patients who are currently out of Colorado if the relationship was already established

Doctor-patient Relationship

CMB allows the providers to establish a relationship with the patients by using telehealth technology as long as it complies with the general standards of practice in the state. This means that an in-person meeting is not required, but the physician and the patient must meet face-to-face in a video conference in real-time.

Emails, chats, text messages, or online questionnaires do not meet Colorado standards of practice. Once the relationship is established, the provider can use different communication channels to interact with the patient.

The following requirements are also mandatory for the doctor-patient relationship to be considered valid:

• The doctor must agree to treat the patient
• The patient (or their proxy) must agree to receive treatment, regardless of whether there was an in-person meeting
• The physician obtains written informed consent from the patient and verifies the patient’s identity and location
• The provider discloses their identity and credentials to the patient

Evaluation

Proper evaluation of the patient must happen before any telehealth treatment, including setting the diagnosis and prescribing medication. The evaluation includes checking the patient’s medical history and full physical and mental examination.

The Board states that the physician is responsible for determining whether the patient and their condition are eligible for telehealth treatment. In case they are not, the doctor should recommend another course of action or refer the patient to a different institution.

Prescriptions 

Telehealth providers in Colorado can issue prescriptions online as long as they comply with practice standards that apply in the state. Face-to-face contact via video call is necessary before prescribing any medication. This means that texts, audio-only calls, and online questionnaires are not a valid means of communication in this regard.

Controlled substances are not an exception, and CMB allows telemedicine practitioners to issue prescriptions for them as long as they follow standard procedures that apply on the state and federal level. The restrictions apply to medical marijuana, and it cannot be prescribed via telehealth.

Informed Patient Consent

The Colorado Medical Board deems informed written consent to be a mandatory document for the first telemedicine visit. It should comply with all the rules and regulations that apply to traditional practice.

Informed consent is permission for treatment that the patient grants to the physician in full knowledge of possible consequences that the treatment may have. The doctor is responsible for the explanation of the treatment and all limitations connected to telehealth.

Written consent should be obtained before the initial telemedicine visit and filed with other relevant documentation. 

Data Protection

All tools used in telehealth practice must be compliant with the strict regulation of the patient’s privacy protection. The medical data must be secure from third-party breaches, and the provider should disclose them only with the permission of the patient.

It is vital to use only the tools and platforms that can guarantee the safety of information. Doctor-patient confidentiality applies to telemedicine as it does to traditional practice, and any violations are subject to legal action.

According to Colorado laws, HIPAA and HITECH compliant communication is obligatory for remote care services. Encryption and password protection are necessary to avoid any failures to keep the information safe.

Medical Records

CBM is clear in stating that medical records must be kept for every patient receiving telemedicine treatment. They should be available to the patient on request and should contain the following:

• All doctor-patient communication, including session transcripts or recordings, emails, chats, text messages
• Patient’s medical history, if possible even before the telehealth treatment
• Prescriptions, scans, test results, etc.
• Reports from specialists
• Instructions from the doctor, as well as all information related to the current, or future treatments

Standard of Care

The Board instructs the practitioners to maintain the same standard of care that applies to in-person practice. This implies that the continuity of care is essential in telehealth. Providers must ensure that patients can seek follow-up care or information.

Every practitioner should have emergency backup plans in case the patient suddenly takes a turn for the worst and requires hospitalization. Even though it is not obligatory, CBM recommends that written emergency protocols should be given to patients upon the first virtual visit.

Reimbursement for Telemedicine in Colorado

As of January 2017, Colorado has a full parity law. This means that reimbursement for telehealth services is required for both private payers and Medicaid across the entire state. The officials removed location restrictions, making the service available to all CO residents.

Private Payers

Private payers cover all telehealth services. The insurers must reimburse the originating and consulting telehealth providers in the same way they would medical professionals in traditional in-person practice.

CO insurers should not deny coverage just because the treatment is available through telehealth only. They can withhold from the reimbursement if they deem that the treatment does not meet the necessary standard of care.

The fees that apply to telehealth services must not exceed the fees in equaling in-person services. 

Medicaid

CO Medicaid beneficiaries can use telemedicine services. This state-federal partnership defines telemedicine as the delivery of medical services using interactive video, audio, and data communication. This means that Medicaid covers for live services and does not include store-and-forward into the plan.

The only exception is teledentistry, when the patient receives an interim therapeutic restoration. Medicaid covers home health monitoring services by the home health agency of the member. Remote patient monitoring is available for certain chronic conditions.

Healthcare providers eligible for telemedicine coverage, according to CO Medicaid are:

1. Physicians
2. Physician Assistants
3. Nurse Practitioners
4. Clinics
5. Psychologists
6. MA Psychologists
7. Osteopaths
8. Rural Health Clinics
9. Federally Qualified Health Centers

Choosing the Right Telemedicine Platform in Colorado

Successful telemedicine practice depends on the knowledge and expertise of the medical professionals, but also on the digital platform that is being used. Choosing the right telehealth platform is essential in establishing and running a successful remote care service.

We at Curogram offer efficient and comprehensive solutions that allow practitioners to focus on what they do best—treat requesting patients. With two-way texting features and tools that mimic the workflow, we enable easy, secure, and effective communication that improves patient experience and boosts the productivity of the staff.

Since the electronic health records (EHRs) became a standard in both telemedicine and in-person practice, we offer a platform that integrates with over any EHR. Double entries are reduced to a minimum, and the resources can be allocated to patient care instead of administration.

For practitioners who would like to set a COVID-19 testing site, we provide software support, as well as assistance in organizing schedules and communicating test results to the 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.