The American Telemedicine Association (ATA) has released the latest edition of its telemedicine state-by-state score card reports. There’s good news and bad news. In the area of coverage and reimbursement, 11 states and the District of Columbia saw their grades improve since September 2014, when ATA released the first editions of these reports, and only two saw their grades decline. But in the area of physician practice standards and licensure, 11 states saw their grades lowered while just six improved. Nevada was the only state to improve in both categories.

ATA attributes the drop in the latter category — a composite score encompassing physician-patient encounter policies, telepresenter laws, informed consent requirements, and licensing laws —  to increasing scrutiny of telemedicine by state medical boards. 

“Since the first version of this report in 2014, medical boards have moved towards a trend to impose different regulations or guidance for medical practice via telemedicine when compared to in-person practice,” authors Latoya Thomas and Gary Capistrant wrote in the report. “Further, states are becoming more prescriptive in their requirements for an additional patient informed consent and the types of modalities permitted for appropriate clinical practice when using telemedicine. As a result of incongruent guidance and regulation for telemedicine when compared to in-person practice, more states have dropped a letter grade than those that have improved since 2014.”

Idaho, Colorado, Texas, Arkansas, Indiana, West Virginia, Virginia, South Carolina, Delaware, Connecticut and Maine all dropped a grade or more while Nevada, South Dakota, Michigan, Alabama, Pennsylvania, and New York all improved. Overall, the lowest scored states were Arkansas and Texas, which earned composite grades of C and the best were Alabama, Minnesota, and New Mexico, which earned As in every category except licensure and out-of-state practice, a category in which no state scored an A.

The reimbursement report — which included telemedicine parity laws, Medicaid coverage laws, and state employee health plans in its analysis — was more positive, with only Maryland and New Hampshire losing ground. Washington, Washington, D.C., Nevada, Utah, Wyoming, North Dakota, Oklahoma, Iowa, Wisconsin, Ohio, New York, and Delaware all raised their grade, and Iowa jumped from an F in 2014 up to a B.

States jumped for different reasons. Eight states have enacted new telemedicine parity laws since 2014, 48 states now offer Medicaid coverage of telemedicine at some level, and 26 states now include telemedicine coverage in state employee health plans. Just two states earned an F overall for reimbursement, the same two from the May 2015 version of the report: Rhode Island and Connecticut.