ERIC’s Comment Letter on Proposed Telemedicine Rules in North Dakota

Administrative Rules Committee
North Dakota Legislative Council
600 E. Boulevard Ave.
Bismarck, ND 58505-0360

RE: Comment on Proposed Telemedicine Rules for December 5, 2017 Administrative Rules Committee Meeting

Dear Chairman Devlin and Members of the Administrative Rules Committee:

On behalf of The ERISA Industry Committee (ERIC), thank you for accepting input from interested stakeholders as you consider the North Dakota Board of Medicine’s proposed rules regarding telemedicine. ERIC is the only national association that advocates exclusively for large employers on health, retirement, and compensation public policies at the federal, state, and local levels. We speak in one voice for our members on their benefit and compensation interests, including many members with employees and retirees in North Dakota.

As plan sponsors, our members strive to provide the best health care possible to their employees, retirees, and families at an affordable cost. At ERIC, we seek to enhance our members’ ability to provide high-quality, affordable health care, and we recognize the significant opportunity provided by telemedicine to modernize health care delivery and improve access to quality medical care for workers and their dependents. Telemedicine minimizes the time spent attending a health care provider visit, making telehealth a great value to working parents, caregivers, and others struggling to balance work and family demands. It also provides access to care for rural and urban underserved populations, retirees, the elderly, disabled employees, and those with language barriers, chronic conditions, or transportation barriers that may otherwise not have access to care.

We applaud the Board of Medicine’s proposed rules providing for the same standard of care for telemedicine visits as for those conducted in-person and for permitting the patient-licensee relationship to be established via telemedicine. The benefits of telemedicine will be greatly diminished if it can only be used by those with preexisting patient-licensee relationships. For example, many people that have recently moved for work, college students, those in need of a specialist, or those that have never been to a health care provider would not be able to utilize telemedicine services if a preexisting relationship was required.

In Proposed Rule 50-02-05-03, however, to establish a patient-licensee relationship via telemedicine, the mode of delivery must be by video examination, even though the Board’s proposed telemedicine definition includes “asynchronous store-and-forward technologies.” We encourage you to send these rules back to the Board to reconsider the restrictive video requirement to establish the patient-licensee relationship. The State Legislature defined telehealth in 2015 as “the use of interactive audio, video, or other communications technology that is used by a health care provider or health care facility at a distant site to deliver health services at an originating site….” At ERIC, we support technology-neutral requirements in telemedicine regulations because restrictive requirements create a barrier to access—especially in rural areas where a significant proportion of the population lacks access to a fast, reliable internet connection capable of two-way audio-video communication.

We believe that it should be within the health care provider’s professional judgment to determine if a telemedicine visit will meet the requisite standard of care and what type of technology is appropriate to establish a relationship with a certain patient. Additionally, restrictive technology requirements prevent new forms of telemedicine technology, which are ever-evolving, from being quickly implemented. Patients should not be prevented from using telemedicine solely because they lack the capability to communicate with a provider via video. We request that the Board of Medicine consider allowing interactive audio in conjunction with asynchronous store-and-forward technology to be used to establish the patient-licensee relationship.

Thank you for accepting our input on this rule. ERIC is pleased to represent large employers with the goal of ensuring telemedicine benefits are accessible for millions of workers, retirees, and their families. If you have any questions concerning our written testimony, or if we can be of further assistance, please contact Adam Greathouse at or 202-627-1914.


Adam J. Greathouse
Health Policy Associate