The legislative language, which was included in the combined budget bill that passed the U.S. Senate and House of Representatives, was signed by Clinton in mid-December.

The new Medicare coverage for telemedicine will be important for Alaska, said Jonathan Linkous, executive director of the American Telemedicine Association. The Washington, D.C.-based organization has pushed for the change for five years, he said.

The bill is set to go into effect Oct. 1.

Alaska health care providers in the Bush use telemedicine services to link with specialists in Anchorage.

For Alaska, the bill recognizes special needs of rural areas, said Kathe Boucha, director of international medicine and telehealth at Providence Alaska Medical Center. The bill applies to federal telemedicine demonstration programs, she said.

Medicare already covers telemedicine services like radiology, as well as rural areas like Alaska where health care specialists are sometimes few and far between, Linkous said. Also, Medicare already reimburses remote cardiac monitoring and related telemedicine services available throughout the country.

The legislation expands Medicare coverage to include nonmetropolitan counties and existing urban Medicare demonstration sites.

The new law adds Medicare coverage for services in Alaska and Hawaii that use telemedicine in remote areas for still rather than live images, he said. For example, in a dermatology case a picture or video is taken of the affected area and sent via a high-speed telecommunications connection and can be viewed like e-mail, Linkous said.

This method is cheaper than live transmissions and allows physicians to view the images at their own schedule, he said.

Congressional representatives included the two states because "they wanted to walk before they could run," Linkous said. Also, "Alaska and Hawaii have very important senators," he said.

The law expands the telemedical services that can be billed to Medicare, according to the American Telemedicine Association.