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Among the many changes Americans experienced during the COVID-19 pandemic was the sudden, widespread adoption of telehealth services when visiting medical professionals in person became effectively impossible.
The dramatic surge in telehealth usage became possible as a multitude of pandemic-driven policy changes, executive orders and governor actions at both the state and federal level temporarily loosened the legal requirements around remote patient care.
More than two years later, however, as Americans have grown accustomed to interacting with their doctors over video chat, policymakers across the country are now grappling with whether to make the temporary telehealth changes permanent.
Their decisions could have far-reaching implications for how medical care is delivered in the United States for years to come.
Sydne Enlund is a senior policy specialist for the National Conference of State Legislatures (NCSL), where she tracks telehealth policy changes across the nation. She says state legislatures began to make some telehealth policy changes permanent last year, but the trend was far from uniform as uncertainty over the course of the pandemic reigned for much of 2021.
Still, by the end of the year, she said 37 states had enacted a total of 50 bills to make policy changes allowing for greater telehealth flexibility to become permanent.
Among the states that took action, at least 27 of them made permanent reimbursement of Medicaid coverage and private insurance for telehealth appointments. At least 29 states have also made permanent reimbursement for audio-only telehealth consultations. Before COVID-19, Enlund says, no one allowed reimbursement for medical appointments conducted over the phone.
Enlund notes that other states that didn’t pass bills in 2021 extended their temporary telehealth policy changes or established committees to review telehealth best practices and make recommendations to their legislatures.
However, she says, some states have allowed certain temporary policies benefiting telehealth to lapse. Kansas, for example, will no longer allow out-of-state doctors to treat patients within the Sunflower State via telehealth services beginning March 31, 2022.
Enlund says the biggest legislative issues around telehealth will always orbit reimbursement rates and the privacy of patients.
For many years, she says, most states did not allow reimbursement to private insurance for telehealth visits. In fact, in 2015, only 15 states permitted private insurance to seek reimbursement for remote patient care.
Today, that number has risen to 40 states.
Increasing provider access is also a growing concern for legislatures. Some states have explicit limitations on what kind of medical professionals can see patients via remote access. With telehealth’s widespread adoption, there’s growing pressure to expand those rules to allow more practitioners to serve patients remotely.
Similarly, many states are joining cross-state compacts to allow medical professionals licensed in one state to see patients in another state via telehealth. The Interstate Medical Licensure Compact is for medical doctors, but there’s also compacts for nurses, physical therapists and psychologists, Enlund says.
Another major issue surrounding telehealth is access to broadband services. Telehealth access obviously depends on consumers having reliable access to the Internet. So it’s fair to expect that as legislators continue examining telehealth issues, the topic of broadband access, particularly to poorer and rural communities, will also be involved.
At the federal level, the Centers for Medicare & Medicaid Services (CMS) released a physician fee schedule that outlined some permanent telehealth policy changes.
One change creates a new set of criteria for adding Medicare telehealth services on a temporary basis. Another removes geographic restrictions for Medicare telehealth services for the diagnosis, evaluation, or treatment of a mental health disorder, and adds a patient's home as a permissible originating site for telehealth services.
CMS also indicated that given the success of audio-only telehealth communications during the pandemic that “we now believe that it will be appropriate to revisit our regulatory definition of ‘interactive telecommunications system’ beyond the circumstances of the [COVID-19 public health emergency] to allow for the inclusion of audio-only services under certain circumstances.”
So what telehealth policy changes are expected at the state level this year? “We’re kind of still waiting to see what is coming down in 2022,” Enlund says.
We do, however, have some clues right now.
A search of State Net’s legislative tracking database turns up 360 current proposals in state legislature introduced this session that mention telehealth or telemedicine in their titles or bill summaries. Fifty-five of those bills deal with mental health, 17 with virtual check-ins, and 23 with abortions, which has become a big concern among insurers of late.
The Center for Connected Health Policy (CCHP), a program of the Public Health Institute, also tracks telehealth policy changes at both the state and federal level. According to the center’s tracking, there are currently hundreds of pending pieces of policy both as legislative bills or regulatory changes.
On the federal level, there are over 200 pending telehealth policy bills on the table. Many of these federal bills address the temporary telehealth waivers made during the pandemic, including making permanent certain telehealth related policies in Medicare. Other issues covered in the pending bills include licensure, mental health and pilot programs.
United States Sen. Ron Wyden (D-OR) announced last week plans to introduce a bipartisan measure by summer that would emphasize both pay parity for mental health care and an expanded use of telehealth in providing those services.
Wyden said during a recent hearing of the Senate Committee on Finance he is working on the proposal with fellow Democratic Sens. Michael Bennet of Colorado and Ben Cardin of Maryland as well as Republican Sens. John Thune of South Dakota and Richard Burr of North Carolina.
Another bipartisan federal measure introduced last year – the Parity Assistance Implementation Act, sponsored by Sens. Bill Cassidy (R-LA) and Chris Murphy (D-CO) – would give states $25 million in federal grant dollars to enforce state mental health parity laws.
All of which suggests that expanding telehealth access will undoubtedly continue to be a major topic of discussion for both state and federal lawmakers throughout 2022.
--By SNCJ Correspondent Brian Joseph
At least 41 states have considered measures dealing substantively with telehealth or telemedicine in their 2021-2022 legislative sessions, according to State Net’s legislative tracking system. Nineteen of those states have enacted such measures.