State Legislative and Regulatory Changes Regarding Telehealth

Telehealth trends highlight state legislative and regulatory changes that impact health care providers, telehealth and digital health companies, pharmacists, and technology companies that provide and facilitate the delivery of virtual care.

Last week’s trends:

• Reimbursement Requirements
• Professional standards

A CLOSER LOOK

Finalized legislation and rulemaking

• Iowa The Board of Physiotherapy and Occupational Therapy has amended two rules, Chapter 201 for physical therapists and Chapter 208 for occupational therapists. These policies establish standards for telehealth visits for physical and occupational therapy, allowing the use of audio or video equipment, or both, at the licensee’s discretion. In connection with the adoption of the revised policy, the board noted that the expansion was in response to public comment from ATA Action, a trade association affiliated with American Telemedicine Associate, which urged the board to expand the options that can be used for telehealth visits in response to interest in expanding access for Iowa patients to affordable, high-quality health care.
• Maryland Passed HB 1127, which authorizes certain health care providers to provide sexual assault forensic examinations conducted through “peer-to-peer telehealth” to victims at no cost to victims and makes these services eligible for reimbursement by Criminal Injuries Compensation Board (CICB). Peer-to-peer telehealth allows a forensic examination to be performed using interactive audio, video, or other telecommunications or electronic technology by a forensic nurse to assist in the completion of a forensic examination while the forensic nurse is in one location and the patient is under the care of a qualified provider in another place.
• Maryland also passed HB 1078, which requires Medicaid to provide remote ultrasound examinations and remote non-stress fetal examinations in certain circumstances.
• South Carolina enacted S 858. This bill adds acute care inpatient home care programs as exempt from Certificate of Need review by the S.C. Department of Health and Environmental Control. “Acute hospital care at home” involves the use of technology to provide continuous remote patient monitoring and connectivity.

Legislative activity and rule-making in the proposal phase

Overview of the most important events:

• IN Colorado, SB 24-054 passed the first chamber. The bill requires all private insurance companies to provide coverage for treatment of the chronic disease of obesity and treatment of prediabetes, including intensive behavioral or lifestyle therapy, bariatric surgery, and FDA-approved anti-obesity medications. The definition of intensive behavioral or lifestyle therapy includes interventions virtually via telehealth.
• IN Michigan, HB 4580 and HB 4213 passed through the second chamber. If passed, HB 4580 would require telemedicine services to be covered by the Medicaid program if the source site is a home or school, in addition to other source sites allowed in the Medicaid provider manual. HB 4213 would also require Medicaid to cover telemedicine services, but further clarifies Medicaid coverage requirements. First, HB 4213 requires Medicaid parity for telehealth services. Additionally, HB 4213 requires consideration of telemedicine services both when synchronous remote provider interactions occur using electronic audio and video media and when only electronic audio media is used. Under HB 4213, telemedicine services are permitted as an appropriate form of care in a federally qualified health center, rural health clinic, or tribal health center.
• IN Michigan, both HB 4579 and HB 4131 passed the second chamber. If passed, HB 4579 would require parity for telehealth coverage in health plans. Similarly, HB 4131 would also update state private payer laws to require payment parity for telehealth services. However, HB 4131 also prohibits health plans from requiring providers to provide services via telemedicine unless they are covered by a contract for telemedicine-only or telemedicine products.
• IN Alaska, HB 126 passed the second chamber. If enacted, this bill would authorize affiliated counselors to provide certain services via telehealth.
• New Hampshire SB 403 passed the second chamber. This bill would establish requirements for local health care workers, including allowing certified health care workers to provide services via telemedicine.
• The Washington The Office of the Insurance Commissioner has published a rulemaking schedule that includes a proposed rule establishing a uniform standard for establishing established relationships for audio-only telemedicine services. The provision will implement SB 5821, which goes into effect on June 6, 2024.
• There has been action in several states related to interstate compacts.
  • IN AlaskaSB 75 passed the two houses that were supposed to pass the Audiology and Speech Pathology Agreement.
  • IN AlabamaSB 207 passed the second chamber, which passed the Dietitian Licensing Agreement.
  • IN LouisianaHB 888 passed the second chamber, which passed the Social Work Licensing Agreement.

Why is it important:

• States continue to evaluate reimbursement standards for the delivery of care delivered via telehealth. Michigan’s proposed legislation is an example of the state’s efforts to promote access to telehealth by implementing Medicaid and health plan reimbursement parity for telehealth services. In addition to reimbursement parity, Maryland HB 1078, South Carolina S 858, and Colorado 24-054 reflect the growing emphasis on expanding coverage of various types of telehealth services.
• States continue to revise and clarify professional practice standards for telehealth. States continue to adopt and revise standards to govern the practice of telehealth across the health professions. In some cases, states have sought to allow additional types of providers to provide services via telehealth, such as counselors and certified local health care providers under Alaska HB 126 and New Hampshire SB 403. Other states, such as Iowa, have clarified standards for providers who may provide telehealth services, such as physical therapists and occupational therapists.