Source: Center for Connected Health Policy – The National Telehealth Policy Resource Center
…Telehealth Policy Shifts Again!!
Today the Center for Connected Health Policy (CCHP) is releasing its bi-annual summary of state telehealth policy changes for Fall 2021. Additionally, we are also making available a summary chart showing where states stand on many key telehealth policies, as well as an infographic highlighting our key findings. Historically, CCHP has released twice a year (Spring and Fall) updates to its “State Telehealth Laws and Reimbursement Policies” report in the form of a PDF report document that details all the telehealth policies for all 50 states and the District of Columbia.
Over the years this has evolved to include an update to CCHP’s online database of the same information. In Spring 2021, the policy database transitioned exclusively to a new and improved online Policy Finder tool. This online database tool allows CCHP to easily update each state’s information on a more frequent basis instead of updating only in the Spring and Fall. Additionally, while there will no longer be a single PDF report with every state, the information from the online database can now be exported for each state into a PDF document using the most current information available on CCHP’s website. The information for this summary report covers updates in state telehealth policy made between June and September 2021.
Please note that many states continue to keep their temporary telehealth COVID-19 emergency policies siloed from their permanent telehealth policies. These temporary policies are not included in this executive summary, although they are listed under each state in the online Policy Finder under the COVID-19 category. In instances where the state has made policies permanent, or extended policies for multiple years, CCHP has incorporated those policies into the summary.
Highlighted Findings
The main areas where changes were made since our Spring 2021 update fall in the three buckets that CCHP uses to categorize information within its policy finder: (1) Medicaid policy, (2) private payer policy, and (3) regulation of health professionals. Changes were also highly influenced by temporary expansions made during the COVID-19 pandemic. Some states took approaches to extend their pandemic policies multiple years into the future, while others made policies (or portions of their COVID policies) permanent. Still others have not adopted their more lenient COVID policies at all.
In Medicaid, it was common for states to make slight adjustments to their telehealth policies to add or clarify the services that can be delivered via telehealth, types of professionals that can deliver care through telehealth or the types of settings a patient can be in during a telehealth interaction. For example, Mississippi clarified that Federally Qualified Health Centers (FQHC), Rural Health Clinics (RHC) and community mental health centers can be originating and distant sites, and Arkansas now specifies that both the home is an eligible patient site and that group meetings may be performed via telemedicine. Although reimbursement for audio-only telephone has become pretty standard during the COVID-19 public health emergency (PHE), less than half of state Medicaid programs explicitly are reimbursing for the modality permanently, though that number has increased since Spring 2021. Many state Medicaid programs that have added audio-only coverage have placed restrictive parameters around its reimbursement.
Many states also made modifications to their telehealth private payer reimbursement law language to alter the definition of telehealth/telemedicine. This typically included an expansion of the definition to be broader in scope so that it entails more than just live video, although often with some caveats. For example, Arkansas’ private payer law now stipulates that telemedicine does not include audio-only communication, unless the audio-only communication is real-time, interactive, and substantially meets the requirements for a healthcare service that would otherwise be covered by the health benefit plan. Requirements around payment parity were also a common change, with eight states passing a law requiring the same reimbursement amount whether a service is provided via telehealth or in-person since Spring 2021. Illinois, for example, now requires reimbursement parity for in-network or tiered network health care professionals or facilities, including services provided via audio-only.
Finally, there is a noticeable shift in telehealth policy towards tightening of professional requirements around the use of telehealth by providers. For example, Michigan passed new consent requirements for social work, athletic trainers, massage therapists, acupuncturists and veterinary medicine, and West Virginia adopted emergency telehealth practice standard regulations for five professions, including dentistry, nursing, osteopathic medicine, social work and medicine. While many states have had these types of standards for several years, the rate at which new telehealth standards are being adopted has increased significantly within the last six months. States that offer special licenses or certificates or have exceptions to licensing requirements related to telehealth has also slightly increased since Spring 2021. For example, Florida and Arizona are two states that have recently relaxed their licensing requirements, requiring out-of-state telehealth providers to only register with their applicable professional board within the state. Additionally, at least ten states entered into licensing compacts since Spring 2021.
KEY FINDINGS FOR FALL 2021 INCLUDE:
• Fifty states and Washington, DC provide reimbursement for some form of live video in Medicaid fee-for-
service.
• Twenty-two states provide reimbursement for store-and-forward.
• Twenty-nine state Medicaid programs provide reimbursement for remote patient monitoring (RPM).
• Twenty-two states allow for telephone reimbursement, although in most cases it is extremely limited.
• Fourteen states limit the type of facility that can serve as an originating site.
• Thirty-five state Medicaid programs offer a transmission or facility fee when telehealth is used.
• Forty-three states and DC currently have a law that governs private payer telehealth reimbursement
policy.
Complete information by state can be viewed on CCHP’s Policy Finder Look Up page. In addition, CCHP will continue to make available bi-annually an infographic, state summary chart and an analysis report summarizing changes. The report is available on the web, and in PDF form.
