State and Federal Telehealth Policy Activity

March 14, 2019|1:32 p.m.| ASTHO Staff

With access to health services becoming an increasingly important issue, states are looking to telehealth as a mechanism to increase access and remove access barriers in 2019 legislative sessions. Telehealth uses electronic information and telecommunication technologies to support and promote long-distance clinical healthcare, patient and professional health-related education, public health, and health administration. Telehealth modalities include live videoconferencing, store-and-forward, remote patient monitoring, and mobile health.

Evidence indicates that telehealth is cost-effective across several populations, with comparable or improved health outcomes for conditions such as heart disease, stroke, depression, and diabetes. However, telehealth adoption is influenced by private and public payers for reimbursement requirements (e.g., regulations on delivery setting, provider relationship, and modality). Additional factors include licensure and credentialing, technology and broadband access, and patient and provider awareness.

There is significant variation in telehealth policies at the state level, with some states incorporating telehealth policy into law and others addressing issues in program guidelines or regulations. In February, the legislature in Alaska introduced a bill (House Bill 29) that would require private insurance companies to cover mental health benefits provided by an in-state telehealth provider. In March, the Arizona senate passed a bill (Senate Bill 1089) eliminating the list of specialties eligible for telemedicine and prohibiting insurers from imposing originating site restrictions, distinguishing between rural and urban locations for coverage, and limiting services by condition. The bill also amends the definition of telemedicine to include store and forward and remote patient monitoring. In Connecticut, Senate Bill 293 and Senate Bill 307 would require the state’s commissioner of social services to integrate telehealth services into the state Medicaid program.

Other states considering legislation related to telehealth include Texas and Hawaii. In Texas, House Bill No. 1738 would establish an enhanced Medicaid reimbursement for home telemonitoring services and create a Medicaid fee schedule for home monitoring provided by a federally qualified health center. In Hawaii, an advisory council, proposed in House Bill 141 and led by the state’s department of health, lead a statewide strategic approach to telehealth. This bill would also fund a coordinator, designated by the director of health, to coordinate public and private sector policies and programs for expanding telehealth.

In addition to telehealth legislation, interstate licensure compacts have also proven an active policy topic, as some telehealth providers may be in another region than the patients they are serving. Examples include the Interstate Medical Licensure Compact (six states with pending legislation), the Psychology Interjurisdictional Compact (eight states pending), and the Nursing Licensure Compact (nine states pending).

While much of the activity in telehealth policy has been at the state level, there have also been several notable federal policy changes. In November 2018, the Centers for Medicare and Medicaid Services (CMS) published the 2019 Physician Fee Schedule for Medicare Part B rule, revising payment and other policies. In 2019, CMS included reimbursement for services they believe fall outside of the traditional telehealth services, which have specific restrictions for reimbursement by Medicare, including virtual check-ins, remote evaluation of prerecorded patient information, and interprofessional internet consultation.

The SUPPORT for Patients and Communities Act (H.R. 6) law eliminated restrictions for Medicare coverage based on rurality and originating site for telehealth services provided to individuals with substance use disorder or a co-occurring mental health disorder, with reimbursement provided at the same rate as in-person services. In addition, the Drug Enforcement Administration is expected to establish a special registration for telemedicine in 2019. Additional information on state legislation and regulations is available online through the Center for Connected Health Policy. ASTHO also highlights state success stories on its central telehealth resource page. ASTHO will continue to monitor emerging trends in telehealth, with staff available to assist with technical assistance.

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