What’s Next for Telehealth: States Try to Make COVID-19 Telehealth Options Permanent

April 29, 2021 | Janet Oputa

During the early months of the COVID-19 pandemic, the federal government enacted the Coronavirus Aid, Relief, and Economic Security (CARES) Act, temporarily expanding the use of telehealth technologies by removing various requirements and waiving certain restrictions. Many states also expanded telehealth access through changes to state Medicaid laws. These temporary policy changes created an uptick of telehealth use that improved access to care for millions of Americans—but questions remain about which policy changes will stick around beyond the pandemic. Currently, states are making decisions about what temporary policies to permanently implement and which policies to end without disrupting the delivery of care and further exacerbating health disparities.

2021 Update to Federal Guidance

In January, HHS released a letter to governors stating the federal public health emergency declaration will likely remain in place for the entirety of 2021. Many of the telehealth flexibilities issued by the Centers for Medicare and Medicaid Services remain in place to allow patients to continue receiving telehealth services in the home. It also expands options for providers to deliver telehealth services from different geographical locations, such as Federally Qualified Health Centers that serve communities in predominantly underserved areas.

At the state level, several common themes are emerging as states extend Medicaid coverage of telehealth policies and propose legislation either extending or permanently implementing telehealth services through private insurance.

Coverage and Payment Parity Options

Limited reimbursement options for telehealth have been a barrier to the adoption of telehealth, as providers may be less likely to utilize telehealth services due to uncertainties and confusion around proper reimbursement. Some states have taken action to address this by proposing legislation that will permanently cover provider reimbursement for telehealth services under Medicaid, private insurance, and offer parity options. New York introduced legislation that will require Medicaid health plans to cover telehealth services if the same in-person service is covered under the health plan. In Florida, a bill would require the state’s Medicaid agency to reimburse for telehealth services under certain circumstances, including reimbursement for out-of-state providers who are enrolled in Florida Medicaid. The West Virginia Senate passed a bill that requires Medicaid health plans to allow equal reimbursement for telehealth services.

Similar parity options were included to require reimbursement of telehealth services at the same rate as in-person services. New York and Maine introduced legislation that allows telephonic and telehealth services to be reimbursed at the same rate as in-person services. In addition, an Illinois bill titled the “Telehealth Parity Act” requires all health insurance issuers regulated by the Department of Insurance to cover costs of all telehealth services rendered by in-network providers.

Coverage for Services

Many states are extending their public health emergency declarations to ensure continuous coverage of telehealth services. Alaska introduced legislation to extend telehealth flexibilities through Sept. 2021 and New Jersey introduced legislation to extend telehealth flexibilities for up to one year following the end of the public health emergency.

States are also expanding coverage for telehealth services to address access barriers for communities who lack broadband and telehealth technologies to hold telehealth visits in the home. Several states are moving forward with legislation that will permanently expand coverage of telehealth services and allow patients to utilize audio-only services, allowing them to use the telephone to communicate with providers. The Iowa House passed legislation to allow health professionals to deliver healthcare services through interactive audio-only communication. Vermont enacted legislation to require health insurance coverage of healthcare services delivered by audio-only telephone.

Beyond the Pandemic

A July 2020 HHS issue brief highlights the differences in telehealth utilization by patient characteristics and urban vs. rural residencies. This data emphasizes the need for states to continue studying the impact of telehealth expansion on access to care and leverage policies that will equitably improve telehealth adoption by providers and access for consumers.

Many states are developing task forces to study telehealth data collected during the COVID-19 pandemic to ensure they are implementing appropriate actions that will not cause gaps in care and create more accessible digital opportunities for communities. For example, Connecticut introduced legislation that will expand telehealth services for Medicaid beneficiaries for two years and conduct a study on whether benefits of this expansion should be made permanent.

Kentucky enacted a bill to study the impact of telehealth on its healthcare system and assess the quality of care derived from telehealth services, reimbursement, and the delivery of telehealth services. The Nevada Senate passed legislation to create a data dashboard related to access to telehealth services and evaluate policies to make access more equitable.

Furthermore, states are interested in learning more about how to close the digital divide to address access barriers that hinder communities from accessing efficient broadband services and digital technologies. For example, Hawaii passed a concurring resolution requesting the state’s Legislative Reference Bureau conduct a study on ways to close the digital divide, including widespread access to affordable high-quality internet on all islands and policies to grow wireless broadband. Also, New Hampshire introduced legislation to establish committees to study ways to improve infrastructure to increase internet access and ways to close the digital divide through policies and programs that address digital inequities.

There is a national interest in addressing key issues such as telehealth access, reimbursement, coverage, and parity options for telehealth services. ASTHO will continue to monitor the telehealth landscape to see which states move forward in enacting legislation that will create permanent solutions for telehealth and improve access to care.