In the wake of the pandemic and its shakeup of traditional healthcare patterns, both patients and physicians are reporting high levels of satisfaction with telehealth. Now, state legislatures and the federal government are also getting in on the action, seeking to make some of the emergency provisions enacted during the crisis permanent.
According to an update released by the Federation of State Medical Boards on March 31, there are currently 41 states with waivers in place which relax restrictions regarding telehealth. Many of these have to do with allowing physicians to provide telehealth services to patients outside of the state in which they are licensed. While many of these waivers are extensions of the public health emergency declared in January 2020 and renewed earlier this year to help the healthcare system tend to those affected by COVID-19, some states are looking to make permanent changes to the way in which they restrict or permit telemedicine.
In South Dakota for example, a bill was passed last month allowing patients to establish a telemedicine relationship with a physician remotely. This stands in contrast to some laws on the books in other states requiring at least one initial physical visit with a clinician before moving on to telemedicine appointments. The law, entitled “An Act to revise certain provisions regarding the use of telehealth technologies” (SB 96), also expands its definition of telemedicine to include audio-only consults in addition to those conducted through email, texting or even faxing.
Massachusetts, meanwhile, has passed its own law relating to telemedicine entitled “An Act Promoting A Resilient Health Care System That Puts Patients First” which tackles the important issue of rate-parity, among other things. Rate-parity is emerging as an important issue regarding the widespread adoption of telemedicine because if providers are not reimbursed by insurers for telemedicine services as they are for in-person visits, they will likely shy away from the system. The law requires parity until 2023 for all chronic-disease management services, while allowing parity for all telehealth services through 90 days after the PHE is declared over.
The Massachusetts bill also has a key differentiator, one that hospitals and healthcare providers have supported. It centers around the issue of “credentialing by proxy.” In civilian terms, credentialing by proxy means that the hospital of healthcare system can fast-track the onboarding to telehealth providers, even to practitioners outside the system. The new bill allows hospitals to keep control of the providers they onboard, even to the point where they can require that their own providers are prioritized.
New York Gov. Andrew Cuomo introduced one of the most comprehensive packages of telehealth expansion proposals of all during his 2021 State of the State. Building on momentum from a bill passed last summer that expands the definition of telehealth services to include audio-only communication, his proposals include making most of the telehealth emergency provisions related to COVID permanent. These include requiring that insurers offering products in the state make telemedicine available to their customers, and eliminating Medicaid’s requirements for in-person evaluations as well as any location requirements for reimbursement.
Although it doesn’t provide for out-of-state doctors to conduct telemedicine in New York, it does advocate for: “Developing interstate licensing reciprocity with states in the Northeast region for specialties with historical access shortages to ensure that there is sufficient access to medical and behavioral health professionals.”
The federal government is also looking to expand access to telemedicine. In January, the Protecting Access to Post-COVID–19 Telehealth Act of 2021 was reintroduced in the House by a bi-partisan group of lawmakers. Although the law doesn’t tackle rate-parity, it most significantly allows patients’ homes to count as “eligible distant sites,” clearing the way for Medicare reimbursements for telemedicine services.
“For decades, the Medicare statute has severely limited telehealth services, while other payers increasingly relied on telehealth to provide care to patients when and where they need it,” said Ann Mond Johnson, CEO of the American Telemedicine Association, in a statement. “This disparity has become shockingly clear during the COVID-19 pandemic, when in-person care has not been an option for most patients.
“While Congress and the Centers for Medicare and Medicaid Services acted quickly to implement waivers to allow for the reimbursement of telehealth services during the COVID19 public health emergency,” she added, “older adults will lose access to this important care unless Congress again takes decisive action.”
The earlier effort to get the bill passed in July 2020 was stalled once it moved to committee. Lawmakers are hoping to have more success this time around.
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