It feels cliche to say the last two years have brought about a lot of changes to the way we operate as a society– of course they have. Pandemics have a way of altering the landscape of many areas of life, especially healthcare.
With the microscope set firmly on virtual healthcare options as a safe alternative to in-office visits, telehealth laws have had to sprint to keep up with the needs of its consumer base. According to a January 5 report, the laws determining access to telehealth are varied across the United States and interstate telehealth care is even more varied.
You might think a telehealth visit is as easy as calling up a doctor and scheduling your visit. It is true, for the most part. In 47 of our 50 states you are not required to establish an in-person relationship with your provider before receiving telehealth benefits. But, in the remaining three: Alaska, Tennessee, and West Virginia there are restrictions.
Both West Virginia and Alaska require certain specialty providers to establish an in-person relationship before telehealth services can be administered. Tennessee requires this for all uses of telehealth.
Modality of Services
In telehealth, there are two types of appointments: synchronous, where you meet with your doctor in real-time through a video conferencing tool to explain your symptoms; and, asynchronous, which covers remote patient monitoring and the “stow-and-go” of information for your provider to analyze at a later date.
Forty-six states have laws allowing both options, however, 28 have additional laws covering remote patient monitoring and other asynchronous telehealth options. For example, in Vermont and Iowa, telemedicine is defined only as live, interactive audio and video.
Provider Types & Licensure
In many states, any provider can utilize telehealth services: medical doctors, mental health service providers, etc. This is true in 22 states. In 24 states, the use of telehealth is limited to specific occupations as listed in their codes. Provider types are not specified in telehealth laws in North Carolina or Pennsylvania, however, in Wisconsin and Wyoming, the provider type is much more narrow.
There is also a breakdown of providers not just in area-of-care, but also provider licensure. In 20 states, nurse practitioners can practice telehealth independent from physician supervision or a collaborative practice agreement. In 11 states, laws state they can practice independently only after a certain period of time unless the aforementioned agreements or supervisory requirements are met. In 19 states, they cannot practice telemedicine independently at all unless they have the collaborative practice agreement or supervision.
Barriers to Telehealth
While telehealth laws are pushing forward, there are still barriers to care. Only three states — Arizona, Florida, and Indiana — have a clear registration/licensing process for all out-of-state healthcare providers to “practice” in their state. Thirteen have the processes in place but they only apply to physicians or specific provider types in surrounding states. The remaining 34 states have very clear barriers to receiving inter-state telehealth care.
In addition to barriers surrounding crossing state lines, eight states are members of neither the Nurse Licensure Compact nor the Medical Licensure Compact, which allow for physicians and medical professionals to practice across state lines. Twenty-six states are members of both, 16 are a member of one or the other.
Coverage & Payment Mandates
When it comes to healthcare, insurance coverage and payment mandates are a major talking point.
Currently, 35 states have enacted regulations requiring insurers to cover all services offered through telehealth; eleven have no mandates for insurance coverage; while four states mandate certain coverages.
While you may be covered for telehealth services in 35 states, it is not always mandated that insurers pay the same rate for telehealth and in-person visits. At present, 22 states have no mandate for reciprocal payment amounts between telehealth and in-person visits. An additional 22 states have a payment mandate for all services to pay the same rate for in-person and telehealth. Six have a mandate for insurers to pay some services or provide cost-sharing.