female patient receives telehealth treatment from a dentist

States Turn to Telehealth During the Pandemic

By Jack Pitsor and Sydne Enlund | Oct. 29, 2020 | State Legislatures Magazine

The COVID-19 pandemic has states and health providers grappling with new demands.

States—many of which already had health workforce deficits—are facing an unprecedented demand for health care workers and services. And some providers still experiencing drops in patient visits are adapting how they deliver services, while also minimizing in-person interaction during the public health crisis.

To meet these demands and anticipated long-term health workforce needs, states continue to examine their telehealth policies to increase access to care. Telehealth allows health care providers to screen, triage and treat symptoms remotely. It can also potentially help reduce coronavirus exposure, which may occur while visiting health care facilities.

Since March, 36 states, the District of Columbia and Puerto Rico have enacted more than 79 bills changing telehealth policies, either permanently or temporarily, during the pandemic.

Shoring Up Private Insurance and Medicaid Coverage

To ensure patients have access to telehealth, several states are addressing coverage for private insurance and Medicaid. One strategy, referred to as payment parity, is to require private insurers to reimburse for services delivered via telehealth at the same rate as in-person services. According to the Center for Connected Health Policy, six states had comprehensive payment parity laws before the pandemic. Since March, an additional 14 states have established payment parity requirements—many of which are in effect only during the declared state of emergency. States pursued payment parity through a mix of legislative and executive action.

Beyond payment parity, 15 states and the District of Columbia enacted legislation to shore up private insurance coverage for telehealth in other ways, such as covering different types of services via telehealth or limiting out-of-pocket expenses for telemedicine. For example, Alaska enacted coverage parity, which expands private insurance coverage to include all medical services that could be reasonably delivered through telehealth. New Jersey enacted legislation requiring health insurers to cover telemedicine without cost-sharing to patients until 90 days after the declared state of emergency.

For those enrolled in Medicaid, all 50 states and the District of Columbia have expanded access to telehealth through emergency waiver authorities and other actions since the start of the pandemic. Legislatively, 10 states and D.C. enacted bills bolstering Medicaid coverage for telehealth, including evaluating reimbursement rates and covering additional modalities (store-and-forward, remote patient monitoring, etc.). In New York, legislators established Medicaid coverage for audio-only telephone consultations, which are useful for patients with limited access to video technology or broadband connectivity.

Bolstering Provider Access to Patients

Before the pandemic, many states required an in-person visit to establish a patient-provider relationship before a telehealth consultation could occur, especially if the provider was prescribing a controlled substance. After emergency orders were declared, several states suspended this requirement and allowed a patient-provider relationship to be established via telehealth. Arkansas, Kansas and Maine are among the states that suspended requirements for in-person exams.

States are also allowing more types of providers to receive reimbursement for telehealth services during the pandemic, specifically those providing behavioral and mental health care. Louisiana allows behavioral health providers (licensed professional counselors, psychologists, licensed clinical social workers, etc.) to see patients through telehealth, and New Hampshire now allows all types of health care providers to receive Medicaid and private insurance reimbursement for telehealth services.

Addressing Additional Barriers

States are also pursuing policies addressing various barriers patients may face when seeking services through telehealth. One strategy is to expand the number of settings where patients can receive telehealth care. Idaho, Michigan and Minnesota expanded the definition of originating site—where a patient gets telehealth services—to include a patient’s home. The Michigan bill also authorized telehealth in school settings.

Additionally, states are addressing broadband connectivity issues to enhance access to telehealth, especially in many rural communities and Indian country. Some states—including Idaho, Mississippi, New Hampshire, South Carolina and Vermont—allocated federal COVID-19 relief funds for improved broadband in order to bolster telehealth capacity.

Looking Ahead

A growing topic of conversation is whether states plan to make permanent the many telehealth flexibilities they pursued during COVID-19.

In Connecticut, lawmakers extended the state’s emergency telehealth modifications until March 2021, and they intend to study the long-term effects of the changes before making anything permanent. Colorado and New Hampshire, on the other hand, have already passed bills permanently incorporating all or parts of their governors’ telehealth emergency orders into state law.

Heading into the 2021 legislative session, lawmakers will likely continue examining whether to limit telehealth flexibilities to the pandemic or keep their telehealth changes for the long haul.

Jack Pitsor is a research analyst and Sydne Enlund is a policy specialist in NCSL’s Health Program.

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