Telehealth Payment Parity Laws Boosted Odds of Virtual Care Visits

States with telehealth payment parity laws had a 23 percent higher likelihood of telehealth use among residents compared to states that did not implement these laws, according to a new study.

Published in the Journal of Public Health Management and Practice, the study examines the impact of states' telehealth parity payment requirements on telehealth use among adults 18 and older in the United States. Telehealth parity payment laws require payers to reimburse for telehealth and in-person services at equal rates.

Researchers from the University of Massachusetts Boston and the Global Health and Education Projects in Maryland examined data from the US Census Bureau's Household Pulse Survey, a nationally representative online survey. They studied data from April 2021 through August 2022. The study sample included 1.06 million adults. Information on the type of telehealth modality used was available from July 2021. Researchers assessed data from 760,474 people who used either video or telephone to engage in telehealth.

As of March 15, 2021, 24 states required telehealth payment parity, while 22 did not. Among the 1.06 million respondents, 55.57 percent resided in states that implemented parity laws, and 44.43 percent resided in non-parity states.

The study shows that the odds of telehealth use were 23 percent higher among adults in parity states than those in non-parity states. Telehealth parity laws significantly boosted video-based telehealth use, with the likelihood of video-based telehealth use among adults in parity states being 124 percent higher than in non-parity states.

Telehealth parity laws also impacted telehealth use along racial lines, according to the study.

Non-Hispanic White adults in parity states had 24 percent higher odds of telehealth use than their counterparts in non-parity states. Similarly, Non-Hispanic Black adults in parity states had 31 percent higher odds of telehealth use than their peers in non-parity states.

Further, White and Black adults in parity states had a 143 percent and 77 percent higher likelihood, respectively, of engaging in video visits compared to their counterparts in non-parity states. Black adults in parity states also had 1.60 times higher odds of phone-based telehealth use than those in non-parity states.

Telehealth use among Hispanic adults, non-Hispanic Asian adults, and other racial groups did not show a significant link with parity requirements.

"Limited English proficiency might be the biggest barrier against telehealth utilization for Asians or Hispanics, even after parity payment legislation," the study notes.

The researchers concluded that telehealth parity laws were associated with higher overall and video telehealth usage rates, with particularly striking increases among White and Black populations in parity states.

But the racial and ethnic disparities in telehealth use highlight the need for federal and state governments to implement policies supporting telehealth access, they added.

These study findings align with recent research showing the impact of state laws on telemental healthcare.

A new RAND Corporation study showed that four state-level policies helped spur the use of telehealth at mental health facilities. The study examined the impact of payment parity for in-person and telehealth services among private insurers, authorization of audio-only telehealth for patients enrolled in Medicaid or the Children's Health Insurance Program (CHIP), the Interstate License Exchange Program, and the Psychology Interjurisdictional Compact.

The researchers analyzed information from the Mental Health and Addiction Treatment Tracking Repository. They found that the proportion of mental health facilities that used telehealth jumped from 39 percent in April 2019 to 88 percent in September 2022 after the policies were enacted.

In addition, research has shown that Medicaid coverage of telehealth services boosts telehealth use significantly.

A study published last month revealed that Medicaid telehealth coverage requirements were linked to a 6.01 percentage-point increase in the use of live video communication between 2013 and 2019. Medicaid telehealth coverage requirements were also associated with a 10.42 percentage-point increase in same-day appointments.

Researchers analyzed survey data from the 2013-2019 Association of American Medical Colleges Consumer Survey of Health Care Access. The respondents included 4,492 Medicaid-enrolled and 15,581 privately insured adults under 65.