Rollback of Telehealth Flexibilities Will Affect Each State Differently

Researchers from the University of Michigan have determined that states must consider how they intend to proceed with virtual care strategies as previous policies restricting interstate telehealth return.

When the COVID-19 pandemic began in 2020, all states withdrew policies that required an initial in-person visit before a telehealth appointment and expanded patients' ability to obtain virtual care from an out-of-state provider.

However, as the pandemic wanes, many policies are returning. Aiming to assist states in defining priorities, researchers from the University of Michigan's Institute for Healthcare Policy and Innovation (IHPI) conducted a study to determine the fate of Americans across the country following the return of telehealth barriers.

The researchers analyzed trends in interstate telehealth use by Medicare beneficiaries during 2017-2020.

Overall, out-of-state telehealth made up 0.8 percent of all outpatient visits and 5 percent of all telehealth visits. Within individual states, out-of-state telehealth encompassed between 0.2 percent and 9.3 percent of all outpatient visits.

Regulatory flexibilities for telehealth proved beneficial for rural residents in particular. More out-of-state telehealth users (28 percent) lived in rural areas compared with those who did not receive care outside of their state (23 percent).

In some states, less than 1 percent of telehealth visits in 2020 were interstate. But in states such as Vermont, New Hampshire, and Washington, D.C., 4 percent to 9 percent of evaluation and management visits occurred through telehealth.

Researchers also observed that in 64 percent of interstate telehealth visits, the patient and provider were in neighboring states.

As each state differs with regard to interstate telehealth use, researchers noted that the strategies used to manage the return of interstate barriers will vary.

“With patients and providers now much more used to telehealth than they were two years ago, and with interstate licensure waivers expired or expected to expire soon, the question of how to design longer-term licensure policies to facilitate interstate telehealth is urgent,” said Chad Ellimoottil, MD, the study’s senior author and director of IHPI’s Telehealth Research Incubator lab, in a press release. “Each state should prioritize this issue based on patterns of care among their residents.”

For example, states such as Vermont, New Hampshire, and Washington, D.C., which have a higher use rate of interstate telehealth, must prioritize the management of laws that are reintroduced. Whereas in states such as California and Texas, 2 percent of telehealth visits occurred out of state, meaning this issue is likely not a major concern.

Other studies have also provided insight into how telehealth laws vary by state.

For example, a report from January mentioned that states like New York, California, Connecticut, Massachusetts, Washington, and New Jersey — ones which were hit the hardest by the pandemic — have some of the biggest barriers to interstate virtual care access.

Another report from November 2021 provided insight into how telehealth payment policies differ between states. For example, all states and Washington, D.C., provide Medicaid reimbursement for some form of telehealth, but some states may only reimburse certain services while others reimburse all services covered under Medicaid.