Many States Hit Hard by COVID-19 Limit Telehealth Practice, Report Finds

Though telehealth use reached new heights during the COVID-19 pandemic, a new report shows that some of the states that were hit the hardest by the novel coronavirus have restrictive telehealth laws.

These include New York, California, Connecticut, Massachusetts, Washington and New Jersey, where telehealth restrictions include clear barriers to virtual care services across state lines, such as not joining interstate licensing compacts. These compacts allow certain providers to practice in states they are not licensed in provided they have a license and are in good standing in their home state.

Released by policy research organizations Reason Foundation, Cicero Institute, and Pioneer Institute, the report examines laws in all 50 states along with evaluations by the Center for Connected Health Policy and the National Conference of State Legislatures. In the report, the term "telehealth" encompasses a wide array of care delivery services, including teledentistry and telepsychiatry. But the report does not include an examination of state Medicaid telehealth policies.

The calls to make permanent the telehealth flexibilities enacted during the COVID-19 public health emergency have grown louder in recent months. Prominent organizations, like the American Hospital Association, athenahealth, Johns Hopkins Medicine, and Teladoc Health launched a campaign last month that aims to preserve telehealth access after the pandemic has ended.

"Once the public health emergency declarations started to end or executive orders were withdrawn many of the new flexibilities for providers, insurers, and patients were lost overnight," said Vittorio Nastasi, policy analyst at Reason Foundation and co-author of the report, in the news release. "States need to adopt a number of telehealth reforms to provide their residents better access to this safe and effective virtual care."

Currently, the laws governing virtual care modalities at the state level are piecemeal, resulting in barriers to provider use and patient access, according to the new report.

Not only do some of the hardest hit states have the most restrictive interstate telehealth laws, but only three states allow all providers to easily practice telehealth across state lines: Arizona, Florida, and Indiana. All three states provide a registration process that allows out-of-state providers to practice telehealth without obtaining a separate license for their state.

One requirement that nearly all states lifted was mandating that patients see a provider in-person before they are allowed to use virtual care services. Tennessee was the only state that did not lift the requirement, while Alaska and West Virginia require an in-person visit before certain services can be offered virtually.

Another popular state policy is allowing "modality-neutral" telehealth services, which includes both asynchronous and synchronous telehealth, as well as store-and-forward services and remote patient monitoring.

A majority of states allow synchronous and asynchronous telehealth services explicitly or have broad enough definitions that allow their use, along with store-and-forward telehealth and remote patient monitoring. A handful of states only allow synchronous and asynchronous telehealth services.

But there are two states — Vermont and Iowa — that limit the use of at least one kind of telehealth modality. The definition for telemedicine in these states only includes live interactive audio and video.

The report also shows that nearly all states allow a broad swath of providers to use telehealth, with 20 states allowing nurse practitioners to use telehealth without the supervision of a physician.

Further, the report offers policy best practices as state policymakers consider the path forward for telehealth. The best practice recommendations include allowing all kinds of providers to utilize telehealth, supporting interstate telehealth, and advancing "modality-neutral" policies.

But the report does make a case against payment parity laws that require telehealth visits to be reimbursed at the same rates as in-person care, stating that these laws harm "vulnerable patients as they pay more, and small businesses as large companies are not subject to these mandates."

This contradicts other reports that say payment parity could help close care gaps and solidify access to certain types of treatment, such as virtual opioid use disorder treatment.