Permanent Audio-Only Telehealth, Licensure Flexibilities Key to Virtual Care

As temporary policies to expand access to telehealth inch closer to their expiration dates, states must decide which ones will be made permanent amid the ongoing COVID-19 pandemic. A new report recommends solidifying flexibilities related to audio-only telemedicine services, store-and-forward data services and medical licensure.

Released by public policy research organization R Street Institute, the report details telehealth policy trends amid the COVID-19 pandemic as demand for virtual care options exploded and offers recommendations for state legislators.

Perhaps one of the most impactful changes prompted by the pandemic was the widespread adoption of audio-only telehealth. Allowed by only a handful of states pre-pandemic, this type of virtual care became a key part of telehealth programs across the country after the Centers for Medicare & Medicaid Services announced in March 2020 that it would allow telephone-based check-ins.

Behavioral healthcare, in particular, experienced a boost as a result of expanded access to audio-only telehealth. All states made temporary allowances for behavioral health professionals to provide care via audio-only devices. Previously, only Alaska allowed this type of care delivery for some behavioral health cases, if video visit options were unavailable.

This year, as executive orders and temporary rules ended, 18 states, including California, Delaware, New Hampshire, New York and Virginia, enacted permanent audio-only allowances.

For the states still deciding on allowances, policymakers should consider evidence showing where audio-only telehealth is most useful and use it to guide their decisions on permanent changes, according to the report.

Another key policy recommendation centers on store-and-forward telehealth services, that is, services enabling patients to upload data for providers to review later remotely and provide a diagnosis. Though several states made temporary store-and-forward allowances during the pandemic, there is little consistency across state lines.

Oregon, for instance, reimburses store-and-forward data services in teledentistry, while in Washington this type of data-based diagnosis is only allowed for behavioral healthcare.

Store-and-forward telehealth can be a great boon for rural and urban patients alike, providing them with a convenient way to access care without having to carve out time for an appointment.

"Thus, more states should move towards legislation that reimburses store-and-forward telehealth," the report states.

But states should be careful about establishing privacy policies to protect patient data.

Finally, there is the issue of cross-state licensing for telehealth providers. Prior to the pandemic, there was a piecemeal approach to licensing across state lines, with about half of all states participating in various licensure compacts that only applied to some providers. CMS and most states got rid of this limitation, allowing providers to conduct telehealth visits across borders during the pandemic.

Some states, including Arizona, New York and West Virginia, have enacted permanent legislation enabling out-of-state providers to deliver care via telehealth.

But others are lagging behind, prompting more than 200 organizations, including the American Telemedicine Association, Alliance for Connected Care and Mayo Clinic, to send a letter urging state policymakers to maintain and expand licensure flexibilities through the end of the pandemic.

The R Street Institute report echoes these suggestions, recommending that state legislatures lift licensure restrictions and consider joining larger compacts.