22 States Changed Policies to Include Pandemic Telehealth Coverage

Telehealth coverage has significantly increased across the country during the coronavirus pandemic, but the challenge lies in maintaining that coverage after the pandemic is over, according to a Commonwealth Fund study.

Researchers looked at states’ telehealth coverage policies between March 2020 and March 2021, as well as coverage that was already in place prior to the public health emergency. To date, 22 states have changed their policies during the pandemic to increase and improve telehealth coverage.

Most of these changes are centered around audio-only telehealth coverage, which generally wasn’t allowed prior to COVID-19. States are now waiving or limiting cost-sharing and requiring reimbursement for certain services that meet the standard of care and are deemed necessary. 

In March 2020, federal regulators eased telehealth restrictions for Medicare plans and prompted states and private payers to do the same, with many following suit. Many states increased telehealth coverage by way of executive orders, according to the study. This allowed for rapid adoption but meant the policies were only temporary and would expire after the pandemic. Other states took legislative action, ensuring the permanency of the coverage changes.

Before the pandemic, 35 states required healthcare payers to cover telehealth services. During the pandemic, five additional states changed their policies to comply with this standard.

The number of states that required payers to cover audio-only telehealth services went from three pre-pandemic to 21 post-pandemic. Although there has been debate about whether these services should be covered, audio-only visits can be particularly beneficial for many patients.

Many individuals, such as those living in rural or low-income areas, do not have access to reliable internet or the devices needed for video visits, the study noted. Audio-only services can provide a more comfortable option for patients with behavioral health conditions as well. The services can also benefit older adults who might not know how to work the technology needed for audio-visual visits. 

Going forward, however, the benefits of audio-only services must be weighed with the possible negative side effects.

“Regulators observed that some providers have begun to charge for short, three- to four-minute phone calls (for example, to answer a brief question of convey test results) that previously would not have required an in-person visit and thus would not have been billed,” researchers wrote. “Regulators noted that these short calls can leave patients with unexpected cost sharing.”

Cost-sharing is another aspect that states altered their policies around to improve telehealth coverage. Lowering cost-sharing or eliminating it altogether was a key driver in the increase of telehealth services during the pandemic. 

Prior to the pandemic, 22 states required cost-sharing parity between telehealth visits and in-person visits that provided the same service. Since the pandemic, three states updated this policy to temporarily prohibit cost-sharing. Three additional states adopted the policy of requiring parity, while one additional state eliminated cost-sharing completely for telehealth services.

States changed their protocols surrounding provider reimbursement as well. Pre-pandemic, 15 states required equal reimbursement for telehealth services and in-person care - also known as payment parity. During the pandemic, another 10 states adopted this policy, according to the study. However, some payers have expressed concerns, as telehealth visits can require lower operating costs compared to an in-person visit for the same service. They’d prefer the freedom to negotiate their own reimbursement rates with providers.

As the study results show, many states and payers were open to providing more flexibility when it came to telehealth coverage during the pandemic. But according to regulators, the hard part will be trying to maintain the coverage in a post-pandemic world. 

To increase the chances of states and payers continuing their telehealth coverage, they should collect and examine data that gives a clear picture of the financial and health benefits telehealth can yield, the Commonwealth Fund researchers suggested. Having access to this data could help policymakers predict the results that long-term telehealth coverage could have on patients, providers, and payers.

During the pandemic, telehealth use has proved to be beneficial for behavioral health services as well as expanding access to care for individuals in rural areas. The permanent adoption of telehealth coverage policies could ensure the continuation of this care and more to individuals in a post-pandemic setting.