States Announce Partnership to Coordinate Their Telehealth Efforts

The governors of four western states have announced plans to coordinate their activities on telehealth access and coverage.

The announcement from the governors of Colorado, Nevada, Oregon and Washington is the first regional agreement of its kind, and could impact how the states manage such connected health issues as Medicaid and private payer coverage, license portability and population health programs.

“Our states have significant individual and collective experience with telehealth,” the governors said in a joint statement. “To ensure that the nation benefits from our knowledge as changes to federal regulations are contemplated, to support continued application and availability of telehealth in our states, and to ensure that we address the inequities faced in particular by tribal communities and communities of color, we … have agreed to work together to identify best practices that support telehealth services for residents of our states.”

The agreement will focus on seven areas of interest: access; payment or reimbursement; patient choice; confidentiality and informed consent; equitable access to address disparities in care; standards of care and stewardship.

Once issue that could come up sooner rather than later is licensure. Washington, Nevada and Colorado are all part of the Interstate Medical Licensure Compact, which gives physicians from those states an expedited pathway to apply for a license to practice in member states. Oregon hasn't joined that effort. This could prompt a dicussion on the effectiveness of such a compact, or whether other strategies for practicing in multiple states would be better.

As with nearly every other state, the four states charted their own individual courses for telehealth coverage and access during the early days of the coronavirus pandemic, issuing emergency orders to relax or expand existing guidelines. The partnership may help those states coordinate their efforts to make some of those emergency rules permanent.

Colorado has already taken a step in that direction, with a new law signed in July that requires the state Medicaid program to reimburse for telehealth services at rural health clinics, federally qualified health centers and the federal Indian Health Service at the same rate as for in-person treatment; expands coverage to include speech therapy, physical therapy, occupational therapy, hospice care, home health care, and pediatric behavioral health care; and allows home health care providers to supervise their own telehealth services.

The states are also waiting on federal action to telehealth access and coverage.

President Donald Trump has issued an Executive Order aimed at expending telehealth in rural areas and making permanent some of the federal emergency measures enacted to address COVID-19, and the Centers for Medicare & Medicaid Services has released a proposed 2021 Physician Fee Schedule that looks to expand Medicare coverage for telehealth.

The remaining piece of the puzzle is Congress, which is under pressure to enact meaningful legislation to keep the momentum going for telehealth.