After Past Failures, 2 States Push Ahead With New Telehealth Rules

Two states with troubled histories of telehealth support are pushing ahead with plans that would improve the connected health landscape.

In Massachusetts – long considered one of the least telehealth-friendly states – the Board of Registration in Medicine recently approved its first permanent policy on telemedicine. The one-paragraph policy states that an in-person visit between a provider and patient is not needed to establish the patient-provider relationship before a telehealth encounter, and specifies that the standard of care for telehealth is the same as that for an in-person visit.

In Pennsylvania, meanwhile, the House of Representatives is once again poised to debate a bill that would outline regulation and coverage of telehealth services – just two months after a similar bill was vetoed by Governor Tom Wolf because it would have banned telemedicine abortions.

In introducing HB 2454, State Rep. Christina Sappey said she was following through with the goals outlined in SB 857 “without the controversial political language.” That bill, introduced in 2019, aimed to establish definitions for telemedicine and telehealth, provide temporary evaluation and treatment guidelines and ground rules for reimbursement, and give state departments up to two years to draft permanent rules and regulations.

Her bill would also expand reimbursement for telehealth to the Children’s Health Insurance Program (CHIP) and ensure reimbursement parity during the COVID-19 emergency. Previous bills in Pennsylvania that supported payment parity were shot down due to opposition from payers who feel reimbursement should be negotiated.

SB 857 had received unanimous support from the Legislature when it was introduced, but Republicans amended the bill to ban the use of telemedicine for administrating medications included on the US Food and Drug Administration’s Approved Risk Evaluation and Mitigation Strategies (REMS) List. The list includes mifepristone, which is used to induce medical abortions.

After the Republican controlled Legislature passed the bill, Wolf vetoed it in April, saying he supports telehealth expansion but not to anti-abortion clause. At the same time he released a “Cross-Agency Telehealth Guidance” aimed at relaxing state regulations during the coronavirus pandemic to allow expanded use of coverage of telehealth.

Just up the Northeast coast, Massachusetts has faced similar setbacks in establishing guidelines for virtual care use and coverage – so much so that the medical board’s June 25 action is seen as a significant milestone.

“This policy is an important step for the Massachusetts BORIM, as it had previously hesitated to provide any formal guidance on the practice of telehealth,” Sarah Beth S. Kuyers and Ellen L. Janos, two attorneys with the national law firm of Mintz, Levin, Ferris, Glovsky and Popeo, recently wrote in Lexology.

As with every other state, Massachusetts had expanded telehealth coverage and access to deal with the COVID-19 emergency, and Governor Charles Baker last year introduced a massive healthcare bill that would, among other things, establish a regulatory framework for telehealth and mandated reimbursement parity.

But in 2018, the commonwealth’s House and Senate both approved telehealth bills, then couldn’t come to any agreement on a final version that would have passed both chambers, so the bills died when the legislative session ended that summer.

Telehealth experts say the state medical board’s new order on telehealth could be the kick needed to spur a state that scored an F on the American Telemedicine Association’s 2017 state telehealth report card to push new rules and regulations through.