PA Governor Vetoes Telehealth Bill, Promotes New COVID-19 Guidance

As expected, Pennsylvania Gov. Tom Wolf has vetoed a telehealth bill because it includes a ban on telemedicine abortions.

At the same time, Wolf released a “Cross-agency Telehealth Guidance,” aimed at relaxing state regulations to allow healthcare providers to use connected health services and giving them guidance in using telehealth and mHealth during the Coronavirus pandemic..

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The four-page document, which follows up on the governor’s March 6 emergency disaster declaration, expands the list of healthcare providers, both in and outside the state, who can use telehealth to treat patients. It also expands coverage for telehealth services under Medicaid, notes the Pennsylvania Insurance Department’s expectations for telehealth coverage by private insurers, enables Early Intervention programs to use telehealth and expands telemental health opportunities, including for substance abuse programs.

The guidance is designed, in part, to give some direction on telehealth that the bill would have provided.

Wolf’s veto of SB 857 focused solely on issue: The use of telemedicine to prescribe mifepristone, which is used to induce medical abortions. The drug is included on the US Food & Drug Administration’s Approved Risk Evaluation and Mitigation Strategies (REMS) list, and abortion opponents have argued that it should not be dispensed unless the doctor and patient are in the same room.

Lawmakers had almost unanimously supported the bill when it was introduced in 2019, but Republicans later included an amendment negating the use of telemedicine for medications on the REMS list. Democrats called the amendment a “poison pill” and withdrew their support, though the GOP majority in both the House and Senate was enough to secure passage.

In his April 29 veto, Wolf said he supports the bulk of the bill, which would have established definitions for telemedicine and telehealth, set ground rules for insurance coverage – including letting insurers and healthcare providers negotiate reimbursement rates – and given the state two years to draft permanent rules.

“Physicians and their patients must be able to make choices about medical procedures based on best practices and standards or care, and telemedicine can be an important and accessible way to assist in making those choices,” the governor wrote. “I supported a prior printer’s number of the bill, but as amended in the House of Representatives, this legislation arbitrarily restricts the use of telemedicine for certain doctor-patient interactions. As amended, this bill interferes with women’s health care and the crucial decision-making between patients and their physicians.”

Wolf also countered GOP complaints that his veto was damaging the state’s efforts to use telehealth to improve access and care during the COVID-19 emergency. The bill doesn’t require payer coverage for telehealth to begin until six months after passage, he noted.

“Given the potential for widespread transmission of COVID-19 across Pennsylvania, my administration has been taking a number of steps to ensure that patients in need of vital health care services are receiving them in a timely, safe, and appropriate manner,” Wolf concluded. “These steps expand and promote telehealth for physical health, behavioral health, and substance use disorder services and expand the use of telemedicine in the Medical Assistance Program and the Children’s Health Insurance Program (CHIP).”