Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

• Interstate compacts
• Professional standards and supervision requirements
• Reimbursement requirements

A CLOSER LOOK

Finalized Legislation & Rulemaking

• Arizona enacted SB 1173, enacting the counseling compact.
• Mississippi enacted SB 2157 (mentioned in last week’s post) adopting the Psychology Interjurisdictional Compact.
• Kentucky enacted both bills mentioned in last week’s blog post:
• SB 255 establishes requirements and standards for the provision of social work services via telehealth.
• SB 111: Requires health benefit plans, limited health service benefit plans, Medicaid and state health plans to provide coverage for speech therapy provided in person or via telehealth.
• West Virginia also enacted rulemaking pertaining to the practice of licensed dietitians. Specifically, the rulemaking established procedures for the practice of telehealth by licensed dietitians. The rule provides for relevant telehealth definitions, licensure standards, establishing a practitioner-provider relationship solely via telehealth and standards of telehealth practice (e.g., consent, identify verification, standards for confidentiality, etc.).
• Arizona enacted rulemaking, applicable to the Medicaid program, which requires the Arizona Department of Health Services (Department) to allow a healthcare provider who is not licensed in Arizona to provide telehealth services to a client located in Arizona if the healthcare provider registers with the Department and pays a registration fee. Providers who register with the Department must maintain a statutory agent for service of process in the state and ensure the provider’s professional liability insurance policy includes coverage for telehealth services provided to clients in Arizona, among other requirements.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

• Wyoming enacted emergency rulemaking which provides that a physician or physician assistant who has established a provider-patient relationship in another state with a patient who is a resident of Wyoming may provide continued care to the patient via telehealth without a Wyoming physician or physician assistant license subject to the following:
• (i) The provider-patient relationship must have been established in an in-person encounter in a state in which the physician or physician assistant is licensed;
• (ii) Subsequent care may be provided to the patient via telehealth while the patient is in Wyoming if the care is a logical and expected continuation of the care provided in an in-person encounter in the state where the physician or physician assistant is licensed. If the patient is presenting with new medical conditions, or conditions that the standard of care dictates an in-person encounter is needed, patient must either return to the state in which the physician or physician assistant is licensed for care or must be referred to a Wyoming-licensed healthcare provider.
• (iii) The telehealth care may continue for up to six months after the establishment of the provider-patient relationship in another state, after which an in-person encounter must take place in a jurisdiction where the physician or physician assistant is licensed before the telehealth may resume for another six months.
• In Tennessee, HB 2318 passed both chambers. If enacted the bill would, among other things, provide for remote supervision of physician assistants (PA) operating by telehealth in the state. Specifically, the bill provides that a operat solely via telehealth may arrange for the required personal review of the charts by a collaborating physician, with the same authority to render prescriptive services that the physician assistant is authorized to render, in the remote office or practice site of the physician, or any required visit by a collaborating physician to any remote site, or both, via HIPAA-compliant electronic means rather than at the site of the clinic.
• In Vermont, H 453 passed both chambers. If enacted, the bill would enact the Social Worker Compact.
• In Iowa, HF 2512, also passed both chambers and would enact the Social Worker Compact.

Why it matters:

• States continue to increase activity surrounding licensure compacts for a variety of health professionals. These state efforts ease the burdens of the licensing process and demonstrate a desire to facilitate multijurisdictional practice without giving up authority over professional licensure. This week, the Social Work Compact, Counseling Compact and Psychology Interjurisdictional Compact all saw progress.
• States continue to amend and clarify professional practice standards for telehealth. With the increase in the delivery of care through virtual modalities, professional boards are adopting standards governing telehealth practice across multiple health professions and revising existing standards to reflect current technologies and practices, and to ensure there is consistency across the professions. This week, we saw a particular emphasis on physician assistant practice standards, including a proposed bill which would allow for remote supervision flexibilities in Tennessee.