Trending in Telehealth is a series from the McDermott digital health team in which we highlight state legislative and regulatory developments that impact healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate virtual care.

Trending in the past week:

• Interstate Compacts

• Professional Practice Standards

• COVID-19 Licensure Flexibilities

A CLOSER LOOK

Finalized Legislation & Rulemaking

• Illinois enacted HB 559, which allows any person who was issued a temporary out-of-state permit by the Illinois Department of Financial and Professional Regulation during the COVID-19 pandemic to continue to practice under her temporary out-of-state permit if she submits an application for licensure by endorsement to the Department on or before May 11, 2023. The legislation allows any such person to continue to practice under his temporary out-of-state permit until the Department issues the license or denies the application, at which time the temporary out-of-state permit will expire. The legislation also updates the definition of “direct supervision” for a speech language pathologist assistant to include video conferencing.

• Tennessee enacted HB 498 and companion bill SB 721. The legislation exempts a patient receiving an initial behavioral health evaluation via telehealth from the reimbursement requirement that the patient have an in-person encounter with a healthcare services provider, the provider’s practice group or the healthcare system within 16 months prior to an interactive visit in order to establish a provider-patient relationship for purposes of telehealth.

• North Dakota, Montana and Oklahoma enacted legislation (SB 2187, HB 777 and SB 575, respectively) to join the Counseling Compact.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

• Montana progressed legislation to join the Occupational Therapy Compact (SB 155). Meanwhile, Iowa and Indiana progressed legislation to the second chamber (HF 671 and SB 160, respectively) to enact the Counseling Compact. South Carolina introduced legislation (S 610) that would enact the Counseling Compact, and Louisiana introduced legislation (SB 186) to join the Occupational Therapy Compact.

• New Hampshire progressed legislation (HB 500) that would modify which controlled substances are permitted to be prescribed via telemedicine. The legislation would allow an advanced practice registered nurse (APRN) to prescribe non-opioid and opioid controlled drugs in schedule II through IV by means of telemedicine after establishing a relationship with the patient. When prescribing a non-opioid or opioid controlled drug classified in schedule II through IV via telemedicine, a practitioner licensed to prescribe the drug must conduct subsequent in-person exams at intervals appropriate for the patient, medical condition and drug, but not less than annually. The legislation further provides that an APRN who prescribes these drugs by telemedicine must obtain oral or written consent for the provision of services through telemedicine from the patient or, if the patient is a minor, from the patient’s parent or guardian unless state or federal law allows a minor to consent to treatment without the consent of a parent or guardian.

• Indiana progressed legislation (HB 1352) that, if enacted, would prohibit the Office of Medicaid Policy and Planning from requiring a provider who is licensed, certified, registered or authorized with the appropriate state agency or board, and who exclusively offers telehealth services, to maintain a physical address or site in Indiana to be eligible for enrollment as a Medicaid provider. The bill would also prohibit the Office from requiring a telehealth provider group with providers who are licensed, certified, registered or authorized with the appropriate state agency or board to have an in-state service address to be eligible to enroll as a Medicaid vendor or Medicaid provider group.

Why it matters:

• Elevated activity involving the adoption of interstate compacts continues. Many states are progressing legislation that would enact various licensure compacts across healthcare professions, easing burdens to licensure and reciprocity for professionals seeking to practice across state lines.

• States continue to refine and adopt professional standards for telehealth practice. This week saw adoption of telehealth practice standards for various professionals, such as nurse practitioners and behavioral health providers, addressing both prescribing and the need for in-person visits. States continue to consider the balance between the accessibility of telehealth visits and patient safety concerns.

• States are maintaining flexibilities for out-of-state providers. States continue to address and account for providers located outside of a state who render care to in-state patients, and continue to ease the burdens of providing such care. States are going about this by extending COVID-19 licensure flexibilities or by prohibiting requirements for in-state physical addresses. Both approaches are examples of states addressing the concerns of many telehealth providers that operate on a multi-state basis.