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 licensure
• Reimbursement requirements and payment parity

A CLOSER LOOK

Finalized Legislation & Rulemaking

• Michigan enacted a final rule that outlines telehealth practice standards including consent to telehealth, referrals to in-person providers (when needed), delegation of prescribing of controlled substances to advanced practice registered nurses, training standards related to human trafficking, licensure and continuing education.
• Delaware enacted a final rule related to social work practice. The amendments change the requirements for direct supervision in post-degree supervised clinical social work experience for licensure applicants to specify that supervision may be through 100% live video conferencing at the discretion of the supervisor. Telehealth requirements are revised to exempt individuals practicing through a Delaware interstate telehealth registration from the prerequisite that the individual hold a Delaware license.
• Tennessee enacted SB 1674, which directs the bureau of TennCare to – no later than December 31, 2024 – amend existing rules, or promulgate new rules, on fee-for-service and Medicaid managed care plans regarding reimbursement (specifically, to allow for the reimbursement of remote ultrasound procedures and remote fetal nonstress tests using established CPT codes for such procedures when the patient is in a residence or other off-site location that is separate from the patient’s provider and meets the same standard of care).

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

• In New Jersey, A 2803 passed the first chamber. If enacted, the bill would authorize certain out-of-state healthcare professionals and recent graduates of healthcare training programs to practice in the state upon application for licensure/certification in the state, but before such license is granted.
• In Texas, HB 1771 passed one chamber. If enacted, the bill would require that each agency with regulatory authority over a health professional providing a telemedicine medical service, teledentistry or telehealth adopt rules necessary to standardize formats for and retention of records related to a patient’s consent to: (i) treatment, (ii) data collection and (iii) data sharing.
• In Minnesota, SF 4399 passed both chambers. If enacted, the bill would provide that, subject to federal approval, substance use disorder services that are otherwise covered as direct face-to-face services may be provided via telehealth as defined in section 256B.0625, subdivision 3b. The use of telehealth to deliver services would need to be medically appropriate to the condition and needs of the person being served. Reimbursement would be at the same rates and under the same conditions that would otherwise apply to direct face-to-face services.
• In Alabama, SB 207 passed one chamber. If enacted, the bill would adopt the dietitian licensure compact. In Tennessee, HB 1863 (paired with SB 1862) also passed one chamber, and if enacted, would adopt the dietitian licensure compact.
• Numerous states progressed legislation related to the Social Work Compact:
  • In Maine, LD 2140 passed both chambers
  • In Alabama, SB 208 passed one chamber
  • In New Hampshire, HB 1190 passed one chamber
  • In New Jersey, A 2813 passed one chamber
  • In Tennessee, SB 2405 passed both chambers
  • In Colorado, HB 24-1002 passed one chamber
  • In Vermont, H 543 passed both chambers

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 and Dietitian Compact saw significant 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 (i) reflect current technologies and practices and (ii) ensure there is consistency across the professions. This week, we saw a particular emphasis in areas such as out-of-state licensure allowances and supervision standards (for both social workers and advanced practice registered nurses).
• States continue to evaluate reimbursement standards as they relate to delivery of care provided via telehealth. State efforts, such as in Minnesota (highlighted above), help to provide reimbursement for telehealth services without also requiring a burdensome in-person visit as a condition of reimbursement. We are also seeing increased efforts at payment parity for services offered via telehealth.