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
• Expanding telehealth
• Regulation of teledentistry

A CLOSER LOOK

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

• In Arizona, HB 2446 passed the first chamber. If enacted, the bill would establish licensing requirements for dietician nutritionists and nutritionists, which would allow for the delivery of dietetic and nutrition services via telehealth.
• In Florida, HB 849 passed both chambers. If enacted, the bill would establish requirements for the delivery of veterinary telehealth services by Florida-licensed veterinarians.
• In Florida, HB 855 passed both chambers. If enacted, the bill would, among other changes, require dental practice to designate a dentist of record with the Florida Board of Dentistry. It would also require dentists to perform an in-person examination of a patient or to obtain records of an in-person evaluation before initiating orthodontic treatment. The proposal would also require that dentists placing advertisements of dental services provided through telehealth include a disclaimer recommending an in-person examination for each of the following services: an impression or digital dental scan, denture services, placement of an appliance or other structure, and orthodontic treatment. Under the proposal, failure to comply with the evaluation requirement and failure to provide patients with contact information of each dentist who is providing dental services to a patient would be grounds for discipline.
• In Georgia, HB 844 passed the first chamber. If enacted, the bill would establish licensing requirements for dietician nutritionists and nutritionists, which would allow for the delivery of dietetic and nutrition services via telehealth.
• In Georgia, HB 441 passed the first chamber. If enacted, the bill would, among other requirements, require a dentist intending to provide care via teledentristry to notify the Georgia Board of Dentistry and to provide documentation that the dentist had established a referral relationship with a dentist capable of providing in-person dental care at a location within the state meeting certain geographic requirements. A dentist providing teledentistry would be permitted to authorize dental hygienists to perform certain dental hygiene functions, prescribe noncontrolled prescriptions and authorize the performance of digital scans and the transmission of patient records to the dentist. The proposed bill would require dentists to perform an initial in-person examination and an in-person exam at least once every 12 months to provide teledentistry services to a patient, except for patients seen in certain specified settings. It would also require dentists to obtain written authorization to a patient with information about the treating dentist and dental hygienist and obtain informed consent after providing a written statement advising the patient that teledentistry was not equivalent to an in-person clinical exam and that the dentist would not physically be present. The bill would prohibit an insurer from excluding coverage for a service solely because it was provided via teledentistry or requiring insureds to receive dental care via teledentistry.
• In Indiana, SB 132 passed both chambers. Currently, Indiana law provides that an out-of-state provider licensed in Indiana may not provide telehealth services in Indiana until the provider and their employer/contractor have filed a certification with the Indiana Professional Licensing Agency that the provider and employer/contractor agree to be subject to Indiana jurisdiction and Indiana substantive and procedural laws. If enacted, the bill would remove the requirement to file the certification, though providers would still be subject to Indiana jurisdiction and Indiana substantive and procedural laws, and the provision of health services (rather than the filing of the certification) would constitute a voluntary waiver of other jurisdictional rights.
• In Indiana, SB 104 passed both chambers. If enacted, the bill would, among other disclosure requirements, require veterinarians and veterinary technicians to disclose whether the practitioner delivers veterinary services via telehealth when renewing a license or registration certificate.
• In Kentucky, a proposed rule would require corrections centers to contract with a healthcare provider to deliver services by telehealth.
• In Oregon, HB 4002 passed both chambers. If enacted, the bill would create new programs to provide services related to opioid use disorder to Oregon inmates and permit the use of telehealth in certain of those programs.
• In Utah, HB 365 passed both chambers. If enacted, the bill would permit physicians, nurse practitioners and physician assistants to conduct initial consults for certain cosmetic procedures via telemedicine.
• In Virginia, SB 250 passed both chambers. If enacted, the bill would provide Medicaid reimbursement under certain conditions for remote ultrasound procedures and remote fetal non-stress tests.
• In Washington, SB 5983 passed both chambers. If enacted, the bill would allow registered medical assistants to administer intramuscular injections to treat syphilis if a healthcare practitioner is providing supervision through interactive audio and video.
• Licensure Compacts. This was a busy week for proposals to enter licensure compacts.
  • Counseling Compact: Arizona, SB 1173 passed the first chamber. If enacted, the bill would enter Arizona into the Counseling Compact.
  • Social Work Licensure Compact: The following states introduced legislation that, if enacted, would enter the state into the compact: Colorado (HB 24-1002); Georgia (HB 839); Kansas (HB 2484); Vermont (HB 543). In Virginia (SB 239) and Washington (HB 1939), legislation to enter the compact has now 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.
• States continue to advance legislation and rules expanding the use of telehealth across multiple health professions. With the growing acceptance of care delivery through telehealth modalities, states have continued to authorize the use of telehealth services in additional health professions such as dietetics and nutrition, dentistry, and even veterinary care. On a smaller scale, state actions such as providing reimbursement for telehealth services and expanding the procedures various providers may provide via telehealth signal support for telehealth.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated. The McDermott digital health team works alongside the industry’s leading providers, payors and technology innovators to help them enter new markets, break down barriers to delivering accessible care and mitigate enforcement risk through proactive compliance. Are you working to make healthcare more accessible through telehealth? Let us help you transform telehealth.