Trending in Telehealth is a new weekly series from the McDermott Digital Health team where we highlight 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 two weeks:

• Telebehavioral Health

• Medicaid Coverage

• Provider Practice Standards

• Teledentistry

• Occupational Therapy

• Audiology and Speech Pathologists

• School-Based Mental Health

A closer look:

Finalized: 8

• Texas has updated its regulations for the Mental Health Rehabilitation and Mental Health Case Management Services Programs, both including rules concerning telehealth use for the services and reimbursement.

• North Carolina has finalized rules for the licensure and regulation of behavioral analysts, which include regulations for the provision of services via telehealth. The state has also issued a final rule to establish telepractice standards for practitioners providing medical nutrition therapy to clients/patients within the state.

• Kentucky and Missouri both passed emergency rules relating to teledentistry. Missouri’s emergency rule implemented a pilot program designed to examine new methods of extending dental care to underserved populations, specifically targeting nursing homes and long-term care facilities utilizing telehealth technology. Kentucky’s emergency administrative regulation was implemented to extend coverage of dental and other types of coverage (audiology and vision) to Medicaid recipients and established Medicaid requirements around dental services.

Proposed: 31

• The Virginia Senate passed a bill that makes changes to Medicaid reimbursement. This new bill specifies that a healthcare provider licensed by the Commonwealth who is providing care exclusively through telemedicine shall not be required to maintain a physical presence in the Commonwealth to be considered an eligible provider for enrollment as a Medicaid provider, and a telehealth group need not have an in-state service address to be eligible to enroll as a Medicaid vendor or provider group.

• Utah’s House passed a bill that would repeal the state’s Online Prescribing, Dispensing, and Facilitation Licensing Act along with sections of various laws related to establishing a provider-patient relationship for purposes of prescribing, specifically removing a related exception to the prohibition against providing prescriptions based solely on a questionnaire, email, or patient-generated medical history.

• Oregon has proposed medical fee reimbursements updates related to workers’ compensation. There are minor adjustments proposed to the reimbursement for telehealth, related to codes required for claims.

• Maryland proposed a new rule that would add telehealth provisions for chiropractic medicine. The new chapter would define licensure, professional standards, and patient/client evaluation requirements.

• In South Dakota, a bill amending the practice guidelines for speech pathologists—allowing any licensed speech pathologist to provide services through telehealth—has passed both chambers and is being presented to the Governor for approval.

• Utah and Washington both proposed bills addressing mental health through telehealth services in school settings. Utah proposed a bill to fund mental health counseling for public school students including telehealth services. Washington proposed a bill to require contracts with telehealth providers for mental and behavioral healthcare for colleges not participating in the mental health and counseling services pilot program.

• Arkansas, Indiana and Mississippi proposed joining the Occupational Therapy Licensure Compact.

• Wyoming, Indiana and Virginia (via a house bill and, separately, a senate bill) proposed joining the Counseling Licensure Compact.

• Washington proposed entering the Audiology and Speech-Language Pathology Interstate Compact and the Mental Health Counseling Compact.

Why it matters:

• Telebehavioral health continues to be an active space for regulators. Two of the adopted rules in Texas relate to providing mental healthcare and specifically reimbursing programs that would increase access to care through Medical Assistance. Additionally, North Carolina follows states like Maryland and Texas who have proposed standardization of behavioral analyst regulations –including telehealth practice standards, providing clarity for practitioners.

• North Carolina’s final rule extends medical nutrition therapy practice standards to telehealth providers, making out-of-state practitioners subject to the North Carolina Board of Dietetics/Nutrition’s discipline in the event of a practice standard violation.

• South Dakota’s bill, if signed by the Governor, will provide a clearer, uniform standard for “telehealth” as a term in the state, amend practice guidelines for speech pathologists, and require that speech pathology services being delivered via telehealth are equivalent to the quality of services delivered face-to-face.

• Trends toward interstate compacts increase licensure portability. In turn, these compacts, if adopted, will increase the ability of out-of-state providers to provide telehealth services to patients in other states.

• The use of telehealth technology remains especially important in reaching critically underserved populations, as seen through the teledentistry pilot program in Missouri and the multiple proposed bills aimed at addressing gaps to mental healthcare through telehealth services in public school systems and colleges.