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
• Reimbursement requirements
• Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking:

• In Connecticut, the governor signed HB 5198, which permanently extends COVID-19 era telehealth provisions, originally set to expire at the end of this month. The bill also creates a registration requirement for mental and behavioral health providers who are providing care via telehealth from outside of the state. These providers do need to submit an application for licensure within 60 days of registration. The bill also addresses payment expectations for providers should a patient’s health insurance not cover telehealth services. Certain provisions went into effect immediately upon the governor’s signature, while others go into effect on July 1, 2024, after the existing provision expires.
• Colorado enacted HB 24-1045, which addresses updates to treatment for substance use disorders generally and requires payment parity for telemedicine care of substance use under the state’s Medicaid program. This takes effect 90 days following the final adjournment of the state congress. Colorado also enacted SB 24-034, which expands school-based healthcare, allowing services to be provided via telehealth.
• Illinois amended the Illinois Public Aid Code, through SB 3268, to include funding for the expansion of telehealth services in critical access hospitals with potential funding coming from the Department of Health Services (DHS) to support expansion. This also includes an amendment which states that beginning January 1, 2025, DHS will pay negotiated, agreed upon administrative fees associated with implementing telehealth services for persons with intellectual and developmental disabilities receiving Community Integrated Living Arrangement residential services.
• Michigan enacted several telehealth related bills, all taking effect 90 days following the end of the congressional session:
  • HB 4131 :This bill updates the state’s private payor laws and requires, among other things, that there be payment parity and that health plans not limit telehealth-delivered services to only be provided via a third-party entity.
  • HB 4580: This bill will ensure coverage parity through Medicaid for telehealth services.
  • HB 4213: This bill will, among other things, require coverage of telehealth in the Medicaid program, including specifically allowing for audio-only and telehealth to be an eligible encounter for federally qualified health centers (FQHCs) and rural health clinics (RHCs).
  • HB 4579: This bill requires that all health plans cover telehealth services at the same rate as in-person care.
• Nebraska’s enrollment in the Dietician Licensure and Physician Assistant Compacts took effect under LB 1215.
• West Virginia finalized a rule that would expand the definition of Occupational Therapist and Occupational Therapist Assistant, to include those enrolled in the Occupational Therapist Compact.
• Wyoming revised rules promulgated by the Medical Board that clearly defined the “active practice of medicine” to include out-of-state practice.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

• The Arizona Senate passed SB 1295, which if enacted would enroll the state in the Advanced Practice Registered Nurse (APRN) Compact. If passed, Arizona would be the fifth state to enact the APRN Compact.
• The California congress had two telehealth related bills progress through the houses:
  • The California senate passed SB 1180, which revised a number of Medi-Cal related payment provisions including the creation of payment for a mobile integrated health program, which is defined to mean a team of licensed healthcare practitioners, operating within their scope of practice, who provide mobile health services to support the emergency medical services system.
  • The assembly passed AB 2339, which would expand the definition of telehealth, for purposes of the certain Medi-Cal provisions, to include asynchronous electronic transmission initiated directly by patients, including through mobile telephone applications. This bill would also amend existing law that only authorizes a healthcare provider to establish a new patient relationship using an audio-only synchronous interaction when the patient requests an audio-only modality or attests that they do not have access to video, as specified, to remove from that exception, the option of the patient attesting that they do not have access to video.
• New York’s Senate introduced and passed SB 8967B, which would allow telehealth for school-based care.
• Rhode Island, under SB 2623, has started the process of enacting the Occupational Therapy Compact, which passed the Senate on June 4, 2024. Five other states currently have legislation pending to enroll in this compact.

Why it matters:

• Payment standards for telehealth services are continuing to evolve. States continue to revise state Medicaid and private insurers requirements to seek parity for healthcare services provided by telehealth. Michigan passed several laws this week that will expand coverage of telehealth under their Medicaid program, including care provided by FQHCs and RHCs. California has two laws pending that will amend the Medi-Cal payments made for telehealth services, expanding the types of technologies that are covered, with one bill including care provided through mobile-based applications. With telehealth access growing, states are making adjustments to ensure that patients have coverage of their services, both at the state-funded insurance level and from private insurers.
• Interstate compacts continue to grow; rapid adoption has not ceased. As reported on consistently this year, state focus on joining licensure compacts has not slowed. This week, Nebraska enrollment in the Dietician and the Physician Assistant Compacts went into effect. Nebraska becomes the third state to enact legislation for the Dietician Compact. Rhode Island and Arizona both had bills that passed one chamber, to enter into the Occupational Therapy Compact and the APRN Compact, respectively. Arizona would be the fifth state to enact the APRN Compact, if passed. We also saw states amend existing laws and rules to accommodate compact licensees, for instance, West Virginia’s final rule that would consider an Occupational Therapist Compact Licensee a healthcare provider under relevant practice rules. Although we haven’t seen much movement in the Interstate Medical Licensure Compact lately, states remain very active in the compact space by enacting legislation to enroll in the less widely adopted compacts, showing that states believe in the benefit of these programs.
• States are revising practice standards with technology in mind. This week, we saw several changes proposed by states that not only encourage the use of telehealth but create programs or payments that are based on the use of technology. This includes California’s bill, SB 1180, which would create a program for mobile-based interventions, and Illinois’s budget related bill, SB 3268, which will pay agreed-upon rates for setting up new telemedicine systems for intellectual and developmentally delayed individuals receiving care through the Community Integrated Living Arrangement residential services. These state actions indicate the utility states are finding in encouraging care arrangements provided outside of the face-to-face context.