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:

• Behavioral Health
• Licensure Compacts
• Telehealth Practice Requirements

A CLOSER LOOK

Finalized Legislation and Rulemaking:

• Florida enacted SB 7016, which, among other things, enters Florida into the Interstate Medical Licensure Compact, the Physical Therapy Compact, and the Audiology and Speech-Language Pathology Compact.
• In Utah, HB 365 was enacted. This act allows physicians, nurse practitioners and physician assistants to conduct initial consults for certain cosmetic procedures via telemedicine, including cryolipolysis (i.e. the removal of fat deposits using cold temperatures) and certain cosmetic laser treatments. Telemedicine consults would not be permitted for hair removal or tattoo removal treatments.
• Washington enacted HB 1939 to enter the Social Work Licensure Compact.
• In Washington, SB 5481 was also enacted. This act establishes professional practice standards for healthcare practitioners that provide telehealth services and establishes requirements for out-of-state health care practitioners.
• Washington also passed SB 5821, which amends existing standards for establishing a provider-patient relationship related to audio-only coverage requirements. The act defines an established relationship to include a provider of audio-only telemedicine who has, among other things, seen the patient in-person or through real-time interactive audio and video technology at least once in the last three years or an audio-only provider to whom the patient was referred by a physician who had seen the patient, in-person or through real-time interactive audio and video technology, at least once in the past three years.
• Wisconsin enacted SB 476, which prohibits the Wisconsin Medicaid program from requiring that telehealth providers have a physical address in the state.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

• In Alaska, SB 91 passed the first chamber. The bill would permit an out-of-state member of a physician’s multidisciplinary care team to provide services in Alaska via telehealth if the service provided by the out-of-state member is not reasonably available in the state or it involves ongoing treatment or follow-up care regarding a suspected or diagnosed life-threatening condition. The bill would also establish grounds for disciplinary action against an out-of-state member of a physician’s multidisciplinary care team.
• In Georgia, HB 441 passed both chambers. If enacted, the bill would, among other things, require a dentist intending to provide care via teledentristry to notify the Georgia Board of Dentistry and to provide documentation that the dentist has 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 provide a 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 Iowa, the Board of Nursing published a proposed rule that would set requirements for the licensure of certified professional midwives and would provide standards for the provision of services by certified professional midwives via telehealth.
• In New Jersey, A 2183 passed the first chamber. This bill would enact the Social Work Licensure Compact. A 2803 also passed the first chamber. This bill would allow alcohol and drug counselors, marriage and family therapists, professional counselors, physicians, homemaker-home health aides, certain nurses, psychologists, psychoanalysts, respiratory care practitioners, and social workers licensed or certified to practice in another state to apply for a license or certification to practice in New Jersey. Recent graduates would be authorized to apply for a practice under a temporary license until the person achieves full licensure.
• In New Hampshire, SB 403 passed the first chamber. This bill would permit certified community health workers to provide through telemedicine.

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 amend and clarify professional practice requirements for telehealth. With the increase in the delivery of care through virtual modalities, legislatures are adopting standards governing telehealth practice across multiple health professions and revising existing standards to reflect current technologies and practices. States continue to expand the kinds of services that may be provided via telehealth modalities, but these expansions often come with new requirements that providers must comply with in order to provide telehealth services.
• States continue to expand access to behavioral health services. This week, states continued to advance legislation and rulemaking that would reduce barriers to residents accessing behavioral health services by permitting practitioners to provide care via telehealth and by reducing barriers for out-of-state practitioners providing services in-state.

Telehealth is an important development in care delivery, but the regulatory patchwork is complicated.