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:

• Professional standards
• Reimbursement requirements
• Interstate compacts

A CLOSER LOOK

Finalized Legislation & Rulemaking

• Connecticut enacted HB 5197, which enacts the Social Work Licensure Compact.
• South Carolina enacted H 5183, which adds certain nursing tasks to the representative list of nursing tasks that may be delegated by a physician, physician assistant, or advanced practice registered nurse to unlicensed assistive personnel, including performing nonclinical tasks via telemedicine.
• South Carolina also enacted S 610, which enacts the Counseling Compact.
• The Wisconsin Psychology Examining Board amended its rules to bring them into alignment with the state’s establishment as a member of the Psychology Interjurisdictional Compact. Specifically, this adopted rule provides that the standards of practice and professional conduct apply to both telehealth and telepsychology services.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

• In California, AB 2339 passed the first chamber. This bill would expand existing Medi-Cal definitions and exceptions that currently restrict the establishment of new patient relationships via telehealth. Specifically, this bill permits the use of asynchronous telehealth modalities to establish a new patient relationship when related to sensitive services or when requested by patient. For purposes of Medi-Cal, this bill expands the definition of “asynchronous store and forward” to include asynchronous electronic transmission initiated directly by patients, including through mobile telephone applications.
• In Illinois, HB 5087 passed the second chamber. This bill would amend the Illinois Physical Therapy Act to provide that physical therapy through telehealth services may be used to address access issues to care, enhance care delivery or increase the physical therapist’s ability to assess and direct the patient’s performance in the patient’s own environment. This bill also provides that a physical therapist or a physical therapist assistant working under the general supervision of a physical therapist may provide physical therapy through telehealth services, subject to certain restrictions.
• In Illinois, SB 2586 also passed the second chamber. This bill would amend the Illinois Dental Practice Act to include in the definition of teledentistry patient diagnosis and treatment planning services. This bill also provides practice standards by which a dentist may practice teledentistry, including that a dentist may only practice or utilize teledentistry on a patient of record and requires the dentist to obtain informed consent from the patient prior to rendering teledentistry services.
• In Ohio, SB 95 passed the first chamber. This bill would permit remote dispensing pharmacies to dispense drugs, provide patient counseling and other pharmacist care through a telepharmacy system. This bill also specifies the requirements for a pharmacy to be eligible to operate as a remote dispensing pharmacy.
• In Pennsylvania, SB 739 passed the first chamber. This bill would amend Title 40 (Insurance) of the Pennsylvania Consolidated Statutes to require insurance providers and Medicaid and the Children’s Health Insurance Program (CHIP) managed care plans to reimburse healthcare providers for covered services provided to a patient through telemedicine, which is defined to include synchronous and asynchronous interactions and remote patient monitoring.
• The Tennessee Board of Optometry proposed a rule to update the practice standards by which optometrists can provide telehealth services.
• Several states saw activity related to interstate compacts.
  • In New Hampshire, SB 218, which would enact the Social Work Compact, passed two chambers.
  • In Rhode Island, SB 2184, which would enact the Social Work Licensure Compact, passed the first chamber.
  • In California, AB 2566, which would enact the Counseling Compact, passed the first chamber.
  • In Rhode Island, SB 2183, which would enact the Counseling Compact passed the first chamber.
  • In California, AB 2051, which would enact the Psychology Interjurisdictional Compact passed the first chamber.

Why it matters:

• States continue to amend and clarify professional practice standards for telehealth. States continue to propose, adopt and revise standards that govern the practice of telehealth across a variety of medical professions. South Carolina HB 5183 recognizes that the certain delegated nursing tasks can be performed via telemedicine, while Illinois HB 1087 and SB 2586 seek to amend the professional practice standards by which physical therapists and dentists may provide telehealth services. In addition, Ohio SB 95 would set the stage for the operation of remote dispensing pharmacies through telephamarcy systems.
• States continue to evaluate coverage and reimbursement for the delivery of care provided via telehealth. Proposals in Pennsylvania and California are examples of state efforts to promote access to telehealth through requiring Medicaid coverage of telehealth services. California AB 2339 seeks to offer more flexibility for Medicaid patients by permitting providers to establish new Medi-Cal patients via telehealth under certain circumstances. In addition to requiring Medicaid coverage, Pennsylvania SB 739 requires health insurance policies to provide coverage for medically necessary healthcare services provided through telemedicine and delivered by a participating network provider.
• 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, states pushed forward bills related to interstate compacts for social work, counseling, and the practice of psychology.

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