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 Colorado, SB 24-168 was signed by the governor, requiring reimbursement for remote monitoring for outpatient services for certain Medicaid members. This bill also creates a grant program to provide grants to outpatient healthcare facilities that are in rural areas to assist with the cost of providing telehealth remote monitoring, recognizing the cost to set up these programs. These parameters go into effect July 1, 2025. This bill also requires that the State cover continuous glucose monitors for Medicaid members.
• Florida enacted HB 855, which addresses teledentistry treatment, specifically requiring a disclaimer to accompany dental care provided via telehealth that an in-person visit is recommended prior to telehealth treatment. The bill goes into effect July 1, 2024.
• Mississippi finalized a rule that removed restrictions for telehealth visits with an evaluation & management code of level IV or V to be reimbursable by the state’s Medicaid program.
• Tennessee enacted several telehealth related bills:
  • HB 2857: In the realm of general healthcare insurance statutes, the bill revises the definition of “provider-based telemedicine” in Tenn. Code Ann. § 56-7-1003 to remove the requirement that the patient has already established the provider-patient relationship via an in-person visit within 16 months prior to the telehealth visit. An in-person visit is still required, however it does not need to be within that 16-month lookback period. This bill took effect on May 28, 2024.
  • HB 2318: This bill allows a physician assistant who operates solely via telehealth to arrange for the required review of the physician assistant’s charts by a collaborating physician or any required visit by a collaborating physician to any remote site to be completed via HIPAA-compliant electronic means, rather than at the site of the clinic. The bill also removes telehealth as an option. This bill went into effect on May 28, 2024.
  • HB 2147: The Tennessee Medicaid Program, TennCare, is now required to cover complex rehabilitation visits that are conducted via telehealth. This goes into effect on July 1, 2024.
  • HB 2808: Tennessee now requires that healthcare services delivered to inmates for human immunodeficiency virus (HIV) treatment can be provided via telemedicine, if requested and associated payment through various state programs, including TennCare, to cover treatment. This bill goes into effect on July 1, 2024.
• Vermont enacted a law through H 861 that requires parity for healthcare services provided via telemedicine, broadly applicable to healthcare insurance plans. This bill goes into effect on January 1, 2025.
• Several states enacted compact-related legislation:
  • Colorado signed HB 24-1002, which enacts the Social Work Licensure compact.
  • Connecticut enacted HB 5058, joining the Nurse Licensure Compact.
  • New Hampshire enacted SB 318, entering into the Social Work Licensure Compact.
  • Ohio enacted SB 90, entering the Social Work Licensure Compact.
  • Vermont enacted H 247, adopting the Occupational Therapy Licensure Compact.
  • Tennessee enacted HB 2405, which enacts the Social Work Licensure Compact.
  • Tennessee also enacted HB 1863, which enacts the Dietician Licensure Compact, becoming the third state to enter into this compact.

Legislation & Rulemaking Activity in Proposal Phase:

Highlights:

• In Washington, DC, the mayor signed B 25-0545, which includes a new “telehealth” section in the general health occupations statutes. This now clearly states that a practitioner-patient relationship may be established via telehealth, which includes synchronous and asynchronous technologies. This has now passed congressional review and, if approved, would go into effect on June 28, 2024.
• Louisiana’s HB 896 passed the second chamber this past week, which would create a remote patient monitoring program and details surrounding the coverage under the Louisiana Medicaid program. This now heads to the governor for signing.
• Louisiana has also sent HB 888 to the governor for signing after it passed the Senate, which would enter the state into the Social Work Licensure compact.
• Montana proposed a rule that would align home health service standards of care with the current federal guidelines in 42 CFR 440.70. This would allow face-to-face encounters to be conducted via telemedicine. Previously, telehealth was not discussed in this rule. A hearing will be held on June 13, 2024, with comments due June 21, 2024.
• The New York Assembly passed A6799B, which establishes a drug-induced movement disorder screening education program, and specifically includes services provided via telehealth.

Why it matters:

• Interstate compacts continue to grow, with smaller compacts seeing expansion in 2024. We continue to see states actively adopt interstate compacts. Seven new bills were enacted during the week of May 28 – June 3 that enrolled states in various compacts. This shows the value that states are finding in the compacts to aid in addressing the healthcare staffing shortage. The Social Work Licensure Compact alone has had four new states enact bills in the last two months, and the Dietician Compact now has three fully adopted members with Ohio having pending legislation. These compacts may not yet be as widely adopted as the Nursing and Physician compacts, but they are rapidly growing.
• States continue to revise reimbursement requirements for telehealth at both the Medicaid level and generally applicable health plan laws. This month Colorado, Tennessee, Mississippi and Vermont finalized or enacted changes to how telehealth services are reimbursed. These states are pushing for clearer reimbursement guidelines and, specifically, reimbursement parity for services provided via telehealth. These changes generally occur in statutes specific to the type of services, for example, Tennessee’s new reimbursement requirements under the state’s Medicaid program for complex rehabilitation care provided via telehealth under HB 2147. However, states are taking broader strokes to address telehealth reimbursement. Vermont’s H 861 requires telemedicine to be reimbursed at the same rate as in-person care, revising statutes relevant to healthcare insurance plans broadly. Another interesting development this week was the inclusion of grant programs in addition to reimbursement requirements in Colorado’s SB 24-168, relating to outpatient remote monitoring. States have consistently addressed telehealth reimbursement since the pandemic began, and based on the activity this week, we expect the requirements and standards to continue to evolve.
• Practice standards for care provided via telehealth are being streamlined. States continue to make changes to align telehealth standards across different practice areas. This is demonstrated by the proposed rule in Montana that aligns home health service standards with federal guidelines in 42 CFR 440.70, which, if adopted, would allow for the use of telehealth services. This week also saw large program-level changes in Louisiana, with HB 896 being sent to the governor for signing, which would create standards for remote patient monitoring and the reimbursement requirements surrounding the program. Additionally, this week has provided both large sweeping changes to practice standards (as seen in Louisiana and Washington, DC), and smaller practitioner-specific or specialty-level changes (as seen in Montana and Tennessee). This comparison emphasizes the importance of staying apprised of changes made at the general health provider level, reimbursement requirements, and the specific provider type level to ensure that all revised practice standards are considered when providing telehealth services.