The COVID-19 pandemic led to a surge in telehealth use in the United States, with policy changes and flexibilities enacted at the state and federal levels. Now, with the public health emergency ends, lawmakers are evaluating how telehealth policy needs to evolve to continue supporting the new normal in healthcare. This article provides an overview of the changes in telehealth policy at the state and federal levels during the pandemic and explores what telehealth policy could look like in the year ahead.
The COVID-19 pandemic has led to a significant increase in the use of telehealth services in the United States. With policy changes and flexibilities enacted at the state and federal levels, the integration of telehealth into routine care delivery has been rapid. However, with the public health emergency coming to an end, lawmakers are evaluating how telehealth policy needs to evolve to continue supporting the new normal in healthcare. This article provides an overview of the changes in telehealth policy at the state and federal levels during the pandemic and explores what telehealth policy could look like in the year ahead.
Federal Telehealth Policy
Various pieces of legislation have been introduced at the federal level to solidify telehealth policy, but many have yet to be voted on. Telehealth proponents scored a win when telehealth flexibilities for Medicare beneficiaries were included in the 2022 year-end spending bill, with provisions extending pandemic-era telehealth and hospital-at-home waivers for two years.
State Telehealth Policy during the Pandemic
Telehealth policy at the state level has changed rapidly over the past few years as COVID-19 cases surged and fell. Payment parity has been one of the most significant changes to state telehealth policies amid the pandemic, with 21 states now having payment parity policies, compared to about 10 in the late 2010s. Payment parity refers to reimbursing services equally whether they are provided via telehealth or in-person. Before the pandemic, coverage parity among states was fairly common, but this did not guarantee the same payment rate. Now, many states are changing their private payer laws to require the same reimbursement for virtual and in-person care.
State governments also decide who is licensed to deliver care within state borders, and during the pandemic, many states adopted licensure compacts allowing medical professionals to practice virtually across state lines. However, there were signs of a return to pre-COVID licensure rules last year, with most states having ended their state of public health emergency in 2022.
Alongside licensure flexibilities, states revised Medicaid policies to expand the list of providers who could be reimbursed for providing services via telehealth, including physical therapists and occupational therapists. Medicaid programs have also begun to pay for care delivered at home with the use of virtual care technologies. Audio-only telehealth also experienced a significant boost from state policy changes, with the Medicaid programs of 34 states and the District of Columbia now reimbursing for audio-only telehealth services.
State Telehealth Policy in 2023
With many of these changes tied to states’ public health emergency declarations, states must decide what telehealth policy will look like moving forward. Policies around cross-state licensure have been allowed to expire in certain states, suggesting a pullback from pandemic-era flexibilities. However, policies like payment parity will likely see continued support at the state level. Audio-only telehealth also appears to be on solid ground, particularly with ongoing broadband and internet connectivity issues that prevent people, especially those living in rural areas, from accessing video-based care.
But one area where the future remains uncertain is the virtual prescribing of controlled substances. The DEA has jurisdiction over these prescribing rules, and the agency recently proposed regulations limiting the virtual prescription of certain controlled substances without an in-person evaluation. Telehealth proponents have decried the DEA’s proposed rules, stating that they are “significantly more restrictive than is warranted.”
The prescription of abortion drugs via telehealth is also in flux. Providers offering abortion care have increasingly turned to telehealth to ensure access following the overturning of Roe v Wade last year. And while some states supported this move, others sought to block access, attempting to ban telehealth use in abortion care or limit the use of the drugs themselves.