The Center for Connected Health Policy (CCHP) released current Telehealth Policy updates that break down the most common areas of focus right now. These updates include licensing laws, prescribing requirements, reimbursement policies and the best resources to track each. Although we have summarized some of these important updates from CCHP for your reference below, be sure to visit CCHP’s website for the latest information and resources on Telehealth Policy.
Telehealth policy has always varied by state, and during the PHE it is often unclear what is still currently allowed and what will continue to be allowed via telehealth moving forward.
As indicated in a letter from the Secretary of Health and Human Services, the PHE will likely remain in place for the entirety of 2021 and states should be given 60 days’ notice prior to termination. During the course of the federal PHE most telehealth flexibilities should remain active. As bills and expansions are still in place, permanent telehealth policy is still unknown. State level telehealth policies are changing rapidly as state PHEs end and legislatures continue to pass new telehealth laws.
According to the National Academy on State Health Policy (NASHP) about half of the states have let their emergency orders expire. Inconsistencies among state policy is still evident, creating more confusion about what applies to providers in each state. To better understand what state specific temporary pandemic policies are still in place for your state, please go to CCHP’s COVID-19 tracking webpage.
Medicaid agencies are winding down many temporary telehealth coverage expansions. Nineteen states now permanently allow for some type of telephone reimbursement. While some states are no longer allowing out-of-state providers to deliver services via telehealth, other states have made permanent out-of-state provider allowances. Given the variance in licensure requirements among states, licensing has become one of the biggest areas of policy confusion.
Providers must adhere to the laws and regulations of the state the patient is physically located in, which means having a license, participating in a Compact or falling under a licensing exception. There are still some active licensing waivers in different states, but many have expired. Check out the cross-state licensing policies for the latest state specific information.
CCHP also recommends double-checking with the state licensing boards both in the state the provider is located and the state the patient is located, to ensure they don’t have any specific rules or laws we may not be aware of, or any unique interpretations of those laws.
CCHP tracks Medicare, Medicaid and private payer reimbursement requirements related to telehealth through our policy finder. It is recommended to check with individual payers to ensure their process and requirements for receiving reimbursement is understood.
Prescribing laws are also changing and are a big factor when it comes to practicing via telehealth across state lines. Some states may explicitly require an in-person visit prior to all prescribing. Federal law, requires an in-person exam prior to the prescribing of controlled substances. Several exceptions currently exist due to the PHE. Please visit CCHP’s online prescribing page to find more specific state policies.
Medicare & Medicaid Reimbursement
Many state Medicaid agencies are monitoring Medicare as they contemplate long-term state telehealth coverage policies. CCHP is tracking many federal bills that would expand telehealth under Medicare, such as the CONNECT Act and the Expanded Telehealth Access Act, and many more that can be found in CCHP’s federal legislative tracker.
As telehealth is becoming a more common modality to deliver care, some boards have started to develop ‘practice standards’ for their licensees to abide by while utilizing telehealth modalities. In many cases these include requirements around forming the physician-patient relationship, prescribing and obtaining consent. A subset of states and/or professions are now even requiring that providers receive a telehealth-specific training course or certification in order to practice telehealth in the state or complete some type of extra registration. While this is not yet widespread, it holds potential for growth as states often copy policies from other states. CCHP tracks board practice standards through its telehealth policy tracker.
Summary & Resources
Additional resources to assist in understanding current and potential federal telehealth policy are provided below:
- CCHP Federal Laws and Policies
- CCHP Billing information consistent with current Medicare Physician Fee Schedule
- CCHP’s Medicare telehealth billing guide
- CMS 2022 Proposed Physician Fee Schedule
- CCHP 2022 Proposed Physician Fee Schedule Video & Fact Sheet
- HHS Telehealth Information
- CMS Medicare Telehealth Codes
- DEA Prescribing Guidance
- Telehealth Specific Waivers
- General Licensing Exceptions
To directly keep up on telehealth policy and forthcoming changes, please utilize these additional CCHP resources: