Telemedicine Industry Trends and Regulations

“Telehealth Trends” focuses on state legislative and regulatory developments that impact healthcare providers, telehealth and digital health companies, pharmacists and technology companies involved in delivering and facilitating virtual care.

Past week trends:

• Interstate Compact
• Refund Requirements
• Professional Standards

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Final legislation and rulemaking:

• in ColoradoThe Governor signed SB 24-168, requiring the state to reimburse the cost of remote monitoring of outpatient services for certain Medicaid enrollees. The bill also creates a grant program to provide grants to rural outpatient health care facilities to assist with the costs of providing telehealth remote monitoring and accounts for the costs of launching these programs. These parameters will become effective on July 1, 2025. The bill also requires the state to cover the cost of continuous glucose monitors for Medicaid enrollees.
• Florida Enacted HB 855, which deals with teledentistry, to specifically require that telehealth dental treatment be accompanied by a disclaimer stating that an in-person consultation is recommended prior to telehealth treatment. The bill would take effect on July 1, 2024.
• Mississippi We have finalized a rule removing the restriction on telehealth visits with evaluation and management codes Level IV or V for the purposes of receiving reimbursement through state Medicaid programs.
• Tennessee Enacted several telehealth-related bills.
  • HB 2857: In the area of ​​general health insurance law, this bill revises the definition of “provider-based telehealth” in Tennessee Code § 56-7-1003 to remove the requirement that a patient-provider relationship must already be established through an in-person visit within 16 months of the telehealth visit. An in-person visit is still required, but it does not have to be within the 16-month lookback period. This bill took effect on May 28, 2024.
  • HB 2318: This bill would allow a physician assistant who practices exclusively through telehealth to allow any required review of the physician assistant’s chart by a collaborating physician and any required remote site visits by the collaborating physician to be completed by HIPAA-compliant electronic means rather than on-site at the clinic. This bill would remove telehealth as an option. This bill took effect on May 28, 2024.
  • HB 2147: Requires the Tennessee Medicaid program (TennCare) to cover complex rehabilitation visits conducted via telehealth, effective July 1, 2024.
  • HB 2808: Requires that health care services provided to Tennessee inmates for human immunodeficiency virus (HIV) treatment can be provided via telehealth upon request, and that treatment be paid for through various state programs, including TennCare. The bill would take effect on July 1, 2024.
• Vermont Through H 861, we enacted legislation requiring parity in health care services provided through telehealth. This legislation applies broadly to health insurance plans. This bill will take effect on January 1, 2025.
• Several states have enacted treaty-related laws.
  • Colorado Signed HB 24-1002, which establishes the Social Work Licensure Compact.
  • Connecticut Enacted HB 5058, joining the Nurse Licensure Compact.
  • New Hampshire Enacted SB 318, social work licensure compact.
  • Ohio Enacted SB 90 and joined the social work licensure compact.
  • Vermont Enacted H 247, adopting the Occupational Therapist Licensure Agreement.
  • Tennessee Enacted HB 2405, which establishes the Social Services Licensing Agreement.
  • Tennessee The state also enacted HB1863, which established the Dietitian Licensure Compact, making the state the third to do so.

Proposed Legislative and Rulemaking Activities:

highlight:

• in Washington DCThe Mayor signed Bill B 25-0545, which includes a new section on “telehealth” in the General Medical Professions Act, clarifying that doctor-patient relationships can be established through telehealth, including synchronous and asynchronous technologies. It is currently undergoing council review and, if approved, will come into effect on June 28, 2024.
• LouisianaHB 896 passed the Louisiana Second House last week. The bill creates details regarding remote patient monitoring programs and coverage under the Louisiana Medicaid program. The bill now goes to the Governor for his signature.
• Louisiana The state also sent HB 888 to the governor for his signature after it passed the Senate, which would have the state join the Social Worker Licensure Compact.
• Montana We proposed a rule to align the standard of care for home health services with current federal guidelines at 42 CFR 440.70, which would allow in-person visits to be conducted via telehealth. Previously, telehealth was not discussed in this rule. A public hearing will be held on June 13, 2024, and comments are due by June 21, 2024.
• of new york The Legislature passed A6799B, which establishes a drug-induced movement disorder screening education program and specifically includes services provided through telehealth.

Why is this important:

• Interstate compacts continue to expand, with smaller compacts expected to expand in 2024We are seeing states continue to aggressively adopt interstate compacts. During the week of May 28-June 3, seven new bills were enacted to enroll states in various compacts, demonstrating that states are seeing value in compacts that can help solve the healthcare worker shortage. The social work licensure compact alone has seen four new states enact legislation in the past two months, and the dietitian compact now has three states fully adopted, with legislation pending in Ohio. While these compacts may not yet be as widely adopted as the nurse and physician compacts, they are expanding rapidly.
• States continue to revise their telehealth reimbursement requirements at both the Medicaid level and in their generally applicable health insurance laws. This month, Colorado, Tennessee, Mississippi, and Vermont finalized or enacted changes to how they reimburse telehealth services. These states are seeking clearer reimbursement guidelines, particularly reimbursement parity for services delivered via telehealth. These changes are typically made in statutes specific to the type of service. For example, Tennessee has new reimbursement requirements in the state’s Medicaid program for complex rehabilitation care delivered via telehealth under HB 2147. However, states are taking more extensive steps to address telehealth reimbursement. Vermont’s H 861 mandates that telehealth be reimbursed at the same rate as in-person care, broadly amending statutes related to health insurance plans. Another interesting development this week is Colorado’s SB 24-168, which includes a grant program in addition to reimbursement requirements for outpatient remote monitoring. States have been consistently addressing telehealth reimbursement since the pandemic began, and based on activity this week, we expect requirements and standards to continue to evolve.
• Standards of practice for care delivered through telehealth are being streamlined. States continue to make changes to align telehealth standards across various areas of practice. This is exemplified by Montana’s proposed rule to align home health services standards with federal guidelines 42 CFR 440.70, which, if adopted, would allow the use of telehealth services. Louisiana also saw major program-level changes this week, with HB 896 being sent to the Governor for signature, creating standards for remote patient monitoring and reimbursement requirements surrounding the program. Additionally, this week provided both large, across-the-board changes to standards of practice (as seen in Louisiana and Washington DC) and smaller physician-specific or specialty changes (as seen in Montana and Tennessee). This comparison highlights the importance of staying on top of changes made at the general provider level, reimbursement requirements, and specific provider type level to ensure all revised standards of practice are considered when providing telehealth services.