State Lawmakers Want to Retain Pandemic Telehealth Plans

States want to extend temporary relaxations of telehealth restrictions made on an emergency basis during the pandemic, legislators and experts said in interviews. Nearly every state is “trying to grapple with what just happened with COVID and telehealth,” said American Telemedicine Association Director-Public Policy Kyle Zebley, citing 550 telehealth bills in 49 states this year.

“The pandemic raised a lot of issues that we had thought about before, but [before], there was not any kind of emergency to get these types of bills through,” California Assemblymember Cecilia Aguiar-Curry (D) told us. Now that lawmakers “see the success in their communities, they’re all on board,” she said. The Assembly Appropriations Committee plans to consider Aguiar-Curry’s bill (AB-32) Thursday to keep temporary telehealth changes.

Emergency changes should stay because they were successful in increasing healthcare access, the lawmaker said. Telehealth “is not meant to take over an in-person visit with a doctor” but can be more convenient and efficient, she said. Aguiar-Curry’s broadband bill (AB-14) would expand who can use more bandwidth-intensive telehealth services, said the member, who backed Gov. Gavin Newsom (D) last week proposing $7 billion in middle-mile funding (see 2105140067).

“North Carolina law has not recognized the value and benefits of telehealth medicine including consultations and early diagnosis,” said House Health Chairman Donny Lambeth (R) in a statement. Lambeth's HB-149 would require private health plans to cover that. Lambeth noted the House passed the bill May 6: “We must work with the Senate to get this into law.”

States want to make it easier for healthcare providers to use telehealth virtual services, including removing restrictions on how and where the technology is used, expanding the modes and ensuring Medicaid and private insurance coverage and reimbursement, said Zebley. All states expanded telehealth to some degree in response to the coronavirus, and ATA sees “tremendous” bipartisan support in most state capitals, he said.

The crisis “pushed forward many policymakers’ thinking” and “comfort level” here, said Public Health Institute’s Center for Connected Health Policy Executive Director Mei Kwong. But she said she still listens to some hesitation in state and federal hearings, such as politicians asking about costs, fraud and if this is as good as in-person. Some states made emergency policies permanent, while many are mulling extensions, said Kwong.

North Carolina made huge strides on such policy when it greatly expanded state Medicaid support for telehealth in the pandemic’s early days, said Kwong. California implemented a strong telehealth policy before COVID-19 and is looking to extend additional temporary changes during the pandemic, she said. States could extend the policies for a year or two, Kwong said, noting Connecticut Gov. Ned Lamont (D) signing a bill this month that extended telehealth services for two years.

“Arkansas is a great example of a state that did a lot right” but had “a lot to catch up on,” said Zebley. Gov. Asa Hutchinson (R) signed a bill last month extending telehealth support beyond the pandemic (see 2104230016). Arizona enacted a law this month.

As with many states before the crises, New York’s telehealth “regulatory structure hadn’t kept up with technology,” Farrell Fritz’s Mark Ustin said. The state had restrictive scope of practice rules, and even in situations allowing telehealth, healthcare providers may not have been reimbursed, said the telemedicine lawyer: “It was technically authorized in some case, but the chance of getting paid for it was not perhaps what it should have been.”

COVID-19 flung the doors open since policymakers wanted to discourage face-to-face interaction, Ustin said. New York’s recently enacted budget kept a policy removing limitations on where the patient and provider can be, he said. The “next big hurdle” is addressing the question of bringing payment parity between telephonic and in-person visits, he said. A bill is moving on that, but Ustin thinks it’s more likely to pass in next year’s budget. Another lingering issue for telehealth access is digital equity, Ustin said. New York tried to address that by requiring ISPs to have a $15 monthly plan, he noted, though providers are now suing (see 2104300065).

“The pandemic demonstrated the value of telemedicine ... and now that’s been legitimized as such, it’s going to be hard for lawmakers to justify any rollbacks,” said Juniper Research’s Adam Wears. The analyst saw “mass adoption” across states, “driven by legislators and regulators not only loosening restrictions that had previously hindered deployment of these services, but promoting new business through ... expanding reimbursement structures," he said. Determining "whether telemedicine succeeds in the long-term will be whether these legislators and regulators make these changes permanent -- and we think they will."