The COVID-19 pandemic prompted emergency waivers of federal rules guiding virtual health services, as well as with most states. But it’s unclear what happens next — and for providers, the uncertainty represents risk.
Before COVID-19, only 15% of physicians in the U.S. worked in practices offering telephone or video consultations;1 interstate licensing prohibitions and disparity in payments between virtual health and in-person services kept uptake limited. But due to the pandemic and waivers being lifted, virtual care is ubiquitous, with 75% of practitioners saying it comprises 40% of their business.2
Federal waivers on telehealth restrictions are expiring, and states are going their own way in regulating telehealth. It’s created a situation in which providers need to be aware of their state’s changing regulatory and legislative environment.
For instance, Florida’s emergency waivers lapsed in June, resulting in a patchwork of conditions altering how virtual care is delivered in that state. Similar lapses in Arizona and Alaska changed the conditions of virtual care, affecting providers located in-state but also providers elsewhere who had been seeing patients virtually.3
Compounding the difficulties for providers is the added risks that have arisen from the legislative state of flux, and the potential impact on insurance.
Looking to D.C. and beyond
Federal policymakers have introduced, debated and reintroduced various bills related to virtual care. One of the most recent and most promising is the Protecting Rural Telehealth Access Act, which seeks to address the healthcare challenges rural states face.4 Most (63%) shortages of primary care health professionals are in rural geographies,5 many of which have limited broadband access.
The bill’s features include permanent waivers of geographic licensing restrictions; giving critical access hospitals allowance to directly bill for telehealth services; and allow payment parity for audio-only services.
At the state level, more than 21 states now require insurance coverage of audio-only (telephone) visits.6 This expansion (only three states required coverage pre-pandemic) is notable, given the value of telephone visits to patients without access to broadband and for patients who are unable to use audio-visual technology.
There are differences and exceptions everywhere. Arizona and Nebraska, for example, allow audio-only services, but only for individual behavioral health or crisis management and intervention for established patients. Connecticut’s governor extended its waivers by two years; in the interim, the state must develop a telehealth policy. And Idaho’s governor made the state’s emergency telehealth waivers permanent by executive order.
The patchwork of approaches can be confusing to even the most sophisticated provider. Not only must they ascertain if their telehealth policies are adequate, but if they are inadvertently illegal.
Compliance has become incredibly complex in this environment. Providers should consult with their broker to review policy details and ensure they’re in compliance with state and federal laws.
HUB International is ready to help your organization respond to the opportunities and risks in telehealth.
1 Modern Healthcare, “Low adoption of telemedicine may spur patient migration away from traditional providers,” March 23, 2019.
2 Open Minds, “How To Succeed With Post-Pandemic Telehealth: Ten Items For Your Checklist,” February 16, 2021.
3 Mhealth Intelligence, “As State Emergencies End, Providers Look for New Telehealth Limits,” June 29, 2021.
4 Healthcare IT News, “Senators introduce bipartisan bill aimed at safeguarding rural telehealth access,” June 15, 2021.
5 Rural Health Information Hub, “Healthcare Access in Rural Communities,” accessed July 20, 2021.
6 The Commonwealth Fund, “States’ Actions to Expand Telemedicine Access During COVID-19 and Future Policy Considerations,” June 23, 2021.