State Actions Advancing Telehealth During Pandemic

By Sean Slone, CSG senior policy analyst

As we reported recently, actions taken by the federal government since the outbreak of the coronavirus have helped to expand access to telehealth services around the country at a critical time. But states too have have done their part to make virtual care available during the pandemic, especially in the wake of the move by the Center for Medicare and Medicaid Services to allow clinicians to provide telehealth services for Medicare beneficiares and to encourage states to relax licensing laws on out-of-state providers.

Florida and Kansas were among the states that took action early to allow out-of-state providers to provide telehealth services. Maine Gov. Janet Mills issued an executive order to allow out-of-state providers to receive a free emergency license to provide services to Maine residents.

Utah Gov. Gary Herbert’s March 26 executive order relaxed privacy and security standards under state law to allow providers to implement new telehealth and videoconferencing programs.

Arizona Gov. Doug Ducey mandated that all state health insurers cover telehealth services. New Jersey’s banking and insurance department ordered all insurers, HMOs, health service corporations and health benefits plans to reimburse providers for telehealth vistis during the pandemic.

Oregon’s health department established a new rule to expand the use of telehealth for Medicaid recipients, covering both inpatient and outpatient services for new and established patients.

Licensure Requirements

The extraordinary circumstances presented by the pandemic prompted states to mobilize quickly to make sure they could tap provider resources.

The Federation of State Medical Boards reports that all 50 states, the District of Columbia and four U.S. territories have now modified licensure requirements for physicians in response to COVID-19.

By late March the number of states that had passed emergency legislation on license portability had already exceeded the number that had signed up for the Interstate Medical Licensure Compact, which was launched in 2017 to facilitate an easier process for acquiring licenses to practice in multiple states, mHealth Intelligence reported.

In Delaware, a joint order of the state department of health and social services and the Delaware Emergency Management Agency issued March 24 outlined the state’s “all hands on deck” approach. It authorized out of state providers of many different stripes with an active license or certification in good standing in any U.S. jurisdiction to provide healthcare services. It authorized the same for those with now inactive, expired or lapsed licenses who were previously in good standing. The order also contained special provisions for nursing students to conduct medical examinations and tests. In addition, it authorized all out of state mental health providers with an active license in good standing to provide both in-person and telemedicine mental health services in the state.

A few state efforts haven’t gone according to plan. In Mississippi, for example, the state Board of Medical Licensure issued a notice March 14 allowing out-of-state physicians to utilize telemedicine when treating patients in the state without the necessity of securing a license to practice medicine there as long as the physician is licensed elsewhere and isn’t under investigation. When the state was overwhelmed with applications from out-of-state providers, the board later revised its guidelines to limit out-of-state physicians to using telehealth to treat residents with whom they’ve already established a doctor-patient relationship and allowing only in-state physicians to use telehealth to treat new patients, mHealthIntelligence reported.

Insurance Coverage a Key for Unlocking Telehealth in States

Illinois Gov. J.B. Pritzker’s March 19 executive order required health insurance companies and Medicaid to cover services by in-network providers via telephone or video technology at the same rate as in-person visits.

Some Illinois providers, who suggested they had wanted to provide telehealth services to their patients for a long time, said what had held them back was that insurance companies wouldn’t reimburse for such services. It took the current crisis to make it all possible in the state, The Belleville News-Democrat reported recently.

Pritzker has also recently launched other elements of a statewide telehealth program, including a remote patient-monitoring program and a mental health support line. Through the Peoria-based OSF Health Care and Springfield-based Southern Illinois University, health workers are using telehealth technology to connect with state residents who are experiencing COVID-19 symptoms and need to stay quarantined. The Illinois Department of Human Services’ mental health division is running a free emotional support line that residents experiencing stress and mental health issues related to COVID-19 can send a text to and receive a call from a mental health counselor within 24 hours.  

Broadband Paving the Way for Telehealth

Its benefits to the accessibility of telehealth may be a longer-term prospect but some states have used the urgency presented by the pandemic to make the case for investment in the technology backbone that makes it possible. While also important during the pandemic for supporting such activities as telework, remote learning and streaming endless hours of Netflix, broadband internet is key to increasing telehealth’s accessibility nationwide.

Even prior to the pandemic, many states were working on various initiatives to expand broadband’s infrastructure and reach. The Pew Charitable Trusts have been tracking those efforts with a state broadband policy explorer. A couple of the most recent states where policymakers have sought to push forward with broadband investment include:

  • Alabama: Senate President Pro Tem Del Marsh has proposed spending $800 million of the estimated $1.7 billion in federal dollars given to the state as part of COVID-19 relief efforts to push broadband expansion throughout the state, The Montgomery Advertiser reported. A March report found that the state ranked 38th for broadband coverage and speed.
  • Maine: During the state’s congressional primary, now moved to mid-July, voters will be asked to consider a $15 million bond issue to invest in high speed internet infrastructure for unserved and underserved areas and match up to $30 million in federal, private, local or other funds, according to the Portland Press Herald.

Challenges Remain

While state efforts have helped to advance telehealth during a critical time when Americans are being advised to stay at home, challenges remain. Providers and patients have experienced barriers with reimbursement and insurance. Some are concerned that with increased telehealth usage may come more fraud. And others worry that the digital divide and other factors could leave underserved rural communities behind and widen health disparities. In the weeks ahead, we’ll examine these challenges as well as some of the most promising ways telehealth is being deployed around the country during the pandemic.

Telehealth policy is one of the topics being studied by the What’s Next? Leveraging Innovation Subcommittee, part of CSG’s Healthy States National Task Force, which is made up of state policymakers from around the country. The task force will issue a final report and national framework in December.