A report from the Commonwealth Fund recently analyzed the varying telehealth regulations and policies present in different US states, taking into account the unique experiences that each state had during the early stages of the pandemic.
At the start of the COVID-19 pandemic, lockdowns across the country caused an increase in the restrictions of in-person care services. Consequently, providers turned to virtual care in order to continue patient care while protecting everyone from the novel coronavirus. However, now that the number and severity of COVID-19 cases have started to decrease, stakeholders have questioned the regulatory flexibilities that were put in place for virtual care. Numerous requests have been made for telehealth waiver extensions, and a year-end package has been proposed containing two-year extensions for Medicare beneficiaries. The bill, which has yet to pass through Congress, would eliminate geographic restrictions, allowing Medicare patients to receive care from any location, and would also authorize federally qualified health centers and rural health centers to use telehealth.
Since March 2021, state legislation regarding telehealth has become increasingly varied. According to the Commonwealth Fund report, at least 20 states have changed their policies to allow or mandate coverage for telephone-only telehealth visits. This is likely due to the need to connect with the 42 million people who do not have broadband access as well as those who lack devices for video visits and those who are not familiar with video technology. Furthermore, the report detailed the significant impact telehealth has had on access to behavioral health services, as 40 percent of behavioral health visits during the pandemic occurred through telehealth. This dominance of telehealth in the specialty led to action from states such as Nebraska and Arizona, who created laws that made an exception for behavioral health services when restricting telephone visits.
In order to ensure patient access to providers and health equity considerations, many states, such as Illinois and Oregon, have established legislation that forbids insurers from requiring patients to use telehealth if they prefer in-person visits. Furthermore, Oregon has enhanced this legislation by requiring insurers to assist those with disabilities, age, or language barriers in accessing telehealth. Additionally, states are beginning to pay closer attention to how telehealth affects the healthcare system, mandating data reporting to better understand its effects on services, cost, and utilization. This data will then be used by states to optimize telehealth availability and use.