Telehealth: In It For the Long-Haul
Telehealth (also referred to as telemedicine) is not a new phenomenon; in fact, it dates back to 1879 when physicians used telephone consults to reduce unnecessary office visits.[1] Telehealth makes complete sense as it is less expensive to provide and greatly expands access to both primary and highly specialized care. Nevertheless, state and federal governments have historically imposed stringent regulations on telehealth that have curtailed wide-spread adoption.
Pre-COVID-19, some states moved toward loosening telehealth restrictions. Many states, including Florida, allow out-of-state providers to perform telehealth services to patients located within their state.[2] Additionally, many states have joined telehealth licensure compacts, which allows certain practitioners to perform telehealth across state lines.[3] Moreover, certain states require parity in insurance reimbursement for services performed via telehealth and those same services performed in-person.[4] While there has been a trend toward telehealth deregulation, it has been slow and varies greatly by state.
COVID-19, however, forced this country’s hand to make telehealth services more accessible.
The Centers for Medicare and Medicaid (“CMS”) authorized various telehealth waivers under the CARES Act that expanded reimbursement opportunities to providers and allowed Medicare beneficiaries to receive telehealth services from the comfort of their own home. Amongst other things, these waivers expand the types of healthcare practitioners eligible for telehealth reimbursement, allow hospitals to bill originating-site facility fees for hospital based-practitioner services, and add a telehealth add-on payment to opioid treatment plan bundled payments.[5]
Additionally, the Federal Communications Commission (“FCC”) provided a total of $802.74 million to the Rural Health Care Program, which provides funding to rural providers to purchase broadband and telecommunications services to create and maintain telehealth programs.[6] To increase access to care, the DEA has allowed opioid addicts to use telehealth to obtain prescriptions for medication assistance therapy to reduce withdrawal symptoms.[7] Furthermore, governors and health departments throughout the country have released emergency orders loosening their state’s telehealth regulations, making telehealth more accessible and mandating insurance
[1] Board on Health Care Services; Institute of Medicine. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. Washington (DC): National Academies Press (US); 2012 Nov. 3, The Evolution of Telehealth: Where Have we Been and Where Are We Going? Available from: https://www.ncbi.nlm.nih.gov/books/NBK201741/
[2] Florida Statute § 456.47.
[3] Interstate Medical Licensure Compact, available at https://www.imlcc.org/a-faster-pathway-to-physician-licensure/; Psychology Interjurisdictional Compact (PSYPACT), available at https://www.asppb.net/page/PSYPACT; Enhanced Njurse Licensure Compact (eNLC), available at https://www.ncsbn.org/11945.htm.
[4] A few states that require parity are Georgia (GA Annotated Sec. 33-24-56-4); Hawaii (HI Revised Statutes § 431:10A-116.3(c)); Minnesota (MN Statute Sec. 62A.672(b)(3)); and New Mexico (NM Statutes Annotated Sec. 24-1G-3).
[5] CMS COVID-19 Accomplishments, available at https://www.cms.gov/files/document/covid-accomplishments.pdf
[6] FCC Announces Funding Increase in Rural Health Care Program for Funding Year 2020, FCC, available at https://docs.fcc.gov/public/attachments/DOC-365250A1.pdf
[7] DEA Information on Telemedicine, available at https://www.samhsa.gov/sites/default/files/programs_campaigns/medication_assisted/dea-information-telemedicine.pdf