Following the decision of the HHS’ Centers for Medicaid and Medicare Services (CMS) to expand access to telehealth services and increase coverage in response to the COVID-19 pandemic, states introduced temporary emergency waivers to their telehealth laws. Healthcare providers and patients have welcomed the changes to telehealth policies, which improved access to telehealth services to help control the spread of the virus, SARS-CoV-2. There have been increasing calls for the changes to be made permanent, and several states such as Massachusetts, Colorado, and Idaho have taken steps to ensure the changes continue after the COVID-19 public health emergency is declared over.

On March 16, 2020, the Massachusetts Board of Registration in Medicine (BORIM) approved a new policy that states the same standard of care applies to in-person and telehealth visits and a face-to-face encounter is not a pre-requisite for a telehealth visit. The policy was introduced on a temporary basis in response to COVID-19, but on June 26, 2020, BORIM made the policy change permanent. This is the first telehealth-specific policy to be adopted by BORIM and Massachusetts was one of the first states to make temporary COVID-19 telehealth policies permanent.

There have been increasing calls at the Federal level for the expansion of access to telehealth services to be made permanent and for there to be continued reimbursement parity for in-person and virtual visits when the COVID-19 nationwide public health emergency is declared over.

CMS Administrator Seema Verma has expressed support for the expansion of telehealth access to continue and, at a recent meeting of the Senate Committee on Health, Education, Labor & Pensions (HELP), the 30+ temporary changes to Federal telehealth policies were discussed and Congress was urged to make several of the changes permanent. There is a commonly held view that telehealth can improve patient outcomes, help providers deliver a better patient experience, and that telehealth will help to reduce the cost of healthcare provision.

Two Federal policy changes that have attracted considerable support are the relaxation of the Medicare originating site requirement to allow physicians to provide telehealth services to all patients, no matter where they are located, and expansion of the number of telehealth services covered under Medicare.

These and other policies changes have received support at the state level. Several other states have now taken steps to improve telehealth access. Colorado Governor, Jared Polis, signed a bill this week that prohibits health insurance companies from requiring a patient to have a pre-established relationship with a virtual care provider. The law, which applies to Medicaid and state-regulated health plans, also prohibits insurers from imposing additional location, certification, or licensure requirements on providers as a condition for telehealth reimbursement and the restrictions on the technology that can be used to provide telehealth services have also been removed. Audio or video communication solutions only need to be compliant with the HIPAA Security Rule.

Idaho Governor Brad Little has similarly taken steps to make the COVID-19 changes to telehealth laws permanent, including the state’s temporary telehealth rule waivers that increased the medications that could be prescribed in telehealth visits, the broadening of the technology that can be used for providing telehealth services, and the change that allows out-of-state providers to treat patients virtually.

“Our loosening of healthcare rules since March helped to increase the use of telehealth services, made licensing easier, and strengthened the capacity of our healthcare workforce – all necessary to help our citizens during the global pandemic,” said Gov. Little. “We proved we could do it without compromising safety. Now it’s time to make those healthcare advances permanent moving forward.”

All states expanded access to telehealth services for Medicaid beneficiaries following the announcement by the CMS about the expansion of access to telehealth and increased coverage. Many more states are now expected to make the emergency changes permanent.  However, health insurers must also make changes and confirm that they will continue to reimburse physicians for virtual visits at the same rate as in-person visits, otherwise it is likely that telehealth will be dropped in favor of in-person visits.

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