As the first quarter of the year begins to wind down, now is a good time to check in on the state telehealth legislation that has been introduced thus far in 2023. For those who may not know, in addition to CCHP’s Policy Finder where we track existing state telehealth laws, regulations, and Medicaid policies, we also track pending legislation and regulations for the 50 states, the District of Columbia and Puerto Rico. Bills are still being introduced in some states, so this is by no means definitive as to what the state legislative landscape will look like for the full year, however we are able to get a sense of what policy issues appear to be rising to the top in 2023.
Licensure, Always on Our Minds
Along with licensure, reimbursement and coverage of telehealth delivered services have been common policy areas addressed by state legislation in the last few years and 2023 is no different. With licensure what’s often seen is the introduction of bills to join a licensure compact. This year, legislation to join the Counselor Licensure Compact and the Social Worker Compact have made appearances in several states. For example, Arkansas’ HB 1181 and IL’s SB 2123 are both pieces of legislation to join the Counselor Licensure Compact, and Kentucky’s HB 405 and Missouri’s HB 1399 are related to joining the Social Work Licensure Compact. As two of the more recent compacts, the Counselor Compact only became active last year after securing the minimum number of states joining as members, it’s not so surprising that more legislation this year focuses on these newer compacts rather than more established ones, such as the Medical Licensure or Nurses Compacts, since the majority of states with an interest in Licensure Compacts already enacted legislation joining those established compacts in previous years.
Unlike some previous licensure compacts, both the Counselor and Social Worker compacts operate on a one-license, able to practice in multiple states concept rather than what is seen in the Interstate Medical Licensure Compact which offers an expedited process to obtain a license in a compact member state. Some have voiced the opinion that a one-license to practice in many states approach offers a more efficient process that still addresses concerns expressed when a practitioner isn’t located within a state’s borders. In contrast, there has also been discussions among some advocates on whether compacts are the best approach to addressing interstate telehealth and the licensure issue. In fact, we’ve seen this question raised by policymakers as evidenced by Massachusetts H 2272 which creates a task force to examine interstate medical licensure compacts and licensure reciprocity.
Who Needs Dr. Doolittle When You Have Telehealth?
Interestingly, this year’s slate of state telehealth bills includes higher than average pieces of legislation that focus on allowing veterinarians to use telehealth. While not something completely new, South Carolina has had something in statute/regulations for years, it it is a little unusual to see more than one bill introduced in a year. States that currently have telehealth and veterinarian related bills include Arkansas SB 5, Arizona SB 1053, Florida SB 554, and Illinois SB 2059. Bucking the trend, New Jersey’s S 2464, makes it clear when talking about a telehealth health care provider, veterinarians are not included in the definition.
It probably isn’t surprising to many of our readers that telehealth would be a tool that veterinarians would also want to utilize to serve their patients. During the pandemic, veterinarians ran into the issue of trying to still provide services while minimizing contact. Telehealth was a natural solution the profession turned to in order to fill this need. However, at the time there was a lack of policy surrounding the use of telehealth in veterinarian medicine. We are now seeing some states address that gap.
Additionally, as with health care providers for humans, there is also a shortage of veterinarians to take care of animals (“The Great Veterinary Shortage” by Sarah Zhang for The Atlantic) and, it’s not just domestic pets that need medical care, but farm animals as well. According to the US Department of Agriculture, 500 counties across 46 states have critical shortages of rural veterinarians which leads to concerns about the impact the nation’s food chain if not soon addressed. As with human health care, while telehealth may not be a solution to all of the issues faced, for veterinary care, it may help alleviate some of the issues.
The Devil in the Details
For the past few years, CCHP has noticed there has been legislation (or in some cases administrative actions such as regulations or guidance documents) that have addressed documentation of a telehealth visit or other very specific issues. While documentation requirements used to be very general, simply specifying the same documentation standards apply to telemedicine as they do to in-person services, new documentation requirements have been more detailed and specific in their nature. For example, bills on specific requirements on how consent is documented, such as Vermont’s H 406, or certain types of information that need to be relayed to patients, such as Florida’s SB 356, have been introduced. This year, CCHP has also noticed several bills which state that Medicaid and/or health plans cannot stipulate providers maintain an in-state physical address, such as Indiana HB 1352 and Tennessee HB 895/SB 680. This is significant for out-of-state providers who may have an in-state professional license to practice in those states, but may be restricted from receiving Medicaid reimbursement because they do not hold a physical office in the state (and do not want to incur the cost to acquire one). These bills would remove that barrier for out-of-state providers in that situation.
This is just one example of pre-existing policies providers may face which could limit their ability to provide telehealth services particularly as we move out of a pandemic environment where some rules had been relaxed.
In Summary
Overall, we are beginning to see states refine their telehealth related policies and address more specific issues. It’s another indication that the telehealth policy landscape remains in flux and will continue to change over not only the next year, but likely the next few years. Additionally, given the specificity of just some of the policies highlighted above, it’s also likely that the telehealth policy landscape will continue to be quite complicated.