COVID-19 and Telehealth Regulations in the States

Changes in telehealth policy brought about by the COVID-19 pandemic are moving nearly as quickly as the pandemic itself. The declaration of a national emergency in March, the aggressive Congressional response to the crisis, and the spread of social distancing recommendations have paved the way for an unprecedented expansion of telehealth across the United States in just a few short weeks.

Even as healthcare providers scramble to implement new federal guidelines including broader access to telehealth for Medicare beneficiaries, they also find themselves navigating a patchwork of new telehealth measures at the state level. Mirroring the federal response, all 50 states and the District of Columbia have declared state or public health emergencies, and more than 30 have broadened access to telehealth in order to mobilize more physicians and create new pathways to care for people under quarantine.

The executive orders and other state-level regulatory changes affecting telehealth fall into three broad categories: license reciprocity and waivers for out-of-state providers, temporary emergency licensing (also for out-of-state providers), and expanded telehealth access and reimbursement.

License reciprocity and waivers. Under normal circumstances, physicians and certain other healthcare professionals must be licensed in any state where they see patients, virtually or in person. In response to the acute demand for healthcare providers and remote care caused by COVID-19, as many as 10 states (including New York and Iowa) have temporarily waived in-state licensing requirements for healthcare professionals who hold a valid out-of-state medical license, in order to remove barriers to emergency care and open the doors to telehealth providers in particular.

Expedited emergency licensing. A much larger group of states (see chart below) have responded to the demand for out-of-state providers and telehealth services by granting temporary emergency licenses, rather than broad waivers or reciprocity. While the ability of telehealth providers to practice across state lines is much the same in both cases, these states tend to require a formal — though typically expedited — registration or application process.

Expanded telehealth coverage. The temporary licensing changes outlined above are usually found in combination with one or more telehealth-specific measures. Echoing the federal changes to Medicare, all but a handful of states have eased at least some restrictions on telehealth to accommodate the need for social distancing and to relieve overburdened brick-and-mortar healthcare facilities. Common measures include:

• Establishing reimbursement parity for telehealth and in-person services, for Medicaid and/or private payers (as the federal government has mandated for Medicare)
• Waiving co-pays, deductibles, or coinsurance for in-network COVID-19-related telehealth services for all payers
• Removing location restrictions to allow patients to access telehealth from their home (rather than a rural health clinic, for instance)
• Waiving an established provider-patient relationship as a precondition for telehealth reimbursement (again, as with Medicare)

Even within these broad categories, regulations vary considerably from state to state. States offering temporary emergency licenses tend to have different application forms and processes. Some grant licenses for the duration of the public health emergency, while others cap the license at 30 or 60 days. And telehealth reimbursement policies for private payers and Medicaid are all over the map.

The state regulatory landscape for telehealth is likely to evolve further as the COVID-19 crisis unfolds. In the past week the U.S. Secretary of Health and Human Services and the National Governors Association have both urged states to relax restrictions on telehealth and out-of-state providers, and the $2 trillion stimulus package signed into law on March 27 contains several sections and appropriations provisions that are likely to trickle down to the states.

In the meantime, simply staying informed of all the state-level changes can be a challenge for telehealth providers. The Alliance for Connected Care, the Federation of State Medical Boards, and the National Conference of State Legislatures are all tracking these changes closely, and we’ll be updating this post and the chart below with new information.

Telehealth-Related Regulatory Changes by State Under COVID-19

Note: Last updated on April 8, 2020. State regulations are changing quickly, and the best source of current information is generally the state health organizations and/or licensing boards in each state (see list above).