A new report that analyzed each state’s current telehealth policy, rating each for both patient access as well as ease of providing telehealth, found that many states that have been hardest hit by the pandemic have the most restrictive telehealth laws.

Those states include New York, California, and Connecticut, which do not allow  interstate licensing compacts. Further, they have “coverage parity mandates that offer no flexibility between the insurer and provider,” the report found. Arizona, Florida, and Indiana were the only three states to allow all providers to practice telehealth across state lines.

Reason Foundation, Cicero Institute, and Pioneer Institute, which published the report, analyzed each state’s current telehealth policy, rating each for both patient access as well as ease of providing telehealth. The goal of the report is to provide a roadmap for policymakers moving forward to implement legislation that will increase access to quality healthcare for all.

During the peak of the pandemic in 2020, several states lifted some restrictions previously in place on medical care, such as requiring a patient to see a provider in person prior to utilizing telehealth or not allowing patients to work with providers out of state. However, as executive orders and temporary exemptions end, some requirements now again restrict telehealth services and provide additional obstacles not in place a year ago.

“Now those regulatory suspensions are starting to expire, and lawmakers in many states are looking to engage in permanent reform,” said Vittorio Nastasi, policy analyst at Reason Foundation in an email. “The report outlines best practices for telehealth policy to maximize patient choice and flexibility for providers.”

The report rates each state’s policy by eight criteria: no in-person requirement, modality neutral, no barriers to across state line telehealth, all providers can use telehealth, independent practice, no coverage mandate, no payment mandate, and compacts.

The report indicates no in-person requirement can prove beneficial in some cases. For instance, in rural areas where in person access proves challenging as well as for lower income patients who cannot afford multiple trips to the doctor, requiring in person visits can prove both an undue burden and superfluous if telehealth can sufficiently address the issue. According to the report, many states kept this no in-person requirement when restrictions were reinstated, with the exception of Tennessee.

In addition, the report advocates for modality neutral telehealth. Specifically, they rate states higher if the state’s policy allows for a variety of modalities to provide telehealth, including video appointments, remote patient monitoring technology, and store-and-forward options, such as forwarding photos of a skin issue to the provider.

The third criteria the report rated was states allowing providers to see patients across state lines. Of note, most states currently scored poorly in this category. The report advocates for removing such barriers for an array of reasons, from some areas not having a local specialist to wanting a second opinion.

Further, the report rated if states allow all providers in good standing to utilize telehealth for their patients. For instance, some only allow doctors to offer telehealth while others give access to nutritionists, endocrinologists, and others.

The fifth category, independent practice, rated states higher if they allow nurse practitioners to perform telehealth services without requiring a doctor to supervise. They state allowing nurses to practice in this way increases access to care for more patients since there is a shortage of doctors.

In addition, the report ranks states more favorably if they do not require all telehealth services to be covered by insurance. The report said some services cannot be rendered via telehealth as successfully as in person and in such cases the report recommends it not be covered.

The following category also relates to costs: no payment mandate. In short, this category rates states more favorably if they do not charge the same for telehealth versus in person sessions. The report advocates telehealth saves on overhead and should not carry the same “facilities” fee that in person appointments do.

Finally, the report rates states in the green, rather than red, if they allow providers to participate in compacts, which allow providers to serve patients in several states.

“Telehealth has the potential to provide convenient, affordable, and timely care to patients who have historically been underserved,” said Nastasi. “However, government-imposed obstacles could make it impossible for patients to access specialized care unless they can overcome the burden and expense of traveling to another state.”

New legislation moving forward will reveal what portions of the lifted restrictions states plan to continue to implement beyond the pandemic and ultimately define the scope of telehealth.

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