Report: U.S. States Making Telehealth Progress, Though Key Barriers Still Remain

Nov. 11, 2019
The survey highlights some important telehealth milestones achieved this year

When it comes to support for telehealth, several states are continuing to make real progress, although numerous core barriers still stand in the way, according to a new report from national law firm Epstein Becker Green.

The comprehensive review found that federal and state lawmakers increasingly support coverage for mental health services provided via telemedicine, for instance. The survey of state telehealth laws, regulations, and policies within mental health, now in its fourth year, highlights the following milestones achieved in 2019:

  • All 50 states and the District of Columbia now provide some level of coverage for telehealth services for their Medicaid members
  • Earlier this year, Massachusetts approved coverage of telehealth services for its 1.9 million Medicaid members seeking access to psychologists, psychiatrists, psychoanalysts, clinical social workers, behavioral health nurses, nurse practitioners, and professional counselors
  • Kentucky adopted legislation that went into effect July 1, which allows telehealth visits to take place in a patient’s home, and home-based telemental health also has bipartisan support in Congress in the Mental Health Telemedicine Expansion Act (H.R. 1301), which was reintroduced earlier this year
  • Arizona expanded its telehealth law to include coverage of treatment services for substance-abuse disorders

To this end, Doximity, an online networking service for medical professionals, recently found in separate research that radiology and psychiatry were the top two specialties most interested in telemedicine opportunities. Mental health services via telemedicine are used in a variety of settings, including private practice, outpatient clinics, hospitals, schools, nursing homes, and correctional facilities.

“We are excited to see telehealth services more widely accepted at the state and federal level,” said Amy F. Lerman, a member of Epstein Becker Green in the Health Care and Life Sciences practice. “Telehealth is a viable and efficient method of care for patients who require quality treatment that may not be close by. It also gives providers an opportunity to share their services and expertise with underserved segments and geographies they couldn’t serve otherwise.”

At the same time, however, the report also revealed that while acceptance of telehealth services continues to grow, obstacles remain that limit participation of providers and patients. Some of these barriers include the following:

  • State parity laws remain loose and ineffective: Telehealth parity laws are intended to ensure the same coverage of services provided in person. Yet the laws themselves are often not very robust, simply stating that telehealth services must be medically necessary (in order to be covered) or that payers should not exclude services solely because they were provided through telehealth.
  • 20 percent of U.S. states lack parity laws: Telehealth parity laws are currently in effect in 39 states and the District of Columbia. Momentum came to a halt last year, as payers, providers, and legislators in several states could not reach agreements on reimbursement levels.
  • Treatment options are limited: The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 prohibits remote prescribing of controlled substances (except under very restricted exemptions) unless an in-person examination between the prescribing physician and the patient has taken place.

However, the report stated, there is reason for optimism as “Current events and issues, such as the opioid epidemic, have put more pressure than ever before on federal and state legislators to pass laws that promote access to telehealth services.”

And moving forward into next year, the report’s authors believe that there are opportunities to improve and expand via the following areas:

  • State professional licensure boards beyond state boards of medicine expanding access to telehealth services
  • Medicare reimbursement for telehealth services to treat opioid use disorder
  • DEA regulations that would allow for the long-awaited “special telemedicine registration,” which would enable physicians to prescribe controlled substances without conducting a prior in-person examination first, to become a reality