Telehealth Visits, telebehavioral health, telehealth providers, telehealth coverage, telehealth policy

Legislators Pave the Way to Improved Access and Coverage for Telehealth Visits


The past two years have seen an exponential increase in telehealth policies regarding telehealth visits and coverage. A recent report published by the Kaiser Family Foundation highlighted the importance of telehealth providers in the behavioral health sector. From March to August 2020, the report found that telehealth providers delivered 40% of telebehavioral health consultations. In 2021, telehealth visits had dropped to 36% over the same period. Still, this is compared favorably with other outpatient telehealth visits at 5%, and telehealth utilization remains high compared to pre-pandemic levels.

Legislation Broadening Access to Telehealth Visits

Manatt on Health tracks telehealth across the country and identified that federal and state policymakers intend to expand post-pandemic telehealth policies and telehealth coverage to ensure continued access to telebehavioral health going forward. To this end, federal authorities have updated the CY 2023 Medicare Physician Fee Schedule to provide permanent coverage of telebehavioral health services and ensure that Medicare telehealth enrollees receive video and audio-only telehealth services in their homes. There are various policy levers states are using to maintain and process access to telehealth coverage. Some of the policy levers related to telehealth visits are discussed below.

Allowing Out-of-State Telebehavioral Health Services

Before the pandemic, practitioners, including behavioral health providers, had to have a license in each state in which they provided a service. During the pandemic, recognizing the need for flexibility, many states dropped this requirement and allowed out-of-state providers to practice in a state without a license under some conditions. For example, Virginia passed House Bill 537, which allows telebehavioral health providers, psychologists, and licensed social workers to provide telehealth services to patients in Virginia for more than one year from the date the provider began providing services to a patient. South Carolina recently introduced Senate Bill No. 1179 and Iowa bill no 2245 to allow behavioral health providers to practice telehealth services over state lines.

Telehealth Coverage for Audio-only Telehealth Visits

Before the pandemic, there was little to no coverage for audio-only telehealth visits. Post-March 2020, it became apparent that many people seeking medical assistance didn’t have the technology or digital know-how needed for video telehealth visits. Legislators realized that it was the poor and marginalized that were most affected. They responded by providing telehealth coverage for audio-only telehealth visits. North Carolina and New York have changed to include audio-only telehealth coverage under their Medicaid programs.

Broadening the Range of Telehealth Provider’s Types

Several states had a limited range of healthcare providers eligible to provide telehealth services until recently. Given the increasing need for telebehavioral health, some states have broadened the lists of eligible telehealth providers, such as addiction counselors, professional counselors, licensed clinical mental health counselors, and board-certified behavioral analysts
Indiana passed Bill No. 284, which includes occupational therapists, occupational therapy assistants, and behavioral analysts to be reimbursed for necessary telehealth services. Louisiana introduced Bill No. 826, which would enable addiction counselors, prevention professionals, and certified compulsive gambling counselors to provide telehealth services if they meet specific licensing, certification, and registration guidelines. 

Payment Parity Required for Telehealth Visits

Lack of telehealth coverage is one of the major barriers to the adoption of telehealth among healthcare providers. Before the COVID 19 pandemic, only ten states had legislation requiring private payers to offer equal reimbursement for in-person and telehealth visits. More than half of the states have active payment parity laws in place now. For example, Massachusetts passed Chapter 260, which requires permanent reimbursement for telebehavioral health services at parity with in-person care. Iowa also passed Insurance Code 514.34, requiring health plans to reimburse telehealth visits for a mental health condition, illness, injury, or disease at the same rate provided in person.

Expanding Telehealth Coverage

As the Public Health Emergency wanes, states will remain focused on ensuring continued access to telebehavioral health. States can consider telehealth policies from other states which have already implemented them as they evolve their approach to telehealth policy going forward. See TBHI’s previous articles for more information regarding telehealth policies and coverage below.

How Can I Legally Practice Telehealth Over State Lines and International Borders?

Practicing telehealth across state lines or international borders? Operate legally & ethically 100% of the time.

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