Understanding Telehealth Regulations and Requirements

Telehealth is about more than doctor-patient video consultations—it’s about leveraging technology to communicate medical information effectively. Medical data transfers between healthcare professionals, communication between providers and patients, remote data collection, and patient portal messaging all fall under the telehealth umbrella.

Telehealth has grown in popularity in recent years due to the efficiency and convenience it offers to both patients and providers. Rural healthcare institutions in particular have come to rely on telehealth technology to reduce travel time for their patients, many of whom trek great distances to access quality care.

During the late 2010s, insurance companies, medical professionals, and legislators began constructing a detailed set of telehealth guidelines to keep pace with the growing demand for these remote services. Organizations like the American Medical Association (AMA) and the Federation of State Medical Boards (FSMB) convened to outline these guidelines and standardize telehealth as we know it.

But the abrupt arrival of COVID-19 has thrust millions of Americans into the world of telehealth at a rate faster than telehealth advocates could have ever anticipated. As patients and healthcare institutions navigate this remote landscape, many are left wondering about the rules and regulations that govern it.

Who Regulates Telemedicine?

There is no one-stop shop for federal telehealth regulations. Telemedicine and telehealth standards are established by the same state-specific regulatory institutions that establish standards for in-person clinical treatment. These state-run regulatory boards must operate in accordance with federal telehealth regulations, including the Health Insurance Portability and Accountability Act (HIPAA) and rules from the Centers for Medicare and Medicaid Services (CMS) governing reimbursement for federal programs.

In light of COVID-19, regulatory agencies are reassessing existing telehealth rules. In March 2020, the Health and Human Services Department (HHS) Office for Civil Rights issued a Notification of Enforcement Discretion during the COVID-19 pandemic. The notification allows flexibility in adherence to HIPAA during this public health crisis to ensure that millions of patients can maintain access to care.

But despite federal adjustments to telehealth oversight, many aspects of telehealth regulation are still determined on a state-by-state level. To help healthcare providers and their patients navigate this complex web of new telehealth regulations and guidance, the FSMB has published an updated, state-specific summary of telemedicine policies. The Center for Connected Health Policy also provides guidance on state-by-state laws and reimbursement policies, as well as legislation and regulations proposed and under consideration.

What Are the Requirements for Telehealth?

The telehealth waivers put forth by HHS and CMS at the request of the AMA and the FSMB have temporarily eased some telehealth requirements, replacing them with significantly more lenient ones. Patients and clinicians can now leverage telehealth during the pandemic for a wider range of services, use common communication platforms like Zoom and FaceTime, and conduct telehealth sessions across state lines.

In general, state telehealth laws are designed to address several critical focus areas:

• Licensing: Licensing requirements for healthcare professionals can vary significantly between states. Cross-state licensing is a topic gaining legislative attention. In many cases, the provider must currently adhere to licensing requirements in the state in which the patient is located during the encounter. Some states allow cross-border delivery of healthcare services in other states in limited situations, and others ban it completely.

• Clinician-patient relationship: States differ in how they define the clinician-patient relationship. Some require in-person visits before telehealth sessions can be conducted, while others believe that a good clinician-patient relationship can be established via telehealth technology in most cases.

• Online prescribing: Compliance with telehealth standards related to prescriptions is vital. Many states have strict requirements for prescribing medication online, with some requiring an in-person visit before certain types of medication can be prescribed.

• Informed consent: Healthcare providers must look closely at their state’s regulations to determine whether written informed consent is needed before conducting telehealth services.

• Reimbursement: Reimbursement for telehealth services from private payers and Medicaid also varies significantly between states. Some require full reimbursement for telehealth services, while others take a more tiered reimbursement approach, outlining which services are covered and which are not.

Some other federal agencies are involved in telehealth regulations as well. The Department of Veterans Affairs (VA) issued a final rule in 2018 that allows VA healthcare providers to provide care in any state regardless of the provider’s and patient’s location. And the Federal Trade Commission has taken action in recent years to ensure that state licensing boards’ rules do not unfairly restrict competition in telehealth.

Infrastructure Requirements for Telehealth

Beyond state and federal guidance, several infrastructure requirements affect the implementation of telehealth services. With the right systems, training, and protocols in place, patients and practitioners can begin reaping the rewards telehealth offers.

• Internet access: A broadband internet connection will minimize internet glitches and transmit video and audio more smoothly, facilitating a productive remote session for patients and clinicians.

• Tech support: Healthcare providers using telehealth technology must have access to 24/7 tech support to resolve technical problems as soon as they arise. A robust tech support team will troubleshoot hardware and software performance issues and quickly answer any questions healthcare professionals have.

• Supplemental telehealth technology: Those who are new to telehealth often wonder how they will be able to remotely perform hands-on tasks like measuring a patient’s blood pressure or heart rate. Fortunately, supplemental telehealth technology—including blood pressure wrist cuffs and digital stethoscopes—can empower patients to effectively conduct these tasks themselves from the comfort of their own homes.

• Training: Telehealth is only productive if healthcare providers know how to conduct it effectively, making telehealth training a critical component of any telehealth practice. Hospitals and clinics that implement new telehealth technology should remember not to rush the training process and allow medical professionals to ask questions and get accustomed to new systems and tools.

Which States Allow Telehealth?

While all states allow telehealth services in some capacity, state-by-state telehealth regulations aren’t uniform. Telehealth becomes particularly complex when it’s conducted across state lines. According to FSMB guidance, all telehealth providers must confirm a patient’s state of residence before proceeding with healthcare services. If a patient is not located in the same state as the healthcare provider, the provider will often need to fill out additional paperwork to ensure they are licensed to practice telemedicine across state lines and prescribe medication to an out-of-state pharmacy if necessary.

Fortunately for Medicare recipients, telehealth legislation has become significantly more relaxed due to the COVID-19 pandemic. While Medicare largely avoided telehealth services prior to 2020, it now covers a wide range of telehealth services, including psychotherapy, annual wellness visits, and advanced care planning.

What Are Telehealth Parity Laws?

COVID-19 has put a spotlight on the need for telehealth parity. Telehealth parity laws require private insurance companies to match reimbursements for any telehealth services that would be reimbursed if conducted in person.

Advocates of telehealth parity laws argue that parity is necessary for a fair and equitable telehealth system. Detractors of parity laws point out that parity compliance is inefficient, vague, and less profitable for private payers. With a sharp increase in telehealth usage in 2020, telehealth advocates have successfully passed parity laws in more than half of all U.S. states.

The Future of Telehealth

With millions of patients and healthcare professionals immersing themselves in the world of telehealth, the advantages of remote, technology-driven health services are becoming even more apparent. With telehealth, transportation time is eradicated, waiting rooms are avoided, and confidentiality persists.

While telehealth was universalized in response to COVID-19, its benefits will remain long after social distancing measures have eased.