States Leading the Nation: Telehealth Parity Law Updates for 2020 & Beyond

By Týr Dustin Miranda, CSSBB | Sr. Consultant | January 21, 2020

Telehealth is quickly emerging as a promising new technology that is being widely accepted by both patients and providers. Not only are advances in telemedicine allowing providers to reach underserved populations and improve the experience of care for patients, but also patients are finding it more convenient and comfortable to interact with the healthcare industry from the comforts of their own home – no matter how remote.

As acceptance and awareness of telehealth grows, we at John Lynch & Associates are keeping a close watch on the legal and regulatory landscapes affecting this burgeoning new method of care. We have recently partnered with the experts at OneTouch Telehealth to support our clients with installing compliant telemedicine software and telemedicine solutions for various-sized providers, hospitals, and outpatient groups.

Before national telehealth laws begin to take effect, we can expect that state-specific laws and regulations will serve as the testing ground for this new territory in healthcare. In particular, Arizona, Texas, and New York are leading the way in telehealth laws.

Depending on the data gathered from the implementation of these telehealth laws in specific states, we can begin to predict what will be on the horizon for nation-wide legislation in the future. The more healthcare organizations can anticipate which changes may be affecting their operations, the better we can all prepare for and embrace those changes gracefully when they come.

Here is what is currently being done to test the waters with regard to telehealth laws and regulations around the country.

Arizona Telehealth Legislation

Here in our home state of Arizona, changes to the telehealth landscape are just around the corner. So far, telemedicine is generally only covered for patients living in rural areas who therefore have limited access to healthcare. As a result, providers and insurers will not cover the cost of telehealth visits unless the client meets criteria that indicate that it is difficult for that patient to see their provider, primary care provider, or specialist in person.

However, that is likely to change with the proposed changes that are being talked about in Arizona. In particular, Senate Bill 1089 will widen the scope of telehealth services so that beginning in January 2021, private insurers will be mandated to cover telehealth services just like they would an in-person visit if the patient meets certain requirements.

Whereas previous requirements limited telemedicine services to patients in rural areas, new requirements expand the application of telehealth to include a far greater population.

Indeed, this is a critical step in expanding the availability and coverage of telehealth services to include behavioral health services, as well.

While the Arizona healthcare industry is preparing for SB 1089 to take effect, we will inevitably hear feedback from private health care insurers who want to be certain that new telehealth laws are covering every aspect of telehealth that providers currently offer while allowing room to maintain quality of care.

Having many of these private health insurers start to cover more telemedicine services will likely drive a trend toward consistency across the entire healthcare continuum as Arizona starts to set an example for the nation.

Texas Telehealth Legislation

In Texas, telehealth laws have a lengthier history. In fact, Texas’s parity laws currently require private payers to reimburse telemedicine services in the same way they would reimburse in-person services. However, despite these laws already being in place, they have not yet been fully adopted.

In the last five to six years, Texas has been leading the charge as consumer technology has caught up with the healthcare industry and is being utilized more in healthcare delivery. While Texas does not have any specific updates that are coming up in the foreseeable future, one trend unique to Texas is that the state is allowing cross-state telemedicine licensing.

Essentially, out of state providers are allowed to obtain licenses to practice telemedicine within the state. Not only is this unprecedented, but it is also certainly revolutionary.

In particular, Texas’s cross-state telemedicine licensing will make continuity of care far more feasible for patients who travel regularly for work, live in multiple cities, or frequently vacation around the U.S. Patients, particularly those with chronic conditions or who need regular check-ups, will be able to see their same doctor if they have an acute issue outside of their home state.

As such, several other states are noticing Texas’s lead and are considering adding legislation to the same effect. We will need to pay close attention to this budding trend in the coming years to further anticipate how national telehealth laws could be structured.

New York Telehealth Legislation

New York is another interesting national trendsetter in the telemedicine space. The state has had a telehealth parity law in effect since 2016. Similar to Arizona’s current laws, New York’s previous telehealth legislation allowed for only rural applications. Additionally, telemedicine was paid at a lower rate than traditional in-person medical care for primary care providers or ambulatory specialists.

The 2016 law that went into effect increased the coverage and the reimbursement of telemedicine. With some of those increases being measured currently, we can expect to see some results coming out of New York very soon.

Because New York’s Medicaid waiver program is the most similar to Arizona’s, the new initiatives taking place in New York and the data derived from those programs will significantly impact how Arizona structures healthcare waivers.

Given that the two states are quite similar – they serve a similar patient population, have similar demographics, and are looking at specific diagnoses – the data coming out of New York in the next two years will inform how these telehealth laws are working. As Arizona moves to increase its own coverage by 2021, the state will have measurable, actionable data from New York to inform the structure of telemedicine.

The Future of National Telehealth Legislation

Telehealth is a new and exciting emerging technology that can have a national impact to many different types of patients, whether they are rural, urban, suburban, or just traveling.

As the rest of the nation watches and learns from Arizona, Texas, and New York, we will expect to see similar patterns of legislative behavior: data will be analyzed to identify what is working and what needs to be improved, states will apply the lessons learned from systems most similar to their own demographics and population needs, and we will see a growing trend of well-informed, data-driven telehealth legislation spread around the country.

Eventually, we will see national telehealth legislation be derived from these state-lead experiments. Effectively, the states are shaping what CMS will do five to ten years down the road.

If you have a telemedicine solution, start measuring your data in the context of the underlying goals of improving access to care, improving the quality of care, and cutting costs of healthcare delivery.

Then, let us know what you think. Is telehealth working for your organization? Why or why not? If you are struggling to maximize the potential of telehealth services, John Lynch & Associates is here to support you.

Phone Number

(623) 980-8018

Mailing Address

PO Box 11651 Glendale, AZ 85318-1651