A better picture of how telehealth will be used, paid for and regulated came into focus in 2023, though emerging state and federal laws and policies continue to extend temporary measures enacted in response to the COVID-19 public health emergency rather than enacting permanent change.
Still, the steps taken so far—particularly those that mandate coverage and payment parity with in-person services—have created the needed stability for physicians to feel comfortable employing telehealth as one of the ways they deliver patient care.
“The implementation of coverage and payment parity laws has enabled physicians to invest in new technologies and fully implement telehealth in their practices over the past few years,” said Jacqueline Marks Smith, a Manatt Health senior manager who spoke during a recent AMA-Manatt webinar that is available on demand (registration required).
“The AMA has long supported coverage parity and fair and equitable payment for telehealth services regardless of the service modality,” said Kimberly Horvath, senior attorney with the AMA Advocacy Resource Center. “We know that one of the greatest barriers to patients being able to access care via telehealth is due to lack of payment from insurers including, at the state level, Medicaid or state-regulated plans.”
The AMA and Manatt also published a report detailing state telehealth policy trends in 2023 (PDF).
Supporting telehealth is an essential component of the AMA Recovery Plan for America’s Physicians.
Telehealth is critical to the future of health care, which is why the AMA continues to lead the charge to aggressively expand telehealth policy, research and resources to ensure physician practice sustainability and fair payment.
2024 will “be a busy year” on telehealth
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At the federal level, the Centers for Medicare & Medicaid Services will maintain its waiver of geographic and originating site restrictions for telehealth through Dec. 31, 2024. The AMA supports the CONNECT for Health Act of 2023, a bipartisan proposal that would further expand Medicare coverage of telehealth services while making pandemic-related flexibilities permanent.
For practices to integrate telehealth services into patient care requires good federal and state policies, and there is a flurry of legislative activity taking place at the state level.”
“There’s been a tremendous amount of activity going on in the states—2023 has been a busy year,” said Jared Augenstein, Manatt Health’s managing director. “We expect 2024 to be a busy year.”
Coverage parity requires payers to cover a service via telehealth if it is also covered in-person and can be delivered remotely while meeting the standard of care. As of January, more than 40 states had a telehealth coverage parity law on the books and 21 had implemented payment parity.
Various types of payment parity bills were introduced in 15 states this year. A law that passed in Nevada, for example, calls for payment equal to in-person services—but only for rural areas, certain health care facilities, or for behavioral health.
Marks Smith noted that, prior to the COVID-19 pandemic, few state Medicaid programs recognized or covered audio-only services as a form of telehealth. By June 2020, 38 programs did so—at least temporarily.
“Audio-only was—and continues to be—a really critical tool” to help doctors connect with patients, especially those “who don’t have reliable access to internet, who live in rural areas, or who otherwise are unable to engage in a video visit,” she said.
In 2023, five states passed legislation concerning audio-only telehealth visits.
These included Florida, which changed its definition of “telehealth” to include audio-only visits, and Utah, which now requires its Medicaid program to reimburse for audio-only services.
“Audio-only is particularly important for patients with lower incomes and seniors who may not have audiovisual capability, as well as patients in rural areas who may have limited internet access,” Horvath said, noting that coverage of audio-only services is essential to address inequities in telehealth access.
Visit AMA Advocacy in Action to learn what’s at stake in supporting telehealth and other advocacy priorities the AMA is working on.
