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Melissa Ward
Sr. Business Analyst - Regulatory Affairs

2022 was another exciting year for telehealth expansion, seeing several states expand a provider’s ability to determine the most appropriate modality of care for their patients— including asynchronous and synchronous audio-only. We saw remaining states end state-level Public Health Emergencies (PHEs), which expired most cross-state provider flexibilities. However, there is much activity surrounding licensure compacts and state-level work to remove barriers to cross-state practice.  

2023 will surely be another exciting year with continued expansion at the federal and state level, with growth in programming targeting underserved areas and specialized populations such as maternal-fetal health, cancer care, substance use disorders, and other areas of behavioral health. Consumers have continued to adopt direct-to-consumer care, saving them time and money while receiving high-quality care that meets in-person standards. 

virtual care regulation

Federal

On January 30, 2023, the Biden Administration announced the official end date of the federal PHE. As promised, the announcement came at least 60 days prior to the expiration to allow providers time to plan for any required changes. Prior to this announcement, President Biden signed H.R. 2617: Fiscal Year 2023 Consolidated Appropriation ACT which provides a 2-year extension to the Medicare 1135 waivers. These flexibilities include: 

  • Suspension of the geographic site requirement  
  • Allowing a patient’s home to service as an originating site 
  • Allowing Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to continue to be eligible telehealth providers 
  • Removing facility fees when a patient’s home is the originating site  
  • Delaying the in-person visit requirement prior to being eligible for telemental health services 
  • Allowing the continued use of audio-only telehealth 

Flexibilities for controlled substance prescribing are separately tied to the federal PHE through the Drug Enforcement Agency (DEA); therefore, unless acted upon by the DEA, patients are at risk of losing access to services such as telehealth treatment of substance use disorders (SUD) on May 11, 2023.  

virtual care regulation

By State

Florida Senate Bill 298 – Introduced 

This bill would remove the audio-only exclusion from the definition of telehealth: 

(a) “Telehealth” means the use of synchronous or asynchronous telecommunications technology by a telehealth provider to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term does not include e-mail messages, or facsimile transmissions. 

Missouri House Bill 710 – Introduced 

This bill would allow providers to establish a provider-patient relationship and prescribe via an asynchronous adaptive interview equivalent to an in-person interview is an acceptable standard of practice. Currently, providers are required to use synchronous audio-video or audio-only to establish a provider-patient relationship. The section in bold is the new language:  

“Any questionnaire completed by the patient, whether via the internet or telephone, shall include questions sufficient to elicit information as though the medical interview has been performed in person. Any questionnaire that fails to elicit information as though the medical interview has been performed in person does not constitute an acceptable medical interview and examination for the provision of treatment by telehealth.” 

Oregon House Bill 2583

The house has proposed this bill which would change the term “physician assistant” to “physician associate” in all documents and signature designations.  

The American Academy of Physician Assistants (AAPA) House of Delegates passed a resolution in 2021 altering the meaning of the acronym PA from “physician assistant” to “physician associate. There has been support and opposition to this change—some believe it is a positive step, while others think it is a waste of time and money. What are your thoughts? 

Rhode Island House Bill 5352

This bill would modify “The Telemedicine Coverage Act” definitions to allow a provider-patient relationship to be established asynchronously without a prior in-person visit. The new language reads: 

“’Patient-provider relationship’ means a collaborative effort between a patient and a healthcare professional for the provision of healthcare services that may be established when the healthcare professional agrees to undertake diagnosis and treatment of the patient, and the patient agrees to be treated, whether or not there is an in-person encounter between the healthcare professional and patient. A patient-provider relationship may be established via either synchronous or asynchronous telemedicine technologies without any requirement of a prior in-person meeting, so long as the standard of care is met.”

Virginia House Bill 2374 – Introduced

This bill would prevent a pharmacist from refusing to fill a prescription solely based on the providers use of a telemedicine platform to provide services.

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