Telehealth restrictions across the US: How each state measures up

Laws determining telehealth access vary widely across the 50 states, according to a report released Jan. 5 by Reason Foundation, Cicero Institute and Pioneer Institute.

The report rates each state's telehealth laws for patient access and ease of providing virtual care, using eight key factors. Here is a breakdown of the findings, organized by each factor the report examined.

In-person requirements: Forty-seven states have no in-person requirement to establish a provider-patient relationship before being able to use telehealth. In Alaska and West Virginia, certain specialty providers have an in-person requirement, and Tennessee requires an in-person visit ahead of using telehealth.

Modality neutrality: Forty-six states allow synchronous and asynchronous appointments explicitly or have a broad enough definition to allow its use. Twenty-eight of these states also have telehealth laws that account for store-and-forward and remote patient monitoring. Vermont and Iowa have laws that limit the use of at least one kind of telehealth modality. In these states, the definition for telemedicine accounts only for live interactive audio and video. This factor was not applicable to North Carolina or Pennsylvania.

Barriers to telehealth across state lines: Three states — Arizona, Florida and Indiana — have clear registration or licensing processes for all out-of-state healthcare providers to see patients across state lines. Thirteen states have a clear registration or licensing process but it only applies to physicians, or certain kinds of providers, or only for surrounding states. Thirty-four states have clear barriers to telehealth across state lines.

Providers: In 22 states, the definition for the kinds of providers is broad enough to allow any provider to use telehealth. In 24 states, the definition for the kinds of providers that can use telehealth is limited to specific occupations listed in code. In Wisconsin and Wyoming, telehealth usage is limited to only some or a very narrow set of providers. This factor was not applicable to North Carolina or Pennsylvania.

Nurse practitioners' independent practice: In 20 states, nurse practitioners can practice fully independently without a collaborative practice agreement or supervision from a physician to provide medical services. In 11 states, nurse practitioners can practice independently after a certain period of time, or they need to have some collaboration or supervision requirement for at least one or more medical services, not including for prescribing. In 19 states, nurse practitioners can never practice independently without a collaborative practice agreement or supervision.

Coverage mandate: Eleven states have no mandate for insurers to cover all services offered through telehealth. Four states have a mandate for certain services, and 35 states have a coverage mandate for all services.

Payment mandate: Twenty-two states have no mandate for insurers to pay the same rate for telehealth services as an in-person visit. Six states have a payment mandate for some services, or cost-sharing requirements that are mandated at the same level for the patient as an in-person visit. Twenty-two states have a payment mandate for all services to pay the same rate for telehealth as an in-person visit.

Compacts: Twenty-six states are members of at least both the Nurse Licensure Compact and Interstate Medical Licensure Compact. Sixteen states are members of at least one, and eight states aren't members of either.

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