Study Rates Every State’s Telehealth Laws For Patient Access

A new report from Reason Foundation, Cicero Institute and Pioneer Institute rates every state’s telehealth policy for patient access and ease of providing virtual care.

Millions of Americans tried telehealth for the first time last year as federal officials and governors temporarily lifted restrictions that limited patient access to virtual care. But many of these restrictions on practices like speaking with doctors across state lines, recording voice messages with care instructions, and mandating insurance coverage have been reinstated, the new report finds.

“Once the public health emergency declarations started to end or executive orders were withdrawn many of the new flexibilities for providers, insurers, and patients were lost overnight,” said Vittorio Nastasi, policy analyst at Reason Foundation and co-author of the report. “States need to adopt a number of telehealth reforms to provide their residents better access to this safe and effective virtual care.”

Nationally, the study finds that several states that have been hardest hit by the pandemic have the most restrictive telehealth laws. These states include New York, California, and Connecticut which have not signed up for interstate licensing compacts and have coverage parity mandates that offer no flexibility between the insurer and provider.

Only three states — Arizona, Florida, and Indiana — allow all providers to easily practice telehealth across state lines. Forty-seven others have arbitrary barriers in place that limit patients’ access to specialists and available appointments based purely on residency.

On a positive note, almost all states have removed the requirement that a patient must first see a provider in-person before they can use telehealth services, the exception being Tennessee, while Alaska and West Virginia require an in-person visit before certain services can be provided. Another 20 states allow full independent practice for nurse practitioners without the supervision of a physician.

The report highlights telehealth policy best practices for states. “While they cannot and should not replace all in-person medical appointments, virtual visits can save patients time and help them avoid germ-filled waiting rooms. Providers can also take some pressure off overburdened systems as they can see patients from an office or home,” writes report co-author Josh Archambault, a senior fellow with Cicero Institute and Pioneer Institute.

The full report with state rankings is available online from Pioneer InstituteReason Foundation, and Cicero Institute.


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