State lawmakers passed at least 176 bills in 2024 that adjust their laws to account for increased demand for virtual medicine after the Covid-19 pandemic.
The slight increase from the 171 bills enacted in 2023 is a sign that telemedicine remains a “critical focus” of state legislatures as it becomes more ingrained in American health care delivery, according to an annual report from the Center for Connected Health Policy, a national nonprofit dedicated to advancing state and federal telehealth policies.
“While states may now be implementing limitations and guardrails on certain aspects of these expansions, the scope of telehealth is set to remain significantly more expansive than it was before the pandemic,” the organization’s executive director Mei Wa Kwong said in an email.
The steady pace of state telehealth legislation also stands in contrast to the situation at the federal level, where flexibilities that allowed Medicare to pay for a broad range of telehealth services during Covid are set to expire at the end of the year unless they are extended by Congress.
Those flexibilities are widely expected to be extended, as they have for the past few years. But the lack of a permanent solution “lingers in the background,” Kwong said.
It has hindered the Centers for Medicare & Medicaid Services, the federal agency that determines the payment rates for physicians accepting Medicare, from “expanding telehealth in a significant long-term way.”
By comparison, states have been able to offer more expansive reimbursement in their Medicaid programs and have also “developed creative licensing solutions to ease hurdles with cross state licensing,” Kwong said.
The Center for Connected Health Policy analysis found state legislatures have continued to “refine, expand, and impose new standards on telehealth;” to respond to evolving needs in telehealth delivery; and leverage lessons from the pandemic. It stated that states are zeroing in on more specific requirements for telehealth delivery, including remote patient monitoring and audio-only services, as an example of how states are working to ensure that telehealth remains accessible and aligns with high standards of care.
In the 2024 sessions, Center for Connected Health Policy found that telehealth-related legislation was introduced in 41 states and Washington, D.C.
States continued to expand Medicaid coverage for a variety of health care services offered via telehealth. That includes Kentucky, where a new law adding speech therapy as a covered service under Medicaid applies to in-person or telehealth delivery. In Colorado, lawmakers added substance use disorder treatment to the definition of a health care or mental health care service in the state’s Medicaid telemedicine statute, effectively requiring the services to be reimbursed at the same rate as in-person care.
Bills also sought to support telehealth for rural health care providers, ensure that telehealth services are reimbursed at the same rate through Medicaid as in-person visits, and increase coverage for remote patient monitoring.
But bills addressing cross-state licensing had the most significant increase among those passed, with 52 enacted cross-state licensing bills, up from 43 enacted bills from the previous year. Every other category tracked by the Center for Connected Health Policy remained mostly steady compared to the previous year, including legislation targeting telehealth for Medicaid and private payers.
The reliance on cross-licensing bills and licensure compacts is a cause for concern for some analysts because they only apply to one provider type and only to providers in the compacts.
“If we treated pilots like we’re treating medical professionals, it would be very difficult to fly in and out of a state, because not everybody that would have enough pilots with licenses in that state, and that’s effectively what we’re doing in healthcare,” said Joshua Archambault, who has co-authored reports on state telehealth policy for Pioneer Institute, Cicero Institute and Reason Foundation.
He said he preferred a model like Florida’s 2019 telehealth law, which allows out-of-state practitioners to provide telehealth services in Florida as long as they are registered in the state.
“If we’re trying to develop a modern, updated health care system where telehealth is part of that, then I don’t think the states are succeeding,” he said. “They’re making some progress, but it’s like crawling right now — instead of even walking — towards an environment in which telehealth can be an option.”