Tracking Telehealth Changes State-by-State in Response to COVID-19

As the COVID-19 pandemic continues to spread across the United States, states, payors and providers are looking for ways to expand access to telehealth services. Improving access to telehealth is an essential tool in ensuring patients are able to access the healthcare services they need in as safe a manner as is possible. In order to provide our clients with quick and actionable guidance on the evolving telehealth landscape, Manatt Health has developed a comprehensive 50-state tracker for state-specific legal, policy and regulatory changes related to telehealth during the COVID-19 pandemic. Our state summaries cover state licensure flexibilities related to COVID-19, telehealth coverage and payment changes for commercial plans, and telehealth coverage and payment changes in Medicaid.

Below we provide highlights of the most recent changes and updates, followed by our full executive summary. Manatt’s complete 50-state tracker is available through Insights@ManattHealth, which delivers tailored analyses and deep insights into health law and policy developments. Available by subscription, Insights@ManattHealth provides a personalized experience that gives you easy access to Manatt Health’s robust library of cutting-edge thought leadership. For more information or to schedule a demo, please contact Barret Jefferds at bjefferds@manatt.com.

Highlights of Recent Updates

As of April 29, 2020:

• All 50 states plus Washington, D.C., have introduced licensure flexibilities.
• 47 states plus Washington, D.C., issued guidance related to the expansion or reimbursement of telehealth services in Medicaid.
• 38 states plus Washington, D.C., provide payment parity in Medicaid for telehealth services.
• 20 states have waived or lowered cost sharing for telehealth.
• 40 states plus Washington, D.C., offer behavioral health services through telehealth.
• 30 states plus Washington, D.C., offer occupational therapy, physical therapy and speech therapy services through telehealth.
• 38 states plus Washington, D.C., have issued Medicaid guidance to include audio-only telehealth services.
• 8 states have issued telehealth guidance for child well-care and Early and Periodic Screening, Diagnostic and Treatment (EPSDT) visits.
• 14 states have issued guidance to providers to allow for telehealth or remote care delivery for early childhood intervention services.

In addition, over the past few weeks, we’ve seen several major trends emerge at the state level. Following are key highlights of recent developments:

• Appendix K Telehealth Flexibilities: As of April 22, CMS has approved Section 1915(c) Waiver Appendix K (Appendix K) from 32 states and Washington, D.C. Appendix K is a long-standing federal authority that helps states streamline and expedite changes to their 1915(c) home and community-based services (HCBS) waivers to prepare for and respond to emergencies. As of April 22, 15 of the approved Appendix K waivers included telehealth flexibilities for states. Some of these flexibilities include adding electronic methods of delivery for case management, personal care services that only require verbal cueing, in-home habilitation or monthly monitoring; temporarily modifying provider qualifications; temporarily modifying processes for level of care evaluations and re-evaluations; or temporarily modifying medication management.
• Child Well-Care and EPSDT Visits: EPSDT is a mandated benefit that provides comprehensive and preventive healthcare services for children under age 21 who are enrolled in Medicaid. Each state is responsible to provide EPSDT services to children and adolescents enrolled in their Medicaid program. As of April 22, only seven states have issued telehealth guidance for child well-care and EPSDT visits.
• Louisiana: During the last week of March, Louisiana went from encouraging use of telehealth to implementing progressive policies in response to the high incidence of the virus in the state. The Department of Health and the Department of Insurance have provided guidance to use telemedicine in COVID-19- and non-COVID-19-related services. Louisiana has specifically outlined telehealth guidance for behavioral health, occupational therapy, physical therapy and speech therapy. Additionally, Louisiana Medicaid and all commercial carriers will now cover audio-only telehealth services waiving the video component requirement to qualify as telemedicine/telehealth. In mid-April, the Louisiana Department of Health issued guidance for treatment-in-place by ambulance providers followed by a telehealth visit in the field with a licensed physician, physician assistant or advanced practice registered nurse. This guidance will allow ambulance providers to be reimbursed at the base rate, without mileage, and licensed healthcare providers to be reimbursed under the general telehealth policy.
• North Carolina: North Carolina has continued to issue frequent guidance expanding telehealth services. Recently, North Carolina released bulletins expanding telehealth coverage for well-child visits and postpartum depression screenings in Medicaid. Notably, for children under 24 months, North Carolina Medicaid continues to recommend in-person visits for the vast majority of well-child services, while a limited set of services may be delivered via telemedicine during the state of emergency, if necessary. However, for children 24 months and older, North Carolina Medicaid recommends that providers consider telemedicine to deliver a broad range of well-child services, as is clinically appropriate. In the weeks prior, North Carolina Medicaid released bulletins broadening telehealth policies to include optometry services; postpartum care visits; self-measured blood pressure monitoring; specialized therapies, such as physical, occupational and speech; dentistry; and behavioral health.