The Covid-19 caused a demand for changes in laws and regulations surronding telehealth. Federal policies surrounding telehealth set limitations on what services can be provided, where the patient can access them, and how they are distributed. Prior to the pandemic patients using telehealth were required to be in a medical facility to utilize the service. These policies also required the services being offered to be done over live video, and did not allow telephone visits. At the start of the pandemic due to the need emergency laws were passed that would allow patients to receive services from their own home on a myriad of platforms. As we shift away from the pandemic, many states are changing regulation back to what they were prior and the widespread access to telehealth is disappating. There are a multitude of components that impact a providers ability to provide telehealth care and the patients ability to access it. 

Licensure Issues

Licensing requirements vary state by state, but in general the provider must be licensed in the states where their originating site patients reside. With regular face to face visits this does not impact the provider greatly, since the patient would likley not be crossing state lines to practice. However, with telehealth, interstate practice could broaden a providers patient census and allow for patients to access more specialized care.

The Center for Connected Health Policy notes 9 states that issue special licenses that allow out-of-state practioners to practice telemedicine in their states: Alabdama, Louisianna, Maine, Minnesota, New Mexico, Ohio, Oregon, Tennesse, and Texas (Fields, 2020). 

The Interstate Medical Licensure Compact (IMLC) has worked to ease federal legislation surrounding interstate licensure. This was created in an effort to better serve rural communities. The compact currently includes 29 states, the District of Columbia and the Territory of Guam, and more states are working towards introducing and implementing the compact. There are specific qualifications a provider must meet for a provider to be able to participate, including maintaning unrestricted licensure, remaining board certified, and having a history of no disciplinary actions. Barriers that may prevent providers from joining the IMLC is that licenses obtained are more expensive thatn those obtained conventionally (Fields, 2020). 

Legal Issues 

Federal and state policy surrounding telemedicine impact the services that can be delivered, reimbursement for the services, medication prescription, and patient privacy regulations. 

There is no federal policy for informed consent requirments in telemedicine, and state laws vary. Informed consent is an imporant part of telemedicine and helps to solidfy the provider-patient relationship and set proper boundaries. Informed consent should include “documentation of the patient, provider, and credentials, type of telemedicine being used, security measures taken to protect PHI, and potential privacy risks,” and so on (Fields, 2020). 

Federal law exists to control the prescription of medicatons over telehealth. The Ryan Haight Online Pharmacy Consumer Protection Act of 2008, which states that no controlled substance “may be delivered, distributed, or dispensed by means of the Internet without a valid prescription” – a valid prescription is obtained only after the patient has been physically examined by the provider during at least one in-person visit (Fields, 2020). It is important to regulate the prescription of medications over telehealth avoid drug misuse and overdose. 

Parity laws were implimented during the pandemic to allow providers to conduct telehealth appointments and receive reimbursement equal to that of in person visits. Now that healthcare is moving forward from the pandemic, the number of states with parity laws has decreased. As of February 2022, 19 states have policies requiring parity and 4 states have laws with caveats, which limit parity to finite services such as mental health appointments (Andrade, et al., 2022). Without parity providers may not be able to provide telehealth due to the expense of telehealth infrastructure. 

Patient privacy in telehealth is expected to be held to the same standard as in person visits. All information and data, including the patients email address, phone, number, etc should encrypted and password protected. The Health Insurance Portability and Accountability Act (HIPAA) are expected to be followed in addition to any state regulation. 

Regulatory Issues