State legislative and regulatory developments for telehealth

Trending in Telehealth highlights state regulatory developments that impact healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate virtual care.

Trends of the past week:

  • Refund Requirements
  • Professional standards


Completed legislation and regulations

  • of Iowa The Physical and Occupational Therapy Council has amended two rules: Chapter 201, relevant to physiotherapists, and Chapter 208, relevant to occupational therapists. These rules establish standards for telehealth visits for physical therapy and occupational therapy, allowing the use of audio or video equipment, or both, at the licensee’s discretion. In connection with the adoption of the revised rules, the Board noted that the expansion was in response to public comments from ATA Action, the affiliated trade association of the American Telemedicine Associate, which urged the Board to expand the modalities that can be used for telehealth appointments in the United States. the importance of expanding Iowa patients’ access to affordable, high-quality health care.
  • Maryland issued HB 1127, which authorizes certain health care providers to perform forensic sexual assault examinations through “peer-to-peer telehealth” at no cost to victims and make these services eligible for reimbursement through the Criminal Injuries Compensation Board (CICB ). The peer-to-peer telehealth modality allows a forensic examination to be conducted using interactive audio, video, or other telecommunications or electronic technology by a forensic nurse examiner to assist in conducting a forensic examination when the forensic nurse examiner is is in one location and the patient is with a qualified healthcare provider in another location.
  • Maryland also passed HB 1078, which requires Medicaid to conduct remote ultrasound procedures and remote fetal non-stress testing under certain circumstances.
  • South Carolina S 858 adopted. This bill adds home-based acute hospital care programs as exempt from Certificate of Need review by the SC Department of Health and Environmental Control. “Acute hospital care at home” involves the use of technology to provide continuous remote patient monitoring and patient connectivity.

Legislative and regulatory activity at the proposal stage


  • In ColoradoSB 24-054 passed the first chamber. The bill requires all private insurance companies to provide coverage for the treatment of the chronic disease obesity and the treatment of pre-diabetes, including coverage for intensive behavioral or lifestyle therapy, bariatric surgery, and FDA-approved anti-obesity medications. The definition of intensive behavioral or lifestyle therapy includes interventions virtually via telehealth.
  • In Michigan, HB 4580 and HB 4213 passed the second chamber. If enacted, HB 4580 would require telemedicine services to be covered by Medicaid if the originating site is home or school, in addition to any other originating site permitted in the Medicaid provider manual. HB 4213 would also require Medicaid to cover telemedicine services, but further clarifies the requirements for Medicaid coverage. First, HB 4213 requires Medicaid coverage parity for telehealth services. In addition, HB 4213 requires coverage of telemedicine services both when a third-party provider’s synchronous interactions occur using electronic audio and video media, and when using audio-only electronic media. Under HB 4213, telemedicine services are permitted as an appropriate form of care at a federally qualified health center, rural health clinic, or tribal health center.
  • In Michigan, both HB 4579 and HB 4131 passed the House of Representatives. If passed, HB 4579 would require telehealth coverage parity for health plans. Similarly, HB 4131 will also update state laws for private payers to require payment parity for telehealth services. However, HB 4131 also prohibits health plans from requiring providers to provide services via telemedicine unless there is a contract for telemedicine-first or telemedicine-only products.
  • In Alaska, HB 126 passed the House of Representatives. If passed, this bill would authorize associate counselors to provide certain services via telehealth.
  • New Hampshire SB 403 passed the second chamber. This bill would impose requirements on community health workers, including allowing certified community health workers to provide services through the use of telemedicine.
  • The Washington Office of the Insurance Commissioner has released a Rules Agenda containing a proposed rule to establish a uniform standard for creating an established relationship for the purpose of audio-only telemedicine services. The rule implements SB 5821, which is effective June 6, 2024.
  • Several states saw activity related to interstate compacts.
    • In AlaskaSB 75 passed two chambers, which would enact the Audiology and Speech Pathology Compact.
    • In AlabamaSB 207 passed the House, which would enact the Dietitian Licensure Compact.
    • In LouisianaHB 888 passed the House, which would enact the Social Work Licensure Compact.

Why it matters:

  • States continue to evaluate reimbursement standards as they relate to the delivery of care delivered via telehealth. The proposed Michigan laws are examples of state efforts to promote access to telehealth by implementing reimbursement parity for Medicaid and health plans for telehealth services. In addition to reimbursement parity, Maryland HB 1078, South Carolina S 858, and Colorado 24-054 reflect the growing emphasis on expanding coverage of different types of telehealth services.
  • States continue to modify and clarify professional practice standards for telehealth. States continue to adopt and revise standards governing the practice of telehealth in a variety of medical professions. In some cases, states have sought to allow additional types of providers to provide services via telehealth, such as associate counselors and certified community health workers under Alaska HB 126 and New Hampshire SB 403. Other states, such as Iowa, have clarified the standards by which certain types providers can provide telehealth services, such as physiotherapists and occupational therapists.
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