As telehealth becomes more prevalent among US healthcare institutions, states are rolling out or modifying their laws to better define regulatory frameworks specifically affecting remote delivery of care. In fact, every state but Connecticut and Massachusetts has made substantive legal changes to how telehealth is delivered in the past year, with some taking specific actions to better define the path of mental health-focused treatment, according to recent data on telemental regulations released by healthcare and life sciences firm Epstein Becker Green.

“In just the last year, we have seen a number of states that previously had little or no regulation, like Alaska, adopt comprehensive regulatory schemes, while other states, like Texas, have loosened restrictions on telehealth practices to increase competition and utilization,” Brad Davidsen and James Tam, both associates at Epstein Becker Green and contributors to the 2017 update, told MobiHealthNews in an email. “The use of telehealth has really become mainstream and an integrated mode of treatment in most states, so in the future we expect to continue to see changes and refinements in these regulations."

Building upon last year’s 50 State Survey of Telemental/Telebehavioral Health, Epstein Becker Green’s 2017 Appendix re-examines state regulations in light of telehealth’s growth over the past year. According to the firm, these expansions include CMMS’ report of a 28 percent increase in Medicare payments for telehealth services, the telehealth private payer laws enacted in 31 states and the District of Columbia, and HHS’ estimate that 61 percent of healthcare institutions are employing some form of telehealth services. The appendix also noted regulations established in five states allowing physician-patient evaluations to be conduct through telemedicine, and a newly enacted telemedicine law in New Jersey that loosely outlines the definition of a “healthcare provider” to permit a wider variety of telehealth modalities.

“Consumer demand can drive regulation, which we have seen in the number of states with new or expanded parity laws requiring payers to cover telehealth visits in an increasing number of settings,” Davidsen and Tam said. “In states that lack parity laws, payers should be mindful of new legislation and should prepare for a future where every state requires coverage of at least some telehealth services.”

To provide an up-to-date resource on potential new legislation, Epstein Becker Green reviewed the changes in each state’s relevant laws, regulations and regulatory policies since their last report, with a particular focus on telepsychiatry. Along with the 48 states that have made “substantive changes” in the time since 2016, the firm noted that behavioral health regulations for physicians are still the most prevalent, although some states have begun to develop regulatory frameworks for psychologists and other relevant providers. Several states have begun removing barriers regarding the establishment of patient-physician relationships and location of care. Others appear to be listening to the regulatory questions posed by telehealth stakeholders, the authors noted, with some states beginning to provide more clarity as they are establishing these regulatory frameworks.

For mental health care in particular, the new document highlighted New York’s efforts to clarify mental health services through telemedicine, which transformed from a series of agency statements on the state health department’s website to new rulings with several telepsychiatry-specific statements. Also emphasized was a recent West Virginia bill that expanded access to mental and behavioral medications following a telehealth visit.

“Providers seeking to operate in more than one state should ensure they meet licensure and insurance requirements for each state where the practice treats and ensure that the treatments provided to these patients, including prescriptions issued, are permitted under the state’s telehealth and telemedicine laws,” Davidsen and Tam said. “Keeping up with these laws can be difficult; however, there are a number of trade associations, blogs and other resources, like our 50-State Survey of Telemental/Telebehavioral Health, that help providers understand these changes.”