Telehealth Policy and Regulation Changes During COVID-19: Payment, Privacy, Licensing

The coronavirus disease 2019 (COVID-19) pandemic has brought significant changes to the telehealth sector, resulting in wider service availability due to changes in payment, privacy and licensing.

Changes in Payment

One of the most significant changes for telehealth related to the COVID-19 pandemic has been payment parity between telehealth and in-clinic visits. The (much) lower reimbursement payment for telehealth has been a major disincentive for service providers to offer or to expand telehealth services.

Previously, many states required that private insurers reimburse telehealth visits, but not all states require that telehealth visits be reimbursed at the same rate as in-person services. Only 23 states and the District of Columbia have full parity, meaning coverage and reimbursement is comparable (not the same) from in-person to telehealth services.

When the coronavirus pandemic hit the U.S., some private insurers and Medicaid programs announced payment parity for telehealth for the duration of the pandemic. For instance, for a routine primary care visit, such as for a 20- to 30-minute visit with a physician, Louisiana Medicaid reimbursement for 2020 would be $33.95 for a telehealth visit, compared with $62.65 for a physical visit.

Changes in Privacy

Patient privacy regulations, especially the Health Insurance Portability and Accountability Act of 1996 (HIPAA), also has been perceived as a potential barrier to a wider adoption of telehealth.

HIPAA has a set of security rules that stipulate what information is protected, and what safeguards must be in place to ensure appropriate protection of electronic protected health information. These privacy and security rules basically precluded the use of commercial communication tools such as Facetime or Zoom in telehealth services.

Again when the pandemic started, the Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) announced that it would waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communications technologies during the COVID-19 pandemic.

This exercise of discretion applies to widely available communications apps, such as FaceTime or Skype, when used in good faith for any telehealth treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19.

Changes in Licensing

Before the pandemic, virtually all states required that for telehealth, service providers need to be licensed in the state of patient receiving services. In other words, telehealth service providers used to need separate licenses to render cares cross state lines.

During the COVID-19 pandemic, many states relaxed or waived their licensing requirements for telehealth services; as a result, some clinicians from one state are able to care for patients in another state. A detailed state-by-state telehealth licensing waivers and modifications can be found by visiting this webpage.


Source consulted:

Carmel Shachar, et al. 2020. “Implications for Telehealth in a Postpandemic Future: Regulatory and Privacy Issues.” JAMA, 323(23): 2375-2376.