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Trending in Telehealth: November 15 – 28, 2023

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

Trending in the past two weeks:

  • Professional Licensure
  • Telehealth Practice Standards
  • Medicaid Reimbursement
  • Cross-State Licensing Compact

Finalized Legislation and Rulemaking

  • In Alaska, the Board of Optometry’s final rule from October concerning licensing, continuing education and telehealth standards went into effect on November 15, 2023. The final rule created new standards for optometrists providing services via telehealth. Notably, an optometrist must create a pre-existing optometrist relationship verbally, in writing or through an in-person exam before conducting a patient visit through telehealth, as well as verify the patient’s identity. Additionally, the optometrist also may not determine an ophthalmic prescription used to correct a refractive error based solely on an examination conducted through telehealth.
  • The District of Columbia passed legislation requiring professional members of licensing boards to be District residents and to maintain an active, primarily non-telehealth healthcare practice. This legislation was signed by the Mayor of the District of Columbia on November 21, 2023, and will take effect following a 30-day period of congressional review and publication in the District of Columbia Register.
  • Florida’s Department of Health issued a final rule, effective December 7, 2023, to update its procedure for healthcare providers licensed in other states and territories to register with the department to provide telehealth services to patients in Florida.

Legislation and Rulemaking Activity in Proposal Phase

  • Texas, through the Texas Behavioral Health Executive Council, proposed amendments to §781.323, which would provide clarification regarding telehealth practice requirements for social workers.
  • In Utah, the Department of Health & Human Services issued a notice of a proposed rule to update its current telehealth policies, in part to implement the reimbursement provision for audio-only telehealth legislated in H.B. 437, passed in the 2023 general session.
  • Washington’s Department of Health published a proposed rule focused on implementing the multistate nurse licensure compact. The department also published a proposed rule that would allow a certified dietitian or nutritionist to provide services in person or through telehealth, as appropriate, based on the needs of the client.

Why it matters:

  • Increased Barriers to Telehealth Flexibilities. The end of the COVID-19 public health emergency brought with it the expiration of interstate licensure waivers and the rollback of telehealth regulatory flexibilities across the states. As states continue to assess how the shift in telehealth policies will impact residents, some of the recent legislative and rulemaking activity illustrate the impact of restrictive attitudes toward telehealth on patient care. Some common policy barriers to telehealth include a requirement to establish the provider-patient relationship via an in-person visit prior to a telehealth appointment or the outright prohibition of using telehealth as the sole method [...]

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Waiver of State Licensure Requirements for the Delivery of COVID-19 Countermeasures via Telehealth

In a fourth amendment to the March 17, 2020, Public Readiness and Emergency Preparedness Act (PREP Act), the US Department of Health and Human Services (HHS) has expanded access to COVID-19 Covered Countermeasures through telehealth and clarified the scope of liability protections provided by the PREP Act. In particular, the declaration is important to telehealth providers because it appears to preempt, under certain circumstances, state laws that have limited cross-border practice of medicine using telehealth. Healthcare providers should take note that the licensure exception and any immunity protections are limited to healthcare providers who are ordering or administering a Covered Countermeasure and there is no indication of intent to expand beyond these focused measures.

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Enhanced Nurse Licensure Compact Eases the Practice of Nursing across State Lines

The Enhanced Nurse Licensure Compact (Compact) has now been adopted by 26 states, which means the Compact will be taking effect on January 19, 2018. Nurses who seek to practice telemedicine and deliver in-person care across state lines and who meet the Compact’s licensure requirements in these states will have one less obstacle to overcome going forward.

The Compact is an updated version of the original compact allows for registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs) to have one multistate license, which will enable them to practice nursing in person or via technology (e.g., videconference) in both their home state, as well as the other Compact states. Development and implementation of the Compact was not an easy feat, given the need for alignment of licensing standards across the Compact states, including federal and state fingerprint-based criminal background checks.

The 26 states participating in the Compact as of today are Arizona, Arkansas, Delaware, Florida, Georgia, Idaho, Iowa, Kentucky, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia and Wyoming.

For more information about the Compact, please visit:

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