Survey: Here's how the legal landscape for telehealth insurance coverage has changed since 2019

Popular digital health law firm Foley & Lardner released a new state survey of telehealth insurance laws that tracks the changes in the legal landscape from 2019, before the COVID-19 public health emergency, until April 2024.

The survey includes key figures on each state’s telehealth commercial insurance coverage and payment/reimbursement laws.

Nearly all states have adopted a telehealth statute as of April 2024. Of particular note is the number of states that expanded audio-only coverage, states that implemented coverage and payment parity for mental and behavioral health provided via telehealth, and states that passed reimbursement and parity laws. 

Though 43 states had telehealth laws on the books in 2019, many states changed their approach to telehealth insurance laws following the end of the public health emergency. Pre-pandemic, 41 states had telehealth coverage laws that mandated commercial health plans cover telehealth services that are equivalent to in-person services the plan also offers. Only one additional state has implemented a telehealth coverage law since 2019. Though most states already required coverage, the payment landscape for telehealth has significantly shifted in the five years since pre-pandemic status quo. 

Seventeen additional states passed laws that require payment parity for telehealth, meaning providers must be paid the same rate for conducting telehealth services as they are paid for in-person services. Some telehealth payment laws are still narrow, though, and only require payment parity for mental and behavioral health services or when the patient is in a rural area. Telehealth payments are not yet on par with payment for in-person services, the survey finds.

Commercial insurance plans in states that lack telehealth coverage and payment laws often still cover and provide payment for telehealth, Foley & Lardner Partner Nate Lacktman told Fierce Healthcare at the American Telemedicine Association’s Nexus conference in Phoenix.

Rather, the plans in states such as Wisconsin, Pennsylvania, North Carolina, South Carolina, Alabama, Idaho and Wyoming lack statutory mandates to provide such coverage and payment. 

An additional seven states passed laws to prevent health plans from imposing extra cost sharing requirements on telehealth services such as increasing copayments or deductibles for telehealth. Six additional states banned telehealth exclusivity agreements that limited which telehealth platform in-network providers could use. Now, more providers are able to choose which telehealth platform they want to use in their practices because of the increase of laws that ban such exclusivity agreements. 

“Five years ago, one of the most substantial barriers to growth was the limited and uncertain insurance coverage for digital health services," Lacktman said. "Today, with improvements in telehealth practice standards and insurance coverage laws, far more organizations are implementing and expanding robust digital health services, particularly attractive when woven into traditional in-person services. If these ‘click and mortar’ models can deliver the right care, at the right time, to the right person, telehealth will continue its path to becoming an essential component of health care writ large.”

One of the patchiest areas for coverage across the country, according to the Foley & Lardner survey, is in the remote monitoring space. Twenty-four states mandate coverage of RPM services, which do not have an in-person equivalent and therefore aren’t typically covered by more straight and narrow telehealth coverage laws that don’t include additional provisions for virtual-only services. RPM coverage laws have increased by 22% in the last five years, which is also how long the technology has had Medicare CPT codes. 

Seven additional states mandated coverage of “store and forward” telehealth services, which is often when a provider shares patient information with a second provider for review and consultation.