Regulatory and legislative issues on telehealth.

ABSTRACT

The use of telehealth to deliver health care services in the United States experienced rapid expansion with the advent of the COVID-19 public health emergency (PHE) and associated waivers. Prior to the pandemic, adoption of telehealth by health care providers was hampered by outdated legislative and regulatory barriers at the federal and state levels. This paper provides a review of the legislative and regulatory landscape for telehealth in the United States and how it has changed during the COVID-10 PHE. It remains to be seen whether the temporary flexibilities surrounding delivery and payment of telehealth services will remain in place; some require Congressional action to make permanent while others can be made permanent through rulemaking. Other actions are dependent on state legislatures and commercial payers. Issues under debate by stakeholders include long-term audio-only coverage; broadband connectivity; disparities in access to telehealth; appropriate payment for telehealth versus in-person care; concerns about fraud, quality, and safety; and the need for additional data to inform future policymaking. Insights are provided into these key issues that are expected to shape future legislative and regulatory action at the federal and state levels. Health care providers and patients need to engage in advocacy work at the federal and state level, and with commercial payers, to affect meaningful long-term change.