Introduction
In 2023, state legislative progress on reforming telehealth laws stalled, with a few exceptions. Even as many public health emergency declarations for COVID-19 expired in 2023, state legislation did not keep pace with the momentum to maintain the greatest flexibilities granted under those declarations.
Three states (Idaho, Louisiana, and Utah) deserve special recognition for the largest telehealth policy updates passed in 2023. Other states should take notice and copy their reforms.
This is the third annual 50-state telehealth innovation report card that captures innovation-minded telehealth policy changes that took place this past year. At the 30,000-foot level, the telehealth policy reforms that did pass in 2023 can be characterized as largely tweaking around the edges. Many of the telehealth bills filed around the country fell into the familiar areas pushed by special interests to mandate coverage of certain services or mandating certain payment levels. Few bills focused on making the telehealth landscape flexible enough to allow for innovation.
While news stories of average Americans highlighted the many cost and access challenges that patients routinely face to receive care, most states failed to move the needle on telehealth reform to ease some of that tension. Most patients still lack electronic access to providers outside of their state, even if there are few or no providers of a specific type near them. If we did this for pilots, almost no one could access or afford an airplane ticket. Yet that has been our approach for medical providers.
A new study released in early 2023, “Few Disciplinary Issues with Out-of-State Telehealth: New Data from Florida and Idaho,” co-authored by one of this report’s co-authors and Dr. Ateev Mehrotra of Harvard Medical School found that providers are increasingly interested in offering their expertise to patients in states that allow such a framework, and there had been no disciplinary action taken against those providers over hundreds of thousands of visits. Yet only Louisiana and Utah made moves in 2023 towards opening up these options, with Idaho doing so for behavioral health.
There was some movement on compacts that can impact telehealth access, but compacts are not the most flexible. Two states (Hawaii and Missouri) joined the Interstate Medical Licensure Compact. Indiana joined the counseling compact, and Louisiana joined the occupational therapy compact. Yet compacts only apply to one kind of provider, only apply among mutual compact states, and have faced criticism for still being slow to approve across-state line access and include a decent cost to do so.
This toolkit is designed to guide policymakers in advancing a healthcare system that prioritizes quality, affordability, and innovation. Its primary goal is to assist state governments in revising telehealth laws to eliminate historical barriers that have disproportionately affected certain individuals in specific regions.
The following report outlines policy best practices to optimize the benefits of telehealth services for providers and patients. Additionally, it includes a straightforward stoplight rating system for each state, indicating the alignment of their policies with the identified best practices. The appendix offers specific changes that are needed in each state to improve its rankings.
Urgent action is imperative for states to meet the physical and economic needs of their residents through a forward-thinking and quality-oriented healthcare system.