California should remove outdated barriers to telehealth
118240905 © Miriam Doerr |


California should remove outdated barriers to telehealth

Getting rid of arbitrary barriers and enabling cross-state telehealth licensing would help Californians during the pandemic.

Many Californians have used telehealth services for the first time during the COVID-19 pandemic. But, despite patients and doctors embracing telehealth, state policymakers have been slow to permanently improve access to digital health care services.

In an executive order helping make telehealth services more accessible for Californians by relaxing security and privacy requirements for health care providers, Gov. Gavin Newsom highlighted the problems, “I find strict compliance with various statutes, regulations, and certain local ordinances specified or referenced herein would prevent, hinder, or delay appropriate actions to prevent and mitigate the effects of the COVID-19 pandemic.”

Gov. Newsom is right, but his executive actions reducing some of the barriers preventing patients from using telehealth services are temporary and need to be made permanent. A new Reason Foundation report that rates each state’s telehealth policies according to a set of best practices for promoting patient access and flexibility for providers finds California has plenty of room for improvement.

For example, California currently requires out-of-state health care professionals to hold a California license to provide telehealth services in the state. In other words, Californians don’t have access to specialists in other states unless they are willing to travel to that specialist’s location or that specialist is able to—and wants to—undergo the burdensome process to obtain an additional license from California. This bureaucratic hurdle undermines one of the principal benefits of telehealth: the ability for patients to access care regardless of their physical location.

These types of archaic state-by-state licensing schemes don’t make sense in the context of telehealth. Some states, like Texas, Colorado, and Utah, have tried to promote the use of telehealth across state lines by agreeing to multi-state licensure compacts, which make it easier for professionals in member states to receive licensure in other member states that are part of the compact. However, California hasn’t joined any multi-state licensure compacts.

Florida and Arizona have identified an even better approach for enabling cross-state telehealth services. Both states have created a simple telehealth registration process for out-of-state health care providers. To register, a provider must only submit proof that they are licensed to practice in another state. This system is superior to multi-state compacts because it does not require action on the part of other states.

The telehealth study also notes California mandates that insurers cover and reimburse telehealth services in the same manner as in-person care. These mandates are intended to promote the adoption of telehealth, but ignore some of its key differences and benefits. Telehealth has the potential to provide on-demand health care services without the administrative and overhead costs associated with in-person care in California. These differences in costs mean that many telehealth services have the chance to save patients money and thus shouldn’t always be reimbursed at the same rate as in-person services. Moreover, telehealth is still an evolving field and technology, and the state should avoid forcing telehealth into the same rules of the complex, outdated health care system that everyone agrees isn’t working. The best way to promote telehealth improvements is to maximize flexibility and choice for patients and providers.

On the positive side, in the early months of the COVID-19 pandemic, California passed a law that allows nurse practitioners to practice via telehealth to the full extent of their education and training after three years of practice. According to a report from California Health Care Foundation, the share of California health care providers using telehealth increased from 30 percent before the pandemic to 79 percent by September 2020. A Blue Shield of California/Harris Poll of Californians conducted in February 2021 found that 49 percent of respondents had already had telehealth visits during the pandemic and 89 percent were satisfied with the services. Polling also consistently shows that patients remain likely to use telehealth services in the future.

Telehealth cannot, and should not, replace all in-person health care services. But there are plenty of times where telehealth is the best option and California should ensure its telehealth laws do not prevent new technologies and services from advancing and serving patients. Getting rid of arbitrary barriers and enabling cross-state telehealth licensing would help Californians now and in the long run.

A version of this column previously appeared in the Los Angeles Daily News.