Numerous States Pass Legislation in Support of Telehealth

While Matthew Norman, M.D., was speaking with a patient during a recent telehealth appointment, a toddler appeared on screen. The patient explained that his wife was at work, and even though he had childcare responsibilities, he had wanted to keep the appointment. “Two years ago, when our only option was to meet in person, I would have gotten a phone call from this patient canceling our appointment,” said Norman, a forensic psychiatrist in Atlanta and past president of the Georgia Psychiatric Physicians Association (GPPA).

The COVID-19 pandemic forced many who were previously unfamiliar with telepsychiatry to embrace it as a critical means of continuing care with patients. But the telehealth flexibilities that made that care possible were largely instituted through executive orders and were therefore temporary.

In an effort to prevent patients who will continue to need telepsychiatry from losing access, numerous district branches across the country, with the help of APA staff, successfully advocated for legislation this year that increased access to and coverage of telehealth beyond the end of the pandemic.

More than 20 states passed such laws, and some district branches are still advocating for bills in their states. Some states passed bills related to specific aspects of telehealth, such as allowing audio-only services or ensuring equal reimbursement for services provided via telehealth or in person. Some states, such as Georgia and Arizona, passed sweeping bills that included numerous telehealth provisions.

Last year, the GPPA rallied around APA’s model telehealth legislation, and the bill passed with minimal changes earlier this year. “This is a great example of APA’s national office and a district branch bringing their synergies together to get a lot of good done for not only the profession, but also for the patients,” Norman said.

The Georgia Telehealth Act (HB 307) authorizes health care professionals to provide telehealth services from home and enables patients to receive those services from home, work, or school without requiring an in-person visit first. It further prohibits insurers from making more onerous restrictions on prescribing medications via telehealth than apply to in-person care and prohibits them from instituting separate deductibles for telehealth services.

In summer 2020, GPPA’s leadership met and quickly identified telehealth as a priority for the organization ahead of Georgia’s 2021 legislative session, explained Travis Lindley, GPPA’s executive director. They then worked with the leadership and APA staff to present the model legislation to Georgia’s Composite Medical Board, the state’s licensing board, to make its members familiar with the proposal and gain their support.

There were several keys to the legislation’s success, Lindley said. GPPA has a good relationship with Georgia state Rep. Sharon Cooper (R), who championed the bill. Lindley also said advocacy became a coalition effort, particularly with the Medical Association of Georgia, which helped the bill sail through the legislature.

Howard Maziar, M.D., co-chair of the GPPA’s Advocacy and Legislative Committee and past GPPA president, noted that the relationships that GPPA had before it began advocating for the legislation were critical: Norman is a member of the Composite Medical Board, Maziar is a member of the Medical Association of Georgia’s Council on Legislation, and Lindley had built relationships of trust with members of the legislature. “None of these relationships were formed in response to this bill,” Maziar said. “They were well in place before.”

In Arizona, a similarly broad telehealth bill (HB 2454) passed in May. The new law covers three of the executive orders that Arizona Gov. Doug Ducey issued in 2020 to expand telehealth. It requires reimbursement parity whether services are provided via telehealth or in person; ensures access to audio-only telehealth; allows physicians to prescribe medications via telehealth; allows registered health care professionals licensed in other states to provide telehealth services to Arizona residents (though insurers cannot use out-of-state clinicians to meet network adequacy requirements); and establishes a Telehealth Advisory Committee on Telehealth Best Practices.

Too often, said Arizona Psychiatric Society (APS) President Jasleen Chhatwal, M.D., it is taken for granted that people have access to the care they need. She noted that American Indian and rural populations in Arizona especially have limited or no access to important health resources. “Telehealth reduces the disparities between the haves and the have-nots and allows more people to access good-quality care,” she said.

Just as it did last year to advocate for a sweeping mental health parity bill (Psychiatric News), the APS worked collaboratively with the state’s physician community, particularly with the Arizona Medical Association, the Arizona Healthcare Advocacy Coalition, and the Interprofessional Behavioral Health Collaborative of Arizona. The strong, collaborative relationship within the physician community in the state was critical to the bill’s success, said Chhatwal, APS past President Don J. Fowls, M.D., and APS Executive Director Teri Harnisch.

Fowls has a good relationship with Ducey, maintaining close communication with the governor and his staff since Ducey signed the executive orders last year. Fowls had spoken with Ducey several times about telehealth, even before the pandemic started, which allowed him to be an important resource to the governor and his staff when questions related to telehealth arose.

“For psychiatrists, there is a huge amount of opportunity to get involved and make ourselves available to policymakers,” Fowls said. “Our communities are really seeking responsible, down-to-earth voices on mental health issues right now. There’s every opportunity for psychiatrists to speak up, and people will want to hear.” ■