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Last Updated 5/27/2021

Issue: Telehealth or telemedicine is the practice of using audio and video technologies to provide some types of services to patients from a distance. While these terms are sometimes used interchangeably, they refer to different kinds of services. Telemedicine refers strictly to remote clinical services performed by licensed providers. Telehealth encompasses a broader set of activities including educational webinars, licensing or credentialing services, or patient care meetings. Telehealth and telemedicine have several advantages over in-person services like lower costs, increased access, and infection control.

According to the Telehealth Resource Center, there are four commonly known but distinct domains of applications for telehealth:

  • Live Videoconferencing (Synchronous): Live, two-way interaction between a person and a provider using audiovisual telecommunication technology
  • Store-and-Forward (Asynchronous): Transmission of recorded health history to a practitioner, usually a specialist, who uses the information to evaluate the case outside of a real-time
  • Remote Patient Monitoring (RPM): Caregivers collect data (i.e. blood pressure, blood sugar levels, etc.) to monitor patients
  • Mobile Health (mHealth): Telehealth services delivered via mobile devices like smartphones or tablets, often using an app.

Background: Telemedicine started in 1940s with radiology images sent 24 miles between two townships via telephone line in Pennsylvania. In the 1960s and ‘70s several government agencies, including NASA, the Department of Defense and the U.S. Health and Human Services Department, invested in research on telemedicine. One of the most successful of these projects was a partnership between the Indian Health Service and NASA. The project, called Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC), provided both Native Americans on the Papago Reservation in Arizona and astronauts in orbit with access to medical care.

While telemedicine services have existed for decades, widespread adoption has been slow. However, these services are gaining popularity in large part because of the expansion of easy-to-use video conferencing applications and the coronavirus pandemic of 2020.

Prior to the COVID-19 outbreak, both government and private payers were reluctant to implement telemedicine programs in large part because of concerns the ease of access would drive usage and therefore lead to increased costs. For years, reimbursement for telemedicine was often less than half the amount of a standard in-person visit. However, the first quarter of 2020 saw both private and public payers increase reimbursement rates rise to match those of in-person provider visits. As the pandemic begins to subside, patients and providers alike have expressed interest in maintaining the increased availability of telehealth services.

Status: During the COVID-19 pandemic, many states expanded coverage and availability of telehealth services to limit spread of the disease and expand access to health care. In March 2020, Medicare began allowing all enrollees to use telemedicine, an option previously available only to those in remote areas or for short, specific visits. Additionally, physicians were granted reciprocity to provide telemedicine services to Medicare patients across state lines. Some states, including Missouri and Pennsylvania, also allowed physicians licensed outside the state to provide telemedicine care more easily. Idaho, Colorado and others allowed providers to use non-HIPAA compliant technologies in certain circumstances. Many states required insurers to reimburse telehealth services at the same rate as in-person services.  Several states have also limited or reduced to zero the amount state-regulated insurers may charge in consumer cost sharing for telehealth services during the pandemic.

Health care systems also worked to ease access to telemedicine services by increasing physician availability and waiving copays for the duration of the pandemic. The NAIC tracked state actions in this area and other pandemic-related issues in the Coronavirus Resource Center.

The Health Insurance (B) Committee is charged with monitoring developments in the health insurance industry including telehealth services. At the 2021 Spring National Meeting, the Health Innovations (B) Working Group heard presentations from the Washington Office of the Insurance Commissioner and industry stakeholders on state regulations related to telehealth. The NAIC and state insurance regulators continue to closely observe developments in this area to facilitate robust consumer protection and promote access to care.

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