Publication
Arizona Expands Telehealth Law, Making it Broadest in the Nation
By Paul J. Giancola and Claudia E. Stedman
On May 5, 2021, Governor Ducey signed H.B. 2454, legislation which dramatically expands access to telehealth services in Arizona. The legislation—the most expansive in the country—makes telemedicine a permanent fixture of Arizona’s healthcare system.
Telehealth has been instrumental in ensuring that Arizonans receive care during the public health emergency (PHE). Now that over 2 million Arizonans have received at least one dose of the COVID-19 vaccine, the expansion of telehealth services post-pandemic will transition from a tool used to address potential gaps in care due to social distancing requirements, to a mechanism to expand care to traditionally underserved populations. Specifically, the greatest gains in increasing access to care have been realized among low-income families and those living in rural areas. Likewise, with such a significant seasonally migratory population in this State, expansion of telehealth services allows “snowbirds” to continue to receive care year-round, even when not in Arizona. Even for those who do not typically encounter barriers to care, telemedicine has provided a more convenient and efficient method for many to see their doctor.1 Telemedicine has been particularly useful for those receiving mental health services, speech therapy, and remote patient monitoring—areas of medicine where it is essential to prevent a lapse in care.2
In March 2020, Governor Ducey issued Executive Order 2020-15, which required all health insurance companies to expand telemedicine coverage for all services that would normally be covered for an in-person visit. H.B. 2454 now makes this mandate permanent. The law requires health insurance companies provide parity payments—reimbursement by the health plan for telehealth services at the same or equivalent rate as paid for in-person services—to providers for telehealth services rendered through audio-visual format.
The law also establishes a Telehealth Advisory Committee on Telehealth Best Practices.3 Health insurance companies must cover telehealth services provided through an audio-only format if the Telehealth Advisory Committee “recommends that the services may appropriately be provided through an audio-only telehealth encounter.”4 Audio-only encounters are permitted regardless of whether there is an existing relationship between the provider and patient if the encounter is “for a behavioral health or substance use disorder service.”5 H.B. 2454 also permits healthcare providers licensed in other states to provide telehealth services to Arizonans, subject to certain limitations.6
However, the legislation does not address whether an Arizona-licensed physician providing telehealth services to a patient in another state would be subject to the laws of that other jurisdiction or whether the physician would be deemed to be practicing without a license. Additionally, H.B. 2454 does not specify whether physicians’ malpractice insurance will extend to cover that practitioner even if he or she is licensed in another state. Providers should be aware of these potential limitations and check with their counsel to ensure that the legal requirements of the states in which their patients are receiving care have been met.
Telehealth and licensing expansion efforts have put Arizona on the forefront of a nation-wide push to increase access to healthcare. Arizona’s legislative efforts, aimed at facilitating healthcare consumption for patients and cutting unnecessary red-tape surrounding providers’ practice, may serve as a model for other states considering restructuring aspects of their healthcare systems as the country rounds the corner on the pandemic.
Footnotes
While one study found there was no statistically significant difference between patient satisfaction with telehealth visits versus in person visits, the no-show rate for telehealth visits, 7.5%, was much lower than the no-show rate of in-office visits, 36.1%, in 2020. Brendan Drerup, et al., Reduced No-Show Rates and Sustained Patient Satisfaction of Telehealth During the COVID-19 Pandemic, Telemedicine J. and e-Health (March 4, 2021), https://www.liebertpub.com/doi/pdfplus/10.1089/tmj.2021.0002#:~:text=Results%3A%20The%20no%2Dshow%20rate,)%20(p%20%3C%200.0001).
Evidence shows that in 2020, the majority of telehealth visits were not related to COVID-19, but instead concerned questions for chronic and behavioral care issues. Telehealth consults for these types of conditions increased by more than 100%. Lori Uscher-Pines, et al., Where Virtual Care Was Already a Reality: Experiences of a Nationwide Telehealth Service Provider During the COVID-19 Pandemic, 22 J. of Med. Internet Rsch. 1 (2020).
A.R.S. § 36-3607 (2021).
H.B. 2545, 2021 Leg., 55th Sess. (Az. 2021)
Id.
The provider must register with the applicable Arizona regulatory board or agency that “licenses comparable health care providers,” must register with the “controlled substances prescription monitoring program,” pay the applicable registration fee, hold a “current, valid and unrestricted license in another state . . . and not [be] subject to any past or pending disciplinary proceedings in any jurisdiction.” Id.
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