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Trending in Telehealth: August 26 – September 17, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists, and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Out-of-state telehealth providers
  • Interstate compacts
  • Reimbursement requirements

A CLOSER LOOK

Proposed Legislation & Rulemaking:

  • California’s AB 2339 was approved by both chambers and sent to the governor for signature. The bill would expand the definition of “asynchronous store and forward” for the state’s Medicaid program, Medi-Cal, to include asynchronous electronic transmission initiated directly by patients, including through mobile apps. Existing law prohibits a healthcare provider from establishing a new patient relationship with a Medi-Cal beneficiary via asynchronous store and forward, audio-only, remote patient monitoring, or other virtual communication modalities, except as specified. Among those exceptions, existing law authorizes a healthcare provider to establish a new patient relationship using an audio-only synchronous interaction when the visit is related to sensitive services (e.g., mental or behavioral health, sexual and reproductive health, substance use disorder treatment, gender affirming care) and when established in accordance with Medicaid-specific requirements. AB 2339 would expand this exception to the use of asynchronous store and forward when the visit is related to sensitive services. Existing law also authorizes a healthcare provider to establish a new patient relationship using an audio-only synchronous interaction when the patient requests an audio-only modality or attests that they do not have access to video. AB 2339 would remove from that exception the option of the patient attesting that they do not have access to video, and would add a parallel exception to permit the use of an asynchronous store and forward modality when the client requests.
  • The North Dakota Board of Medicine proposed regulations that would provide exceptions to physician licensure for telehealth providers licensed in another state, including for continuation of care received outside of the state, temporary care while the patient is located within the state temporarily, preparation for a scheduled in-person visit, practitioner-to-practitioner consultations, and emergency circumstances.

Finalized Legislation & Rulemaking:

  • Delaware enacted SB 331 into law. Under the act, out-of-state practitioners who wish to prescribe controlled substances in Delaware, including those who have privilege based on a telehealth registration or compact license, must obtain a Delaware controlled substance registration.
  • Alaska enacted SB 75 into law, entering the state into the Audiology and Speech-Language Pathology Interstate Compact.
  • Alaska enacted SB 91 into law. The act updates the telehealth licensure exceptions (which currently allow physicians licensed in another state to provide telehealth services in Alaska without Alaska licensure under certain circumstances) to include exceptions for members of a physician’s multidisciplinary care team. “Multi-disciplinary care team” is defined to include nurses, advanced practice registered nurses, physician assistants, social workers, psychologists, licensed professional counselors, marriage and family therapists, physical therapists, occupational therapists, and other provider types. The exception applies when such services provided are not reasonably available [...]

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Trending in Telehealth: June 4 – 10, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Interstate compacts
  • Reimbursement requirements
  • Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking:

  • In Connecticut, the governor signed HB 5198, which permanently extends COVID-19 era telehealth provisions, originally set to expire at the end of this month. The bill also creates a registration requirement for mental and behavioral health providers who are providing care via telehealth from outside of the state. These providers do need to submit an application for licensure within 60 days of registration. The bill also addresses payment expectations for providers should a patient’s health insurance not cover telehealth services. Certain provisions went into effect immediately upon the governor’s signature, while others go into effect on July 1, 2024, after the existing provision expires.
  • Colorado enacted HB 24-1045, which addresses updates to treatment for substance use disorders generally and requires payment parity for telemedicine care of substance use under the state’s Medicaid program. This takes effect 90 days following the final adjournment of the state congress. Colorado also enacted SB 24-034, which expands school-based healthcare, allowing services to be provided via telehealth.
  • Illinois amended the Illinois Public Aid Code, through SB 3268, to include funding for the expansion of telehealth services in critical access hospitals with potential funding coming from the Department of Health Services (DHS) to support expansion. This also includes an amendment which states that beginning January 1, 2025, DHS will pay negotiated, agreed upon administrative fees associated with implementing telehealth services for persons with intellectual and developmental disabilities receiving Community Integrated Living Arrangement residential services.
  • Michigan enacted several telehealth related bills, all taking effect 90 days following the end of the congressional session:
    • HB 4131 :This bill updates the state’s private payor laws and requires, among other things, that there be payment parity and that health plans not limit telehealth-delivered services to only be provided via a third-party entity.
    • HB 4580: This bill will ensure coverage parity through Medicaid for telehealth services.
    • HB 4213: This bill will, among other things, require coverage of telehealth in the Medicaid program, including specifically allowing for audio-only and telehealth to be an eligible encounter for federally qualified health centers (FQHCs) and rural health clinics (RHCs).
    • HB 4579: This bill requires that all health plans cover telehealth services at the same rate as in-person care.
  • Nebraska’s enrollment in the Dietician Licensure and Physician Assistant Compacts took effect under LB 1215.
  • West Virginia finalized a rule that would expand the definition of Occupational Therapist and Occupational Therapist Assistant, to include those enrolled in the Occupational Therapist Compact.
  • Wyoming revised rules promulgated by the Medical [...]

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Trending in Telehealth: May 28 – June 3, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Interstate compacts
  • Reimbursement requirements
  • Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking:

  • In Colorado, SB 24-168 was signed by the governor, requiring reimbursement for remote monitoring for outpatient services for certain Medicaid members. This bill also creates a grant program to provide grants to outpatient healthcare facilities that are in rural areas to assist with the cost of providing telehealth remote monitoring, recognizing the cost to set up these programs. These parameters go into effect July 1, 2025. This bill also requires that the State cover continuous glucose monitors for Medicaid members.
  • Florida enacted HB 855, which addresses teledentistry treatment, specifically requiring a disclaimer to accompany dental care provided via telehealth that an in-person visit is recommended prior to telehealth treatment. The bill goes into effect July 1, 2024.
  • Mississippi finalized a rule that removed restrictions for telehealth visits with an evaluation & management code of level IV or V to be reimbursable by the state’s Medicaid program.
  • Tennessee enacted several telehealth related bills:
    • HB 2857: In the realm of general healthcare insurance statutes, the bill revises the definition of “provider-based telemedicine” in Tenn. Code Ann. § 56-7-1003 to remove the requirement that the patient has already established the provider-patient relationship via an in-person visit within 16 months prior to the telehealth visit. An in-person visit is still required, however it does not need to be within that 16-month lookback period. This bill took effect on May 28, 2024.
    • HB 2318: This bill allows a physician assistant who operates solely via telehealth to arrange for the required review of the physician assistant’s charts by a collaborating physician or any required visit by a collaborating physician to any remote site to be completed via HIPAA-compliant electronic means, rather than at the site of the clinic. The bill also removes telehealth as an option. This bill went into effect on May 28, 2024.
    • HB 2147: The Tennessee Medicaid Program, TennCare, is now required to cover complex rehabilitation visits that are conducted via telehealth. This goes into effect on July 1, 2024.
    • HB 2808: Tennessee now requires that healthcare services delivered to inmates for human immunodeficiency virus (HIV) treatment can be provided via telemedicine, if requested and associated payment through various state programs, including TennCare, to cover treatment. This bill goes into effect on July 1, 2024.
  • Vermont enacted a law through H 861 that requires parity for healthcare services provided via telemedicine, broadly applicable to healthcare insurance plans. This bill goes into effect on January 1, 2025.
  • Several states enacted compact-related legislation:



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Trending in Telehealth: May 21 – May 27, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Professional standards
  • Reimbursement requirements
  • Interstate compacts

A CLOSER LOOK

Finalized Legislation & Rulemaking

  • Connecticut enacted HB 5197, which enacts the Social Work Licensure Compact.
  • South Carolina enacted H 5183, which adds certain nursing tasks to the representative list of nursing tasks that may be delegated by a physician, physician assistant, or advanced practice registered nurse to unlicensed assistive personnel, including performing nonclinical tasks via telemedicine.
  • South Carolina also enacted S 610, which enacts the Counseling Compact.
  • The Wisconsin Psychology Examining Board amended its rules to bring them into alignment with the state’s establishment as a member of the Psychology Interjurisdictional Compact. Specifically, this adopted rule provides that the standards of practice and professional conduct apply to both telehealth and telepsychology services.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

  • In California, AB 2339 passed the first chamber. This bill would expand existing Medi-Cal definitions and exceptions that currently restrict the establishment of new patient relationships via telehealth. Specifically, this bill permits the use of asynchronous telehealth modalities to establish a new patient relationship when related to sensitive services or when requested by patient. For purposes of Medi-Cal, this bill expands the definition of “asynchronous store and forward” to include asynchronous electronic transmission initiated directly by patients, including through mobile telephone applications.
  • In Illinois, HB 5087 passed the second chamber. This bill would amend the Illinois Physical Therapy Act to provide that physical therapy through telehealth services may be used to address access issues to care, enhance care delivery or increase the physical therapist’s ability to assess and direct the patient’s performance in the patient’s own environment. This bill also provides that a physical therapist or a physical therapist assistant working under the general supervision of a physical therapist may provide physical therapy through telehealth services, subject to certain restrictions.
  • In Illinois, SB 2586 also passed the second chamber. This bill would amend the Illinois Dental Practice Act to include in the definition of teledentistry patient diagnosis and treatment planning services. This bill also provides practice standards by which a dentist may practice teledentistry, including that a dentist may only practice or utilize teledentistry on a patient of record and requires the dentist to obtain informed consent from the patient prior to rendering teledentistry services.
  • In Ohio, SB 95 passed the first chamber. This bill would permit remote dispensing pharmacies to dispense drugs, provide patient counseling and other pharmacist care through a telepharmacy system. This bill also specifies the requirements for a pharmacy to be eligible to operate as a remote dispensing pharmacy.
  • In Pennsylvania, SB 739 passed the first chamber. This [...]

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Trending in Telehealth: May 14 – May 20, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Reimbursement requirements
  • Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking

  • Iowa’s Board of Physical and Occupational Therapy amended two rules, Chapter 201, relevant to physical therapists and Chapter 208, relevant to occupational therapists. These rules establish standards for telehealth visits for physical therapy and occupational therapy, permitting the use of audio or video equipment, or both, at the discretion of the licensee. In connection with the adoption of the revised rules, the board noted that the expansion was a response to public comment from ATA Action, the American Telemedicine Associate’s affiliated trade association, which urged the board to expand the modalities that can be used for telehealth appointments in the interest of expanding Iowa patients’ access to affordable, high-quality healthcare.
  • Maryland enacted HB 1127, which authorizes certain healthcare providers to provide sexual assault forensic exams conducted through “peer-to-peer telehealth” without charge to victims and makes those services eligible for reimbursement by the Criminal Injuries Compensation Board (CICB). The peer-to-peer telehealth modality permits the performance of a forensic examination using interactive audio, video, or other telecommunications or electronic technology by a forensic nurse examiner to assist in the performance of a forensic examination when the forensic nurse examiner is in one location and the patient is with a qualified healthcare provider in another location.
  • Maryland also enacted HB 1078, which requires Medicaid to provide remote ultrasound procedures and remote fetal nonstress tests in certain circumstances.
  • South Carolina enacted S 858. This bill adds acute hospital care at home programs as exempt from Certificate of Need review by the SC Department of Health and Environmental Control. “Acute hospital care at home” includes the utilization of technology to provide continuous remote patient monitoring and connectivity to the patient.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

  • In Colorado, SB 24-054 passed the first chamber. The bill requires all private insurance companies to provide coverage for the treatment of the chronic disease of obesity and the treatment of pre-diabetes, including coverage for intensive behavioral or lifestyle therapy, bariatric surgery, and FDA-approved anti-obesity medication. The definition of intensive behavioral or lifestyle therapy includes interventions virtually through telehealth.
  • In Michigan, HB 4580 and HB 4213 passed the second chamber. If enacted, HB 4580 would require telemedicine services to be covered under Medicaid if the originating site is an in-home or in-school setting, in addition to any other originating site allowed in the Medicaid provider manual. HB 4213 would also require Medicaid to cover telemedicine services, however, further clarifies the requirements for Medicaid coverage. First, HB 4213 requires Medicaid coverage parity for telehealth services. Additionally, HB 4213 requires coverage of [...]

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Trending in Telehealth: May 7 – May 13, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Interstate compacts
  • Reimbursement requirements
  • Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking

  • Mississippi enacted legislation, HB 764, which permits the State Board of Health to promulgate rules and regulations, and to collect data and information on the delivery of telemedicine services and the use of electronic records for the delivery of telemedicine services.
  • Alabama enacted legislation, SB 208, which adopts the Social Worker Licensure Compact.
  • The Texas Department of Licensing and Regulation adopted a rule for speech-language pathologists and audiologists confirming that direct and indirect supervision may be performed through tele-supervision and that in-person supervision is not required. This rule also allows a licensee providing telehealth services to provide proof of licensure to a requestor through the department’s online license search.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

  • In Colorado, SB 24-141 passed two chambers. If enacted, all healthcare providers who possess a license, certificate, registration or other approval as a healthcare provider in another state may provide healthcare services through telehealth to patients located in Colorado if the provider registers with the appropriate Colorado regulatory agency.
  • In Colorado, SB 24-168 passed two chambers. This bill requires the Department of Health Care Policy and Financing to provide reimbursement for the use of telehealth remote monitoring for outpatient services for certain Medicaid members.
  • In Minnesota, HF 4247 passed two chambers, which would allow transfer care specialists and veterinarians to provide “direct supervision” via telephone.
  • In South Carolina, H 5183 passed two chambers. This bill would allow for the delegation of nursing tasks, including the performance of nonclinical tasks via telemedicine.
  • In Tennessee, SB 2368 passed two chambers. If enacted, this bill would require that any policy, certificate or agreement for health insurance coverage under TennCare must include coverage for telehealth visits for complex rehabilitation technology.
  • Connecticut HB 5198 passed the second chamber. If enacted, this bill would make permanent certain temporary expanded requirements for telehealth services.
  • Several states saw activity related to interstate compacts.
    • Social Worker Licensure Compact
      • In Connecticut, HB 5197 passed two chambers.
      • In New Hampshire, SB 318 passed one chamber.
      • In Tennessee, SB 2134 passed two chambers.
    • In Connecticut, HB 5058 passed two chambers, which would enact the Nurse Licensure Compact.
    • In Alabama, SB 207 passed two chambers, which would enact the Dietician Licensure Compact.
    • In South Carolina, S 610 passed two chambers, which would enact the Counseling Compact.

Why it matters:

  • States continue to increase activity surrounding licensure compacts for [...]

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Trending in Telehealth: April 30 – May 6, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Interstate compacts
  • Professional standards
  • Reimbursement requirements

A CLOSER LOOK

Finalized Legislation & Rulemaking

  • Iowa enacted HF 2402, which requires the Iowa Department of Health and Human Services to review and update its administrative rules regarding psychiatric medical institutions for children (PMICs), including the review of rules related to the use of telehealth services to conduct post-restraint and seclusion assessments.
  • Iowa enacted HF 2512, which adopts the Social Worker Licensure Compact.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

  • In Louisiana, HB 896 passed one chamber. This bill establishes the Louisiana Remote Patient Monitoring Program Law, which allows remote patient monitoring services provided through telehealth for patients who meet certain criteria as outlined in the bill.
  • In Connecticut, HB 5198 passed one chamber. If enacted, this bill would make permanent certain temporary expanded requirements for telehealth services. These expanded provisions include the following: allows authorized telehealth providers to use audio-only telephone to provide services, allows authorized providers to provide telehealth services from any location to patients at any location, prohibits providers from charging uninsured patients more than the Medicare reimbursement rate for telehealth services, and prohibits health carriers from reducing the amount of reimbursement they pay to telehealth providers for covered services provided through telehealth.
  • In Colorado, HB 24-1045 passed the second chamber. This bill adds substance use disorder treatment to the list of healthcare services required to be reimbursed at the same rate for telemedicine as comparable in-person services.
  • In Colorado, SB 24-141 passed one chamber. If enacted, this bill would allow a licensed out-of-state healthcare provider to provide telehealth services to patients located in Colorado if the provider registered with the appropriate regulator in Colorado.
  • In Hawaii, HCR 125 passed one chamber, which requests the establishment of a telehealth working group to examine the impact of widespread telehealth adoption during the COVID-19 pandemic and to identify public policy initiatives at the federal and state level to optimize telehealth utilization as the state transitions out.
  • Several states saw activity related to interstate compacts.
    • Michigan HB 4169 passed one chamber, which would enact the occupational therapy licensure compact.
    • In South Carolina, S 610 passed two chambers, which would enact the professional counseling compact.
    • In Alabama, SB 208 passed two chambers, which would enact the Social Worker Compact.
  • In Nevada, the Board of Dental Examiners published a proposed rule that expands requirements related to teledentistry. This rule specifies the circumstances under which a licensed provider may provide teledentistry services, including issuing prescriptions.
  • In Kansas, the Board of Pharmacy proposed a rule that sets forth requirements to establish a telepharmacy outlet, as well as requirements for the personnel who would staff the telepharmacy outlet. This rule [...]

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Trending in Telehealth: April 2 – April 8, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Interstate compacts
  • Professional standards and supervision requirements
  • Reimbursement requirements

A CLOSER LOOK

Finalized Legislation & Rulemaking

  • Arizona enacted SB 1173, enacting the counseling compact.
  • Mississippi enacted SB 2157 (mentioned in last week’s post) adopting the Psychology Interjurisdictional Compact.
  • Kentucky enacted both bills mentioned in last week’s blog post:
  • SB 255 establishes requirements and standards for the provision of social work services via telehealth.
  • SB 111: Requires health benefit plans, limited health service benefit plans, Medicaid and state health plans to provide coverage for speech therapy provided in person or via telehealth.
  • West Virginia also enacted rulemaking pertaining to the practice of licensed dietitians. Specifically, the rulemaking established procedures for the practice of telehealth by licensed dietitians. The rule provides for relevant telehealth definitions, licensure standards, establishing a practitioner-provider relationship solely via telehealth and standards of telehealth practice (e.g., consent, identify verification, standards for confidentiality, etc.).
  • Arizona enacted rulemaking, applicable to the Medicaid program, which requires the Arizona Department of Health Services (Department) to allow a healthcare provider who is not licensed in Arizona to provide telehealth services to a client located in Arizona if the healthcare provider registers with the Department and pays a registration fee. Providers who register with the Department must maintain a statutory agent for service of process in the state and ensure the provider’s professional liability insurance policy includes coverage for telehealth services provided to clients in Arizona, among other requirements.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

  • Wyoming enacted emergency rulemaking which provides that a physician or physician assistant who has established a provider-patient relationship in another state with a patient who is a resident of Wyoming may provide continued care to the patient via telehealth without a Wyoming physician or physician assistant license subject to the following:
  • (i) The provider-patient relationship must have been established in an in-person encounter in a state in which the physician or physician assistant is licensed;
  • (ii) Subsequent care may be provided to the patient via telehealth while the patient is in Wyoming if the care is a logical and expected continuation of the care provided in an in-person encounter in the state where the physician or physician assistant is licensed. If the patient is presenting with new medical conditions, or conditions that the standard of care dictates an in-person encounter is needed, patient must either return to the state in which the physician or physician assistant is licensed for care or must be referred to a Wyoming-licensed healthcare provider.
  • (iii) The telehealth care may continue for up to six months after the establishment of the provider-patient relationship in another state, after which an in-person encounter must take place in a jurisdiction where the physician or physician assistant is [...]

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Trending in Telehealth: March 26 – April 1, 2024

Trending in Telehealth highlights state legislative and regulatory developments that impact the healthcare providers, telehealth and digital health companies, pharmacists and technology companies that deliver and facilitate the delivery of virtual care.

Trending in the past week:

  • Interstate compacts
  • Reimbursement requirements
  • Professional standards

A CLOSER LOOK

Finalized Legislation & Rulemaking

  • West Virginia enacted SB 522, which specifies that an emergency medical services agency may triage and transport a patient to a destination other than a hospital, dialysis center, skilled nursing facility or residence within the state or treat the patient in place if the ambulance service is coordinating the care of the patient through medical command or telehealth services. The bill also requires insurance plans to provide coverage for those services. SB 522 further requires the West Virginia Office of Emergency Medical Services to establish related protocols by October 1, 2024.
  • West Virginia also enacted rulemaking pertaining to the practice of medical imaging and radiation therapy technologists. The rulemaking includes a provision stating that telehealth practice is inapplicable to the practice of a medical imaging and radiation therapy technologist.
  • Maine enacted LD 1965, which provides telehealth standards for optometrists, including requirements for establishing an optometrist-patient relationship via telemedicine. While the bill establishes new flexibilities to allow for telehealth and provides relevant practice standards and definitions for telehealth practice, it also includes limiting language requiring either an in-person visit or an established relationship with the patient.
    • For example, an optometrist-patient relationship is established when an individual agrees to receive ocular or healthcare services from the licensee and there has been an in-person encounter between the licensee and the individual, unless the standard of care requires that an individual be seen without an in-person visit, such as in an emergent situation as reasonably determined by the licensee.
    • The bill also provides a pathway for an optometrist-patient relationship in which a licensee who uses telehealth in providing care and a patient who receives telehealth services through consultation with another licensee or other healthcare provider and who has an established relationship agrees to participate in, or supervise, the patient’s care through telehealth.

Legislation & Rulemaking Activity in Proposal Phase

Highlights:

  • Three states – Kansas, Tennessee and Colorado – either introduced or progressed legislation relating to the Social Work Licensure Compact.
    • In Kansas, SB 2484 passed both chambers.
    • In Tennessee, HB 2405 also passed both chambers.
    • In Colorado, SB 24-1002 passed the first chamber.
  • In Arizona, SB 1173 passed both chambers. If enacted, the bill would adopt the Counseling Compact.
  • In Mississippi, SB 2157 passed the second chamber. If enacted, the bill would adopt the Psychology Interjurisdictional Compact.
  • In Tennessee, JB 2587 passed the second chamber. If enacted, the bill would revise the state’s insurance code to remove from the definition of “provider-based telemedicine” the requirement that [...]

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