As the September 30, 2025 Medicare telehealth waiver expiration date approaches, many are concerned about what will be the fate of the policies that have been extended several times since the end of the Public Health Emergency (PHE). The temporary waivers allowed Medicare to more extensively cover and reimburse for telehealth-delivered services by suspending requirements and limitations such as needing to be in a rural area or a specific type of health facility, as well as expanding the list of eligible providers who will be reimbursed if they use telehealth to treat their patients. While Medicare telehealth policy is certainly important, we should not forget that there are also other coverage and reimbursement policies that will impact the utilization and reimbursement of telehealth, such as Medicaid and private payer policies. Unlike the Medicare telehealth policies, the fate of telehealth private payer policies rest primarily in the hands of the states, as each state crafts their own policies regarding commercial payers’ coverage and reimbursement of telehealth delivered services.
Currently, a large majority of states have some type of telehealth private payer law in statute. These laws can range greatly from mandates on coverage and reimbursement parity all the way to allowing payers the option to cover services delivered via telehealth. Since the PHE, we have seen a handful of states enact private payer laws, however, more commonly, we've seen states make modifications to existing laws rather than adopt entirely new ones. In a prior edition of CCHP’s In Focus, we examined the telehealth policies of a few specific health plans in different states highlighting the impact the variations in state laws can have. A few of the recently passed pieces of legislation that will have a direct impact on private payer coverage are examined below. Two of the bills address situations that are similar to what is occurring on the federal level with Medicare by addressing the issue of expiring temporary policies.
- Maryland HB 869/SB 372 – Among the items related to private payers in the Preserve Telehealth Access Act of 2025 is the removal of the time limitations placed into law through previous legislation. These changes include making audio-only in the definition of "telehealth" permanent and ensuring continued payment parity in Maryland's Medicaid program and for certain insurers.
- Mississippi SB 2415 – With a deadline quickly approaching, the Mississippi Legislature decided to make a soon to expire temporary policy, permanent: health insurance and employee benefit plans will be required to provide coverage for telehealth services to the same extent the services would have been covered if provided in-person. Additionally, these plans must reimburse out-of-network providers under the same reimbursement policies as in-person out-of-network services. This act goes into effect on June 30, 2025.
- Texas HB 1052 – Under this piece of legislation, health plans will be required to provide coverage for covered health services delivered via telehealth on the same basis and to the same extent when the originating or distant site is located out of the state as the plan would have had if the service had been delivered via telehealth to an originating and distant site located in the state if the individual receiving the services primarily resides in Texas and the health care professional providing the service via telehealth is licensed in Texas and has a physical office in Texas. This act goes into effect on September 1, 2025.
With Maryland’s HB 869/SB 372 and Mississippi’s SB 2415, both addressed policies that were soon to expire, similar to what is currently occurring with federal Medicare telehealth policy. Like the federal government, Maryland had extended some of its public health emergency telehealth waivers over the last few years. However, this year they have decided to make some of those policies permanent, including policies related to audio-only coverage. Federal policymakers could take a similar approach making some of the temporary Medicare telehealth waivers permanent, though to date we have only seen extensions of said policies. CCHP has not yet heard any news regarding whether or not federal policymakers might also be considering making some of the temporary Medicare telehealth waivers permanent, but we do already see that this has taken place on the state level.
Mississippi’s SB 2415 also made permanent a temporary policy. The policy itself is a little more unusual from what is generally seen in private payer statutory language. Mississippi had written into statute that health plans are required to provide coverage for out-of-network providers, whereas most state telehealth private payer laws do not address the out-of-network provider issue. Perhaps many of these states rely on more general language such as treating telehealth delivered services in the same manner had the service been delivered in-person. There may have been an issue with an out-of-network telehealth provider that originally spurred the creation of this language.
Texas HB 1052 has made an interesting addition to their existing state private payer law by requiring health plans to reimburse on the same basis and to the same extent when the originating or distant site is located out of the state as the plan would have had the patient and provider been located within Texas at the time of the telehealth service. It is important to highlight, however, that there are specific conditions that have to also be met, such as the individual receiving the services must primarily reside in Texas and the health care professional providing the service via telehealth must also be licensed in Texas and have a physical office in the state. This is unusual language compared to policies we see in other states, not because of the language addressing what happens when a patient and provider are out-of-state, as a few states’ policies mention this scenario, but rather because of the requirement that the telehealth provider must have a physical office in Texas.
Often, unless otherwise specified in state laws, health plans will engage with a telehealth company to provide telehealth services to meet any service needs or requirements. The providers that work under contract with these companies may not have a physical office within the state though they are licensed to practice in that specific state. For example, there might be a physician that Telehealth Company A has hired to provide services to a health plan’s enrollees in Oklahoma, but the physician is physically located in Utah. It is unlikely that physician would have a physical office in Oklahoma (and in some states, to qualify for certain exceptions such as with licensure, an out of state telehealth practitioner may be prohibited from opening a physical office within the state). It’s also possible the telehealth company itself might not even have an office in the state, though it would likely be easier for the company to open an office rather than requiring all of the potential practitioners under the telehealth company to have an office in the state. However, it is not entirely clear if the telehealth company opens an office in the state if that would be considered adequate to meet the requirement.
Furthermore, as the legislation is currently written, if a telehealth company or provider cannot meet the physical office in Texas requirement, it does not prohibit the health plan from engaging with that company, or prevent a provider from delivering telehealth services to their enrollees. However, the health plan would not be required to provide payment coverage for that service on the same basis and to the same extent had the service been in-person or delivered via telehealth when both the patient and telehealth provider were located in Texas at the time of the interaction.
Increasingly, states have become more concerned with their ability to oversee telehealth providers and companies when they are not within their state borders and their options of regulating such entities is limited when they are in another state. These types of concerns might be part of the reason such legislation was passed, but it also does set up an outlet for a health plan to not be mandated to provide coverage in the same manner as they would have been required to had both patient and provider been located within the state when the telehealth interaction took place. We will have to see how the regulations for this bill are crafted to see if an option such as the telehealth company opening up an office will be considered adequate to meet this requirement.
It is important to note that there are additional policy items within some of the bills that we have not highlighted here today. Please click on the links to the bills above, or you can visit CCHP’s Policy Finder, for more information on the aforementioned bills or to learn more about legislation for all the states. To track all pending private payer bills, monitor CCHP’s Pending Legislation webpage and filter by “private payer”. |
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