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Policy changes during the COVID-19 Public Health Emergency

The federal government has taken concrete steps to make telehealth services easier to implement and access during this national emergency. These changes are temporary measures during the COVID-19 Public Health Emergency and are subject to revision.

See the current Public Health Emergency declaration for details.

The U.S. Department of Health and Human Services Office for Civil Rights issued a Notification of Enforcement Discretion to empower covered health care providers to use widely available communications applications without the risk of penalties imposed by the U.S. Department of Health and Human Services Office for Civil Rights for violations of Health Insurance Portability and Accountability Act of 1996 (HIPAA) rules for the good faith provision of telehealth services. For more information, read FAQs on Telehealth and HIPAA during the COVID-19 nationwide public health emergency (PDF) or visit HIPAA and COVID-19.

Under this notice, covered health care providers may use popular applications to deliver telehealth as long as they are “non-public facing”. Examples of public facing applications are Facebook Live and Twitch.

Examples of non-public facing video chat applications include:

  • Apple FaceTime
  • Facebook Messenger video chat
  • Google Hangouts video
  • Zoom
  • Skype

Examples of non-public facing text-based applications include:

  • Signal
  • Jabber
  • Facebook Messenger
  • Google Hangouts
  • WhatsApp
  • iMessage

Under this notice, covered health care providers that seek additional privacy protections should use technology vendors that are HIPAA compliant and will enter into HIPAA business associate agreements in connection with the provision of their video communication products. The list below includes some vendors that say they provide HIPAA-compliant video communication products and that they will enter into a HIPAA business associate agreement.

  • Skype for Business / Microsoft Teams
  • Updox
  • VSee
  • Zoom for Healthcare
  • Doxy.me
  • Google G Suite Hangouts Meet
  • Cisco Webex Meetings / Webex Teams
  • Amazon Chime
  • GoToMeeting
  • Spruce Health Care Messenger

Note: The U.S. Department of Health and Human Services Office for Civil Rights has not reviewed the business associate agreements offered by these vendors, and this list does not constitute an endorsement, certification, or recommendation of specific technology, software, applications, or products. There may be other technology vendors that offer HIPAA-compliant video communication products that will enter into a HIPAA business associate agreement with a covered entity. Further, the U.S. Department of Health and Human Services Office for Civil Rights does not endorse any of the applications that allow for video chats listed above.

Disclaimer: The reference to named video- and text-based communications software for telehealth is informational and not intended as an endorsement of those services.

The Centers for Medicare & Medicaid Services is making it easier for patients enrolled in Medicare to receive medical care using telehealth technology. See also Billing Medicare for Fee-for-Service telehealth.

Patient location

Health care providers may offer telehealth services to patients located in their homes and outside of designated rural areas.

For the duration of the COVID-19 Public Health Emergency, the Centers for Medicare & Medicaid Services will reimburse telehealth visits in lieu of many in-person appointments.

Practicing across state lines

The Centers for Medicare & Medicaid Services announced a waiver allowing health care providers to furnish telehealth and other services using communications technology wherever the patient is located, including at home, even across state lines.

However, practicing across state lines is subject to requirements set by the states involved. For information about state-level policies and interstate agreements, see Licensing requirements and interstate compacts.

Relationship between patient and provider

During the COVID-19 Public Health Emergency, health care providers may see both new and established patients for telehealth and other visits furnished using communications technology.

Types of telehealth services covered

The Centers for Medicare & Medicaid Services significantly expanded the list of services that can be provided by telehealth during the COVID-19 Public Health Emergency. Some types of telehealth services no longer require both audio and video — visits can be conducted over the telephone. See this list of telehealth services for details.

Types of eligible providers

Generally, any provider who is eligible to bill Medicare for their professional services is eligible to bill for telehealth during this period.

Supervision of health care providers

Health care providers may supervise services through audio and video communication, instead of only in-person.

For more information about these Medicare policy changes, refer to:

During the COVID-19 Public Health Emergency, Federally Qualified Health Centers and Rural Health Clinics can provide telehealth services to patients wherever they are located, including in their homes. This includes coverage of certain audio-only telephone evaluation and management services. For more information, refer to:

Read more about Billing Medicare as a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC).

Almost every state has modified licensure requirements/renewal policies for health care providers in response to COVID-19, including out-of-state requirements for telehealth. For emerging updates and the latest requirements for each state, see:

See also the Provider Bridge exit disclaimer icon  platform, created by the Federation of State Medical Boards, for additional resources related to licensing.

Interstate compacts

Interstate compacts make it easier for health care providers to practice in multiple states — expediting the licensing process or allowing members to practice under a single multistate license. The list below includes some of the larger compacts backed by well-established regulatory boards. Many also meet the federal licensing requirements of the Centers for Medicare & Medicaid Services. For details, see Medicare Clarifies Recognition of Interstate License Compacts (PDF).

For physicians

The Interstate Medical Licensure Compact (IMLC) exit disclaimer icon  streamlines the licensing process for physicians so they can practice medicine in multiple states. About 80% of physicians meet the criteria for licensure through the Compact, according to the Interstate Medical Licensure Compact Commission (IMLCC) exit disclaimer icon . For a list of participating states, see Compact State Map exit disclaimer icon .

For nurses

The Nurse Licensure Compact (NLC) authorizes eligible nurses to practice across multiple member states while maintaining a single license. For a list of member states, see Nurse Licensure Compact (NLC) exit disclaimer icon .

For psychologists

The Psychology Interjurisdictional Compact (PSYPACT) exit disclaimer icon  authorizes eligible psychologists to practice telepsychology across member states. For a list of member states, see Legislative Resources - Map exit disclaimer icon .

For physical therapists

The PT Compact exit disclaimer icon  authorizes eligible physical therapists to work in multiple member states under a single license. For a list of member states, see Compact Map exit disclaimer icon .

For Emergency Medical Services (EMS) workers

The EMS Compact authorizes EMS personnel to work in multiple member states under a single license. For a list of member states, see EMS Compact Member States & Commissioners.

For speech language therapists

The Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC) exit disclaimer icon  authorizes telehealth and in-person practice across state lines. For a list of member states, see Compact Map – ASLPCompact exit disclaimer icon .

The Drug Enforcement Administration (DEA) has made 2 changes related to prescribing controlled substances during the COVID-19 Public Health Emergency.

  • A practitioner can prescribe a controlled substance to a patient using telemedicine, even if the patient isn’t at a hospital or clinic registered with the DEA
  • Qualifying practitioners can prescribe buprenorphine to new and existing patients with opioid use disorder based on a telephone evaluation

For more on the specific requirements for practitioners, see:

Health care providers won’t face administrative sanctions for reducing or waiving any cost-sharing obligations for telehealth services paid for by federal or state health care programs, such as Medicare and Medicaid.

For more information, refer to:

Last updated: October 20, 2020