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Policy changes during COVID-19

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.

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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 and coding Medicare Fee-for-Service claims.

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 telehealth licensing requirements and interstate compacts and exceptions for interstate telehealth practice and liability under the PREP Act.

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:

Medicare Coverage and Payment of Virtual Services (video) — from the Centers for Medicare & Medicaid Services
List of Telehealth Services (covered for COVID-19) — from the Centers for Medicare & Medicaid Services
COVID-19 Telehealth Coverage Policies — from the National Telehealth Policy Resource Center
COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing (PDF) — from the Centers for Medicare & Medicaid Services
COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers (PDF) — from the Centers for Medicare & Medicaid Services
Coronavirus Waivers & Flexibilities — from the Centers for Medicare & Medicaid Services

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:

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs): CMS Flexibilities to Fight COVID-19 (PDF) — from the Centers for Medicare & Medicaid Services

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:

U.S. States and Territories Modifying Requirements for Telehealth in Response to COVID-19 (PDF) — from the Federation of State Medical Boards
U.S. States and Territories Modifying Licensure Requirements for Physicians in Response to COVID-19 (PDF) — from the Federation of State Medical Boards
COVID-19 Related State Actions — from the National Telehealth Policy Resource Center

Interstate compacts

Interstate compacts (agreements between two or more states) 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) 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) . For a list of participating states, see the Compact state map .

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) .

For psychologists

The Psychology Interjurisdictional Compact (PSYPACT) authorizes eligible psychologists to practice telepsychology across member states. For a list of member states, see legislative resources - map . The Multi-Discipline Licensure Resource Project also offers online and phone support to address psychology licensure questions.

For physical therapists

The PT Compact authorizes eligible physical therapists to work in multiple member states under a single license. For a list of member states, see Compact map . The Multi-Discipline Licensure Resource Project also offers online and phone support to address physical therapy licensure questions.

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) authorizes telehealth and in-person practice across state lines. For a list of member states, see Compact map – ASLPCompact .

The 2005 Public Readiness and Emergency Preparedness Act (PREP Act) authorizes HHS to make declarations that provide immunity from liability in certain emergency circumstances. On December 3, 2020, HHS published Amendment 4 to the PREP Act to preclude state and local governments from establishing or enforcing prohibitions that keep “qualified persons” from administering countermeasures recommended by a PREP Act declaration. Specifically, this allows for interstate practice of telemedicine to improve public health outcomes in an emergency. The December 3, 2020 amendment provides liability protection when delivering specific COVID-19 related services, expands telehealth access, and makes it easier to treat and prevent COVID-19.

Many states already allow providers to deliver out-of-state telehealth services. The new Declaration, however, ensures specific COVID-19 “covered countermeasures’’ can be provided or ordered via telehealth across state lines without additional state licensure. The countermeasures covered by liability immunity include:

Qualified products used to treat, diagnose, cure, prevent, or mitigate COVID-19
Drugs, biological products, or devices authorized for COVID-19 emergency use
Respiratory protective devices approved by the National Institute for Occupational Safety and Health

This exception from state licensure and liability protection applies only to providers ordering or administering the specific covered countermeasures. For more details, see: HHS Amends PREP Act Declaration and 4th Amendment to the Declaration Under the PREP Act .

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:

How to Prescribe Controlled Substance to Patient During the COVID-19 Public Health Emergency (PDF) – from the Drug Enforcement Administration
COVID-19 Information Page — from the Drug Enforcement Administration
Letter to physicians about buprenorphine (PDF) — from the Drug Enforcement Administration

Last updated: January 13, 2021

Policy changes during COVID-19

Incorporating newly allowed technology due to HIPAA flexibility

Providing telehealth services for Medicare patients