Telemedicine is a way to provide physical and behavioral health services virtually, such as through video conferencing or over the phone. In Pennsylvania, Medical Assistance (MA) enrolled providers have been allowed to provide physical health and behavioral health services since 2007 and 2011, respectively, but the option was not widely used until many providers had to deliver services via telemedicine during the COVID-19 pandemic. Similarly, commercial health insurance plans may have had individual policies allowing for reimbursement for services provided via telemedicine but there is no statute in Pennsylvania that explicitly authorizes the use or disallowance of telemedicine in Pennsylvania or that sets reimbursement rates for services delivered by telemedicine.
With regard to licensed healthcare practitioners and the use of telemedicine, there is currently no statute in Pennsylvania that explicitly authorizes its use, nor one that explicitly prohibits it. This was true even before the pandemic. The purpose of the telemedicine waiver issued by the Department of State at the beginning of the COVID-19 disaster declaration was to address significant confusion and make it clear that licensees under the Department’s Bureau of Professional and Occupational Affairs (BPOA) health-licensing boards can provide services within their existing scopes of practice via the use of telemedicine when appropriate, provided it is done according to accepted standards of care.
While engaging in telemedicine is allowable from a professional licensing standpoint, it is important to note that there may be additional issues to consider − such as, for example, insurance coverage, payment and reimbursement, and the intersection of telemedicine services with existing facility licensing requirements that must be met by hospitals or other licensed health care facilities.
These additional considerations are not within the purview of the Department of State. Rather, such issues fall within the purview of other state and federal agencies, such as the Pennsylvania Department of Human Services (DHS), the Pennsylvania Insurance Department, the Pennsylvania Department of Drug and Alcohol Prevention (DDAP), and the Pennsylvania Department of Health (DOH).
Act 30 of 2022 extended certain COVID-19 waivers — including the BPOA telemedicine waiver — until October 31, 2022, unless terminated sooner by the agencies that issued them. The Department of State has no plans to expire its telemedicine waiver prior to October 31, 2022. When the telemedicine waiver does expire, it will not affect licensees’ continued use of telemedicine from a professional licensing standpoint. It will continue to be allowable in the same way it was allowable prior to the pandemic.
Act 30 of 2022 also extended suspended regulations for DHS, DOH, DDAP, and DOS, including extending the suspended regulations tied to the federal Public Health Emergency (PHE) until the PHE or federal authorization of the flexibility allowed under the PHE ends. A full list of suspended regulations across agencies can be found here.
Yes. The Department of Human Services (DHS) has allowed services to be provided via telemedicine since 2007 and has allowed MA-enrolled providers to bill MA for these services. MA enrolled providers should consult the Office of Medical Assistance Programs (OMAP) and Office of Mental Health and Substance Abuse Services (OMHSAS) telemedicine bulletins for more information on service delivery and billing (see question 7 below). DHS will continue allowing physical health and behavioral health services to be provided via telemedicine delivery and will continue to reimburse at the same rate as services delivered in-person in the fee for service program. The Managed Care Organizations (MCOs) may, but are not required to, allow for the use of telemedicine. MA MCOs may negotiate payment for services rendered via telemedicine.
The MA program will continue to reimburse both physical health and behavioral services delivered via telemedicine after October 31, 2022, when the suspended regulations expire.
Act 98 of 2022 permanently abrogated the two DHS regulations that prohibited payment specifically for audio-only telehealth service delivery—outpatient psychiatric clinics (which includes Mobile Mental Health Treatment and Partial Hospitalization Outpatient Services) under 55 Pa. Code § 1153.14(1), and Outpatient Drug & Alcohol Clinic Services under 55 Pa. Code § 1223.14(2). Providers will no longer be required to submit waiver requests for audio-only telehealth service delivery when delivered in accordance with DHS telehealth bulletins (see question 7).
DHS will continue to reimburse services delivered via telemedicine at the same rates as in-person delivered services for the MA Fee-for-Service (FFS) Program.
MA MCOs may negotiate payment for services rendered via telemedicine in the MA HealthChoices managed care program. To date, all MCOs are reimbursing for services delivered via telemedicine. DHS cannot require the MCOs to have payment parity for services delivered via telemedicine, as MCOs are allowed to negotiate rates. Our understanding is that the MCOs are reimbursing for telemedicine currently and most, if not all, are currently paying the same rates for services delivered via telemedicine. DHS will be surveying the MCOs to determine if they plan to continue reimbursing at the same rate for services delivered via telemedicine.
Coverage for, and reimbursement of, services delivered via telemedicine will be dependent on each commercial insurer’s coverage and operational policies, as well as the terms of any applicable provider contracts. This includes payment rates, as there are no insurance laws or regulations requiring payment parity. The Pennsylvania Insurance Department (PID) surveyed the commercial insurers and determined that all insurers were covering telehealth services to some extent at the time of the survey. The Department has not been made aware of any significant changes since the survey was completed. Moreover, no insurer has reported that it is planning major changes for telehealth coverage post-PHE, but many of them indicated they will likely re-evaluate their policies at the end of the PHE.
Coverage for, and reimbursement of, services delivered via telemedicine will continue to be dependent on each commercial insurer’s coverage and operational policies, as well as the terms of any applicable provider contracts. Insurers may have policy limitations that prohibit coverage for school-based services. The only exception is that for fully-funded coverage subject to PA insurance law, autism services may not be denied solely on the basis that the service is provided in a school setting.
as clarified in MA
Bulletin 99-22-02, telemedicine remains a mode of service deliveries
that providers can utilize. FQHCs that are licensed by the Office of Mental
Health and Substance Abuse Services should refer to bulletin OMHSAS-22-02
- Revised Guidelines for Delivery of BH Services Through Telehealth 7.1.22.pdf
(pa.gov) when rendering the
behavioral health services for which they are licensed. In addition, DHS
recently issued MA
Bulletin 08-22-13, 27-22-07 related to teledentistry services that is also
relevant to FQHC providers that offer dental services.
After October 31, hospitals will continue to be permitted to provide telehealth/telemedicine services in accordance with the Pennsylvania Department of Health’s Telemedicine Survey Guidelines. Hospitals providing health care services via telehealth/telemedicine should refer to the guidelines for information on the conditions under which the services can be provided.
licensee can be disciplined for a violation of a provision in a practice act or
regulations of the Board. Health care practitioners must also practice within
the acceptable and prevailing standard of care. Because the practice acts and
regulations do not currently address the provision of health-related services
by telehealth/telemedicine, there could be no violation for simply using
telehealth/telemedicine after October 31, 2022, and in general there is nothing
that would prohibit licensees from using telehealth/telemedicine so long as
doing so complies with the standards of acceptable and prevailing medical
practice. This was true even prior to the pandemic. It is possible, however,
that violations of certain regulations could occur in some circumstances where
telemedicine is used. For example, there are regulations that specifically call
for a physical examination to be conducted. If a Pennsylvania-licensed
instead “examines” the patient via telemedicine, there could be a violation of
the regulation. The violation would not be for the practitioner’s use of
telemedicine, but rather the practitioner’s failure to conduct the required
The Department of Drug and Alcohol Programs (DDAP) currently has two regulatory suspensions that allow for the initial evaluation for a patient who will be treated with buprenorphine for their opioid use disorder (OUD) at a narcotic treatment provider (NTP) to be completed via telehealth. The suspension of 28 Pa. Code § 715.9(a)(4) permits NTPs to admit patients for buprenorphine treatment without an initial in-person physical exam, and the suspension of 28 Pa. Code § 715.6(d) relaxes the requirement for NTPs to have narcotic treatment physician services onsite. Under Act 30 of 2022, these regulatory suspensions are “related to federal exemptions granted under the federal public health emergency declaration” and will continue until “the last day federal exemptions granted under the federal public health emergency declaration are authorized.” DDAP is aware that U.S. DEA is working on permanent regulations for buprenorphine teleprescribing, but does not currently know any additional details or timeline.
On September 4, 2020, the Department of State issued a waiver suspending the State Board of Medicine’s regulation at 49 Pa. Code § 16.92(b)(1), which requires an initial physical examination of a patient prior to prescribing buprenorphine for the treatment of opioid use disorder. This waiver was sought specifically to complement DDAP’s suspension of 28 Pa. Code § 715.9(a)(4)).
This waiver “relates to Federal exemptions granted under the Federal public health emergency declaration,” specifically the exemptions granted by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) and the U.S. Drug Enforcement Agency (DEA).
Therefore, in accordance with section 2102-F(a.3) of the Pennsylvania Administrative Code of 1929 (amended by Act 14 of 2022), the Department of State’s waiver will continue until the last day of the federal public health emergency declaration, unless the exemptions are ended sooner by the Substance Abuse and Mental Health Services Administration (SAMHSA) or the U.S. Drug Enforcement Administration (DEA). More information about the federal public health emergency can be found here.
It is important to note that, to be considered within the acceptable and prevailing standard of care, the physician/prescriber must be following the applicable SAMHSA/DEA guidelines.
Additional information may be found at:
As was the case prior to the pandemic, practitioners
wishing to provide services to individuals in Pennsylvania need to be licensed
in Pennsylvania in order to practice in Pennsylvania. This holds true whether
the provision of services occurs in-person or via an electronic interaction
such as a telehealth consultation. Practitioners who are not licensed in
Pennsylvania and wish to provide services to individuals in Pennsylvania via
telemedicine or otherwise may apply for licensure here: https://www.pals.pa.gov.