How telehealth visits became the ultimate screen savers

Regulatory waivers for the use of telemedicine services issued during the COVID-19 pandemic proved to be a game-changer in Pennsylvania. The temporary changes allowed doctors, nurses, chiropractors, optometrists, pharmacists, psychologists, therapists, speech pathologists and others to care for patients using telemedicine, and even allowed practitioners who were licensed in another state to treat patients in Pennsylvania. 

When those waivers expired, state lawmakers revisited efforts to pass a law to create a framework for telemedicine services in Pennsylvania. As commonsense as that may sound, such telemedicine legislation frequently failed to earn a signature from the governor due to the addition of a controversial amendment.

The amendment, added to the bill in several legislative sessions, blocked health care providers from prescribing drugs on the U.S. Food & Drug Administration’s Approved Risk Evaluation and Mitigation Strategies (REMS) list, including drugs that induce non-surgical abortions. That amendment drew immediate opposition from then-Gov. Tom Wolf, who refused to sign the bill as long as it included the abortion drug prohibition.

But this year, after years of failed efforts to get a signable bill to the governor’s desk, lawmakers approved Senate Bill 739 – sans the controversial amendment – and advanced it to Democratic Gov. Josh Shapiro’s desk. Shapiro signed the bill into law on July 3, stating that “it shouldn’t be up to an insurance company to pick and choose what they cover.”

The law, Act 42 of 2024, requires health insurance policies issued in Pennsylvania to provide coverage for “medically necessary health care services provided through telemedicine and delivered by a participating network provider …” It goes on to state that “a health insurance policy may not exclude a health care service from coverage solely because the health care service is provided through telemedicine.”

“More and more Pennsylvanians are relying on telemedicine to see their doctors … this bill requires insurers to cover services delivered via telemedicine the same way they cover traditional in-person services,” Shapiro said in July after signing the bill, adding that his administration would continue to work in a bipartisan manner to expand health care access. 

Senate Bill 739 was sponsored by Republican state Sen. Elder Vogel, with Democratic state Rep. Christina Sappey sponsoring the companion legislation in the state House. 

“I think it’s going to have a huge impact on access to health care services for many sectors of folks that don’t have access,” Sappey told City & State in an interview. She said she could see the new law helping populations that otherwise might put off medical care and not be able to access it, like those in rural communities, as well as disabled Pennsylvanians. 

“It takes an enormous amount of time, unfortunately, to make an appointment, find transportation, or drive yourself to an appointment, wait, see the doctor,” Sappey added. “You’re taking a lot of time off of work – for our workforce, that’s problematic.”

She said the bill will be a difference-maker for those living in rural areas, noting that many such parts of the state can be considered health care deserts, or areas where people lack adequate access to key health care services. According to research from GoodRx, more than 80% of counties in the U.S. lack such access. 

“For our rural Pennsylvanians, particularly the farm industry, the agricultural industry, those folks really have a long trip to see a health care provider,” Sappey said. “They live in health care deserts, so making that appointment, it really is basically an entire day away from their operation to go get care. So, unfortunately, they skip care, they skip regular maintenance appointments … sometimes, things are more serious by the time they actually do see a health care provider.” 

According to the National Rural Health Association, 80% of rural America is considered medically underserved, underscoring just how important telehealth can be in addressing gaps in health care access. 

Nicole Stallings, president of The Hospital and Healthsystem Association of Pennsylvania, said Act 42 will also likely relieve some of the burden on overstretched hospitals, health systems and health care workers. 

“Act 42 expands access to routine and preventative care for both physical and behavioral health,” Stallings said. “The commonwealth is navigating extensive health care workforce shortages across specialties, across communities, and this law will extend the reach of those providers.”

She added that the COVID-19 pandemic inspired innovative uses of telemedicine services that could help ease stressors on hospitals while still allowing them to provide care. 

“One of the ways that we saw telehealth be utilized during the pandemic was really exciting, and that was hospitals partnering with nursing homes and doing those visits via telehealth at first to determine if the nursing home resident should even come to a busy hospital emergency room and take up that hospital bed,” she said. “Now it’s an established practice in many of our communities.”

Sappey noted that the new telemedicine law could also benefit Pennsylvanians with disabilities. 

“When I think about the disability community and telemedicine, I’m thinking a lot about our folks in the intellectual disability and autism communities, people who are neurodiverse, particularly families with children in those categories,” she said. “Frequently, they have other children, so taking the entire family to an appointment is the norm for them. If one child gets the flu, or sick, or the tummy bug, the child with a disability then is going to miss a very important appointment – it can be occupational therapy, physical therapy, speech therapy, social skills therapy. These are things that help these young people gain independence in the future, and skipping appointments is really detrimental. So when a family is able to keep an appointment … it’s just incredibly important.”

In addition to helping patients who may have transportation or mobility challenges, Stallings said telehealth services could also play an essential role in improving maternal health care. 

“You could do something like remote patient monitoring during and after a pregnancy so that patients are monitored via scales and blood pressure monitors, so that if there is a troubling reading, those clinicians – they can reach out and make sure that we’re treating that patient before it becomes an emergency,” she added. “I think really having telehealth being integrated into the routine ways in which we provide care to individuals is exciting.”

Still, there are challenges that policymakers and stakeholders can address to continue to improve access to telehealth services in the commonwealth. Stallings said efforts to expand broadband access are crucial to ensuring that people in all corners of the state can access telehealth tools for their health care needs. Looking to the future, she said, lawmakers may want to consider expanding the parameters of who can provide telehealth services in the state, which could ease challenges facing the health care workforce. 

“I think these are conversations that will play out in the future, but for now, I do believe we need to really focus on making sure people have access and can benefit from telehealth, and that includes broadband investments,” she said. 

Given the challenges the law faced over the last several legislative sessions, getting Act 42 across the finish line was a significant lift. Sappey said it’s a prime example of why many lawmakers run for office in the first place – and is worth celebrating.

“Getting this done – this is why we’re in office – to help people,” she said. “I think it’s a wonderful thing.”