Transforming the Telemedicine Regulatory Landscape on a State and Federal Level

For the past 20 years, InSight Telepsychiatry has led the growth of the telepsychiatry industry. Driven by our mission to transform access to health care through innovative applications of technology, InSight has provided telepsychiatry services to a multitude of settings and consumers across all populations.  Given our two decades of experience within this field, InSight has become the leading national telepsychiatry service provider organization.

One reason InSight has become a leading expert in the industry is due to the early recognition that telehealth friendly federal and state regulations would be key determinants of the success of the field. Back in 1999, the regulatory landscape surrounding telemedicine and telepsychiatry was largely unregulated. Telepsychiatry was still a novel application of medicine and there were limited state and federal restrictions surrounding it. InSight turned this unregulated landscape into an opportunity to advocate for and help craft telehealth friendly guidelines and legislation that exemplified the impact that telepsychiatry could have on the practice of medicine.

Federal Level Advocacy

On a federal level, the most significant regulatory influence on telepsychiatry has been the Ryan Haight Online Pharmacy Consumer Protection Act. Passed in 2008, the Act is named after a young man who overdosed and subsequently died after ordering prescription pills through an online survey. The intention of this Act was to crack down on rogue internet pharmacies by limiting the prescribing of controlled substances without a prior in-person examination. On its face, the Ryan Haight Act is not intended to limit the legitimate practice of telemedicine and even went as far as to outline seven “practice of telemedicine” exceptions to the in-person examination requirement. Unfortunately, while well intentioned, the exceptions are very narrow in scope and do not fully contemplate the current and future application of telemedicine.

One of those outlined exceptions was if a provider had a special registration for telemedicine. To date, however, the Drug Enforcement Agency (DEA) has yet to develop this registration process. This lack of action spurred InSight to advocate strongly for its development for the past five years. In 2015, a group of telemedicine advocates, including InSight, started to put pressure on the DEA to create this registration. InSight worked in conjunction with a small committee from the American Telemedicine Association (ATA) Telemental Health Special Interest Group to craft a letter to the DEA that focused heavily on the applications of controlled substance prescribing for child and adolescent telepsychiatry. While this letter resulted in both groups meeting with the DEA to discuss this issue in 2016, efforts stalled again for the next several years.

In 2018, with growing attention surrounding the opioid crisis and the rise of Medication Assisted Treatment (MAT), interest in a special registration resurfaced due to the enactment of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. Signed into law in October 2018, this package of bills was intended to combat the growing opioid crisis in the United States. One key aspect of the Act was the provision that required the DEA to create a special registration for telemedicine no later than one year after the SUPPORT Act’s enactment. For the first time since the Ryan Haight Act was adopted in 2008, the DEA had a deadline to put this registration in place.

With this deadline in place, InSight assisted the ATA in creating and releasing another letter, very similar to the 2015 letter, that provided detailed recommendations for what a special registration should look like. Overall, the recommendations were centered around the idea that the registration should allow for care anywhere, anyway, meaning that either a provider or a facility should be able to qualify for a special registration. Although the registration has yet to be proposed, InSight is continuing to be a staunch advocate to have the long-awaited registration in place in order to increase access to care to even more consumers.

State Level Advocacy

InSight’s advocacy efforts continue on the state level as well. InSight’s CEO, Geoffrey Boyce, played a key role in drafting language for New Jersey Senate Bill No. 2729, which introduced significant regulations for the proper delivery of health care services through telemedicine in 2015. He was among experts to testify before the New Jersey state Senate Health, Human Services and Senior Citizens Committee on the current and potential applications of telemedicine services and continued to be a resource to policymakers throughout the process. Boyce also played a role in passing the New Jersey Telemedicine Bill in 2017.

In addition to New Jersey, InSight assisted Delaware in drafting its own telemedicine policy. Boyce worked closely with the Delaware Telehealth Coalition, the Delaware Medical Society and other stakeholders to draft legislation that made telemedicine more broadly available in the state. The bill passed remarkably quickly and granted telemedicine parity for private payer reimbursement.

While InSight continues to advocate for telehealth regulations on both the national and state levels, present-day advocacy efforts have expanded to focus on topics such as licensure compacts. Compacts, like the Interstate Medical Licensure Compact and the Nurse Licensure Compact, offer providers an expedited pathway to licensure for those who want to practice in multiple states. This is important particularly for telemedicine providers since all states require providers to be licensed in the state where the patient is located at the time of the encounter.  Given that the traditional licensure application process is typically redundant and time-consuming, InSight has been a strong advocate for compacts as they create a more streamlined process for licensure in participating states. Furthermore, InSight recently joined the ATA’s Interstate Special Interest Group that focuses on increasing states’ uptake in introducing compact legislation and on education around the benefits of these compacts.

Overall, InSight is committed to the growth of appropriate, clinically sound telepsychiatry and will continue to advocate for telehealth friendly policies and regulations across the county. Backed with 20 years of experience, InSight is prepared to help influence positive telehealth regulations for years to come.

About InSight Telepsychiatry

InSight is the leading national telepsychiatry service provider organization with a mission to increase access to quality behavioral health care through innovative applications of technology.  InSight has over two decades of telepsychiatry experience and serves hundreds of organizations across the country with its on-demand, scheduled services and Inpathy divisions. InSight is uniquely positioned to offer scalable telepsychiatry services in settings across the continuum of care. InSight has a diverse team of psychiatry providers, a robust internal infrastructure and a history of adapting its programs to fit the needs of a variety of different settings and populations.  InSight has led the growth of the telepsychiatry industry and remains an industry thought leader and advocate.  To learn more about telepsychiatry and how it can benefit you or your organization, visit www.InSightTelepsychiatry.com.