Did State-level telehealth policies in 2020 Reduce Urban-rural Disparity in Care Utilization? A Multilevel Analysis

Introduction We aim to examine whether state-level telehealth policies in 2020 were associated with a reduction in the urban-rural disparity in telehealth utilization. Method A multilevel model was used to assess state actions’ impact on urban-rural differences in healthcare utilization. We used the percentage of Medicare Fee-for-Service beneficiaries receiving any telehealth services (measured by county level) in 2020 as the dependent variable. We examined the following state-level policies as key independent variables at the state level: 1) telehealth coverage parity requirement for payers; 2) recognizing a call from patient’s address as the originating site of telehealth visit; 3) mandating the coverage of audio-only telehealth visits. Results Both mandating the coverage of audio-only visits and telehealth coverage parity requirement were significantly associated with higher level of telehealth utilization. For audio-only reimbursement mandate and telehealth coverage parity requirement, the interaction between the state policy and the county’s rurality was associated with a significant increase in telehealth utilization rate, whereas the interaction between the state’s waiver for the requirement of originating site and the county’s rurality was negatively associated with telehealth utilization rate. Conclusion The audio-only telecare reimbursement mandate and telehealth payment parity could help close the urban-rural gap in telehealth utilization.