COVID-19 Prompts Telerehab Regulation Changes

2 years ago

COVID-19 Prompts Telerehab Regulation Changes

COVID-19 has caused tremendous disruption within the workers’ compensation industry. In a recent webinar, we sat down with One Call’s government solutions team Thomas Novelli, VP of Government Relations & Public Affairs, and Susan Curley, Director of Government Relations, to discuss how COVID-19 impacted regulation changes for telehealth services, specifically telerehab. 

Webinar: COVID-19 Prompts Telerehab Regulation Changes
Instructor: Thomas Novelli, VP of Government Relations & Public Affairs, One Call


Telehealth laws and regulations changed more significantly in the two months following the pandemic declaration than they had over the previous 10 years. Telehealth technology has existed for more than three years but was not widely adopted. Once stay-at-home orders were enacted, the medical community turned to telehealth services as its primary patient-care solution, forcing lawmakers to modify regulations to facilitate treatment. 


As the government relations team discusses policy changes, it is important to have a fundamental understanding of key terms and the differences between them. Below are five terms referenced throughout the webinar. 

  • Telehealth: Refers broadly to electronic and telecommunication technologies used to provide care and services at-a-distance. 
  • Telemedicine: The practice of medicine using technology to deliver care at a distance. A physician in one location uses a telecommunications infrastructure to deliver care to a patient at a distant site. 
  • Telerehab: The delivery of rehabilitation services via information and communication technologies, such as audio and visual platforms. This can include a broad range of rehabilitative services, including physical therapy
  • Law: A rule of conduct or action prescribed or formally recognized as binding or enforced by a controlling authority. 
  • Regulation: Rules from respective agencies about how laws are enforced. Creates the context or framework of a law. 

Telehealth and Workers’ Compensation

Workers’ compensation regulatory policies are influenced by a complex array of external factors, including federal regulations (ex: Centers for Medicare & Medicaid Services, CMS), federal laws, state regulations, and state laws. With different entities influencing regulations, it can lead to confusion surrounding coverage of care. Some common misperceptions include: 

  • Telehealth automatically means telerehab
  • Changes to CMS telehealth policy automatically trigger state changes
  • Any provider can treat any patient across the country  

It is important to note that many policies provided by CMS, including use of telehealth, are meant to inform the individual state workers’ compensation policies but do not dictate regulation. As a result, many states select elements of CMS policies to workers’ compensation policies. In contrast, federal laws, such as HIPAA, apply universally and workers’ compensation boards and states cannot preempt. 

Regulatory Changes Due the COVID-19 Pandemic 

Following the emergency declaration by the federal government, changes were quickly made to the CMS policies to expand use of telehealth services to meet the on-going recovery needs for injured workers. Key milestones included: 

  • March 17: CMS expands use of telehealth with 1135 waiver
  • March 30: CMS allows additional CPT codes to be utilized
  • April 30: CMS clarifies who can furnish/bill for services 

Lawmakers are responding to constituents in real-time, resulting in on-going regulation modifications. Another significant change is medical licensure reciprocity. A challenge for telehealth prior to COVID-19 was the ability for providers to treat across state lines. At the time this webinar was recorded, 49 states enacted waivers for telehealth providers, an increase from approximately 26 prior to COVID-19.  The term “provider” does not always include physical or occupational therapists, please review each state’s regulations for current status. 

In addition to federal changes, every state has modified its regulations around telehealth -while continuing to make modifications as the pandemic evolves. No two states are alike, leaving room for interpretation. When comparing North Dakota to Hawaii – North Dakota has issued specific guidelines, outlined codes and restrictions, and recognized physical medicine.  In contrast, Hawaii does not have specific policies or procedures in place and references a link to the CMS guidelines for current regulations. 

As providers and patients use telehealth services and the country moves forward, the utilization and permanency of this product is unclear. CMS rule changes are likely to be permanent which may pressure states to review and refine their individual regulations.    

For questions regarding state specific regulatory changes, please contact Thomas Novelli at 

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What is Telerehab? Telerehab is a virtual treatment option that brings providers right into a patient's home with extended therapy hours and eliminating the need to travel. Click here to learn more about telerehab or email to begin utilizing telerehab services. 

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