What Improvements are Needed for South Carolina Telehealth Policy?

In February 2024, the General Assembly passed the SC Telehealth and Telemedicine Modernization Act (“The Act”). This legislation outlined a new definition of “Telehealth” as well as enhanced access to specific controlled substances through telehealth by updating tele-prescribing regulations. The update was careful to preserve necessary safeguards.

The Act was a good first step, but how can South Carolina move more aggressively toward true telehealth freedom?

The Cicero Institute has some answers to that question.

In January 2024, Cicero published a report titled 2024 State Policy Agenda for Telehealth Innovation. In this monograph, authors rated the 50 states in 4 telehealth categories: “Modality Neutral,” “Start Telehealth by Any Mode,” “No Barriers to Across State Line Telehealth,” and “Independent Practice for Nurse Practitioners.”

South Carolina was found to be deficient in three of the four categories:

Modality Neutral. Using the American Telemedicine Association’s definition, telehealth includes various methods and technologies, both synchronous (with a live medical provider interacting in real-time) and asynchronous (communication that is not live). South Carolina has received good marks for allowing both synchronous and asynchronous doctor-patient relationships but does not have legislation that specifically mentions remote patient monitoring. Remote monitoring is when a patient’s personal health data, such as heart rate, blood sugar, blood pressure, weight, etc., is transferred via electronic communications.

Start Telehealth by Any Mode. In this category, the authors consider accommodations for interaction with healthcare providers that ensure a patient and provider can start their relationship using any form of telehealth.  While South Carolina was listed with states that allow both synchronous and asynchronous options, South Carolina is not the ideal.  The ideal model was an example listed in their report from Idaho. That state passed legislation that not only allowed for more across-state-line care and also updated state law to explicitly allow providers to start a relationship with a patient using asynchronous options. For example, a relationship with a provider could be initiated by text message.

No Barriers to Across State Lines Telehealth. South Carolina, which is particularly poorly rated in this area, follows many other states in this category, where there are clear barriers that prevent across-state-line telehealth care. By being allowed to provide telehealth care across-state-lines, patients are given access to specific healthcare not available in their area. In Louisiana, legislators passed a law to clearly open a pathway for patient access to provider options from other states through an interstate registration. Cicero highlights Utah’s legislation as one of the most promising in this category because its provider application process automatically approves a provider after 15 days, so long as the provider is licensed in another state and in good standing.

Independent Practice. States were ranked based on whether Nurse Practitioners (NPs) are allowed to perform at the “top of their license” and perform all of the services they were taught independently or if a doctor must provide oversight. They note the healthcare worker shortage in the United States, which is only projected to grow more. South Carolina is listed with states that do not allow NPs to practice independently without supervision. (Legislation has been filed here in South Carolina but has failed in the past.)

The Cicero Institute included recommendations, in each category, on how to improve before the following year’s report is released. They suggest adding definitions for remote-patient monitoring, ensuring provider-patient relationships can be created regardless of the modality of telehealth, removing the ban on lifestyle prescribing drugs or treatments over telehealth, creating legislation that allows for easy registration for all providers for across state line care, and removing the written protocol for independent practices for nurse practitioners.

South Carolina’s Response

The SC Telehealth and Telemedicine Modernization Act only amended 3 things.

• Defined telehealth as, “the use of electronic communications, information technology, or other means to deliver clinical health care, patient and professional health-related education, public health, or health administration between a licensee in one location and a patient in another location with or without an intervening licensee.”
• Amended the Nurse Practice Act by allowing Nurse Practitioners to perform medical acts as well as prescribe medications via telehealth, but did not change their practice arrangement mandate.
• Changed the previous requirement of an in-person evaluation to prescribe non-narcotics as well as narcotics. Instead, they added exceptions to the previous requirement for patients in palliative care or hospice, when buprenorphine is being prescribed as a medication for opioid use disorder, or when telehealth is being practiced while the patient is physically located in a hospital and being treated.

Room for Improvement

To address all the concerns in the Cicero Institute’s report, South Carolina still has work to do. Legislation needs to be added to allow for streamlined across-state-line telehealth for all providers. In addition, we need to allow telehealth to be more accessible. Although South Carolina has now added a definition for telehealth, it has not explicitly addressed the modalities by which provider-patient relationships can start.

To score higher on the next report, specific definitions must be added to address remote patient monitoring in the provider code. The legislation must also ensure a patient-provider relationship may start over any mode. A lack of clarity in legislation may lead to a lack of availability of telehealth resources for SC citizens. In addition to the introduction of legislation to increase patient-provider relationships, the written protocol for Nurse Practitioners must be removed to allow independent practice.

Cicero’s biggest recommendation for change in South Carolina includes a reciprocity law that allows for out-of-state telehealth and all providers may participate in this easy registration process. Florida passed a law in 2019 that allows for across-state-line telehealth practices. Since then, they have seen very few complaints from patients for out-of-state telehealth providers compared to in-state providers. They have also seen few disciplinary issues.

South Carolina has addressed some of Cicero Institute’s concerns for telehealth requirements, but there is room for significant improvement. In this upcoming legislative session, it is imperative that more telehealth legislation is introduced and passed to ensure telehealth is an easily accessible healthcare option for all