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The 2020 holiday season is coinciding with a nationwide surge of COVID-19 cases. With great concern that holiday travel to see loved ones may exacerbate community spread of the virus, many states are increasing public health measures before the winter holiday season. As of November 16, 2020, 13 states and D.C. had a quarantine requirement for out-of-state travelers. The U.S. territories also have instituted travel restrictions to limit the spread of COVID-19.

The ASTHO State Health Policy team provides brief updates on 5 of the ten state health policy issues to watch in 2022: mental and behavioral health, rural health, e-cigarettes and flavored tobacco products, HIV and PFAS.

How New Laws Support Telehealth and Access to Health Care How New Laws Support Telehealth and Access to Health Care Ashley Cram Learn how federal and state policies are improving access to health care by supporting telehealth. Telehealth strengthens the health system by reducing barriers to access to health care and extending services to underserved communities. Federal and state policies — many born out of the COVID-19 pandemic — have increased the use of telehealth by patients and providers. This includes expanded reimbursement to allow more providers to deliver telehealth services in more locations and through more modalities. This Health Policy Update summarizes recent federal and state laws and policies that impact telehealth delivery and access to care. Federal Laws and Policies Rural Health Transformation Program Enacted as part of the One Big Beautiful Bill Act in July 2025, the Rural Health Transformation Program appropriates $10 billion per fiscal year for the Centers for Medicare & Medicaid Services (CMS) to award to eligible states looking to improve rural health care. CMS encouraged state applicants to focus on select strategies, including investment in technology platforms that enhance care delivery. This includes tools and resources that support telehealth overall and remote patient monitoring (RPM), which is a way for providers to monitor and support patients through the use of devices that support data collection and transmission. Applicants that participate in interstate licensure compacts are also incentivized throughout the five-year program period by being awarded additional points for participation, which may lead to states pursuing compact legislation in the coming years. Medicare Telehealth Flexibilities Set to Expire During the COVID-19 pandemic, CMS issued numerous flexibilities that authorized broader telehealth use to expand access to care. Flexibilities included expansion of certain audio-only services, geographic areas and patient locations, and additional provider types eligible to deliver telehealth services. Current policy authorizes these pandemic-related telehealth flexibilities through January 30, 2026. Without permanent extension of these flexibilities, Medicare coverage for telehealth services beyond January 30, 2026, telehealth will again be limited to patients living in rural areas and to certain services, providers, and facilities. Physician Fee Schedule Changes CMS establishes the annual Medicare Physician Fee Schedule (PFS), which sets payment policy for health care services provided by physicians and other professionals to Medicare beneficiaries. The 2026 PFS includes new codes for RPM that allow providers to tailor monitoring frequency and engagement levels to meet patient needs. These codes, and the expansion of RPM, allow providers to effectively monitor health indicators such as weight, blood pressure, blood glucose, and respiratory flow rates, to manage health issues. By regularly monitoring a patient’s health status, a provider can reduce the risk of adverse health outcomes and emergency department visits. Additionally, the PFS streamlined the process for adding eligible telehealth services for reimbursement by removing distinction between permanent and provisional services and focusing review on whether services can be delivered via telehealth. State Legislation Impacting Telehealth Delivery States are also developing policy solutions to enable broader access to telehealth services, including expansion of audio-only and RPM services. Audio-only telehealth services are the use of communications technology, without a visual component, to deliver synchronous health care services. This modality can ensure continuity of and access to care for patients who live in areas with limited broadband and/or those who lack access to a video-enabled device. In 2025, at least four states enacted laws related to audio-only telehealth services. This includes at least three states that extended coverage that would have otherwise expired. In Hawaii, SB 1281 extended the expiration of the state’s coverage of certain audio-only behavioral health services through 2027, while Minnesota (HF 2) took a similar approach to audio-only telehealth services, including certain behavioral health and substance use disorder services, through July 1, 2027. Similarly, Maryland (SB 372/HB 869) removed the sunset date for coverage of audio-only telehealth services. And more broadly, Missouri (SB 79) clarified the state’s telehealth definition to include audio-only technologies. RPM uses digital devices to monitor a patient’s health by collecting and sharing health information with providers. RPM is particularly effective for management of chronic conditions, allowing providers to engage in shared decision making with patients and prevent adverse health outcomes through more regular monitoring. In recent years, several states enacted legislation to expand access to RPM including two bills in Louisiana. Enacted in 2024, HB 896 established the Louisiana RPM program for Medicaid patients with chronic conditions and a history of high-cost services, with the goal of improved care coordination and reduced costs. Then in 2025, SB 70 expanded these criteria to include pregnant and postpartum women and infants following discharge from the NICU. In Maryland, HB 553 specifies that the Medicaid program must cover the equipment and provider oversight of blood pressure monitoring for eligible recipients, including pregnant and postpartum individuals and those with chronic health conditions. Lastly, Virginia enacted SB 843 which directs the state Medicaid agency to develop a plan and cost estimate for expanding Medicaid eligibility for RPM for patients with chronic conditions. State and territorial health agencies can encourage public health programs to incorporate telehealth and propose policy solutions that enable broader utilization of telehealth modalities across the entire jurisdiction. States that are interested in expanding access to telehealth can visit ASTHO’s Telehealth Project Initiation and Scoping Assessment to conduct a review and identify opportunities to expand access to telehealth, particularly related to policy, infrastructure, and funding. UD3OA22890-13-00 article yes

Continuing ASTHO’s Legislative Prospectus series—which highlights the top 10 public health policy issues for 2022—this post focuses on mental and behavioral health, as well as supporting the public health workforce.

In 2020 and early 2021, state policymakers took action to raise awareness of the impacts of racism on health outcomes, to reverse the damage of racist polices, and to implement policy changes to ensure that future policies are enacted with a racial equity lens. In the past two years, many states introduced and adopted resolutions declaring racism a public health crisis. In the early weeks of 2022, there is notably less legislation that has been introduced as compared to the same time last year.

ASTHO staff identified a range of evidence-supported policies considered by state legislatures that could prevent ACEs. This report synthesizes these research and policy proposals and is intended for public health practitioners and policymakers who are considering adopting similar policies.

Navigating Public Health Planning with Precision and Purpose Discover examples and best practices for developing strategic plans that enhance community health outcomes. Embarking on the journey of public health planning demands more than good intentions. It requires a meticulous blueprint that encompasses budgetary considerations and strategic timelines, and effectively leverages external support. Across a landscape in which every decision has the potential to uplift entire communities, there are a world of opportunities and details to explore. Included among them are the critical components of crafting a robust plan, the value of engaging contractors, and strategies for optimizing resources. Mining Existing Plans for Insight and Inspiration Organizational strategic plans, Community Health Assessments (CHAs), and Community Health Improvement Plans (CHIPs) can supply guidance and inspiration for comprehensive public health planning. These documents offer both valuable insights into public health initiatives and tangible examples of effective planning frameworks. There are multiple examples of existing plans within health agencies across jurisdictions; when seeking them out, consider various criteria (e.g., population characteristics, geographic location, and specific health priorities). By examining plans tailored to communities with similar demographics or facing comparable health challenges, planners can apply approaches that resonate in their own context. Additionally, understanding the distinctions between strategic plans, CHAs, and CHIPs is essential, particularly for agencies aspiring towards PHAB Pathways Recognition Program or PHAB Accreditation. These plans are separate entities within the PHAB framework, each playing a vital role in shaping public health strategies and fostering community well-being. Strategic Plans Strategic plans outline organizational goals, plans to achieve them, and how to measure success. They drive resource allocation, decision-making, and other priorities organization wide. Examples U.S. Virgin Islands Hawaii Forest County Potawatomi* El Paso County, CO* San Joaquin County, CA* Community Health Assessments Community health assessments offer a complete view of risks, resources, and factors influencing outcomes. Supported by diverse environmental and socio-economic data, CHAs inform health policy, staff protocols, partnerships, program development, funding, resource allocation, and health improvement planning. Examples U.S. Virgin Islands Oneida Nation* Forest County Potawatomi* El Paso County, CO* San Joaquin County, CA* Pierce County, WA* Community Health Improvement Plans Community Health Improvement Plans are strategic, collaborative roadmaps derived from CHAs. They outline how health agencies, partners, and communities will unite to enhance overall health. They guide priorities, resource allocation, and steer project, program, and policy implementation. Examples U.S. Virgin Islands Hawaii Oneida Nation* Forest County Potawatomi* El Paso County, CO* San Joaquin County, CA* Pierce County, WA* *PHAB Accredited Health Department Plan Components, Timeline, and Budget Agencies considering planning processes and examples from other jurisdictions should recognize the diversity in approaches across different agencies and jurisdictions. There truly isn’t a singular “right” way to undertake public health planning. Instead, it’s about tailoring the process to suit the jurisdiction’s unique needs and circumstances. Examples to Guide Plan Development The Kansas Institute of Health’s Strategic Planning in the Public Health Sector Handbook offers a comprehensive breakdown of planning elements and timeframes based on a six-month plan development calendar. Explore Minnesota Department of Health’s Community Health Assessment and Planning Toolkit, a rich resource for navigating the CHA-CHIP process and timeline. Their template includes a detailed approach that considers capacity to accomplish each step within a desired timeline. Given the variation in the depth and breadth of jurisdiction planning processes, it is challenging to pinpoint a specific dollar amount to cover a planning endeavor. NACCHO’s MAPP Budget Template (part of their downloadable MAPP 2.0 process) can help systematically think through the resources necessary for planning processes. Outsourcing Key Support External support—in the form of facilitators, contractors, or other specialized professionals—can play a pivotal role in enhancing public health planning by offering fresh insights, innovative strategies, and diverse perspectives. Such support also allows for full, active organizational participation in the planning process. Moreover, they can provide valuable technical assistance, helping to navigate complex challenges and identify best practices from other contexts. By harnessing external support, organizations can optimize their decision-making processes, foster collaboration, and enhance the delivery of services to communities, thereby promoting better health outcomes for all. Conducting a SWOT Analysis: Contractors can assist in facilitating a thorough analysis of the organization's strengths, weaknesses, opportunities, and threats (SWOT). This structured assessment helps identify internal factors that impact the organization's ability to achieve its objectives and external factors that may affect its operations. Proposing Strategic Priorities: Based on the SWOT analysis and input from stakeholders, contractors can help planning teams crystallize priorities aligned with the organization's mission and vision. These priorities serve as the foundation for developing the plan. Facilitating Steering Committee Meetings: Steering committee meetings are crucial for decision-making and guiding the strategic planning process. External facilitators can lead these meetings, ensuring productive discussions, consensus-building, and alignment with organizational goals. Developing Components of the Strategic Plan: Contractors can support in drafting or reviewing various components of the plan, including vision and mission statements, goals, objectives, and action plans. They may ensure these components are clear, concise, and aligned with the overarching strategic direction. Developing a Draft Implementation Plan: An implementation plan outlines how to achieve strategic goals, including timelines, responsible parties, and resource allocation. Contractors can support an organization to develop a draft implementation plan that outlines actionable steps to translate the strategic plan into reality. Developing Quality Improvement Metrics: Contractors can assist in guiding the development of metrics to measure the effectiveness of the strategic plan. These metrics should be specific, measurable, achievable, relevant, and time-bound (SMART), providing a framework for monitoring progress and making data-driven decisions. Conducting Training Among Organization Staff: To ensure buy-in and understanding of the strategic plan and process itself, contractors can help develop and co-facilitate training sessions for staff members. These sessions may cover strategic objectives, action plans, and their roles in achieving organizational goals. Developing a Communication Plan: Effective communication is an essential key for keeping any strategic plan off the shelf. Contractors can support an organization in developing a comprehensive communication plan that outlines key messages, target audiences, communication channels, and timelines to ensure consistent and transparent communication throughout the organization and with partners. Developing Process Logs, Templates, and Meeting Notes: Contractors can create documentation tools such as process logs, templates for strategic planning documents, and detailed meeting notes. These resources streamline the planning process, capture important discussions and decisions, and serve as valuable references when considering sustainability. In summary, external support brings valuable expertise and resources to public health planning processes, enabling organizations to navigate complexities, engage partners effectively, and develop actionable strategic plans that drive positive health outcomes for communities. OE22-2203 PHIG website yes

During the 2023 legislative session, a number of states enacted policies that advance ACEs prevention measures and support families in ensuring safe places for their children to live, grow, and play.