Requirements

Each issuer of a health coverage plan shall display in a conspicuous manner on the health coverage plan issuer’s website information regarding how to receive covered telehealth healthcare services and remote patient monitoring services.

A link clearly identified on the health coverage plan’s issuer’s website to the information required pursuant to this Subsection shall be sufficient to meet the requirements of this Section.

This Section shall not require an issuer of a health coverage plan to display negotiated contract payment rates for healthcare providers who contract with the issuer to provide telehealth healthcare services.

SOURCE: LA Revised Statute Sec. 22: 1842, (Accessed Feb. 2025).

To receive reimbursement for the delivery of remote patient monitoring services through telehealth, all of the following conditions shall be met:

The services shall consist of all of the following:

• An assessment, problem identification, and evaluation which includes all of the following:
  • Assessment and monitoring of clinical data including but not limited to appropriate vital signs, pain levels, and other biometric measures specified in the plan of care and an assessment of responses to previous changes in the plan of care.
  • Detection of condition changes based on the telehealth encounter that may indicate the need for a change in the plan of care.
• Implementation of a management plan through one or more of the following:
  • Teaching regarding medication management as appropriate based on the telehealth findings for that encounter.
  • Teaching regarding other interventions as appropriate to both the patient and the caregiver.
  • Management and evaluation of the plan of care including changes in visit frequency or addition of other skilled services.
  • Coordination of care with the ordering healthcare provider regarding the telehealth findings.
  • Coordination and referral to other healthcare providers as needed.
  • Referral for an in-person visit or the emergency room as needed.

See statute for entity protocols.

 SOURCE: LA Revised Statute Sec. Sec. 22: 1843. (Accessed Feb. 2025).

Notwithstanding any provision of any policy or contract of insurance or health benefits issued, whenever the policy provides for payment, benefit, or reimbursement for any healthcare service, including but not limited to diagnostic testing, treatment, referral, or consultation, and the healthcare service is performed via transmitted electronic imaging or telehealth, the payment, benefit, or reimbursement under the policy or contract shall not be denied to a licensed physician conducting or participating in the transmission at the originating healthcare facility or terminus who is physically present with the individual who is the subject of the electronic imaging transmission and is contemporaneously communicating and interacting with a licensed physician at the receiving terminus of the transmission. The payment, benefit, or reimbursement to the licensed physician at the originating facility or terminus shall not be less than seventy-five percent of the reasonable and customary amount of payment, benefit, or reimbursement that the licensed physician receives for an intermediate office visit.

Any healthcare service proposed to be performed or performed via transmitted electronic imaging or telehealth pursuant to this Subsection shall be subject to the applicable utilization review criteria and requirements of the insurer. Terminology in a health and accident insurance policy or contract that either discriminates against or prohibits such a method of transmitted electronic imaging or telehealth shall be void as against public policy of providing the highest quality health care to the citizens of the state.

The provisions of this Subsection shall not apply to limited benefit health insurance policies or contracts authorized to be issued in the state.

SOURCE: LA Revised Statutes 22:1821(F). (Accessed Feb. 2025).

Requirements in the event of a declared emergency

Health insurance issuers shall waive any coverage limitations restricting telemedicine access to providers included within a plan’s telemedicine network.

Health insurance issuers shall waive any requirement that the patient and provider have a prior relationship in order to have services delivered through telemedicine.

Health insurance issuers shall cover mental health services provided by telemedicine consultation to the same extent the services would be covered if provided through an in-person consultation. This shall not be interpreted to require coverage of telemedicine services that cannot be appropriately provided remotely.

Health insurance issuers shall waive any requirement limiting coverage to provider-to-provider consultations only and shall cover telemedicine consultations between a patient and a provider to the extent the same services would be covered if provided in person.

SOURCE: LA Admin Code, Sec. 37:XIII.17947, (Accessed Feb. 2025).

When the governor declares a state of emergency or a public health emergency, the commissioner may issue emergency rules or regulations that may remove restraints to telehealth and telemedicine, as well as other things. See statute for full details.

SOURCE: LA Revised Statute 22:11(C) (Accessed Feb. 2025).

Physical Therapy

A health coverage plan shall pay for covered physical therapy services provided via telehealth to an insured person.

A health coverage plan shall require a healthcare professional to be licensed or otherwise authorized to practice physical therapy in this state to be eligible to receive payment for telehealth services.

A health coverage plan shall not do any of the following:

• Require a previously established in-person relationship or the provider to be physically present with a patient or client, unless the provider determines that it is necessary to perform that service in person.
• Require prior authorization, medical review, or administrative clearance for telehealth that would not be required if that service were provided in person.
• Require demonstration that it is necessary to provide services to a patient or client as telehealth.
• Require a provider to be employed by another provider or agency in order to provide telehealth services that would not be required if that service were provided in person.
• Restrict or deny coverage based solely on the communication technology or application used to provide the telehealth service; however, a health coverage plan may restrict physical therapy services via telehealth when the services are being provided solely by telephone.
• Impose specific requirements or limitations on the technologies used to provide telehealth services; however, a health coverage plan may require the provider to demonstrate that the technology used to provide telehealth services is both safe and secure.
• Impose additional certification, location, or training requirements as a condition of payment for telehealth services; however, this Paragraph does not prohibit a health coverage plan from providing additional reimbursement incentives  to providers with an enhanced certification, training, or accreditation.
• Require a provider to be part of a telehealth network.

A health coverage plan is not required to provide coverage or reimbursement for any of the following procedures or services provided via telehealth:

• A modality that is a type of electrical, thermal, or mechanical energy.
• Manual therapy, massage, dry needling, or other invasive procedures

SOURCE: LA Revised Statute 22:1845.1, (Accessed Feb. 2025).

Occupational Therapy

Telehealth coverage and reimbursement for occupational therapy; prohibitions and limitations; exceptions; rulemaking

• A health coverage plan shall pay for covered occupational therapy services provided via telehealth to an insured person. Telehealth coverage and payment shall be equivalent to the coverage and payment for the same service provided in person unless the telehealth provider and the health coverage plan contractually agree to an alternative payment rate for telehealth services.
• Benefits for a service provided as telehealth may be subject to a deductible, copayment, or coinsurance. A deductible, copayment, or coinsurance applicable to a particular service provided through telecommunications technology shall not exceed the deductible, copayment, or coinsurance required by the health coverage plan for the same service when provided in person.
• A health coverage plan shall not impose an annual dollar maximum on coverage for healthcare services covered under the health coverage plan that are provided as telehealth, other than an annual dollar maximum that applies to the same services when provided in person by the same provider.
• A health coverage plan shall require a healthcare professional to be licensed or otherwise authorized to practice occupational therapy in this state to be eligible to receive payment for telehealth services.
• Payment made pursuant to this Section shall be consistent with any provider network arrangements that have been established for the health coverage plan.
• A health coverage plan shall not do any of the following:
  • Require a previously established in-person relationship or the provider to be physically present with a patient or client, unless the provider determines that it is necessary to perform that service in person.
  • Require prior authorization, medical review, or administrative clearance for telehealth that would not be required if that service were provided in person.
  • Require demonstration that it is necessary to provide services to a patient or client as telehealth.
  • Require a provider to be employed by another provider or agency in order to provide telehealth services that would not be required if that service were provided in person.
  • Restrict or deny coverage based solely on the communication technology or application used to provide the telehealth service; however, a health coverage plan may restrict occupational therapy services via telehealth when the services are being provided solely by telephone.
  • Impose specific requirements or limitations on the technologies used to provide telehealth services; however, a health coverage plan may require the provider to demonstrate that the technology used to provide telehealth services is both safe and secure.
  • Impose additional certification, location, or training requirements as a condition of payment for telehealth services; however, this Paragraph does not prohibit a health coverage plan from providing additional reimbursement incentives to providers with an enhanced certification, training, or accreditation.
  • Require a provider to be part of a telehealth network.
• Nothing in this Section shall be construed to require a health coverage plan to do either of the following:
  • Provide coverage for telehealth services that are not medically necessary.
  • Reimburse any fees charged by a telehealth facility for transmission of a telehealth encounter.
• A health coverage plan is not required to provide coverage or reimbursement for any of the following procedures or services provided via telehealth:
  • A modality that is a type of electrical, thermal, or mechanical energy.
  • Manual therapy, massage, dry needling, or other invasive procedures.

The department may take any action authorized in this Title to enforce the provisions of this Section and the commissioner may, in compliance with the Administrative Procedure Act, R.S. 49:950 et seq., promulgate and adopt rules as are necessary or advisable to effectuate the provisions of this Section.

SOURCE: LA Revised Statute 22:1845.2, (Accessed Feb. 2025).