Private Payer

Parity

There are two types of parity requirements when it comes to telehealth laws.  One is referred to as coverage or ‘service parity’ and requires the same services be covered via telehealth as would be covered if delivered in-person.  This type of parity does not guarantee the same rate of payment.  The other type of parity, which is less common among states, is ‘payment parity’.  This is a requirement for the same payment rate or amount to be reimbursed via telehealth as would be if it had been delivered in-person.  In determining whether a state has payment parity, CCHP looks for an explicit mention of the payment rate or amount and requirement for it to be the same as in-person services.

Click the map to scroll down to the state

Federal

Last updated 01/19/2022

SERVICE PARITY

There is service parity for Medicare Advantage with …

SERVICE PARITY

There is service parity for Medicare Advantage with what is covered through telehealth by Medicare Part B, however there is not service parity with all covered services generally.

Subject to the conditions and limitations set forth in this subpart, an MA organization offering an MA plan must provide enrollees in that plan with coverage of the basic benefits (except that additional telehealth benefits may be, but are not required to be, offered by the MA plan) and, to the extent applicable, supplemental benefits by furnishing the benefits directly or through arrangements, or by paying for the benefits.

Basic benefits are all items and services (other than hospice care or coverage for organ acquisitions for kidney transplants) for which benefits are available under parts A and B of Medicare, including additional telehealth benefits.

SOURCE:  42 CFR Sec. 422.100 (Jan. 2022).


PAYMENT PARITY

MA plans offering additional telehealth benefits may maintain different cost sharing for the specified Part B service(s) furnished through an in-person visit and the specified Part B service(s) furnished through electronic exchange.

SOURCE:  42 CFR § 422.254 (Accessed Jan. 2022).

READ LESS

Alabama

Last updated 03/25/2022

SERVICE PARITY

No Reference Found

PAYMENT PARITY

No Reference Found

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

READ LESS

Alaska

Last updated 03/14/2022

SERVICE PARITY

Health care insurers shall provide coverage for benefits …

SERVICE PARITY

Health care insurers shall provide coverage for benefits provided through telehealth by a health care provider and may not require that prior in-person contact between a health care provider and a patient before payment is made for covered services.

SOURCE: AK Statute, Sec. 21.42.422 (Accessed Mar. 2022).


PAYMENT PARITY

No Reference Found

 

READ LESS

Arizona

Last updated 03/21/2022

SERVICE PARITY

All contracts issued, delivered or renewed in this …

SERVICE PARITY

All contracts issued, delivered or renewed in this state must provide coverage for health care services that are provided through telehealth if the health care service would be covered were it provided through an in-person encounter between the subscriber and a health care provider and provided to a subscriber receiving the service in this state.

A corporation may not limit or deny the coverage of health care services provided through telehealth, including ancillary services, and may apply only the same limits or exclusions on a health care service provided through telehealth that are applicable to an in-person encounter for the same health care service, except for procedures or services for which the weight of evidence, based on practice guidelines, peer-reviewed clinical publications or research or recommendations by the telehealth advisory committee on telehealth best practices established by section 36-3607, determines not to be appropriate to be provided through telehealth.

Beginning January 1, 2022, a corporation shall cover services provided through an audio-only telehealth encounter if the telehealth advisory committee on telehealth best practices established by section 36-3607 recommends that the services may appropriately be provided through an audio-only telehealth encounter.

Certain other requirements apply.  See above ‘requirements’ section.

SOURCE:  AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05  (Accessed Mar. 2022)


PAYMENT PARITY

A corporation shall reimburse health care providers at the same level of payment for equivalent services as identified by the healthcare common procedure coding system, whether provided through telehealth using an audio-visual format or in-person care. A corporation shall reimburse health care providers at the same level of payment for equivalent in-person behavioral health and substance use disorder services as identified by the healthcare common procedure coding system if provided through telehealth using an audio-only format. This paragraph does not apply to a telehealth encounter provided through a telehealth platform that is sponsored or provided by the corporation. A corporation may not require a health care provider to use a telehealth platform that is sponsored or provided by the corporation as a condition of network participation.

A health care provider shall bill for a telehealth encounter using the healthcare common procedure coding system and shall identify whether the telehealth encounter was provided in an audio-only or audio-video format. To submit a claim for an audio-only service, the health care provider must make telehealth services generally available to patients through the interactive use of audio, video or other electronic media.

SOURCE:  AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05  (Accessed Mar. 2022)

READ LESS

Arkansas

Last updated 03/25/2022

SERVICE PARITY

Health plans must reimburse “on the same basis” …

SERVICE PARITY

Health plans must reimburse “on the same basis” if the service were delivered in-person.  A health benefit plan is not required to reimburse for a healthcare service provided through telemedicine that is not comparable to the same service provided in-person.

SOURCE: AR Code 23-79-1602(c). (Accessed Mar. 2022).


PAYMENT PARITY

The combined amount of reimbursement that a health benefit plan allows for the compensation to the distant site and the originating site shall not be less than the total amount allowed for healthcare services provided in-person.

SOURCE: AR Code 23-79-1602(d)(2).  (Accessed Mar. 2022).

READ LESS

California

Last updated 01/17/2022

SERVICE PARITY

A health care service plan or insurer shall …

SERVICE PARITY

A health care service plan or insurer shall not require that in-person contact occur between a health care provider and a patient before payment is made for the covered services appropriately provided through telehealth, subject to the terms and conditions of the contract entered into between the enrollee or subscriber and the health care service plan or insurer, and between the health care service plan or insurer and its participating providers or provider groups.

A health care service plan or insurer shall not limit the type of setting where services are provided for the patient or by the health care provider before payment is made for the covered services appropriately provided through telehealth, subject to the terms and conditions of the contract entered into between the enrollee or subscriber and the health care service plan or insurer, and between the health care service plan or insurer and its participating providers or provider groups.

Applies to Medi-Cal Managed Care.

SOURCE: CA Health & Safety Code Sec. 1374.13 & Insurance Code Sec. 10123.85(AB 744 – 2019 Legislative Session). (Accessed Jan. 2022).

A health care service plan or health insurer contract shall specify that the health care service plan or insurer shall provide coverage for health care services appropriately delivered through telehealth services on the same basis and to the same extent that the health care service plan or insurer is responsible for coverage for the same service through in-person diagnosis, consultation, or treatment. Coverage shall not be limited only to services delivered by select third-party corporate telehealth providers. Does not apply to Medi-Cal managed care.

SOURCE: CA Health & Safety Code Sec. 1374.14 & Insurance Code 10123.855 (AB 744, 2019 – Legislative Session). (AB 457, 2021 – Legislative Session). (Accessed Jan. 2022).

PAYMENT PARITY

A contract between a health care service plan or insurer and a health care provider for the provision of health care services to an enrollee or subscriber shall specify that the health care service plan or insurer shall reimburse the treating or consulting health care provider for the diagnosis, consultation, or treatment of an enrollee or subscriber appropriately delivered through telehealth services on the same basis and to the same extent that the health care service plan or insurer is responsible for reimbursement for the same service through in-person diagnosis, consultation, or treatment. Does not apply to Medi-Cal managed care.

Services that are the same, as determined by the provider’s description of the service on the claim, shall be reimbursed at the same rate whether provided in person or through telehealth. When negotiating a rate of reimbursement for telehealth services for which no in-person equivalent exists, a health care service plan or insurer and the provider shall ensure the rate is consistent with subdivision (h) of Section 1367. Does not apply to Medi-Cal managed care.

SOURCE: CA Health & Safety Code Sec. 1374.14 & Insurance Code 10123.855 (AB 744, 2019 – Legislative Session). (AB 457, 2021 – Legislative Session). (Accessed Jan. 2022).

READ LESS

Colorado

Last updated 01/08/2022

SERVICE PARITY

CO insurers cannot deny coverage solely because the …

SERVICE PARITY

CO insurers cannot deny coverage solely because the service is provided through telehealth rather than in-person consultation or contact between the participating provider or, subject to section 10-16-704, the nonparticipating provider and the covered person where the health care service is appropriately provided through telehealth; or based on the communication technology or application used to deliver the telehealth services pursuant to this section.  However, use of the word solely, may mean they can find other reasons, such as the service doesn’t meet the appropriate standard of care in the insurer’s view.

SOURCE: CO Revised Statutes 10-16-123(2)(b)(II). (Accessed Jan. 2022).


PAYMENT PARITY

Subject to all terms and conditions of the health benefit plan or dental plan, a carrier shall reimburse the treating participating provider or the consulting participating provider for the diagnosis, consultation, or treatment of the covered person delivered through telehealth on the same basis that the carrier is responsible for reimbursing that provider for the provision of the same service through in-person consultation or contact by that provider.

SOURCE: CO Revised Statutes 10-16-123(2)(b)(I). (Accessed Jan. 2022).

READ LESS

Connecticut

Last updated 02/07/2022

SERVICE PARITY

Coverage must be provided for telehealth if it …

SERVICE PARITY

Coverage must be provided for telehealth if it would be covered in-person, subject to the terms and conditions of all other benefits under such policy.

SOURCE: CT General Statute 38a, Sec. 499a. & 38a, Sec. 526a. (Accessed Feb. 2022).


PAYMENT PARITY

Effective Now Until June 30, 2023

Until June 30, 2023, no health carrier shall reduce the amount of a reimbursement paid to a telehealth provider for covered health care or health services that the telehealth provider appropriately provided to an insured because the telehealth provider provided such health care or health services to the patient through telehealth and not in person.

SOURCE: HB 5596 p.18 (2021 Session) (Accessed Feb. 2022).

READ LESS

Delaware

Last updated 03/28/2022

SERVICE PARITY

A payer must reimburse the provider for the …

SERVICE PARITY

A payer must reimburse the provider for the diagnosis, consultation, or treatment of the patient on the same basis as in-person services for telemedicine.

SOURCE: Title 18, Sec. 3370; & Title 18, Sec. 3571R. (Accessed Mar. 2022).


PAYMENT PARITY

An insurer, health service corporation, or health maintenance organization shall reimburse the treating provider or the consulting provider for the diagnosis, consultation, or treatment of the insured delivered through telemedicine services on the same basis and at least at the rate that the insurer, health service corporation, or health maintenance organization is responsible for coverage for the provision of the same service through in-person consultation or contact. Payment for telemedicine interactions shall include reasonable compensation to the originating or distant site for the transmission cost incurred during the delivery of health-care services.

SOURCE: Title 18, Sec. 3370; & Title 18, Sec. 3571R. (Accessed Mar. 2022).

READ LESS

District of Columbia

Last updated 02/22/2022

SERVICE PARITY

A health insurer must reimburse a provider for …

SERVICE PARITY

A health insurer must reimburse a provider for the diagnosis, consultation or treatment of the patient when the service is delivered by telehealth.

SOURCE: DC Code Sec. 31-3862. (Accessed Feb. 2022).


PAYMENT PARITY

No explicit payment parity.

READ LESS

Florida

Last updated 02/11/2022

SERVICE PARITY

Insurers and providers must mutually agree on payment …

SERVICE PARITY

Insurers and providers must mutually agree on payment rates and payment methodologies for telehealth delivered services.

SOURCE: FL Statute 641.31 (45). & 627.42396. (Accessed Feb. 2022).


PAYMENT PARITY

Any contract provision that distinguishes between payment rates or payment methodologies for services provided through telehealth and the same services provided without the use of telehealth must be initialed by the telehealth provider.

SOURCE: FL Statute 641.31. & 641.42396. (Accessed Feb. 2022).

READ LESS

Georgia

Last updated 03/21/2022

SERVICE PARITY

An insurer shall reimburse the treating provider or …

SERVICE PARITY

An insurer shall reimburse the treating provider or the consulting provider for the diagnosis, consultation, or treatment of the insured delivered through telemedicine services on the same basis for services provided via telemedicine.

An insurer shall not exclude a service for coverage solely because the service is provided through telemedicine services and is not provided through in-person consultation or contact between a health care provider and a patient for services appropriately provided through telemedicine services.

No insurer shall require an in-person consultation or contact before a patient may receive telemedicine services from a health care provider, except for the purposes of initial installation, setup, or delivery of in-home telehealth devices or services, or as otherwise required by state or federal law, rule, or regulation.

SOURCE: Official Code of GA Annotated Sec. 33-24-56.4. (Accessed Mar. 2022).


PAYMENT PARITY

Payment must be at least at the rate that the insurer is responsible for coverage for the provision of the same service through in-person consultation or contact; provided, however, that nothing in this subsection shall require:

  1. A health care provider or telemedicine company to accept more reimbursement than they are willing to charge, or
  2. An insurer to pay for a telemedicine service provided through an audio-only call for any service other than mental or behavioral health services.

Payment for telemedicine interactions shall include reasonable compensation to the originating or distant site for the transmission cost incurred during the delivery of health care services; provided, however, that this shall not require the insurer to include payment for transmission costs if the originating or distant site is a home.

SOURCE: Official Code of GA Annotated Sec. 33-24-56.4. (Accessed Mar. 2022).

READ LESS

Hawaii

Last updated 03/25/2022

SERVICE PARITY

No accident and health or sickness insurance plan/health …

SERVICE PARITY

No accident and health or sickness insurance plan/health maintenance organization, mutual benefit society plan that is issued, amended, or renewed shall require face-to-face contact between a health care provider and a patient as a prerequisite for payment for services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided. Coverage may be subject to all the terms and conditions of the plan agreed upon among the enrollee or subscriber, the insurer and the health care provider.

SOURCE: HI Revised Statutes § 431:10A-116.3(b); 432D-23.5(b); & 432:1-601.5(b). (Accessed Mar. 2022).


PAYMENT PARITY

Reimbursement for services provided through telehealth must be equivalent to reimbursement for the same services provided via face-to-face contact between a health care provider and patient.

SOURCE: HI Revised Statutes § 431:10A-116.3(c); 432D-23.5(c); & 432:1-601.5(c). (Accessed Mar. 2022).

READ LESS

Idaho

Last updated 02/06/2022

SERVICE PARITY

No Reference Found

PAYMENT PARITY

No Reference Found

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

READ LESS

Illinois

Last updated 03/14/2022

SERVICE PARITY

An individual or group policy of accident or

SERVICE PARITY

An individual or group policy of accident or health insurance shall cover telehealth services, e-visits, and virtual check-ins rendered by a health care professional when clinically appropriate and medically necessary to insureds, enrollees, and members in the same manner as any other benefits covered under the policy. An individual or group policy of accident or health insurance may provide reimbursement to a facility that serves as the originating site at the time a telehealth service is rendered.

SOURCE: IL Insurance Code. Sec. 356z.22.  (Accessed Mar. 2022).


PAYMENT PARITY

For purposes of reimbursement, an individual or group policy of accident or health insurance shall reimburse an in-network health care professional or facility, including a health care professional or facility in a tiered network, for telehealth services provided through an interactive telecommunications system at the same reimbursement rate that would apply to the services if the services had been delivered via an in-person encounter by an in-network or tiered network health care professional or facility.

This subsection applies only to those services provided by telehealth that may otherwise be billed as an in-person service. This subsection is inoperative on and after January 1, 2028, except that this subsection is operative after that date with respect to mental health and substance use disorder telehealth services.

Nothing in this Section is intended to limit the ability of an individual or group policy of accident or health insurance and a health care professional or facility to voluntarily negotiate alternate reimbursement rates for telehealth services. Such voluntary negotiations shall take into consideration the ongoing investment necessary to ensure these telehealth platforms may be continuously maintained, seamlessly updated, and integrated with a patient’s electronic medical records.

SOURCE: IL Insurance Code. Sec. 356z.22.  (Accessed Mar. 2022).

READ LESS

Indiana

Last updated 04/08/2022

SERVICE PARITY

Coverage must be provided in accordance with the …

SERVICE PARITY

Coverage must be provided in accordance with the same clinical criteria as would be provided in-person.

SOURCE: IN Code, 27-8-34-6 & 27-13-7-22. (Accessed Apr. 2022).


PAYMENT PARITY

No explicit payment parity.

READ LESS

Iowa

Last updated 03/29/2022

SERVICE PARITY

Health care services that are delivered by telehealth …

SERVICE PARITY

Health care services that are delivered by telehealth must be appropriate and delivered in accordance with applicable law and generally accepted health care practices and standards prevailing at the time the health care services are provided, including all rules adopted by the appropriate professional licensing board having oversight of the health care professional providing the health care services.

SOURCE: IA Code 514C.34(3) (Accessed Mar. 2022).

A health carrier shall reimburse a health care professional and a facility for health care services provided by telehealth to a covered person for a mental health condition, illness, injury, or disease on the same basis and at the same rate as the health carrier would apply to the same health care services for a mental health condition, illness, injury, or disease provided in person to a covered person by the health care professional or the facility.

SOURCE: IA Code 514.34(4a), (Accessed Mar. 2022).


PAYMENT PARITY

A health carrier shall reimburse a health care professional and a facility for health care services provided by telehealth to a covered person for a mental health condition, illness, injury, or disease on the same basis and at the same rate as the health carrier would apply to the same health care services for a mental health condition, illness, injury, or disease provided in person to a covered person by the health care professional or the facility.

SOURCE: IA Code 514.34(4a), (Accessed Mar. 2022).

READ LESS

Kansas

Last updated 01/25/2022

SERVICE PARITY

Payment can be limited to only services that …

SERVICE PARITY

Payment can be limited to only services that are medically necessary, subject to the terms and conditions of the covered individual’s health benefits plan.

SOURCE:  KS Statute Ann. § 40-2,213.  (Accessed Jan. 2022).


PAYMENT PARITY

Payment or reimbursement for covered services delivered through telemedicine may be established by an insurance company, nonprofit health service corporation, nonprofit medical and hospital service corporation or health maintenance organization in the same manner as payment or reimbursement for covered services that are delivered via in-person contact are established.

SOURCE:  KS Statute Ann. § 40-2,213. (Accessed Jan. 2022).

READ LESS

Kentucky

Last updated 03/15/2022

SERVICE PARITY

New Legislation (Effective Jan. 1, 2022)

A h

SERVICE PARITY

New Legislation (Effective Jan. 1, 2022)

A health benefit plan, issued or renewed on or after the effective date of this section, shall reimburse for covered services provided to an insured person through telehealth, including telehealth services provided by a home health agency licensed under KRS Chapter 216.

SOURCE: KY Revised Statute Sec. 304.17A-138. (Accessed Mar. 2022).


PAYMENT PARITY

New Legislation (Effective Jan. 1, 2022)

Telehealth coverage and reimbursement shall, except as provided in paragraph (b) of this subsection, be equivalent to the coverage for the same service provided in person unless the telehealth provider and the health benefit plan contractually agree to a lower reimbursement rate for telehealth services.

Rural health clinics, federally qualified health centers, and federally qualified health center look-alikes shall be reimbursed as an originating site in an amount equal to that which is permitted under 42 U.S.C. sec. 1395m for Medicare-participating providers, if the insured was physically located at the rural health clinic, federally qualified health center, or federally qualified health center look-alike at the time of service or consultation delivery and the provider of the telehealth service or telehealth consultation is not employed by the rural health clinic, federally qualified health center, or federally qualified health center look-alike.

SOURCE: KY Revised Statute Sec. 304.17A-138. (Accessed Mar. 2022).

READ LESS

Louisiana

Last updated 03/25/2022

SERVICE PARITY

No Reference Found

PAYMENT PARITY

The payment, benefit, …

SERVICE PARITY

No Reference Found


PAYMENT PARITY

The payment, benefit, or reimbursement to such a 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 which that licensed physician receives for an intermediate office visit.

SOURCE: LA Revised Statutes 22:1821(F). (Accessed Mar. 2022).

READ LESS

Maine

Last updated 02/08/2022

SERVICE PARITY

Coverage for health care services provided through telehealth …

SERVICE PARITY

Coverage for health care services provided through telehealth must be determined in a manner consistent with coverage for health care services provided through in-person consultation. If an enrollee is eligible for coverage and the delivery of the health care service through telehealth is medically appropriate, a carrier may not deny coverage for telehealth services. A carrier may offer a health plan containing a provision for a deductible, copayment or coinsurance requirement for a health care service provided through telehealth as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to a comparable service provided through in-person consultation. A carrier may not exclude a health care service from coverage solely because such health care service is provided only through a telehealth encounter, as long as telehealth is appropriate for the provision of such health care service.

A carrier shall provide coverage for any medically necessary health care service delivered through telehealth as long as the following requirements are met:

  • The health care service is otherwise covered under an enrollee’s health plan.
  • The health care service delivered by telehealth is of comparable quality to the health care service delivered through in-person consultation.
  • Prior authorization is required for telehealth services only if prior authorization is required for the corresponding covered health care service. An in-person consultation prior to the delivery of services through telehealth is not required.
  • Coverage for telehealth services is not limited in any way on the basis of geography, location or distance for travel.
  • The carrier shall require that a clinical evaluation is conducted either in person or through telehealth before a provider may write a prescription that is covered.
  • The carrier shall provide coverage for the treatment of 2 or more persons who are enrolled in the carrier’s health plan at the same time through telehealth, including counseling for substance use disorders involving opioids.
  • The carrier may not place any restriction on the prescribing of medication through telehealth by a provider whose scope of practice includes prescribing medication that is more restrictive than any requirement in state and federal law for prescribing medication through in-person consultation.

A carrier shall provide coverage for telemonitoring if:

  • The telemonitoring is intended to collect an enrollee’s health-related data, including, but not limited to, pulse and blood pressure readings, that assist a provider in monitoring and assessing the enrollee’s medical condition;
  • The telemonitoring is medically necessary for the enrollee;
  • The enrollee is cognitively and physically capable of operating the mobile health devices or the enrollee has a caregiver willing and able to assist with the mobile health devices;  and
  • The enrollee’s residence is suitable for telemonitoring. If the residence appears unable to support telemonitoring, the telemonitoring may not be provided unless necessary adaptations are made.

SOURCE: Maine Revised Statutes Annotated, Title 24-A, Sec. 4316, (Accessed Feb. 2022).


PAYMENT PARITY

No explicit payment parity.

READ LESS

Maryland

Last updated 01/25/2022

SERVICE PARITY

Recently Passed Legislation – Effective until June 30,

SERVICE PARITY

Recently Passed Legislation – Effective until June 30, 2023

From July 1, 2021, to June 30, 2023, both inclusive, when a health care service is appropriately provided through telehealth, an insurer, nonprofit health service plan, and health maintenance organization shall provide reimbursement on the same basis as if the health care service were delivered by the health care provider in person.

Reimbursement required does not include:

  • clinic facility fees unless the health care service is provided by a health care provider not authorized to bill a professional fee separately for the health care service; or
  • any room and board fees

SOURCE: Insurance Code 15-139 (As amended by HB 123/SB 3 (2021 Session). (Accessed Jan. 2022).

 

PAYMENT PARITY

Recently Passed Legislation – Effective until June 30, 2023

From July 1, 2021, to June 30, 2023, both inclusive, when a health care service is appropriately provided through telehealth, an insurer, nonprofit health service plan, and health maintenance organization shall provide reimbursement at the same rate as if the health care service were delivered by the health care provider in person.

This paragraph may not be construed to supersede the authority of the Health Services Cost Review Commission to set the appropriate rates for hospitals, including setting the hospital facility fee for hospital–provided telehealth.

SOURCE: Insurance Code 15-139 (As amended by HB 123/SB 3 (2021 Session). (Accessed Jan. 2022).

READ LESS

Massachusetts

Last updated 03/23/2022

SERVICE PARITY

An individual policy of accident and sickness insurance …

SERVICE PARITY

An individual policy of accident and sickness insurance issued under section 108 that provides hospital expense and surgical expense insurance and any group blanket or general policy of accident and sickness insurance issued under section 110 that provides hospital expense and surgical expense insurance that is issued or renewed within or without the commonwealth  shall provide coverage for health care services delivered via telehealth by a contracted health care provider if:

  • the health care services are covered by way of in-person consultation or delivery; and
  • the health care services may be appropriately provided through the use of telehealth

SOURCE: Massachusetts General Laws, Part 1, Title XXII, Ch. 175, Sec. 47MM, (Accessed Mar. 2022). 

Section repeated in Civil Service, Retirement and Pensions section applying to active or retired employees of the commonwealth; Non-profit hospital service corporations; medical service corporation; health maintenance organizations; preferred provider arrangement

SOURCE: Massachusetts General Laws Part 1, Title IV, Ch. 32A, Section 30 & Part 1, Title XXII, Ch. 176A, Sec. 38, Ch. 176B, Sec. 25, Ch. 176G Sec. 33, Ch. 176I Sec. 13. (Accessed Mar. 2022).


PAYMENT PARITY

Coverage that reimburses a provider with a global payment, as defined in section 1 of chapter 6D, shall account for the provision of telehealth services to set the global payment amount.

Insurance companies organized under this chapter shall ensure that the rate of payment for in-network providers of behavioral health services delivered via interactive audio-video technology and audio-only telephone shall be no less than the rate of payment for the same behavioral health service delivered via in-person methods; provided, that this subsection shall apply to providers of behavioral health services covered (see bill language for types of providers).

SOURCE: Massachusetts General Laws, Part 1, Title XXII, Ch. 175, Sec. 47MM, (Accessed Mar. 2022). 

Section repeated in Civil Service, Retirement and Pensions section applying to active or retired employees of the commonwealth; Non-profit hospital service corporations; medical service corporation; health maintenance organizations; preferred provider arrangement

SOURCE: Massachusetts General Laws Part 1, Title IV, Ch. 32A, Section 30 & Part 1, Title XXII, Ch. 176A, Sec. 38, Ch. 176B, Sec. 25, Ch. 176G Sec. 33, Ch. 176I Sec. 13. (Accessed Mar. 2022).

READ LESS

Michigan

Last updated 01/19/2022

SERVICE PARITY

Insurers and health care corporations must cover services …

SERVICE PARITY

Insurers and health care corporations must cover services appropriately provided through telemedicine, as determined by the insurer or health care corporation.

SOURCE: MI Compiled Law Services Sec. 500.3476 & Sec. 550.1401k. (Accessed Jan. 2022).


PAYMENT PARITY

No explicit payment parity.

READ LESS

Minnesota

Last updated 03/28/2022

SERVICE PARITY

A health carrier must not restrict or deny

SERVICE PARITY

A health carrier must not restrict or deny coverage of a health care service that is covered under a health plan solely because the health care service provided by the health care provider through telehealth is not provided through in-person contact; or based on the communication technology or application used to deliver the health care service through telehealth, provided the technology or application complies with this section and is appropriate for the particular service.

SOURCE: MN Statute Sec. 62A.673. (Accessed Mar. 2022).


PAYMENT PARITY

A health carrier must reimburse the health care provider for services delivered through telehealth on the same basis and at the same rate as the health carrier would apply to those services if the services had been delivered by the health care provider through in-person contact.

A health carrier must not deny or limit reimbursement based solely on a health care provider delivering the service or consultation through telehealth instead of through in-person contact. A health carrier must not deny or limit reimbursement based solely on the technology and equipment used by the health care provider to deliver the health care service or consultation through telehealth, provided the technology and equipment used by the provider meets the requirements of this section and is appropriate for the particular service.

Nothing in this subdivision prohibits a health carrier and health care provider from entering into a contract that includes a value-based reimbursement arrangement for the delivery of covered services that may include services delivered through telehealth, and such an arrangement shall not be considered a violation of this subdivision.

SOURCE: MN Statute Sec. 62A.673. (Accessed Mar. 2022).

READ LESS

Mississippi

Last updated 01/14/2022

SERVICE PARITY

All health insurance plans must provide coverage for …

SERVICE PARITY

All health insurance plans must provide coverage for telemedicine services, including live video and store-and-forward, to the same extent as in-person consultations.  Remote patient monitoring is also reimbursed based on the criteria outlined in MS code.

A health insurance plan may charge a deductible, co-payment, or coinsurance for a health care service provided through telemedicine so long as it does not exceed the deductible, co-payment, or coinsurance applicable to an in-person consultation.

A health insurance or employee benefit plan can limit coverage to health care providers in a telemedicine network approved by the plan.

SOURCE: MS Code Sec. 83-9-351 & MS Code Sec. 83-9-353. (Accessed Jan. 2022).


PAYMENT PARITY

No explicit payment parity.

Remote Patient Monitoring Reimbursement

Remote patient monitoring services are required to include reimbursement for a daily monitoring rate at a minimum of ten dollars per day each month and sixteen dollars per day when medication adherence management services are included, not to exceed 31 days per month.

A one-time installation/training fee for remote patient monitoring services will also be reimbursed at a minimum rate of fifty dollars per patient, with a maximum of two installation/training fees per calendar year.

These reimbursement rates are only eligible to Mississippi-based telehealth programs affiliated with a Mississippi health care facility.

SOURCE: MS Code Sec. 83-9-353. (Accessed Jan. 2022).

READ LESS

Missouri

Last updated 01/11/2022

SERVICE PARITY

A health carrier may not exclude an otherwise …

SERVICE PARITY

A health carrier may not exclude an otherwise covered health care service from coverage solely because the service is provided through telehealth rather than face-to-face consultation or contact between a health care provider and a patient.  A health carrier or health benefit plan may limit coverage for health care services that are provided through telehealth to health care providers that are in a network approved by the plan or the health carrier.

SOURCE: MO Revised Statutes § 376.1900. (Accessed Jan. 2022).


PAYMENT PARITY

Missouri Consolidated Health Care Plan – Emergency Rule

Virtual visits offered through the vendor’s telehealth tool are covered at one hundred percent (100%) after deductible is met.

SOURCE:  MO Consolidated State Reg. 22:10-2.053 & 22:10-3.055 (expires June 29, 2022), (Accessed Jan. 2022).

The following services are not subject to deductible, coinsurance, or copayment requirements and will be paid at one hundred percent (100%) when provided by a network provider: …

  • Virtual visits offered through the vendor’s telehealth tool.

SOURCE:  MO Consolidated State Reg. 22:10-3.058, 3.059, 2.047

READ LESS

Montana

Last updated 03/30/2022

SERVICE PARITY

Private payers are required to provide coverage for …

SERVICE PARITY

Private payers are required to provide coverage for services delivered through telehealth if the services are otherwise covered by the policy, certificate, contract, or agreement.

Coverage must be equivalent to the coverage for services that are provided in-person by a health care provider or health care facility.

SOURCE: MT Code Sec. 33-22-138, (Accessed Mar. 2022).


PAYMENT PARITY

No explicit payment parity.

READ LESS

Nebraska

Last updated 03/26/2022

SERVICE PARITY

Any insurer shall not exclude a service from …

SERVICE PARITY

Any insurer shall not exclude a service from coverage solely because the service is delivered through telehealth, including services originating from any location where the patient is located, and is not provided through in-person consultation or contact between a licensed health care provider and a patient.

Any insurer shall not exclude from coverage telehealth services provided by a dermatologist solely because the service is delivered asynchronously. An insurer shall reimburse a health care provider for asynchronous review by a dermatologist delivered through telehealth at a rate negotiated between the provider and the insurer.

SOURCE: NE Rev. Statute, 44-7,107 (Accessed Mar. 2022).

Any health insurance plan delivered, issued, or renewed in this state if coverage is provided for treatment of mental health conditions other than alcohol or substance abuse,

  • Shall not establish any rate, term, or condition that places a greater financial burden on an insured for access to treatment for a serious mental illness than for access to treatment for a physical health condition,
  • Shall not establish any rate, term, or condition that places a greater financial burden on an insured for accessing treatment for a mental health condition using telehealth services as defined in section 44-312,
  • Shall provide, at a minimum, a reimbursement rate for accessing treatment for a mental health condition using telehealth services that is the same as the rate for a comparable treatment provided or supervised in person, and
  • If an out-of-pocket limit is established for physical health conditions, shall apply such out-of-pocket limit as a single comprehensive out-of-pocket limit for both physical health conditions and mental health conditions, or
  • If no coverage is to be provided for treatment of mental health conditions, shall provide clear and prominent notice of such noncoverage in the plan.

If a health insurance plan provides coverage for serious mental illness, the health insurance plan shall cover health care rendered for treatment of serious mental illness (a) by a mental health professional, (b) by a person authorized by the rules and regulations of the Department of Health and Human Services to provide treatment for mental illness, (c) using telehealth services as defined in section 44-312, (d) in a mental health center as defined in section 71-423, or (e) in any other health care facility licensed under the Health Care Facility Licensure Act that provides a program for the treatment of a mental health condition pursuant to a written plan. The issuer of a health insurance plan may require a health care provider under this subsection to enter into a contract as a condition of providing benefits.

SOURCE: NE Revised Statute Section 44-793 (Accessed Mar. 2022).


PAYMENT PARITY

Any health insurance plan delivered, issued, or renewed in this state if coverage is provided for treatment of mental health conditions other than alcohol or substance abuse …

  • Shall not establish any rate, term, or condition that places a greater financial burden on an insured for access to treatment for a serious mental illness than for access to treatment for a physical health condition,
  • Shall not establish any rate, term, or condition that places a greater financial burden on an insured for accessing treatment for a mental health condition using telehealth services as defined in section 44-312,
  • Shall provide, at a minimum, a reimbursement rate for accessing treatment for a mental health condition using telehealth services that is the same as the rate for a comparable treatment provided or supervised in person, and
  • If an out-of-pocket limit is established for physical health conditions, shall apply such out-of-pocket limit as a single comprehensive out-of-pocket limit for both physical health conditions and mental health conditions, or
  • If no coverage is to be provided for treatment of mental health conditions, shall provide clear and prominent notice of such noncoverage in the plan.

SOURCE: NE Revised Statute Section 44-793, (Accessed Mar. 2022).

An insurer shall reimburse a health care provider for asynchronous review by a dermatologist delivered through telehealth at a rate negotiated between the provider and the insurer.

SOURCE: NE Rev. Statute, 44-7,107, (Accessed Mar. 2022).

READ LESS

Nevada

Last updated 01/03/2022

SERVICE PARITY

Applies to policies delivered, issued or renewed on

SERVICE PARITY

Applies to policies delivered, issued or renewed on or after October 1, 2021

A policy of health insurance must include coverage for services provided to an insured through telehealth to the same extent and, except for services provided through audio-only interaction, in the same amount as though provided in person or by other means.

Various other version of these provisions become effective under various circumstances, including:

  • 1 year after the date on which the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, only if the Governor terminates that emergency before July 1, 2022.
  • On July 1, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, before July 1, 2022.
  • On June 30, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, on or after July 1, 2022.

See bill for alternate versions and accompanying effective dates.

SOURCE: Senate Bill 5 (2021 Session); NV Revised Statute Sec. 689A.0463; Sec. 689B.0369; Sec. 689C.195; Sec. 616C.730 [certain provisions don’t apply to this provision, see text]; Sec. 695A.265; Sec. 695B.1904; Sec. 695C.1708; Sec. 695D.216; & Sec. 695G.162. (Accessed Jan. 2022).


PAYMENT PARITY

Applies to policies delivered, issued or renewed on or after October 1, 2021

A policy of health insurance must include coverage for services provided to an insured through telehealth to the same extent and, except for services provided through audio-only interaction, in the same amount as though provided in person or by other means.

Various other version of these provisions become effective under various circumstances, including:

  • 1 year after the date on which the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, only if the Governor terminates that emergency before July 1, 2022.
  • On July 1, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, before July 1, 2022.
  • On June 30, 2023, only if the Governor terminates the emergency described in the Declaration of Emergency for COVID-19 issued on March 12, 2020, on or after July 1, 2022.

See bill for alternate versions and accompanying effective dates.

SOURCE: Senate Bill 5 (2021 Session); NV Revised Statute Sec. 689A.0463; Sec. 689B.0369; Sec. 689C.195; Sec. 616C.730 [certain provisions don’t apply to this provision, see text]; Sec. 695A.265; Sec. 695B.1904; Sec. 695C.1708; Sec. 695D.216; & Sec. 695G.162. (Accessed Jan. 2022).

READ LESS

New Hampshire

Last updated 01/01/2022

SERVICE PARITY

Insurers may not deny coverage for services on …

SERVICE PARITY

Insurers may not deny coverage for services on the sole basis that the coverage is provided through telemedicine if the health care service would be covered if it were provided through in-person consultation between the covered person and a health care provider.  For the purposes of this chapter, covered services include remote patient monitoring and store and forward.

An insurer shall provide reimbursement for all modes of telehealth, including video and audio, audio-only, or other electronic media provided by medical providers to treat all members for all medically necessary services.

An insurer offering a health plan in this state shall provide coverage and reimbursement for health care services provided through telemedicine on the same basis as the insurer provides coverage and reimbursement for health care services provided in person. An insurer shall not impose on coverage for health care services provided through telemedicine any additional benefit plan limitations to include annual or lifetime dollar maximums on coverage, deductibles, copayments, coinsurance, benefit limitation or maximum benefits that are not equally imposed upon similar services provided in-person. Nothing in this section shall be construed to allow an insurer to reimburse more for a health care service provided through telemedicine than would have been reimbursed if the health care service was provided in person.

If an insurer excludes a health care service from its in-person reimbursable service, then comparable services shall not be reimbursable as a telemedicine service.

SOURCE: NH Revised Statutes Annotated, 415-J:3, (Accessed Jan. 2022).


PAYMENT PARITY

An insurer offering a health plan in this state shall provide coverage and reimbursement for health care services provided through telemedicine on the same basis as the insurer provides coverage and reimbursement for health care services provided in person.

An insurer shall provide reasonable compensation to an originating site operated by a health care provider or a licensed health care facility if the health care provider or licensed health care facility is authorized to bill the insurer directly for health care services. In the event of a dispute between a provider and an insurance carrier relative to the reasonable compensation under this section, the insurance commissioner shall have exclusive jurisdiction under RSA 420-J:8-e to determine if the compensation is commercially reasonable. The provider and the insurance carrier shall each make best efforts to resolve any dispute prior to applying to the insurance commissioner for resolution, which shall include presenting to the other party evidence supporting its contention that the compensation level it is proposing is commercially reasonable.

The combined amount of reimbursement that a health benefit plan allows for the compensation to the distant site and the originating site shall be the same as the total amount allowed for health care services provided in person.

SOURCE: NH Revised Statutes Annotated, 415-J:3, (Accessed Jan. 2022).

READ LESS

New Jersey

Last updated 04/12/2022

SERVICE PARITY

A carrier that offers a health benefits plan …

SERVICE PARITY

A carrier that offers a health benefits plan in this State shall provide coverage and payment for health care services delivered to a covered person through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation in New Jersey, provided the services are otherwise covered under the plan when delivered through in-person contact and consultation in New Jersey . Reimbursement payments under this section may be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate.

A health care plan is not prohibited from providing coverage only for services that are medically necessary, subject to the terms and conditions of the plan.

A health care plan may not require a covered person to use telemedicine or telehealth in lieu of receiving an in-person service from an in-network provider.

SOURCE: NJ Statute C.26:2S-29 as amended by NJ S2559. (Accessed Apr. 2022).

The above also applies to contracts purchased by the State Health Benefits Commission and the School Employees’ Health Benefits Commission.

SOURCE: NJ Statute C.52:14-17.29w & C.52:14-17.46.6h as amended by NJ S2559. (Accessed Jan. 2022).

A carrier that offers a health benefit plan in this state shall provide coverage, without the imposition of any cost sharing requirements, including deductibles, copayments or coinsurance, prior authorization requirements, or other medical management requirements, for the following items and services furnished during any portion of the federal state of emergency declared in response to the Coronavirus disease 2019 pandemic:

  • Testing for COVID-19, provided that a health care practitioner has issued a medical order for the testing; and
  • Items and services furnished to an individual health care provider office visit, including in-person visits and telemedicine and telehealth encounters, urgency care center visits, and emergency department visits, that result in an order for administration of a test for COVID-19, but only to the extent that the items and services relate to the furnishing or administration of the test for COVID-19 or to the evaluation of the individual for purposes of determining the need of the individual for that test.

SOURCE: NJ S2559. (Accessed Apr. 2022).


PAYMENT PARITY

A carrier that offers a health benefits plan in this State shall provide coverage and payment for health care services delivered to a covered person through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that does not exceed the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation in New Jersey, provided the services are otherwise covered under the plan when delivered through in-person contact and consultation in New Jersey . Reimbursement payments under this section may be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate.

A carrier may limit coverage to services that are delivered by health care providers in the health benefits plan’s network, but may not charge any deductible, copayment, or coinsurance for a health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation.

SOURCE: NJ Statute C.26:2S-29 as amended by NJ S2559. (Accessed Apr. 2022).

The above also applies to contracts purchased by the State Health Benefits Commission and the School Employees’ Health Benefits Commission.

SOURCE: NJ Statute C.52:14-17.29w & C.52:14-17.46.6h. (Accessed Apr. 2022). 

The Commissioner of Health shall conduct a study to assess whether or to what extent coverage and payment for health care services delivered to a covered person through telemedicine or telehealth should be reimbursed at a provider reimbursement rate that equals the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation in New Jersey, as well as to assess whether telemedicine and telehealth may be appropriately used to satisfy network adequacy requirements applicable to health benefits plans in New Jersey. See statute for details.

SOURCE: NJ S2559. (Accessed Apr. 2022).

READ LESS

New Mexico

Last updated 03/14/2022

SERVICE PARITY

An insurer shall provide coverage for services provided …

SERVICE PARITY

An insurer shall provide coverage for services provided via telemedicine to the same extent that the health insurance plan, policy or contract covers the same services in-person.

An insurer shall not limit coverage of services delivered via telemedicine only to those health care providers who are members of the health insurance plan, policy or contract provider network where no in-network provider is available and accessible, as availability and accessibility are defined in network adequacy standards issued by the superintendent.

An insurer shall reimburse for health care services delivered via telemedicine on the same basis and at least at the same rate that the insurer reimburses for comparable services delivered via in-person consultation or contact.

SOURCE: NM Statutes Annotated. Sec. 59A-22-49.3(A), (F) & (I)., 59A-46-50.3, 59A-47-45.3 & 59A-23-7.12 (Accessed Mar. 2022).


PAYMENT PARITY

An insurer shall reimburse for health care services delivered via telemedicine on the same basis and at least at the same rate that the insurer reimburses for comparable services delivered via in-person consultation or contact.

An insurer shall not impose any annual or lifetime dollar maximum on coverage for services delivered via telemedicine, other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the health insurance plan, policy or contract, or impose upon any person receiving benefits pursuant to this section any copayment, coinsurance or deductible amounts, or any plan, policy or contract year, calendar year, lifetime or other durational benefit limitation or maximum for benefits or services, that is not equally imposed upon all terms and services covered under the health insurance plan, policy or contract.

SOURCE: NM Statutes Annotated. Sec. 59A-22-49.3 (H) & (I). , 59A-46-50.3, 59A-47-45.3 & 59A-23-7.12 (Accessed Mar. 2022).

A plan that provides a benefit conditioned on a covered person’s receipt of a health care service shall provide that benefit if the service is delivered in-person or virtually.

SOURCE: NM Administrative Code Title 13, Ch. 10,  13.10.34.8 (J). (Accessed Mar. 2022).

READ LESS

New York

Last updated 04/07/2022

SERVICE PARITY

An insurer shall not exclude from coverage a …

SERVICE PARITY

An insurer shall not exclude from coverage a service that is otherwise covered under a policy that provides comprehensive coverage for hospital, medical or surgical care because the service is delivered via telehealth; provided, however, that an insurer may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the policy.

SOURCE: NY Insurance Law Article 32 Section 3217-h, (Accessed Apr. 2022)

A corporation shall not exclude from coverage a service that is otherwise covered under a contract that provides comprehensive coverage for hospital, medical or surgical care because the service is delivered via telehealth, as that term is defined in subsection (b) of this section; provided, however, that a corporation may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the contract.

SOURCE: NY Insurance Law Article 43 Section 4306-g. (Accessed Apr. 2022).


PAYMENT PARITY

No Reference Found

READ LESS

North Carolina

Last updated 03/25/2022

SERVICE PARITY

No Reference Found

PAYMENT PARITY

No Reference Found

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

READ LESS

North Dakota

Last updated 04/06/2022

SERVICE PARITY

An insurer must provide coverage for telehealth delivered …

SERVICE PARITY

An insurer must provide coverage for telehealth delivered services to the same extent as the same coverage for in-person services.  They are not required to provide coverage for health services that are not medically necessary.

SOURCE: ND Century Code Sec. 26.1-36-09.15(2) & (5). p. 23 (Accessed Apr. 2022).

Insurance carriers must start or continue to provide covered services via telehealth visits. These services include, but are not limited to the following:

  • Office visits for patients
  • Physical therapy plan evaluation
  • Occupational therapy plan evaluation
  • Speech therapy plane valuation
  • Behavioral health and substance use disorder treatment
  • Diabetes Education
  • Nutrition Counseling.

SOURCE: ND Insurance Department. Bulletin 2021-1.  June 2, 2021, Expansion of Telehealth Services, (Accessed Apr. 2022).


PAYMENT PARITY

Payment or reimbursement of expenses for covered health services delivered by means of telehealth under this section may be established through negotiations conducted by the insurer with the health services providers in the same manner as the insurer establishes payment or reimbursement of expenses for covered health services that are delivered by in-person means.

SOURCE: ND Century Code Sec. 26.1-36-09.15(3). p. 23 (Accessed Apr. 2022).

In addition to traditional telehealth services carriers must expand telehealth under the CMS guidance and now offer coverage for e-visits and virtual check-ins. Insurance carriers shall establish reasonable requirements for the coverage of these virtual check-ins and e-visits in accordance with the guidance issued by CMS on MArch 17, 2020.  See bulletin for required codes.

SOURCE: ND Insurance Department. Bulletin 2021-1.  June 2, 2021, Expansion of Telehealth Services, (Accessed Apr. 2022).

READ LESS

Ohio

Last updated 03/31/2022

SERVICE PARITY

A health benefit plan shall provide coverage for …

SERVICE PARITY

A health benefit plan shall provide coverage for telemedicine services on the same basis and to the same extent that the plan provides coverage for in-person health care services. Plans cannot exclude coverage for a service solely because it is provided as a telehealth service.

A health benefit plan shall not impose any annual or lifetime benefit maximum in relation to telehealth services other than such a benefit maximum imposed on all benefits offered under the plan. A health benefit plan shall not impose a cost-sharing requirement for telehealth services that exceeds the cost-sharing requirement for comparable in-person health care services.

SOURCE: OH Revised Code Annotated, 3902.30. (Accessed Mar. 2022).


PAYMENT PARITY

A health plan issuer shall reimburse a health care professional for a telehealth service that is covered under a patient’s health benefit plan. Division (B)(3) of this section shall not be construed to require a specific reimbursement amount.

SOURCE: OH Revised Code Annotated, 3902.30. (Accessed Mar. 2022).

READ LESS

Oklahoma

Last updated 04/08/2022

SERVICE PARITY

For services that a health care professional determines …

SERVICE PARITY

For services that a health care professional determines to be appropriately provided by means of telemedicine, health care service plans, disability insurer programs, workers’ compensation programs, or state Medicaid managed care program contracts issued, amended, or renewed on or after January 1, 1998, shall not require person-to-person contact between a health care professional and a patient.

An insurer may limit coverage of services provided by telehealth consistent with coding and clinical standards recognized by the American Medical Association or the Centers for Medicare and Medicaid Services as covered if delivered by telehealth or telemedicine, except as agreed to by the insurer and provider.

SOURCE: OK Statute, Title 36, Sec. 6803, (Accessed Apr. 2022).


PAYMENT PARITY

An insurer shall reimburse the treating health care professional or the consulting health care professional for the diagnosis, consultation or treatment of the patient delivered through telemedicine services on the same basis and at least at the rate of reimbursement that the insurer is responsible for coverage for the provision of the same, or substantially similar, services through in-person consultation or contact.

Any copayment or coinsurance applied to telemedicine benefits by an insurer shall not exceed the copayment or coinsurance applied to such benefits when provided through in-person consultation or contact.

SOURCE: OK Statute, Title 36, Sec. 6803, (Accessed Apr. 2022).

READ LESS

Oregon

Last updated 01/14/2022

SERVICE PARITY

A health benefit plan and a dental-only plan …

SERVICE PARITY

A health benefit plan and a dental-only plan must provide coverage of a health service that is provided using telemedicine if:

  • The plan provides coverage of the health service when provided in person by a health professional;
  • The health service is medically necessary;
  • The health service is determined to be safely and effectively provided using telemedicine according to generally accepted health care practices and standards; and
  • The application and technology used to provide the health service meet all standards required by state and federal laws governing the privacy and security of protected health information.

Plans may not distinguish between originating sites that are rural and urban in providing coverage.

Coverage is subject to the terms and conditions of the plan and the reimbursement specified in the contract between the plan and the health professional.

A health benefit plan and dental-only plan must pay the same reimbursement for a health service regardless of whether the service is provided in person or using any permissible telemedicine application or technology.

SOURCE: OR Revised Statutes Sec. 743A.058, (Accessed Jan. 2022).

Treatment of Diabetes

A health benefit plan must provide coverage of a telemedical health services provided in connection with the treatment of diabetes if:

  • The plan provides coverage of the health service when provided in-person by the health professional;
  • The service is medically necessary;
  • The telemedical health service relates to a specific patient; and
  • One of the participants in the telemedical health service is a representative of an academic health center.

A health benefit plan may subject coverage of a telemedical health service to all terms and conditions of the plan, including but not limited to deductible, copayment or coinsurance requirements that are applicable to coverage of a comparable health service when provided in-person.

SOURCE: OR Revised Statutes Sec. 743A.185. (Accessed Jan. 2022).

Worker’s Compensation

All services must be appropriate, and the form of communication must be appropriate for the service provided.  Medical services that may be provided through telemedicine are not limited to those listed in Appendix P of CPT® 2021 or CPT® 2022.

Equipment or supplies at the distant site are not separately payable.

SOURCE: OR Administrative Rules 436-009-0012, (Accessed Jan. 2022).


PAYMENT PARITY

Plans not prohibited from the use of value-based payment methods, including capitated, bundled, risk-based or other value-based payment methods, and does not require that any value-based payment method reimburse telemedicine health services based on an equivalent fee-for-service rate.

SOURCE: OR Revised Statutes Sec. 743A.058, (Accessed Jan. 2022).

Worker’s Compensation

Insurers must pay distant site providers at the non-facility rate.

The payment amount for code Q3014 is $35.70 per unit or the provider’s usual fee, whichever is lower. In calculating the units of time, 15 minutes, or any portion of 15 minutes, equals one unit.  Professional fees of supporting providers at the originating site are not separately payable.  Insurers are not required to pay a telehealth transmission fee (HCPCS code T1014).

SOURCE: OR Administrative Rules 436-009-0012, (Accessed Jan. 2022).

READ LESS

Pennsylvania

Last updated 04/07/2022

SERVICE PARITY

No Reference Found

PAYMENT PARITY

No Reference Found

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

READ LESS

Rhode Island

Last updated 02/11/2022

SERVICE PARITY

A health insurer shall not exclude a healthcare …

SERVICE PARITY

A health insurer shall not exclude a healthcare service for coverage solely because the healthcare service is provided through telemedicine and is not provided through in-person consultation or contact, so long as such healthcare services are medically necessary and clinically appropriate to be provided through telemedicine services.

SOURCE:  RI General Law, Sec. 27-81-4(b). (Accessed Feb. 2022).


PAYMENT PARITY

All such medically necessary and clinically appropriate telemedicine services delivered by in-network primary care providers, registered dietitian nutritionists, and behavioral health providers shall be reimbursed at rates not lower than services delivered by the same provider through in-person methods.

SOURCE:  RI General Law, Sec. 27-81-4. (Accessed Feb. 2022).

READ LESS

South Carolina

Last updated 03/22/2022

SERVICE PARITY

No Reference Found

PAYMENT PARITY

No Reference Found

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

READ LESS

South Dakota

Last updated 01/25/2022

SERVICE PARITY

A health insurance policy, contract, or plan providing …

SERVICE PARITY

A health insurance policy, contract, or plan providing for third-party payment may not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth as long as the services are appropriate to be provided through telehealth. Nothing in §§ 58-17-167 to 58-17-170, inclusive, prohibits a health insurer and a health care professional from entering into a contract for telehealth with terms subject to negotiation.

Health insurers cannot exclude a service for coverage solely because the service is provided through telehealth and not provided through in-person consultation or contact between a health care professional and a patient.

Health insurers are not required to provide coverage for health care services that are not medically necessary.

Health insurers are NOT prohibited from:

  • Establishing criteria that a health care professional must meet to demonstrate the safety and efficacy of delivering a particular health care service via telehealth that the health insurer does not already reimburse other health care professionals for delivering via telehealth so long as the criteria are not unduly burdensome or unreasonable for the particular services;
  • Requiring a health care professional to agree to certain documentation or billing practices designed to protect the health insurer or patients from fraudulent claims so long as the practices are not unduly burdensome or unreasonable for the particular services;
  • Including a deductible, copayment, or coinsurance requirement for a health care service provided via telehealth, if the deductible, copayment, or coinsurance is not in addition to and does not exceed the deductible, copayment, or coinsurance applicable if the same services were provided through in-person contact.

SOURCE: SD Codified Laws Ann. § 58-17-168 &  58-17-169. (Accessed Jan. 2022).


PAYMENT PARITY

No Reference Found

READ LESS

Tennessee

Last updated 04/11/2022

SERVICE PARITY

Provider-based Telemedicine

A health insurance entity shall provide …

SERVICE PARITY

Provider-based Telemedicine

A health insurance entity shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine and shall not exclude from coverage a healthcare service solely because it is provided through provider-based telemedicine and is not provided through an in-person encounter between a healthcare services provider and a patient.  They shall also reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

SOURCE: TN Code Annotated, Sec. 56-7-1003 (Accessed Apr. 2022)

Telehealth Services

Health insurance entities (including managed care organizations) participating in the medical assistance program are required to provide coverage for telehealth (which includes live video) delivered services in a manner that is consistent with the health insurance policy or contract provided for in-person services.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002.  (Accessed Apr. 2022).

Remote patient monitoring

A health insurance entity may consider any remote patient monitoring service a covered medical service if the same service is covered by Medicare. The appropriate parties may negotiate the rate for these services in the manner in which is deemed appropriate by the parties.

Reimbursement of expenses for covered remote patient monitoring services must be established through negotiations conducted by the health insurance entity with the healthcare services provider, healthcare system, or practice group in the same manner as the health insurance entity establishes reimbursement of expenses for covered healthcare services that are delivered by in-person means.

SOURCE: TN Code Annotated, Sec. 56-7-1011, (Accessed Apr. 2022). 

Worker’s Compensation

Except when a medical fee waiver in accordance with Rule 0800-02-17-.18 is obtained from the bureau, nothing in this Chapter 0800-02-31 shall require an employer to pay a total reimbursement for a telehealth encounter for workers’ compensation, including the use of telehealth equipment, in an amount exceeding the amount that would be paid for the same service provided by a healthcare services provider during an in-person encounter under the medical fee schedule set forth in Chapters 0800-02-17, 18, and 19. The medical fee schedule, including but not limited to Tennessee specific conversion percentages, shall apply to the providers of telehealth services rendered pursuant to the workers’ compensation law.

Billing for telehealth services shall be by standard HCFA-1500 using modifier -95 and the appropriate place of service code as specified by CMS for the date of service or their successors as used by CMS. The provider shall append modifier -95 to the CPT® code with the place of service code -02 (telehealth) or -11 (office) as specified by CMS for the date of service. All other modifiers should also be added to the CPT® code as applicable.

When a procedure is provided using telemedicine, reimbursement shall be as follows:The procedure code is reimbursed at the non-facility Medicare maximum allowable payment or the billed charge, whichever is less, regardless of the practitioner’s physical location at the time of service.

Coding and billing regulations shall follow the Medicare guidelines in effect for the date of service with no geographic qualifier.

SOURCE:  TN Admin Code 0800-02-31.05, (Accessed Apr. 2022).


PAYMENT PARITY

Provider-based Telemedicine

This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.

This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.

This section does not require a health insurance entity to provide coverage or reimbursement for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not provide coverage or reimbursement for the same healthcare services if delivered by in-person means.

This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.

Insurers shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

SOURCE: TN Code Annotated, Sec. 56-7-1003 (Accessed Apr. 2022)

Telehealth Services

Health Insurance entities are required to reimburse for the diagnosis, consultation, and treatment of an insured patient for a healthcare service covered under a health insurance policy or contract provided through telehealth without distinction of the geographic location or any federal, state, or local designation, or classification of the geographic area where the patient is located.

Out-of-network providers providing healthcare services through telehealth must be reimbursed under the same policies applicable to other out-of-network healthcare service providers.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002. (Accessed Apr. 2022).

Reimbursement of expenses for covered remote patient monitoring services must be established through negotiations conducted by the health insurance entity with the healthcare services provider, healthcare system, or practice group in the same manner as the health insurance entity establishes reimbursement of expenses for covered healthcare services that are delivered by in-person means.

SOURCE: TN Code Annotated, Sec. 56-7-1011 (Accessed Apr. 2022).

READ LESS

Texas

Last updated 04/11/2022

SERVICE PARITY

Prohibits a health benefit plan from excluding from …

SERVICE PARITY

Prohibits a health benefit plan from excluding from coverage a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service, a teledentistry dental service, or a telehealth service solely because the covered health care service or procedure is not provided through an in-person consultation. A health benefit plan is not required to provide coverage for a telemedicine medical service, a teledentistry dental service, or a telehealth service provided by only synchronous or asynchronous audio interaction including audio-only telephone; email or facsimile.

SOURCE: TX Insurance Code 1455.004(a)  (Accessed Apr. 2022).


PAYMENT PARITY

No Reference Found

READ LESS

Utah

Last updated 02/22/2022

SERVICE PARITY

A health benefit plan shall provide coverage for:…

SERVICE PARITY

A health benefit plan shall provide coverage for:

  • telemedicine services that are covered by Medicare; and
  • treatment of a mental health condition through telemedicine services if:
    • the health benefit plan provides coverage for the treatment of the mental health condition through in-person services; and
    • the health benefit plan determines treatment of the mental health condition through telemedicine services meets the appropriate standard of care; and
  • reimburse a network provider that provides the telemedicine services at a negotiated commercially reasonable rate.

SOURCE: UT Code, 31A-22-649.5. (Accessed Feb. 2022).

Telepsychiatric Consultations

A health benefit plan that offers coverage for mental health services shall:

  • Provide coverage for telepsychiatric consultation during or after an initial visit between the patient and a referring in-network physician;
  • Provide coverage for a telepsychiatric consultation from an out-of-network board certified psychiatrist if the telepsychiatric consultant is not made available to a physician within seven business days after the initial request is made by an in-network provider of telepsychiatric consultations; and
  • Reimburse for the services at the equivalent of the in-network or out-of-network rate set by the benefit plan after taking into account cost-sharing that may be required under the health benefit plan.

Telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist, both of whom are licensed to engage in the practice of medicine in the state, that utilizes:

  • The health records of the patient, provided from the patient or the referring physician;
  • A written, evidence-based patient questionnaire; and
  • Telehealth services that meet industry security and privacy standards, including compliance with the:
    • Health Insurance Portability and Accountability Act; and
    • Health Information Technology for Economic and Clinical Health Act

SOURCE: UT Code, 31A-22-649. (Accessed Feb. 2022).


PAYMENT PARITY

A health benefit plan shall reimburse a network provider that provides the telemedicine services at a negotiated commercially reasonable rate.

SOURCE: UT Code, 31A-22-649.5 (2(b)) (Accessed Feb. 2022).

Telepsychiatric Consultations

A health benefit plan that offers coverage for mental health services shall reimburse for the services at the equivalent of the in-network or out-of-network rate set by the benefit plan after taking into account cost-sharing that may be required under the health benefit plan.

SOURCE: UT Code, 31A-22-649, (Accessed Feb. 2022).

READ LESS

Vermont

Last updated 03/14/2022

SERVICE PARITY

All health insurance plans in this State shall …

SERVICE PARITY

All health insurance plans in this State shall provide coverage for health care services and dental services delivered through telemedicine by a health care provider at a distant site to a patient at an originating site to the same extent that the plan would cover the services if they were provided through in-person consultation.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k. (Accessed Mar. 2022).

Audio-Only Telephone

A health insurance plan shall provide coverage for all medically necessary, clinically appropriate health care services delivered remotely by audio-only telephone to the same extent that the plan would cover the services if they were provided through in-person consultation.

SOURCE: VT Statutes Annotated, Title 8 Sec. 41001. (Accessed Mar. 2022).

On or before July 1, 2021, the Department of Final the Department of Financial Regulation, in consultation with the Department of Vermont Health Access, the Green Mountain Care Board, representatives of health care providers, health insurers, and other interested stakeholders, shall determine the appropriate codes or modifiers, or both, to be used by providers and insurers, including Vermont Medicaid to the extent permitted by the Centers for Medicare and Medicaid Services, in the billing of and payment for health care services delivered using audio-only telephone in order to allow for consistent data collection, identify appropriate codes for services that do not have in-person equivalents, and minimize the administrative burden on providers. To the extent possible, the use of codes or modifiers, or both, shall be done in a manner that allows data on the use of audio-only telephone services to be identified using the Vermont Healthcare Claims Uniform Reporting and Evaluation System (VHCURES).

Not later than January 1, 2022, all Vermont-licensed health care providers and health insurers offering major medical health insurance plans in Vermont shall use the codes and modifiers determined by the Department of Financial Regulation pursuant to subdivision (1) of this subsection when delivering services by audio-only telephone. Vermont Medicaid shall participate to the extent permitted by the Centers for Medicare and Medicaid Services.

SOURCE:  Senate Bill 117 (2021 Session), (Accessed Mar. 2022).


PAYMENT PARITY

To be repealed Jan. 1, 2026

A health insurance plan shall provide the same reimbursement rate for services billed using equivalent procedure codes and modifiers, subject to the terms of the health insurance plan and provider contract, regardless of whether the service was provided through an in-person visit with the health care provider or through telemedicine.

This shall not apply to:

  • Services provided pursuant to the health insurance plan’s contract with a third-party telemedicine vendor to provide health care or dental services; or
  • In the event that a health insurer and health care provider enter into a value-based contract for health care services that include care delivered through telemedicine or by store-and-forward means.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k. (Accessed Mar. 2022).

Audio-Only Telephone

The Department of Financial Regulation, in consultation with the Department of Vermont Health Access, the Green Mountain Care Board, representatives of health care providers, health insurers, and other interested stakeholders, shall determine the amounts that health insurance plans shall reimburse health care providers for delivering health care services by audio- only telephone during plan years 2022, 2023, and 2024. In determining the reimbursement amounts, the Department shall seek to find a reasonable balance between the costs to patients and the health care system and reimbursement amounts that do not discourage health care providers from delivering medically necessary, clinically appropriate health care services by audio-only telephone. The Department may determine different reimbursement amounts for different types of services and may modify the rates that will apply in different plan years as appropriate but shall finalize its determinations not later than April 1 for plan years after 2022.

SOURCE:  Senate Bill 117 (2021 Session), (Accessed Mar. 2022).

READ LESS

Virginia

Last updated 04/09/2022

SERVICE PARITY

An insurer shall not be required to reimburse …

SERVICE PARITY

An insurer shall not be required to reimburse the treating provider or the consulting provider for technical fees or costs for the provision of telemedicine services; however they shall reimburse the treating provider or the consulting provider for the diagnosis, consultation, or treatment of the insured delivered through telemedicine services on the same basis that the insurer  is responsible for coverage for the provision of the same service through face-to-face consultation or contact.

SOURCE: VA Code Annotated Sec. 38.2-3418.16 (Accessed Apr. 2022).


PAYMENT PARITY

No explicit payment parity.

READ LESS

Washington

Last updated 04/11/2022

SERVICE PARITY

Services must be considered an essential health benefit …

SERVICE PARITY

Services must be considered an essential health benefit under the ACA and be determined to be safely and effectively provided through telemedicine or store-and-forward.

Reimbursement of store and forward technology is available only for those covered services specified in the negotiated agreement between the health carrier and the health care provider.

SOURCE: RCW 48.43.735 & Sec. 41.05.700 & WAC 284-170-433. (Accessed Apr. 2022).


PAYMENT PARITY

A health carrier shall reimburse a provider for a health care service provided to a covered person through telemedicine the same amount of compensation the carrier would pay the provider if the health care service was provided in person by the provider.

Hospitals, hospital systems, telemedicine companies, and provider groups consisting of eleven or more providers may elect to negotiate an amount of compensation for telemedicine services that differs from the amount of compensation for in-person services.

SOURCE: RCW 48.43.735 & Sec. 41.05.700 & WAC 284-170-433. (Accessed Apr. 2022).

“Same amount of compensation” means providers are reimbursed by a carrier using the same allowed amount for telemedicine services as they would if the service had been provided in-person unless negotiation has been undertaken. Where consumer cost-sharing applies to telemedicine services, the consumer’s payment combined with the carrier’s payment must be the same amount of compensation, or allowed amount, as the carrier would pay the provider if the telemedicine service had been provided in person. Where an alternative payment methodology other than fee-for-service payment would apply to an in-person service, “same amount of compensation” means providers are reimbursed by a carrier using the same alternative payment methodology that would be used for the same service if provided in-person, unless negotiation has been undertaken.

SOURCE: WA Rev. Code Sec. 284-170-130, as amended by Insurance Commissioner Permanent Rule. (Accessed Apr. 2022).

READ LESS

West Virginia

Last updated 04/12/2022

SERVICE PARITY

An insurer that issues, renews, amends, or adjusts …

SERVICE PARITY

An insurer that issues, renews, amends, or adjusts a plan, policy, contract, or agreement on or after July 1, 2021, shall provide reimbursement for a telehealth service at a rate negotiated between the provider and the insurance company for the virtual telehealth encounter.  They shall also provide reimbursement for a telehealth service for an established patient, or care rendered on a consulting basis to a patient located in an acute care facility whether inpatient or outpatient on the same basis and at the same rate under a contract, plan, agreement, or policy as if the service is provided through an in-person encounter rather than provided via telehealth.  The coverage required by this section shall include the use of telehealth technologies as it pertains to medically necessary remote patient monitoring services to the full extent that those services are available.

SOURCE: WV Statute Sec. 5-16-7b & 33-57-1. (Accessed Apr. 2022).


PAYMENT PARITY

The insurer shall provide reimbursement for a telehealth service at a rate negotiated between the provider and the insurance company.

For an established patient, or care rendered on a consulting basis to a patient located in an acute care facility whether inpatient or outpatient, an insurer must pay the same rate as if the service is provided through an in-person encounter.

SOURCE: WV Statute Sec. 5-16-7b & 33-57-1. (Accessed Apr. 2022).

READ LESS

Wisconsin

Last updated 03/26/2022

SERVICE PARITY

No Reference Found

PAYMENT PARITY

No Reference Found

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

READ LESS

Wyoming

Last updated 01/17/2022

SERVICE PARITY

No Reference Found

PAYMENT PARITY

No Reference Found

SERVICE PARITY

No Reference Found


PAYMENT PARITY

No Reference Found

READ LESS

Private Payer

Parity

jump to: