Private Payer

Requirements

Laws that require private payers to provide some type of reimbursement for telehealth delivered services often have requirements associated with them — for example, requiring that the same standard of care be met as when delivering services in-person.  There are also often requirements for utilization reviews, and cost sharing to be the same as they would had the service not been provided via telehealth.

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Federal

Last updated 10/10/2021

Medicare Advantage (MA)

For plan year 2020 and subsequent plan …

Medicare Advantage (MA)

For plan year 2020 and subsequent plan years, an MA plan may provide additional telehealth benefits to enrolled individuals.

The Secretary shall specify requirements for the provision or furnishing of additional telehealth benefits, including with respect to the following:

  • Physician or practitioner qualifications (other than licensure) and other requirements such as specific training.
  • Factors necessary for the coordination of such benefits with other items and services including those furnished in-person.
  • Such other areas as determined by the Secretary.

If an MA plan provides a service as an additional telehealth benefit –

  • the MA plan shall also provide access to such benefit through an in-person visit (and not only as an additional telehealth benefit); and
  • an individual enrollee shall have discretion as to whether to receive such service through the in-person visit or as an additional telehealth benefit.

If a plan provides additional telehealth benefits, such additional telehealth benefits shall be treated as if they were benefits under the original Medicare fee-for-service program option.

SOURCE:  Social Security Act, Sec. 1852 (Accessed Oct. 2021).

An MA plan may treat additional telehealth benefits as basic benefits covered under the original Medicare fee-for-service program provided that the requirements of this section are met. If the MA plan fails to comply with the requirements of this section, then the MA plan may not treat the benefits provided through electronic exchange as additional telehealth benefits, but may treat them as supplemental benefits, subject to CMS approval.

An MA plan furnishing additional telehealth benefits must:

  • Furnish in-person access to the specified Part B service(s) at the election of the enrollee.
  • Advise each enrollee that the enrollee may receive the specified Part B service(s) through an in-person visit or through electronic exchange.
  • Comply with the provider selection and credentialing requirements provided in § 422.204, and, when providing additional telehealth benefits, ensure through its contract with the provider that the provider meet and comply with applicable State licensing requirements and other applicable laws for the State in which the enrollee is located and receiving the service.
  • Make information about coverage of additional telehealth benefits available to CMS upon request. Information may include, but is not limited to, statistics on use or cost, manner(s) or method of electronic exchange, evaluations of effectiveness, and demonstration of compliance with the requirements of this section.

An MA plan furnishing additional telehealth benefits may only do so using contracted providers. Coverage of benefits furnished by a non-contracted provider through electronic exchange may only be covered as a supplemental benefit.

MA plans offering additional telehealth benefits must exclude any capital and infrastructure costs and investments directly incurred or paid by the MA plan relating to such benefits from their bid submission for the unadjusted MA statutory non-drug monthly bid amount.

SOURCE:  42 CFR § 422.135 (Accessed Oct. 2021).

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Alabama

Last updated 09/27/2021

No Reference Found

No Reference Found

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Alaska

Last updated 10/15/2021

Recently Amended through Legislation (Now Effective)

A health care insurer …

Recently Amended through Legislation (Now Effective)

A health care insurer that offers, issues for delivery, or renews in the state a health care insurance plan in the group or individual market shall provide coverage for benefits provided through telehealth by a health care provider licensed in this state 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 (HB 29 – 2020 Session). (Accessed Oct. 2021)

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Arizona

Last updated 09/20/2021

Recently Passed Legislation

All contracts issued, delivered or renewed in …

Recently Passed Legislation

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. The following requirements apply to coverage of telehealth services:

  • 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.
  • Except as otherwise provided in this paragraph, 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.
  • Before January 1, 2022, a corporation shall cover services provided through an audio-only telehealth encounter if that service is covered by medicare or the Arizona health care cost containment system when provided through an audio-only telehealth encounter. 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.
  • 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.
  • At the time of the telehealth encounter, the health care provider shall access clinical information and records, if available, that are appropriate to evaluate the patient’s condition. The health care provider shall inform the subscriber before the telehealth encounter if there is a charge for the encounter.
  • A corporation may establish reasonable requirements and parameters for telehealth services, including documentation, fraud prevention, identity verification and recordkeeping, but such requirements and parameters may not be more restrictive or less favorable to health care providers or subscribers than are required for health care services delivered in person.
  • Covered telehealth services may be provided regardless of where the subscriber is located or the type of site.
  • The contract may limit the coverage to those health care providers who are members of the corporation’s provider network.

This section does not relieve a corporation from an obligation to provide adequate access to in-person health care services. Network adequacy standards required by federal or state law may not be met by a corporation through the use of contracted health care providers who provide only telehealth services and do not provide in-person health care services in this state or within fifty miles of the border of this state.

Services provided through telehealth or resulting from a telehealth encounter are subject to all of this state’s laws and rules that govern prescribing, dispensing and administering prescription pharmaceuticals and devices and shall comply with Arizona licensure requirements and any practice guidelines of the telehealth advisory committee on telehealth best practices established by section 36-3607 or, if not addressed, the practice guidelines of a national association of medical professionals promoting access to medical care for consumers via telecommunications technology or other qualified medical professional societies to ensure quality of care.

SOURCE:  AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05 as amended by House Bill 2454 (2021 Session).  (Accessed Sept. 2021)

Health Care Service Organizations (HCSO) are allowed, but not mandated, to provide access to covered services through telemedicine, telephone, and email.

SOURCE: AZ Admin. Code Sec. R20-6-1915. Pg. 132 (Accessed Sept. 2021).

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Arkansas

Last updated 10/07/2021

A health plan shall cover the telehealth-delivered healthcare services on …

A health plan shall cover the telehealth-delivered healthcare services on the same basis it would if the services 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. A health benefit plan may voluntarily reimburse for healthcare services provided through means of telephone, facsimile, text message or electronic mail.

A healthcare plan must provide a reasonable facility fee to an originating site operated by a healthcare professional or licensed healthcare entity if licensed to bill the health benefit plan.

A health benefit plan cannot prohibit its providers from charging patients directly for services provided by audio-only communication that aren’t reimbursed by the plan.

A health plan may not impose:

  • An annual or lifetime dollar maximum on coverage for services provided through telemedicine unless it applies to the aggregate of all items and services covered
  • A deductible, copayment, coinsurance, benefit limitation or maximum benefit that is not equally imposed upon other healthcare services; or
  • A prior authorization requirement that exceeds the requirements for in-person healthcare services.
  • A requirement for a covered person to choose any commercial telemedicine service provider or a restricted network of telemedicine-only providers rather than the covered person’s regular doctor or provider of choice; or
  • A copayment, coinsurance, or deductible that is not equally imposed upon commercial telemedicine providers as those imposed on network providers.

SOURCE: AR Code Sec. 23-79-1602. (Accessed Oct. 2021). as amended by AR HB 1063 (2021). (Accessed Oct. 2021).

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California

Last updated 08/28/2021

A health care service plan and health insurer shall not …

A health care service plan and health 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 and health 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 Aug. 2021).

Recently Effective Legislation

Coverage shall not be limited only to services delivered by select third-party corporate telehealth providers. Insurers are not required to cover telehealth services provided by an out-of-network provider, unless coverage is required under other provisions of law. 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). (Accessed Aug. 2021).

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Colorado

Last updated 08/16/2021

A health benefit plan or dental plan that is issued, …

A health benefit plan or dental plan that is issued, amended or renewed shall not require in-person contact between a provider and a covered person for services appropriately provided through telehealth, subject to all terms and conditions of the health plan or dental plan.

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 the provider.

A carrier shall not restrict or deny coverage solely because the service is provided through telehealth or based on the communication technology or application used to deliver the telehealth services.

A health plan is not required to pay for consultation provided by a provider by telephone or facsimile unless the consultation is provided through HIPAA compliant interactive audio-visual communication or the use of a HIPAA compliant application via a cellular telephone.

A carrier shall include in the payment for telehealth interactions reasonable compensation to the originating site for the transmission cost incurred during the delivery of health care services through telehealth except for when the originating site is a private residence.

SOURCE: CO Revised Statutes 10-16-123. (Accessed Aug. 2021).

A carrier shall not:

      1. Impose an annual dollar maximum on coverage for health care services covered under the health benefit plan or dental plan that are delivered through telehealth, other than an annual dollar maximum that applies to the same services when performed by the same provider through in-person care;
      2. Impose specific requirements or limitations on the HIPAA-Compliant technologies that a provider uses to deliver telehealth services, including limitations on audio or live video technologies;
      3. Require a covered person to have a previously established patient-provider relationship with a specific provider in order for the covered person to receive medically necessary telehealth services from the provider; or
      4. Impose additional certification, location, or training requirements on a provider as a condition of reimbursing the provider for providing health care services through telehealth.

SOURCE: CO Statute 10-16-123 & SB 20-212 (2020 Session), SB 21-139 (2021 Session) (Accessed Aug. 2021).

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Connecticut

Last updated 06/28/2021

Effective Now Until June 30, 2023

Insurers shall provide coverage …

Effective Now Until June 30, 2023

Insurers shall provide coverage for medical advice, diagnosis, care or treatment provided through telehealth, to the same extent coverage is provided for such advice, diagnosis, care or treatment when provided to the insured in person. The policy shall not, at any time during such period, exclude coverage for a service that is appropriately provided through telehealth because such service is provided through telehealth or a telehealth platform selected by an in-network telehealth provider.

No telehealth provider who receives a reimbursement for a covered service shall seek any payment for such service from the insured who received such service, except for any coinsurance, copayment, deductible or other out-of-pocket expense set forth in the insured’s policy. Such amount shall be deemed by the telehealth provider to be payment in full.

Nothing prohibits or limit a health insurer, health care center, hospital service corporation, medical service corporation or other entity from conducting utilization review for telehealth services, provided such utilization review is conducted in the same manner and uses the same clinical review criteria as a utilization review for an in-person consultation for the same service.

A telehealth provider that is an in-network provider or a provider enrolled in the Connecticut medical assistance program that provides telehealth services to a Connecticut medical assistance program recipient, may use any information or communication technology in accordance with the directions, modifications or revisions, if any, made by the Office for Civil Rights of the United States Department of Health and Human Services to the provisions of the Health Insurance Portability and Accountability Act of 1996 P.L. 104-191.

No telehealth provider shall charge a facility fee for a telehealth service provided during the period beginning on the effective date of this section and ending on June 30, 2023.

No telehealth provider shall provide health care or health services to a patient through telehealth unless the telehealth provider has determined whether or not the patient has health coverage for such health care or health services.

A telehealth provider who provides health care or health services to a patient through telehealth during the period beginning on the effective date of this section and ending on June 30, 2023, shall accept as full payment for such health care or health services:

  • An amount that is equal to the amount that Medicare reimburses for such health care or health services if the telehealth provider determines that the patient does not have health coverage for such health care or health services; or
  • The amount that the patient’s health coverage reimburses, and any coinsurance, copayment, deductible or other out-of-pocket expense imposed by the patient’s health coverage, for such health care or health services if the telehealth provider determines that the patient has health coverage for such health care or health services.

If a telehealth provider determines that a patient is unable to pay for any health care or health services described in subdivisions (1) and (2) of this subsection, the provider shall offer to the patient financial assistance, if such provider is otherwise required to offer to the patient such financial assistance, under any applicable state or federal law.

SOURCE: HB 5596 (2021 Session), (Accessed June 2021).

Permanent Statute

Each individual health insurance policy and group health insurance policy providing coverage of the type specified in subdivisions (1), (2), (4), (11) and (12) of section 38a-469 shall provide coverage for medical advice, diagnosis, care or treatment provided via telehealth to the extent coverage is provided for such advice, diagnosis, care or treatment when provided through in-person consultation between the insured and a health care provider. and shall be subject to the same terms and conditions of the policy.

No such policy shall: (1) Exclude a service for coverage solely because such service is provided only through telehealth and not through in-person consultation between the insured and a health care provider, provided telehealth is appropriate for the provision of such service; or (2) be required to reimburse a treating or consulting health care provider for the technical fees or technical costs for the provision of telehealth services.

SOURCE: CT General Statute 38a, Sec. 499a. & 38a, Sec. 526a. (Accessed June 2021).

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Delaware

Last updated 07/12/2021

Private payers must provide coverage for the cost of health …

Private payers must provide coverage for the cost of health care services provided through telemedicine, and telehealth as directed through regulations by the Department.  Insurers must pay for telemedicine services at the same rate as in-person.  Payment for telemedicine must include reasonable compensation to the originating or distant site for the transmission cost.

Private payers may not impose an annual or lifetime dollar maximum on coverage for telemedicine services other than what would apply in the aggregate to all items and services covered under the policy. Additionally, no copayment, coinsurance, or deductible amounts, or any policy year, calendar year, lifetime, or other durational benefit limitation or maximum for benefits or services may be imposed unless equally imposed on all terms and services under the policy.

SOURCE: Title 18, Sec. 3370; & Title 18, Sec. 3571R. (Accessed July 2021).

No insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; health service corporation providing individual or group accident and sickness subscription contracts; or managed care organization or health maintenance organization providing a health care plan for health care services shall impose any limitation on the ability of an insured to seek medical care through the use of telehealth service solely because the health care service is being provided through telehealth. Such prohibited limitations shall include, but not be limited to, preauthorization, medical necessity, homebound requirements.

SOURCE: 18 DE Administrative Code 1409 (Accessed July 2021).

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District of Columbia

Last updated 08/19/2021

Health insurers are required to pay for telehealth services if …

Health insurers are required to pay for telehealth services if the same service would be covered when delivered in-person.

A health insurer shall reimburse the provider for the diagnosis, consultation, or treatment of the insured when the service is delivered through telehealth.

A health insurer may require a deductible, copayment, or coinsurance that may not exceed the amount applicable to the same service delivered in-person.  A health insurer shall not impose any annual or lifetime dollar maximum on coverage for telehealth services other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services under the health benefits plan.

SOURCE: DC Code Sec. 31-3862. (Accessed Aug. 2021).

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Florida

Last updated 07/17/2021

Contracts between health insurers or health maintenance organizations and telehealth …

Contracts between health insurers or health maintenance organizations and telehealth provider must be voluntary and must establish mutually acceptable payment rates or payment methodologies for services provided through telehealth.  Any contract provision that distinguishes between payment rates or payment methodologies for services provided through telehealth and the same service provided without telehealth must be initialed by the telehealth provider.

SOURCE: FL Statute 641.31(45). & 627.42396. (Accessed July 2021).

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Georgia

Last updated 10/01/2021

Each insurer proposing to issue a health benefit policy shall …

Each insurer proposing to issue a health benefit policy shall provide coverage for the cost of health care services provided through telehealth or telemedicine as directed through regulations promulgated by the department.

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.

For the originating site, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.

No insurer shall require its insureds to use telemedicine services in lieu of in-person consultation or contact.

If a treating provider obtains interprofessional consultation from a consulting provider for a patient for whom the treating provider conducted an examination through telemedicine services, an insurer shall not require the consulting provider to conduct, either in-person or through telemedicine services, an examination of such patient in order to receive reimbursement, unless such examination by the consulting provider would be required for the provision of the same services when the initial examination of the patient by the treating provider was conducted through in-person consultation or contact.

No insurer shall impose any type of utilization review on telemedicine services unless such type of utilization review is imposed when the same services are provided through in-person consultation or contact.

No insurer shall restrict coverage of telehealth or telemedicine services to services provided by a particular vendor, or other third party, or services provided through a particular electronic communications technology platform; provided, however, that nothing in this Code section shall require an insurer to cover any telehealth or telemedicine services provided through an electronic communications technology platform that does not comply with applicable state and federal privacy laws.

No insurer shall place any restrictions on prescribing medications through telemedicine that are more restrictive than what is required under applicable state and federal laws for prescribing medications through in-person consultation or contact.

A health care provider shall maintain documentation of each health care service provided through telemedicine in a manner that is at least as extensive and thorough as when the health care service is provided through in-person consultation or contact and, upon request, make such documentation available in accordance with applicable state and federal law.

SOURCE: Official Code of GA Annotated Sec. 33-24-56.4. (Accessed Oct. 2021).

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Hawaii

Last updated 09/29/2021

Insurance plans, health maintenance organizations and mutual benefit society plans …

Insurance plans, health maintenance organizations and mutual benefit society plans cannot require face-to-face contact between a health provider and a patient as a prerequisite for payment for services appropriately provided through telehealth.

All insurers must provide to current and prospective insureds a written disclosure of covered benefits associated with telehealth services, including information on copayments, deductibles, or coinsurance requirements under a policy, contract, plan, or agreement. The information provided must be current, understandable, and available prior to the issuance of a policy, contract, plan, or agreement and upon request thereafter

SOURCE: HI Revised Statutes § 431:10A-116.3; 432D-23.5; & 432:1-601.5. (Accessed Sept. 2021).

Health benefit plans must maintain a network sufficient in numbers and appropriate types of providers to assure that all covered benefits will be accessible without unreasonable travel or delay. Plans may use telehealth as a service delivery system option for ensuring network adequacy.

SOURCE: HI Revised Statutes § 431:26-103. (Accessed Sept. 2021).

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Idaho

Last updated 10/05/2021

No Reference Found

No Reference Found

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Illinois

Last updated 08/25/2021

New Law in Effect:

An individual or group policy of …

New Law in Effect:

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.

To ensure telehealth service, e-visit, and virtual check-in access is equitable for all patients in receipt of health care services under this Section and health care professionals and facilities are able to deliver medically necessary services that can be appropriately delivered via telehealth within the scope of their licensure or certification, coverage required under this Section shall comply with all of the following:

  • An individual or group policy of accident or health insurance shall not:
    • require that in-person contact occur between a health care professional and a patient before the provision of a telehealth service;
    • require patients, health care professionals, or facilities to prove or document a hardship or access barrier to an in-person consultation for coverage and reimbursement of telehealth services, e-visits, or virtual check-ins;
    • require the use of telehealth services, e-visits, or virtual check-ins when the health care professional has determined that it is not appropriate;
    • require the use of telehealth services when a patient chooses an in-person consultation;
    • require a health care professional to be physically present in the same room as the patient at the originating site, unless deemed medically necessary by the health care professional providing the telehealth service;
    • create geographic or facility restrictions or requirements for telehealth services, e-visits, or virtual check-ins;
    • require health care professionals or facilities to offer or provide telehealth services, e-visits, or virtual check-ins;
    • require patients to use telehealth services, e-visits, or virtual check-ins, or require patients to use a separate panel of health care professionals or facilities to receive telehealth service, e-visit, or virtual check-in coverage and reimbursement; or
    • impose upon telehealth services, e-visits, or virtual check-ins utilization review requirements that are unnecessary, duplicative, or unwarranted or impose any treatment limitations, prior authorization, documentation, or recordkeeping requirements that are more stringent than the requirements applicable to the same health care service when rendered in-person, except procedure code modifiers may be required to document telehealth.

Deductibles, copayments, coinsurance, or any other cost-sharing applicable to services provided through telehealth shall not exceed the deductibles, copayments, coinsurance, or any other cost-sharing required by the individual or group policy of accident or health insurance for the same services provided through in-person consultation.

An individual or group policy of accident or health insurance shall notify health care professionals and facilities of any instructions necessary to facilitate billing for telehealth services, e-visits, and virtual check-ins.

An individual or group policy of accident or health insurance shall provide coverage for telehealth services for licensed dietitian nutritionists and certified diabetes educators who counsel diabetes patients in the diabetes patients’ homes to remove the hurdle of transportation for diabetes patients to receive treatment, in accordance with the Dietitian Nutritionist Practice Act.

Any policy, contract, or certificate of health insurance coverage that does not distinguish between in-network and out-of-network health care professionals and facilities shall be subject to this Section as though all health care professionals and facilities were in-network.

Health care professionals and facilities shall determine the appropriateness of specific sites, technology platforms, and technology vendors for a telehealth service, as long as delivered services adhere to all federal and State privacy, security, and confidentiality laws, rules, or regulations, including, but not limited to, the Health Insurance Portability and Accountability Act of 1996 and the Mental Health and Developmental Disabilities Confidentiality Act.

Nothing in this Section shall be deemed as precluding a health insurer from providing benefits for other telehealth services, including, but not limited to, services not required for coverage provided through an asynchronous store and forward system, remote patient monitoring services, other monitoring services, or oral communications otherwise covered under the policy.

There shall be no restrictions on originating site requirements for telehealth coverage or reimbursement to the distant site under this Section other than requiring the telehealth services to be medically necessary and clinically appropriate.

The Department may adopt rules, including emergency rules subject to the provisions of Section 5-45 of the Illinois Administrative Procedure Act, to implement the provisions of this Section.

The Department and the Department of Public Health shall commission a report to the General Assembly administered by an established medical college in this State wherein supervised clinical training takes place at an affiliated institution that uses telehealth services, subject to appropriation. The report shall study the insurer telehealth coverage and reimbursement policies to determine if the policies improve access to care, reduce health disparities, promote health equity, have an impact on utilization and cost-avoidance, including direct or indirect cost savings to the patient, and to provide any recommendations for telehealth access expansion in the future. An individual or group policy of accident or health insurance shall provide data necessary to carry out the requirements of this subsection upon request of the Department. The Department and the Department of Public Health shall submit the report by December 31, 2026. The established medical college may utilize subject matter expertise to complete any necessary actuarial analysis.

SOURCE: IL Insurance Code Chap. 215, Sec. 5/356z.22.  As amended by HB 3308 (2021 Session).(Accessed Aug. 2021).

Insurers are required to include information on the use of telehealth or telemedicine in an electronic provider directory, including but not limited to:

  • whether the provider offers the use of telehealth or telemedicine to deliver services to patients for whom it would be clinically appropriate;
  • what modalities are used and what types of services may be provided via telehealth or telemedicine; and
  • whether the provider has the ability and willingness to include in a telehealth or telemedicine encounter a family caregiver who is in a separate location than the patient if the patient wishes and provides his or her consent

SOURCE: IL Compiled Statutes, Chapter 215, 124/25. As amended by SB 332 (2021 Session) Accessed Aug. 2021).

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Indiana

Last updated 08/25/2021

Accident and sickness insurance (dental or vision insurance is excluded) …

Accident and sickness insurance (dental or vision insurance is excluded) policies and individual or group contracts must provide coverage for telehealth services in accordance with the same clinical criteria as would be provided for services provided in-person.

Coverage for telehealth services may not be subject to a dollar limit, deductible or coinsurance requirement that is less favorable to a covered individual than those applied to the same health services delivered in-person.

A separate consent cannot be required.

If a policy provides coverage for telehealth services via:

  • Secure video conferencing;
  • Store and forward technology; or
  • Remote patient monitoring technology;

between a provider in one (1) location and a patient in another location, the policy may not require the use of a specific information technology application for those services.

SOURCE: IN Code, 27-8-34-6 & 27-13-7-22. as amended by SB 3 (2021). (Accessed Aug. 2021).

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Iowa

Last updated 10/12/2021

Policies, contracts, or plans providing third-party payment or prepayment of …

Policies, contracts, or plans providing third-party payment or prepayment of health or medical expenses shall not discriminate between coverage benefits for health care services that are provided in-person and the same health care services provided through telehealth.

As a condition of reimbursement, a health carrier shall not require that an additional health care professional be located in the same room as a covered person while health care services for a mental health condition, illness, injury, or disease are provided via telehealth by another health care professional to the covered person.

SOURCE: IA Code 514.34(3A) as amended by IA SF 619 (Accessed Oct. 2021).

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Kansas

Last updated 08/30/2021

Insurers cannot exclude an otherwise covered healthcare service from coverage …

Insurers cannot exclude an otherwise covered healthcare service from coverage solely because such service is provided through telemedicine, rather than in-person contact, or based upon the lack of a commercial office for the practice of medicine, when such service is delivered by a healthcare provider.

The insured’s medical record shall serve to satisfy all documentation for the reimbursement of all telemedicine healthcare services, and no additional documentation for telemedicine is required.

SOURCE:  KS Statute Ann. § 40-2,213.  (Accessed Aug. 2021).

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Kentucky

Last updated 09/15/2021

Effective Until Dec. 31, 2021

A health benefit plan shall …

Effective Until Dec. 31, 2021

A health benefit plan shall reimburse for covered services provided to an insured person through telehealth. A health benefit plan shall not:

  • Require a provider be physically present with a patient or client, unless the provider determines that it is necessary to perform those services in-person;
  • Require prior authorization, medical review, or administrative clearance for telehealth that would not be required if a service were provided in-person;
  • Require demonstration that it is necessary to provide services to a patient or client through 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 of telehealth based solely on the communication technology or application used to deliver the telehealth services; or
  • Require a provider to be part of a telehealth network.

A provider must be licensed in Kentucky to receive reimbursement for telehealth services.

SOURCE: KY Revised Statute Sec. 304.17A-138. (Accessed Sept. 2021).

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.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.

A health plan shall not:

  • Require a provider to be physically present with a patient or client, unless the provider determines that it is necessary to perform those services in person;
  • Require prior authorization, medical review, or administrative clearance for telehealth that would not be required if a service were provided in person;
  • Require demonstration that it is necessary to provide services to a patient or client through 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 of telehealth based solely on the communication technology or application used to deliver the telehealth services; or
  • Require a provider to be part of a telehealth network.

A health plan Shall:

  • Require that telehealth services reimbursed under this section meet all clinical, technology, and medical coding guidelines for recipient safety and appropriate delivery of services established by the Department of Insurance or the provider’s professional licensure board;
  • Require a telehealth provider to be licensed in Kentucky, or as allowed under the standards and provisions of a recognized interstate compact, in order to receive reimbursement for telehealth services; and
  • Reimburse a rural health clinic, federally qualified health clinic, or federally qualified health center look-alike for covered telehealth services provided by a provider employed by the rural health clinic, federally qualified health clinic, or federally qualified health center look-alike, regardless of whether the provider was physically located on the premises of the rural health clinic, federally qualified health clinic, or federally qualified health clinic look-alike when the telehealth service was provided; and

May utilize audits for medical coding accuracy in the review of telehealth services specific to audio-only encounters.

Benefits for a service provided through telehealth required by this section may be made subject to a deductible, copayment, or coinsurance requirement. A deductible, copayment, or coinsurance applicable to a particular service provided through telehealth shall not exceed the deductible, copayment, or coinsurance required by the health benefit plan for the same service provided in person.

The section does not require the health plan to:

  • Provide coverage for telehealth services that are not medically necessary; or
  • Reimburse any fees charged by a telehealth facility for transmission of a telehealth encounter.

Providers and home health agencies are strongly encouraged to use audio-only encounters as a mode of delivering telehealth services when no other approved mode of delivering telehealth services is available.

SOURCE: KY Revised Statute Sec. 304.17A-138, as amended by House Bill 140 (2021 Session), (Accessed Sept. 2021).

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Louisiana

Last updated 08/30/2021

Newly Passed Legislation (Effective Now)

When the governor declares a …

Newly Passed Legislation (Effective Now)

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/telemedicine, as well as other things. See statute for full details.

SOURCE: LA Revised Statute 22:11(C) (SB 29 – 2021 Session) (Accessed Aug. 2021).

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 telemedicine medical services, telehealth healthcare services, and remote patient monitoring services.

A link clearly identified on the health coverage plan’s issuer’s website to the information shall be sufficient to meet the requirements.

Certain requirements apply in order to receive reimbursement for remote patient monitoring.  See text of legislation.

SOURCE: LA Revised Statute Sec. 22: 1842 & 1843. (Accessed Aug. 2021).

Payment, benefit, or reimbursement under such policy or contract shall not be denied to a licensed physician conducting or participating in the transmission at the originating health care facility or terminus who is physically present with the individual who is the subject of such 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 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.

No reference found for distant-site physician reimbursement.

SOURCE: LA Revised Statutes 22:1821(F). (Accessed Aug. 2021).

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Maine

Last updated 08/05/2021

A carrier offering a health plan in this State may …

A carrier offering a health plan in this State may not deny coverage on the basis that the health care service is provided through telehealth if the health care service would be covered if it was provided through in-person consultation between an enrollee and a provider.

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.

Provider must be acting within the scope of practice of the provider’s license and in accordance with rules adopted by the board, if any, that issued the provider’s license related to standards of practice for the delivery of a health care service through telehealth.

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.

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 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.

A carrier shall provide coverage for telephonic services when scheduled telehealth services are technologically unavailable at the time of the scheduled telehealth service for an existing enrollee and the telephonic services are medically appropriate for the corresponding covered health care services.

In order to be eligible for reimbursement under this section, a provider providing health care services through telehealth must be acting within the scope of the provider’s license. A carrier may not impose additional credentialing requirements or prior approval requirements for a provider as a condition of reimbursement for health care services provided under this section unless those credentialing requirements or prior approval requirements are the same as those imposed for a provider that does not provide health care services through telehealth.

A carrier may not require a provider to use specific telecommunications technology and equipment as a condition of coverage under this section as long as the provider uses telecommunications technology and equipment that comply with current industry interoperability standards and that comply with standards required under HIPAA.

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.

The availability of health care services through telehealth may not be considered for the purposes of demonstrating the adequacy of a carrier’s network.

SOURCE: Maine Revised Statutes Annotated, Title 24-A, Sec. 4316 as amended by LD 791 (2021 Session), (Accessed Aug. 2021).

A carrier may provide coverage for health care services delivered through telehealth that is consistent with the Medicare coverage policy for interprofessional Internet consultations. If a carrier provides coverage consistent with the Medicare coverage policy for interprofessional Internet consultations, the carrier may also provide coverage for interprofessional Internet consultations that are provided by a federally qualified health center or rural health clinic.

SOURCE: Maine Revised Statutes Annotated, Title 24-A, Sec. 4316 &  LD 1974 (2020 Session). (Accessed Aug. 2021).

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Maryland

Last updated 08/31/2021

Recently Passed Legislation

Insurers, nonprofit health service plans, and health …

Recently Passed Legislation

Insurers, nonprofit health service plans, and health maintenance organizations, shall provide coverage under a health insurance policy or contract for health care services appropriately delivered through telehealth regardless of the location of the patient at the time the telehealth services are provided.

Insurers may not exclude from coverage a health care service solely because it is provided through telehealth and is not provided through an in–person consultation or contact between a health care provider and a patient. Insurers may not exclude from coverage or deny coverage for a behavioral health care service that is a covered benefit under a health insurance policy or contract when provided in person solely because the behavioral health care service may also be provided through a covered telehealth benefit. The health care services appropriately delivered through telehealth shall include counseling and treatment for substance use disorders and mental health conditions.

An entity subject to this section:

  • Shall reimburse a health care provider for the diagnosis, consultation, and treatment of an insured patient for a health care service covered under a health insurance policy or contract that can be appropriately provided through telehealth;
  • Is not required to:
    • reimburse a health care provider for a health care service delivered in person or through telehealth that is not a covered benefit under the health insurance policy or contract;
    • or reimburse a health care provider who is not a covered provider under the health insurance policy or contract; and
  • May impose a deductible, copayment, or coinsurance amount on benefits for health care services that are delivered either through an in–person consultation or through telehealth;
    • May impose an annual dollar maximum as permitted by federal law;
    • May not impose a lifetime dollar maximum.

An insurer, health care service plan, and health maintenance organization may not impose as a condition of reimbursement of a covered health care service delivered through telehealth that the health care service be provided by a third–party vendor designated by the entity.

An entity may undertake utilization review, including preauthorization, to determine the appropriateness of any health care service whether the service is delivered through an in–person consultation or through telehealth if the appropriateness of the health care service is determined in the same manner.

A health insurance policy or contract may not distinguish between patients in rural or urban locations in providing coverage under the policy or contract for health care services delivered through telehealth.

A decision by an entity subject to this section not to provide coverage for telehealth in accordance with this section constitutes an adverse decision, as defined in § 15–10A–01 of this title, if the decision is based on a finding that telehealth is not medically necessary, appropriate, or efficient.

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

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Massachusetts

Last updated 09/01/2021

An individual policy of accident and sickness insurance issued under …

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

An insurer shall not meet network adequacy through significant reliance on telehealth providers and shall not be considered to have an adequate network if patients are not able to access appropriate in-person services in a timely manner upon request. Coverage shall not be limited to services delivered by third-party providers.

A contract that provides coverage for services under this section may contain a provision for a deductible, copayment or coinsurance requirement for a health care service provided via telehealth as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to an in-person consultation or in-person delivery of service.

Health care services provided via telehealth shall conform to the standards of care applicable to the telehealth provider’s profession and specialty. Such services shall also conform to applicable federal and state health information privacy and security standards as well as standards for informed consent.

Evidence of coverage provided to a household upon enrollment must include a summary description of the insured’s telehealth coverage and access to telehealth services, including, but not limited to behavioral health services, chronic disease management and primary care services via telehealth, as well as the telecommunications technology available to access telehealth services.

The executive office of health and human services and the division of insurance shall report on the use of telehealth services in the commonwealth and the effect of telehealth on health care access and system cost.

SOURCE: Massachusetts Senate No. 2984. Section 47, 61, 67  (Accessed Sept. 2021).

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 Senate No. 2984. Section 3, 49, 51, 53, 54  (Accessed Sept 2021).

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Michigan

Last updated 09/02/2021

Insurers and group or nongroup health care corporations shall not …

Insurers and group or nongroup health care corporations shall not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the insurer or health care corporation. Telemedicine services must be provided by a health care professional who is licensed, registered, or otherwise authorized to engage in his or her health care profession in the state where the patient is located. Telemedicine services are subject to all terms and conditions of the contract.

SOURCE: MI Compiled Law Services Sec. 500.3476(1) & Sec. 550.1401k(1). (Accessed Sept. 2021).

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Minnesota

Last updated 09/14/2021

New Law In Effect

A health plan sold, issued, or …

New Law In Effect

A health plan sold, issued, or renewed by a health carrier in Minnesota must cover benefits delivered through telehealth in the same manner as any other benefits covered under the health plan. Coverage for services delivered through telehealth must not be limited on the basis of geography, location, or distance for travel subject to the health care provider network available to the enrollee through the enrollee’s health plan.

A health carrier must not create a separate provider network to deliver services through telehealth that does not include network providers who provide in-person care to patients for the same service or require an enrollee to use a specific provider within the network to receive services through telehealth.

A health carrier may require a deductible, co-payment, or coinsurance payment for a health care service provided through telehealth, provided that the deductible, co-payment, or coinsurance payment is not in addition to, and does not exceed, the deductible, co-payment, or coinsurance applicable for the same service provided through in-person contact.

Nothing in this section requires a health carrier to provide coverage for services that are not medically necessary or are not covered under the enrollee’s health plan; or prohibits a health carrier from:

  • establishing criteria that a health care provider must meet to demonstrate the safety or efficacy of delivering a particular service through telehealth for which the health carrier does not already reimburse other health care providers for delivering the service through telehealth;
  • establishing reasonable medical management techniques, provided the criteria or techniques are not unduly burdensome or unreasonable for the particular service; or
  • requiring documentation or billing practices designed to protect the health carrier or patient from fraudulent claims, provided the practices are not unduly burdensome or unreasonable for the particular service.

Nothing requires the use of telehealth when a health care provider determines that the delivery of a health care service through telehealth is not appropriate or when an enrollee chooses not to receive a health care service through telehealth.

Prior authorization may be required for health care services delivered through telehealth only if prior authorization is required before the delivery of the same service through in-person contact. A health carrier may require a utilization review for services delivered through telehealth, provided the utilization review is conducted in the same manner and uses the same clinical review criteria as a utilization review for the same services delivered through in-person contact.

A health carrier or health care provider shall not require an enrollee to pay a fee to download a specific communication technology or application.

Telehealth Equipment

A health carrier must not require a health care provider to use specific telecommunications technology and equipment as a condition of coverage under this section, provided the health care provider uses telecommunications technology and equipment that complies with current industry interoperable standards and complies with standards required under the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, and regulations promulgated under that Act, unless authorized under this section.

Audio-Only – Expires July 1, 2023

A health carrier must provide coverage for health care services delivered through telehealth by means of the use of audio-only communication if the communication is a scheduled appointment and the standard of care for that particular service can be met through the use of audio-only communication. Substance use disorder treatment services and mental health care services delivered through telehealth by means of audio-only communication may be covered without a scheduled appointment if the communication was initiated by the enrollee while in an emergency or crisis situation and a scheduled appointment was not possible due to the need of an immediate response. This paragraph expires July 1, 2023.

Telemonitoring Services

A health carrier must provide coverage for telemonitoring services if:

  • the telemonitoring service is medically appropriate based on the enrollee’s medical condition or status;
  • the enrollee is cognitively and physically capable of operating the monitoring device or equipment, or the enrollee has a caregiver who is willing and able to assist with the monitoring device or equipment; and
  • the enrollee resides in a setting that is suitable for telemonitoring and not in a setting that has health care staff on site.

Exception

This section does not apply to coverage provided to state public health care program enrollees under chapter 256B or 256L.

SOURCE: MN Statute Sec. 62A.673. As amended by HF 33 (2021 Session).(Accessed Sept. 2021).

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Mississippi

Last updated 08/13/2021

A health insurance or employee benefit plan can limit coverage …

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

All health insurance and employee benefit plans in this state must provide coverage for telemedicine services to the same extent that the services would be covered if they were provided through in-person consultation.

A health insurance or employee benefit plan is not prohibited from providing coverage for only those services that are medically necessary, subject to the terms and conditions of the covered person’s policy.

The originating site is eligible to receive a facility fee.

SOURCE: MS Code Sec. 83-9-351 & MS Code Sec. 83-9-353. (Accessed Aug. 2021). 

Store-and-forward and Remote patient monitoring

All health insurance and employee benefit plans in this state must provide coverage and reimbursement for the asynchronous telemedicine services of store-and-forward telemedicine services and remote patient monitoring services based on the criteria set out in this section.

Patients receiving medical care through store-and-forward must be notified of their right to receive interactive communication with the distant site specialist health care provider and shall receive an interactive communication with the distant specialist upon request. If requested, the communication may occur at the time of consultation or within 30 days of the patient’s request. Telemedicine networks unable to offer this will not be reimbursed for store and forward telemedicine services.

To qualify for remote patient monitoring services, patients must meet all of the following criteria:

  • Be diagnosed in the last 18 months with one or more chronic conditions, as defined by CMS.
  • Have a recent history of costly services due to one or more chronic conditions as evidenced by two or more hospitalizations, including emergency room visits in the last 12 months; and
  • The patient’s healthcare provider recommends disease management services via remote patient monitoring.

Remote patient monitoring prior authorization request form must be submitted to request telemonitoring services and includes:

  • An order for home telemonitoring, signed and dated by a prescribing physician
  • A plan of care, signed and dated by the prescribing physician
  • The client’s diagnosis and risk factors that qualify the client for home telemonitoring services
  • Attestation that the client is sufficiently cognitively intact and able to operate the equipment or has a willing and able person to assist
  • Attestation that the client is not receiving duplicative services via disease management services.

The entity providing remote patient monitoring must be located in Mississippi and have protocols in place meeting specified criteria listed in Mississippi law.

The law lists specific technology requirements, non-English language options, and 24/7 technical and clinical support services available.

Monitoring of a client’s data cannot be duplicated by another provider.

The service must include:

  • An assessment, problem identification, and evaluation including:
    • Assessment and monitoring of clinical data
    • Detection of condition changes based on the telemedicine encounter
  • Implementation of a management plan through one or more of the following:
    • Teaching regarding medication management
    • Teaching regarding other interventions
    • Management and evaluation of the plan of care
    • Coordination of care with the ordering health care provider
    • Coordination and referral to other medical providers as needed
    • Referral for an in-person visit or the emergency room as needed

SOURCE: MS Code Sec. 83-9-353. (Accessed Aug. 2021).

Worker’s Compensation

The practice of telemedicine is deemed to occur in the location of the patient. Therefore, only physicians holding a valid Mississippi license are allowed to practice telemedicine in Mississippi. However, a valid Mississippi license is not required where the evaluation, treatment, and/or medicine to be rendered by a physician outside of Mississippi is requested by a physician duly licensed to practice medicine in Mississippi, and the physician who has requested such evaluation, treatment and/or medical opinion has already established a doctor/patient relationship with the patient to be evaluated and/or treated.

Only those CPT codes marked with a star (*) in the current Medical Fee Schedule may be reimbursed as telemedicine. Billing should include the use of modifier 95 and use of POS code.

Telemedicine providers must use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient. Practitioners who may provide telemedicine services include physicians, nurse practitioners, physician assistants, psychiatrists, clinical psychologists, physical therapists, occupational therapists, speech therapists, and dieticians.

Authorized originating sites include: hospitals (acute and critical access), rural health clinics, federally qualified health centers, skilled nursing facilities, community mental health centers, and in the clinics of the telemedicine providers.

SOURCE: MS Workers’ Compensation Commission. Workers’ Compensation Medical Fee Schedule, Telemedicine Rule, Mar. 24, 2021, (Accessed Aug. 2021).

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Missouri

Last updated 08/04/2021

Health carriers shall not deny coverage for a health care …

Health carriers shall not deny coverage for a health care service on the basis that the health care service is provided through telehealth if the same service would be covered if provided through face-to-face diagnosis, consultation, or treatment.

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 shall not be required to reimburse a telehealth provider or a consulting provider for site origination fees or costs for the provision of telehealth services; however, subject to correct coding, a health carrier shall reimburse a health care provider for the diagnosis, consultation, or treatment of an insured or enrollee when the health care service is delivered through telehealth on the same basis that the health carrier covers the service when it is delivered in-person.

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 Aug. 2021). 

Missouri Consolidated Health Care Plan (State employees and retirees health plan)

Telehealth services are covered on the same basis that the service would be covered when it is delivered in-person.

SOURCE: MO Consolidated State Reg. 22:10-3.057. pg. 23, April 30, 2021, (Accessed Aug. 2021).

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Montana

Last updated 09/08/2021

Each group or individual policy, certificate of disability insurance, subscriber …

Each group or individual policy, certificate of disability insurance, subscriber contract, membership contract, or health care services agreement that provides coverage for health care services must provide coverage for health care services provided by a health care provider or health care facility by means of telemedicine [term changes to ‘telehealth’ Jan. 1, 2022] if services are otherwise covered by the policy, certificate, contract, or agreement.

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

Eligible providers under the parity law include:

  • Physicians
  • Physician Assistants
  • Podiatrists
  • Pharmacists
  • Optometrists
  • Physical Therapists
  • Occupational Therapists
  • Speech-language Pathologists and Audiologists
  • Psychologists
  • Social Workers
  • Licensed Professional Counselors
  • Nutritionists
  • Addiction Counselors
  • Registered professional nurse
  • Naturopathic physician (Effective Jan. 1, 2022)
  • Advanced practice registered nurse
  • Genetic counselor certified by the American board of genetic counseling
  • Diabetes educator certified by the national certification board for diabetes
  • Dentists & Dental Hygienists

Eligible facilities under this law include:

  • Critical access hospital
  • Hospice
  • Hospital
  • Long-term care facility
  • Mental health center
  • Outpatient center for primary care
  • Outpatient center for surgical services

A health insurer is not:

  • Required to provide coverage for services that are not medically necessary, subject to the terms and conditions of the policy
  • Permitted to require a health care provider to be physically present with the patient at the site where the patient is located unless the distant site provider determines that the presence of a health care provider is necessary.

SOURCE: MT Code Sec. 33-22-138. MT Code Title 37 (Accessed Sept. 2021)

Newly Passed Legislation (Effective Jan. 1, 2022)

A policy, certificate, contract, or agreement may not:

  • impose restrictions involving:
    • the site at which the patient is physically located and receiving health care services by means of telehealth; or
    • the site at which the health care provider is physically located and providing the services by means of telehealth; or
  • distinguish between telehealth services provided to patients in rural locations and telehealth services provided to patients in urban locations.

Nothing in this section may be construed to require:

  • A health issuer to provide coverage for services that are not medically necessary, subject to the terms and conditions of the policy;
  • Provide coverage of an otherwise noncovered benefit;
  • A health care provider to be physically present with the patient at the site where the patient is located unless the distant site provider determines that the presence of a health care provider is necessary; or
  • Except as provided in 50-46-310 or as provided in Title 37 and related administrative rules, a patient to have a previously established patient-provider relationship with a specific health care provider in order to receive health care services by means of telehealth.

The commissioner may adopt rules necessary to implement the provisions of this section.

SOURCE: MT Code Sec. 33-22-138 & HB 43 (2021 Session). (Accessed Sept. 2021).

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Nebraska

Last updated 08/02/2021

Any insurer shall not exclude a service from coverage solely …

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 & Legislative Bill 400 (2021 Session). (Accessed Aug. 2021).

Private payers and self-funded employee benefit plans shall provide, upon the request of a policyholder, certificate holder, or health care provider, a description of the telehealth and telemonitoring services covered under the relevant policy, certificate, contract, or plan.  The description must include:

  • Description of services in telehealth and telemonitoring (including any coverage for transmission costs);
  • Exclusions or limitations for telehealth and telemonitoring coverage (including limitation on transmission costs); and
  • Requirements for licensing status of health care providers providing telehealth and telemonitoring services.

SOURCE: NE Revised Statute, Sec. 44-312. (Accessed Aug. 2021).

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 … using telehealth services.

SOURCE: NE Revised Statute Section 44-793 & Legislative Bill 487 (2021 Session), (Accessed Aug. 2021).

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Nevada

Last updated 07/28/2021

Certain provisions apply to policies delivered, issued or renewed on

Certain provisions apply to policies delivered, issued or renewed on or after October 1, 2021

Insurers shall not:

  • Require an enrollee to establish an in-person relationship with a provider or provide any additional consent to or reason for obtaining services through telehealth
  • Require a provider of health care to demonstrate that it is necessary to provide services to an enrollee through telehealth or receive any additional type of certification or license
  • Refuse to provide services through telehealth because the distant site or originating site or the technology used to provide the services;
  • Require covered services to be provided through telehealth as a condition of providing coverage for such services; or
  • Categorize a service provided through telehealth differently for purposes relating to coverage or reimbursement than if the service had been provided in person or through other means.

A policy may not require an enrollee to obtain prior authorization for any service provided through telehealth that is not required for the service when provided in-person or by other means.

Insurers are not required to:

  • Ensure that covered services are available to an enrollee through telehealth at a particular originating site
  • Provide coverage for a service that is not a covered service or that is not provided by a covered provider of health care; or
  • Enter into a contract with any provider of health care or cover any service if the insurer is not otherwise required by law to do so.

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 Jul. 2021).

When making any determination concerning the availability and accessibility of the services of any network health plan, the Commissioner of Insurance shall consider services that may be provided through telehealth.

SOURCE: NV Revised Statues Sec. 687B.490(7). (Accessed Jul. 2021).

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New Hampshire

Last updated 07/26/2021

An insurer offering a health plan in this state may …

An insurer offering a health plan in this state may not deny coverage 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.

The following medical providers shall be allowed to perform health care services through the use of all modes of telehealth, including video and audio, audio-only, or other electronic media. Medical providers include, but are not limited to:

  • Physicians and physician assistants, under RSA 329 and RSA 328-D;
  • Advanced practice nurses, under RSA 326-B and registered nurses under RSA 326-B employed by home health care providers under RSA 151:2-b;
  • Midwives, under RSA 326-D;
  • Psychologists, under RSA 329-B;
  • Allied health professionals, under RSA 328-F;
  • Dentists, under RSA 317-A;
  • Mental health practitioners governed by RSA 330-A;
  • Community mental health providers employed by community mental health programs pursuant to RSA 135-C:7;
  • Alcohol and other drug use professionals, governed by RSA 330-C;
  • Dietitians, governed by RSA 326-H; and
  • Professionals certified by the national behavior analyst certification board or persons performing services under the supervision of a person certified by the national behavior analyst certification board as required by RSA 417-E:2.

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. 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 Jul. 2021).

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New Jersey

Last updated 07/21/2021

A carrier that offers a health benefits plan shall provide …

A carrier that offers a health benefits plan 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.  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. (Accessed Jul. 2021).

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New Mexico

Last updated 07/19/2021

An insurer shall provide coverage for services delivered via telemedicine …

An insurer shall provide coverage for services delivered via telemedicine to the same extent that the health insurance plan, policy or contract covers the same service in-person.  An insurer shall not impose any unique condition for coverage of services provided via telemedicine.

An insurer shall not impose an originating-site restriction with respect to telemedicine services or distinguish between telemedicine services provided to patients in rural locations and those provided to patients in urban locations; provided that the provisions of this section shall not be construed to require coverage of an otherwise non-covered benefit.

A determination that a service is not covered through the use of telemedicine are subject to review and appeal.  Nothing in this section shall require a health care provider to be physically present with the patient at the originating site unless the consulting provider deems it necessary.

Telemedicine services shall be encrypted and conform to state and federal privacy laws.

SOURCE: NM Statutes Annotated. Sec. 59A-22-49.3. (Accessed Jul. 2021).

A plan shall pay a benefit to a covered person for eligible telemedicine or otherwise covered services, but shall not offer a benefit for a telemedicine service provided through a contracted provider.

SOURCE: NM Administrative Code Title 13, Ch. 10,  13.10.34.8 (k). (Accessed Jul 2021).

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New York

Last updated 07/15/2021

An insurer shall not exclude from coverage a service that …

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.

An insurer may subject the coverage of a service delivered via telehealth to reasonable utilization management and quality assurance requirements that are consistent with those established for the same service when not delivered via telehealth.

SOURCE: NY Insurance Law Article 32 Section 3217-h (Accessed Jul. 2021).

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.  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. A corporation may subject the coverage of a service delivered via telehealth to co-payments, coinsurance or deductibles provided that they are at least as favorable to the insured as those established for the same service when not delivered via telehealth. A corporation may subject the coverage of a service delivered via telehealth to reasonable utilization management and quality assurance requirements that are consistent with those established for the same service when not delivered via telehealth.

SOURCE: NY Insurance Law Article 43 Section 4306-g. (Accessed Feb. 2021).

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North Carolina

Last updated 07/12/2021

No Reference Found

No Reference Found

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North Dakota

Last updated 07/08/2021

An insurer may not deliver, issue, execute, or renew a …

An insurer may not deliver, issue, execute, or renew a policy that provides health benefits coverage unless that policy provides coverage for health services delivered by means of telehealth which is the same as the coverage for health services delivered by in-person means.

A policy is not required to provide coverage for health services that are not medically necessary, subject to the terms and conditions of the policy.

SOURCE: ND Century Code Sec. 26.1-36-09.15. (Accessed Jul. 2021).

Telehealth. The organization may pay for audio and video telecommunications instead of a face-to-face “hands on” appointment for CPT codes designated by the American medical association as telehealth codes. As a condition of payment, the patient must be present and participating in the telemedicine appointment. The professional fee payable is equal to the fee schedule amount for the service provided. The organization may pay the originating site a facility fee at the scheduled amount.

SOURCE: ND Admin. Code 92-01-02-34 (3d). (Accessed Jul. 2021).

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.

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 Jul. 2021).

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Ohio

Last updated 07/06/2021

A health benefit plan shall provide coverage for telemedicine services …

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 telemedicine service.

A health benefit plan may not impose any annual or lifetime benefit maximum on telemedicine services other than what is imposed on all benefits under the plan.

SOURCE: OH Revised Code Annotated, 3902.30. (Accessed Jul. 2021).

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Oklahoma

Last updated 06/29/2021

Now Effective

For services that a health care professional determines …

Now Effective

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.

SOURCE: OK Statute, Title 36 Sec. 6803. (Accessed Jun. 2021).

Effective January 1, 2022

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

An insurer shall not impose any type of utilization review on benefits provided through telemedicine unless such type of utilization review is imposed when such benefits are provided through in-person consultation or contact. Any type of utilization review that is imposed on benefits provided through telemedicine shall not occur with greater frequency or more stringent application than such form of utilization review is imposed on such benefits provided through in-person consultation or contact.

An insurer shall not restrict coverage of telemedicine benefits or services to benefits or services provided by a particular vendor, or other third party, or benefits or services provided through a particular electronic communications technology platform; provided, that nothing shall require an insurer to cover any electronic communications technology platform that does not comply with applicable state and federal privacy laws.

An insurer shall not place any restrictions on prescribing medications through telemedicine that are more restrictive than what is required under applicable state and federal law.

SOURCE: OK Statute, Title 36, Sec. 6803 as amended by Senate Bill 674, (Accessed Jun. 2021).

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Oregon

Last updated 06/30/2021

A health benefit plan and a dental-only plan must provide …

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.

Permissible telemedicine applications and technologies include:

  • Landlines, wireless communications, the Internet and telephone networks; and
  • Synchronous or asynchronous transmissions using audio only, video only, audio and video and transmission of data from remote monitoring devices.

During a state of emergency, a health benefit plan or dental-only plan shall provide coverage of a telemedicine service delivered to an enrollee residing in the geographic area specified in the declaration of the state of emergency, if the telemedicine service is delivered using any commonly available technology, regardless of whether the technology meets all standards required by state and federal laws governing the privacy and security of protected health information.

A health benefit plan and a dental-only plan may not:

  • Distinguish between rural and urban originating sites in providing coverage or restrict originating sites that qualify for reimbursement.
  • Restrict a health care provider to delivering services only in person or only via telemedicine.
  • Use telemedicine health care providers to meet network adequacy standard.
  • Require an enrollee to have an established patient-provider relationship with a provider to receive telemedicine health services from the provider or require an enrollee to consent to telemedicine services in person.
  • Impose additional certification, location or training requirements for telemedicine providers or restrict the scope of services that may be provided using telemedicine to less than a provider’s permissible scope of practice.
  • Impose more restrictive requirements for telemedicine applications and technologies than those specified above.
  • Impose on telemedicine health services different annual dollar maximums or prior authorization requirements than the annual dollar maximums and prior authorization requirements imposed on the services if provided in person.
  • Require a medical assistant or other health professional to be present with an enrollee at the originating site.
  • Deny an enrollee the choice to receive a health service in person or via telemedicine.
  • Reimburse an out-of-network provider at a rate for telemedicine health services that is different than the reimbursement paid to the out-of-network provider for health services delivered in person.
  • Restrict a provider from providing telemedicine services across state lines if the services are within the provider’s scope of practice and meets certain criteria (see statute).
  • Prevent a provider from prescribing, dispensing or administering drugs or medical supplies or otherwise providing treatment recommendations to an enrollee after having performed an appropriate examination of the enrollee in person, through telemedicine or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically.
  • Establish standards for determining medical necessity for services delivered using telemedicine that are higher than standards for determining medical necessity for services delivered in person.

A health benefit plan and a dental-only plan shall:

  • Work with contracted providers to ensure meaningful access to telemedicine services by assessing an enrollee’s capacity to use telemedicine technologies that comply with accessibility standards, including alternate formats, and providing the optimal quality of care for the enrollee given the enrollee’s capacity;
  • Ensure access to auxiliary aids and services to ensure that telemedicine services accommodate the needs of enrollees who have difficulty communicating due to a medical condition, who need an accommodation due to disability or advanced age or who have limited English proficiency;
  • Ensure access to telemedicine services for enrollees who have limited English proficiency or who are deaf or hard-of-hearing by providing interpreter services reimbursed at the same rate as interpreter services provided in person; and
  • Ensure that telemedicine services are culturally and linguistically appropriate and trauma-informed.

No later than March 1, 2023, the Department of Consumer and Business Services shall report to the interim committees of the Legislative Assembly related to health on the impact of the reimbursement on the cost of health insurance premiums in this state.

SOURCE: OR Statute Ch. 743A.058 as amended by House Bill 2508 (2021 Session), (Accessed Jun. 2021).

Worker’s Compensation

Distant site provider:  When billing for telemedicine services, the distant site provider must:

  • Use the place of service (POS) code “02”; and
  • Use modifier 95 to identify the service as a synchronous medical service rendered via a real-time interactive audio and video telecommunications system.

When billing for telehealth services other than telemedicine services, the distant site provider:

  • Must use the POS code “02”; and
  • May not use modifier 95.

When billing for telehealth services, the originating site may charge a facility fee using HCPCS code Q3014, if the site is:

  • The office of a physician or practitioner; or
  • A health care facility including but not limited to a hospital, rural health clinic, skilled nursing facility, or community mental health center.

SOURCE: OR Administrative Rules 436-009-0012, (Accessed Jun. 2021).

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Pennsylvania

Last updated 10/14/2021

No Reference Found

No Reference Found

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Rhode Island

Last updated 09/24/2021

Each health insurer that issues individual or group accident-and-sickness insurance …

Each health insurer that issues individual or group accident-and-sickness insurance policies for health-care services and/or provides a health-care plan for health-care services shall provide coverage for the cost of such covered health-care services provided through telemedicine services.

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.

All 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.

“Medically necessary” means medical, surgical, or other services required for the prevention, diagnosis, cure, or treatment of a health-related condition, including services necessary to prevent a decremental change in either medical or mental health status.

Prior authorization requirements for medically necessary and clinically appropriate telemedicine services shall not be more stringent than prior authorization requirements for in- person care. No more stringent medical or benefit determination and utilization review requirements shall be imposed on any telemedicine service than is imposed upon the same service when performed in person.

Except for requiring compliance with applicable state and federal laws, regulations and/or guidance, no health insurer shall impose any specific requirements as to the technologies used to deliver medically necessary and clinically appropriate telemedicine services.

SOURCE: RI General Law, Sec. 27-81-4. as amended by RI SB 4 (2021 Session) & HB 6032 (2021 Session) (Accessed Sept. 2021)

Each health insurer shall collect and provide to the office of the health insurance commissioner (OHIC), in a form and frequency acceptable to OHIC, information and data reflecting its telemedicine policies, practices, and experience. OHIC shall provide this information and data to the general assembly on or before January 1, 2022, and on or before each January 1 thereafter.

SOURCE: RI General Law, Sec. 27-81-7 as amended by RI SB 4 (2021 Session) & HB 6032 (2021 Session) (Accessed Sept. 2021)

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South Carolina

Last updated 06/19/2021

No Reference Found

No Reference Found

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South Dakota

Last updated 09/13/2021

Health insurers are prohibited from excluding a service from coverage …

Health insurers are prohibited from excluding a service from coverage solely because it was provided through telehealth.  Health care services 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.

SOURCE: SD Codified Laws Ann. § 58-17-168. (SB – 137). (Accessed Sept. 2021).

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Tennessee

Last updated 06/14/2021

Telehealth Services

A health insurance entity shall provide coverage for …

Telehealth Services

A health insurance entity shall provide coverage for healthcare services provided during a telehealth encounter in a manner that is consistent with what the health insurance policy or contract provides for in-person encounters for the same service, and shall reimburse for healthcare services provided during a telehealth encounter without distinction or consideration of the geographic location, or any federal, state, or local designation or classification of the geographic area where the patient is located.

A provider must be at a qualified site other than the site where the patient is located; and the patient is at a qualified site, at a school clinic staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section, or at a public elementary or secondary school staffed by a healthcare services provider and equipped to engage in the telecommunications described in this section.

A health insurance entity cannot exclude from coverage, a healthcare service solely because it is provided through telehealth and is not provided through an in-person encounter.

“Qualified site” means the s the office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal Medicare regulations, a federally qualified health center, a facility licensed under title 33, or another location deemed acceptable by the health insurance entity; and

Includes, for the provision of behavioral health services provided via telehealth, the patient’s home or a remote location chosen by the patient.

SOURCE: TN Code Annotated, Sec. 56-7-1002, as amended by House Bill 620 & Senate Bill 429, (2021 Session), (Accessed Jun. 2021).

A health insurance entity shall reimburse an originating site hosting a patient as part of a telehealth encounter an originating site fee in accordance with the federal centers for Medicare and Medicaid services telehealth services rule 42 C.F.R. § 410.78 and at an amount established prior to the effective date of this act by the federal centers for Medicare and Medicaid services.

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.

For a healthcare service for which coverage or reimbursement is provided under the Medical Assistance Act of 1968, compiled in title 71, chapter 5, part 1, or provided under title 71, chapter 3, part 11, “medically necessary” means a healthcare service that is determined by the bureau of TennCare to satisfy the medical necessity standard set forth in 71-5- 144; and

For all other healthcare services, “medically necessary” means healthcare services that a healthcare services provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing, or treating an illness, injury, or disease or the symptoms of an illness, injury, or disease, and that are:

  • In accordance with generally accepted standards of medical practice;
  • Clinically appropriate, in terms of type, frequency, extent, site and duration; and considered effective for the patient’s illness, injury or disease; and
  • Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s illness, injury, or disease excluding any costs paid pursuant to subsection (i).

SOURCE: TN Code Annotated, Sec. 56-7-1002 (Accessed Jun. 2021).

“Qualified site” means the primary or satellite office of a healthcare services provider, a hospital licensed under title 68, a facility recognized as a rural health clinic under federal Medicare regulations, a federally qualified health center, a facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

A provider-based telemedicine provider who seeks to contract with or who has contracted with a health insurance entity to participate in the health insurance entity’s network is subject to the same requirements and contractual terms as any other healthcare services provider in the health insurance entity’s network.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Jun. 2021).

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.

SOURCE: TN Code Annotated, Sec. 56-7-1011, (Accessed Jun. 2021).

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Texas

Last updated 09/22/2021

Effective Until  January 01,  2022

A health benefit plan must …

Effective Until  January 01,  2022

A health benefit plan must provide coverage for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service or telehealth service on the same basis and to the same extent that the plan provides coverage for the service or procedure in an in-person setting.  They may not exclude 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 or a telehealth service solely because the covered health care service or procedure is not provided through an in-person consultation.

Insurers may not limit, deny, or reduce coverage for a covered health care service or procedure delivered as a telemedicine medical service or telehealth service based on the health professional’s choice of platform for delivering the service or procedure.

SOURCE: TX Insurance Code Sec. 1455.004 (Accessed Sept. 2021).

Effective on January 01, 2022

A health benefit plan must provide coverage for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service, teledentistry dental service, or telehealth service on the same basis and to the same extent that the plan provides coverage for the service or procedure in an in-person setting. They may not exclude 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.

Insurers may not limit, deny, or reduce coverage for a covered health care service or procedure delivered as a telemedicine medical service, teledentistry dental service, or telehealth service based on the health professional’s choice of platform for delivering the service or procedure.

SOURCE: TX Insurance Code Sec. 1455.004 as amended by HB 2056 (2021 Session) (Accessed Sept. 2021).

Effective Until January 01, 2022

Each issuer of a health benefit plan must adopt and display in a conspicuous manner on their website the policies and payment practices for telemedicine medical services and telehealth services.  They, however, are not required to list payment rates.

SOURCE: TX Insurance Code Sec. 1455.006 as amended by HB 2056 (2021 Session) (Accessed Sept. 2021).

Effective on January 01, 2022

Each issuer of a health benefit plan shall adopt and display in a conspicuous manner on the health benefit plan issuer’s Internet website the issuer’s policies and payment practices for telemedicine medical services, teledentistry dental services, and telehealth services.

SOURCE: TX Insurance Code Sec. 1455.006 as amended by HB 2056 (2021 Session) (Accessed Sept. 2021).

Each evidence of coverage or certificate delivered or issued for delivery by an HMO may provide enrollees the option to access covered health care services through a telehealth service or telemedicine service.

SOURCE: Texas Admin Code, Title 28, Part 1, Ch. 11, Subchapter Q, Sec. 11.1607, (Accessed Sept. 2021).

Worker’s Compensation

A health care provider must bill for telemedicine and telehealth services according to Medicare payment policies as defined in Section 134.203 in the Texas Administrative Code; and provisions of the Texas Administrative Code, Insurance Title.  A health care provider may bill and be reimbursed or telemedicine or telehealth services regardless of where the injured employee is located at the time the telemedicine or telehealth services are provided.

SOURCE: TX Admin. Code, Title 28 Sec. 2.133.30 (Accessed Sept. 2021).

Recently Adopted Rule 

The State Board of Dental Examiners, in consultation with the commissioner of insurance, as appropriate, may adopt rules necessary to:

  • Ensure that patients using teledentistry dental services receive appropriate, quality care;
  • Prevent abuse and fraud in the use of teledentistry dental services, including rules relating to the filing of claims and records required to be maintained in connection with teledentistry dental services;
  • Ensure adequate supervision of health professionals who are not dentists and who provide teledentistry dental services under the delegation and supervision of a dentist; and
  • Authorize a dentist to simultaneously delegate to and supervise through a teledentistry dental service not more than five health professionals who are not dentists.

SOURCE: TX Occupational Code Title 3, Subtitle A, Chapter 111, Sec. 111.004 as amended by TX HB 2056 (2021 Session) (Accessed Sept. 2021).

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Utah

Last updated 06/09/2021

All health insurance plans must disclose whether the insurer provides …

All health insurance plans must disclose whether the insurer provides coverage for telehealth services in accordance with section 26-18-13.5 and terms associated with that coverage.

SOURCE: UT Code 31A-22-613.5(2)(f). (Accessed May 2021).

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 described in Subsection (2)(a) at a negotiated commercially reasonable rate.

A health benefit plan may not impose originating site restrictions, geographic restrictions, or distance-based restrictions.

A network provider that provides the telemedicine services described above may utilize any synchronous audiovisual technology for the telemedicine services that is compliant with HIPAA.

SOURCE: UT Code, 31A-22-649.5. (Accessed May 2021).

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 consultant is not made available to a physician within seven business days after the initial request is made by an in-network provider; 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.

An insurer can also meet the requirement to cover telepsychiatric consultation for a patient by providing coverage for behavioral health treatment; and ensuring that the patient receives an appointment for the behavioral health treatment in person or using telehealth services on a date that is within seven business days after the initial request is made by the in-network referring physician (see statute for details).

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 May 2021).

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Vermont

Last updated 06/02/2021

Health insurance plans must provide coverage for health care service …

Health insurance plans must provide coverage for health care service 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.

An originating site is the location of the patient, whether or not accompanied by a health care provider, at the time services are provided by a health care provider through telemedicine, including a health care provider’s office, a hospital, or a health care facility, or the patient’s home or another nonmedical environment such as a school-based health center, a university-based health center or patient’s workplace.

A distant site is the location of the health care provider delivering services through telemedicine at the time the services are provided.

A health plan may limit coverage to health care providers in the plan’s network.  A health plan cannot impose limitations on the number of telemedicine consultations a covered person may receive that exceed limitations on in-person services.  Health plans are not prohibited from limiting coverage to only services that are medically necessary and clinically appropriate for delivery through telemedicine, subject to the terms and conditions of the covered person’s contract.

A health insurance plan shall reimburse for health care services and dental services delivered by store-and-forward means.  A health insurance plan shall not impose more than one cost-sharing requirement on a patient for receipt of health care services or dental services delivered by store-and-forward means. If the services would require cost-sharing under the terms of the patient’s health insurance plan, the plan may impose the cost-sharing requirement on the services of the originating site health care provider or of the distant site health care provider, but not both.
In order to facilitate the use of telemedicine in treating substance use disorder, when the originating site is a health care facility, health insurers and the Department of Vermont Health Access shall ensure that the health care provider at the distant site and the health care facility at the originating site are both reimbursed for the services rendered, unless the health care providers at both the distant and originating sites are employed by the same entity.

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k. (Accessed May 2021).

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. Services covered under this subdivision shall include services that are covered when provided in the home by home health agencies.

A health insurance plan shall not require a health care provider to have an existing relationship with a patient in order to be reimbursed for health care services delivered by audio-only telephone.

SOURCE: VT Statutes Annotated, Title 8 Sec. 41001, as amended by S. 117. (Accessed May 2021).

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Virginia

Last updated 09/20/2021

An insurer shall not exclude a service for coverage solely …

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

No insurer, corporation, or health maintenance organization shall require a provider to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.

Requirements on the coverage of telemedicine services include medically necessary remote patient monitoring services to the full extent that these services are available.

Prescribing of controlled substances via telemedicine shall comply with the requirements of § 54.1-3303 and all applicable federal law.

SOURCE: VA Code Annotated Sec. 38.2-3418.16, (Accessed Sept. 2021).

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Washington

Last updated 09/08/2021

Insurers (including employee health plans and Medicaid Managed Care) must …

Insurers (including employee health plans and Medicaid Managed Care) must reimburse a provider for services delivered through telemedicine or store-and-forward if:

  • The plan provides coverage when provided in-person;
  • The health care service is medically necessary;
  • The health care service is a service recognized as an essential health benefit under section 1302(b) of the federal patient protection and affordable care act (ACA);
  • The health care service is determined to be safely and effectively provided through telemedicine or store-and-forward technology according to generally accepted health care practices and standards, and the technology used to provide the health care service meets the standards required by state and federal laws governing the privacy and security of protected health information; and
  • Beginning January 1, 2023, for audio-only telemedicine, the covered person has an established relationship with the provider.

“Established relationship” means the covered person has had at least one in-person appointment within the past year with the provider providing audio-only telemedicine or with a provider employed at the same clinic as the provider providing audio-only telemedicine or the covered person was referred to the provider providing audio-only telemedicine by another provider who has had at least one in-person appointment with the covered person within the past year and has provided relevant medical information to the provider providing audio-only telemedicine.

A distant site, a hospital that is an originating site for audio-only telemedicine may not charge a facility fee.  If a provider intends to bill a patient or the patient’s health plan for an audio-only telemedicine service, the provider must obtain patient consent for the billing in advance of the service being delivered. The insurance commissioner may submit information on any potential violations of this subsection to the appropriate disciplining authority, as defined in RCW 18.130.020.

If the commissioner has cause to believe that a provider has engaged in a pattern of unresolved violations obtaining consent (as required above) the commissioner may submit information to the appropriate disciplining authority for action. Prior to submitting information to the appropriate disciplining authority, the commissioner may provide the provider with an opportunity to cure the alleged violations.  See text for additional information.

Eligible Originating Sites

  1. Hospital
  2. Rural health clinic
  3. Federally qualified health center
  4. Physician’s or other health care provider’s office
  5. Licensed or certified behavioral health agency
  6. Skilled nursing facility
  7. Home or any location determined appropriate by the individual receiving the service
  8. Renal dialysis center, except an independent renal dialysis center

Originating sites may not distinguish between rural and urban originating sites

Any originating site (other than #7 above) may charge a facility fee for infrastructure and preparation of the patient. Reimbursement for a facility fee must be subject to a negotiated agreement between the originating site and the health plan. A distant site, a hospital that is an originating site for audio-only telemedicine, or any other site not identified in the list above may not charge a facility fee.

The plan may not distinguish between originating sites that are rural and urban.

SOURCE: RCW 48.43.735 & .Sec. 41.05.700 as revised by House Bill 1196 (2021 Session), (Accessed Sept. 2021).

Insurers offering a plan shall ensure that their benefits and services provided through electronic and information technology, including telehealth, are accessible to individuals with disabilities, unless doing so would result in undue financial and administrative burdens or a fundamental alteration in the nature of the health programs or activities. When undue financial and administrative burdens or a fundamental alteration exist, the issuer shall provide information in a format other than an electronic format that would not result in such undue financial and administrative burdens or a fundamental alteration but would ensure, to the maximum extent possible, that individuals with disabilities receive the benefits or services of the plan that are provided through electronic and information technology.

SOURCE:  WAC 284-43-5965 (Accessed Sept. 2021).

Language assistance services required under subsection (1) of this section must be provided free of charge, be accurate and timely, and protect the privacy and independence of the individual with limited-English proficiency, regardless of whether an associated health service is provided in person or through telehealth.

SOURCE:  WAC 284-43-5960 (Accessed Sept. 2021).

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West Virginia

Last updated 09/13/2021

Newly Passed Legislation (Now Effective)

An insurer shall provide coverage …

Newly Passed Legislation (Now Effective)

An insurer shall provide coverage of health care services provided through telehealth services if those same services are covered through face-to-face consultation by the policy.  The insurer may not exclude a service for coverage solely because the service is provided through telehealth services.

An originating site may charge an insurer a site fee.

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 as amended by HB 2024. (Accessed Sept. 2021).

Health carriers providing a network plan are required to maintain a network that is sufficient in numbers and appropriate types of providers. The commissioner shall determine sufficiency in accordance with the requirements of this section, and may establish sufficiency by reference to any reasonable criteria, which may include telemedicine or telehealth, among other components.

SOURCE: WV Code Sec. 33-55-1, (Accessed Sept. 2021).

Health carriers must create an access plan that addresses how they use telemedicine or telehealth or other technology to meet network access standards.

SOURCE: WV Admin Law Sec. 114-100, (Accessed Sept. 2021).

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Wisconsin

Last updated 09/07/2021

No Reference Found

No Reference Found

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Wyoming

Last updated 09/03/2021

No Reference Found

No Reference Found

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Private Payer

Requirements

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