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 02/28/2021

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 Feb. 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 Feb. 2021).

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Alabama

Last updated 02/28/2021

No Reference Found

No Reference Found

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Alaska

Last updated 02/28/2021

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 Feb. 2021)

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Arizona

Last updated 02/28/2021

Effective December 31, 2020

All contracts (Health Care Service Organizations …

Effective December 31, 2020

All contracts (Health Care Service Organizations and policies) issued, delivered or renewed on or after January 1, 2018 must provide coverage for health care services that are provided through telemedicine if the health care service would be covered were it provided through in‑person consultation between the subscriber and a health care provider and provided to a subscriber receiving the service in this state.  A corporation may not limit or deny coverage of health care services provided through telemedicine and may apply only the same limits or exclusions on a health care service provided through telemedicine that are applicable to an in-person consultation for the same health care service.  The contract may limit the coverage to those health care providers who are members of the corporation’s provider network.

SOURCE:  AZ Senate Bill 1089 (2019). & AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05.  (Accessed Feb. 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. 130 (Accessed Feb. 2021).

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Arkansas

Last updated 02/28/2021

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.

SOURCE: AR Code Sec. 23-79-1602. (Accessed Feb. 2021).

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California

Last updated 02/28/2021

A health care service plan shall not require that in-person …

A health care service plan 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, and between the health care service plan and its participating providers or provider groups.

A health care service plan 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, and between the health care service plan and its participating providers or provider groups.

Applies to Medi-Cal Managed Care.

SOURCE: CA Health & Safety Code Sec. 1374.13 (AB 744 – 2019 Legislative Session). (Accessed Feb. 2021).

Recently Passed 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 Feb. 2021).

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Colorado

Last updated 02/28/2021

A health benefit plan that is issued, amended or renewed …

A health benefit 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.

Subject to all terms and conditions of the health benefit 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, subject to the terms and conditions of the plan.

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 Feb. 2021).

A carrier shall not:

      1. Impose an annual dollar maximum on coverage for health care services covered under the health benefit 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. mpose 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) (Accessed Feb. 2021).

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Connecticut

Last updated 02/28/2021

Each individual health insurance policy and group health insurance policy …

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 Feb. 2021).

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Delaware

Last updated 02/28/2021

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 Feb. 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 Feb. 2021).

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District of Columbia

Last updated 02/28/2021

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 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 Feb. 2021).

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Florida

Last updated 02/28/2021

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 Feb. 2021).

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Georgia

Last updated 02/28/2021

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.

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.

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

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Hawaii

Last updated 02/28/2021

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 Feb. 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 Feb. 2021).

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Idaho

Last updated 02/28/2021

No Reference Found

No Reference Found

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Illinois

Last updated 02/28/2021

If an insurer provides coverage for telehealth services, then it …

If an insurer provides coverage for telehealth services, then it shall not:

  • Require in-person contact occur between a health care provider and a patient;
  • Require the health care provider to document a barrier to an in-person consultation;
  • Require telehealth use when it is not appropriate; or
  • Require the use of telehealth when the patient chooses an in-person consultation

If an individual or group policy of accident or health insurance provides coverage for telehealth services, it must provide coverage for licensed dietitian nutritionists and certified diabetes educators who counsel senior diabetes patients in the senior diabetes patients’ homes to remove the hurdle of transportation for senior diabetes patients to receive treatment.

SOURCE:  IL Insurance Code. Sec. 356z.22. (Accessed Feb. 2021). 

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Indiana

Last updated 02/28/2021

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 telemedicine services in accordance with the same clinical criteria as would be provided for services provided in-person.

Coverage for telemedicine 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.

SOURCE: IN Code, 27-8-34-6 & 27-13-7-22. (Accessed Feb. 2021).

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Iowa

Last updated 02/28/2021

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.

SOURCE: IA Code 514C.34(2) (Accessed Feb. 2021).

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Kansas

Last updated 02/28/2021

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 Feb. 2021).

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Kentucky

Last updated 02/28/2021

A health benefit plan shall reimburse for covered services provided …

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 Feb. 2021).

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Louisiana

Last updated 02/28/2021

Newly Passed Legislation (Effective Now)

Each issuer of a health …

Newly Passed Legislation (Effective Now)

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 (HB 530 – 2020 Session). (Accessed Feb. 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) (2012). (Accessed Feb. 2021).

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Maine

Last updated 02/28/2021

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.

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.

SOURCE: Maine Revised Statutes Annotated, Title 24-A, Sec. 4316. (Accessed Feb. 2021).

Newly Passed Legislation (Now Effective)

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 Feb. 2021).

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Maryland

Last updated 02/28/2021

Insurers must provide coverage under a health insurance policy for …

Insurers must provide coverage under a health insurance policy for health care services appropriately delivered through telehealth and may not exclude coverage solely because it is provided through telehealth and not in-person.  The health care services appropriately provided through telehealth must include counseling for substance use disorder.

A health insurer can undertake utilization review, including preauthorization to determine the appropriateness of any health care service whether delivered in-person or through telehealth if the appropriateness 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.

SOURCE: MD Insurance Code Annotated Sec. 15-139. (Accessed Feb. 2021).

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Massachusetts

Last updated 02/28/2021

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 Jan. 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 Feb 2021).

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Michigan

Last updated 02/28/2021

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 Feb. 2021).

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Minnesota

Last updated 02/28/2021

A health plan sold, issued, or renewed by a health …

A health plan sold, issued, or renewed by a health carrier for which coverage of benefits begins on or after January 1, 2017, shall include coverage for telemedicine benefits in the same manner as any other benefits covered under the policy, plan, or contract.

A health carrier shall not exclude a service for coverage solely because the service is provided via telemedicine and is not provided through in-person consultation or contact between a licensed health care provider and a patient.

A health carrier can establish criteria that a health care provider must meet to demonstrate the safety or efficacy of delivering a particular service via telemedicine for which the health carrier does not already reimburse other health care providers for delivering via telemedicine, so long as the criteria are not unduly burdensome or unreasonable for the particular service.

A health carrier can require a health care provider to agree to certain documentation or billing practices designed to protect the health carrier or patients from fraudulent claims so long as the practices are not unduly burdensome or unreasonable for the particular service.

SOURCE: MN Statute Sec. 62A.672.  (Accessed Feb. 2021)

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Mississippi

Last updated 02/28/2021

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 Feb. 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 Feb. 2021).

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Missouri

Last updated 02/28/2021

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 Feb. 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, 2020, (Accessed Feb. 2021).

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Montana

Last updated 04/27/2021

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. (Accessed Apr. 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 Apr. 2021).

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Nebraska

Last updated 02/28/2021

Any insurer offering any policy, certificate, contract, or plan which …

Any insurer offering any policy, certificate, contract, or plan which coverage of benefits begins on or after January 1, 2021, shall not exclude from coverage telehealth services provided by a dermatologist solely because the service is delivered asynchronously. An insurer shall reimburse a health care provider for asynchronous review by a dermatologist delivered through telehealth at a rate negotiated between the provider and the insurer.

SOURCE: NE Rev. Statute, 44-7,107, (Accessed Feb. 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);
  • Requirements for licensing status of health care providers providing telehealth and telemonitoring services; and
  • Requirements for demonstrating compliance with the signed written statement requirement.

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

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Nevada

Last updated 02/28/2021

Insurers shall not:

  • Require an enrollee to establish an in-person

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
  • Require covered services to be provided through telehealth as a condition of providing coverage for such services.

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.

SOURCE: NV Revised Statute Sec. 689A.0463; Sec. 689B.0369; Sec. 689C.195; Sec. 616C.730; Sec. 695A.265; Sec. 695B.1904; Sec. 695C.1708; Sec. 695D.216; & Sec. 695G.162. (Accessed Feb. 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 Feb. 2021).

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New Hampshire

Last updated 02/28/2021

Recently Passed Legislation (Now Effective)

An insurer offering a health …

Recently Passed Legislation (Now Effective)

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, (NH HB 1623, 2020 Session), (Accessed Feb. 2021).

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New Jersey

Last updated 02/28/2021

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 Feb. 2021).

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New Mexico

Last updated 02/28/2021

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.

A determination that a service is not covered through the use of telemedicine are subject to review and appeal.  Plans cannot require a health care provider to be physically present with the patient at the originating site unless the consulting provider deems it necessary. Insurers cannot impose an originating-site restriction or distinguish between telemedicine services provided to patients in rural and urban locations.

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

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

Recently Adopted Rule

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 Feb. 2021).

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New York

Last updated 02/28/2021

A health plan shall not exclude from coverage services that …

A health plan shall not exclude from coverage services that are provided via telehealth if they would otherwise be covered under a policy, provided that an insurer may exclude coverage of a service by a health care provider where the provider is not otherwise covered under the policy or contract.

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

SOURCE: NY Insurance Law Article 32 Section 3217-h & NY Insurance Law Article 43 Section 4306-g. (Accessed Feb. 2021).

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North Carolina

Last updated 02/28/2021

No Reference Found

No Reference Found

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North Dakota

Last updated 02/28/2021

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 Feb. 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 Feb. 2021).

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Ohio

Last updated 02/28/2021

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 Feb. 2021).

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Oklahoma

Last updated 02/28/2021

For services determined to be appropriately provided by means of …

For services determined 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 practitioner and a patient.

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

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Oregon

Last updated 02/28/2021

Health plans must provide coverage of a health service that …

Health plans must provide coverage of a health service that is provided using synchronous two-way interactive video if the service would be covered when provided in-person, it is a medically necessary service, the service is determined to be safely and effectively provided using live video according to generally accepted health care practices and standards and the technology and application to provide the service meets all standards required by state and federal laws governing privacy and security of protected health information.  Plans are not required to reimburse a health professional for a service that is not a covered benefit under the plan or who has not contracted with the plan.

SOURCE: OR Revised Statutes Sec. 743A.058. (Accessed Feb. 2021).

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Pennsylvania

Last updated 02/28/2021

No Reference Found

No Reference Found

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Rhode Island

Last updated 02/28/2021

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.

SOURCE: RI General Law, Sec. 27-81-4(a). (Accessed Feb. 2021).

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South Carolina

Last updated 02/28/2021

No Reference Found

No Reference Found

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South Dakota

Last updated 04/29/2021

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 Apr. 2021).

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Tennessee

Last updated 02/28/2021

A health insurance entity shall provide coverage for healthcare 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.

Private payers are only required to reimburse for telehealth when the patient is located at a qualified site, a school clinic, or a public elementary or secondary school staffed by a healthcare services provider.

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.

Private payers are only required to reimburse for telehealth when the patient is located at a qualified site, a school clinic, or a public elementary or secondary school staffed by a healthcare services provider.

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.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002.  (Accessed Feb. 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 & HB 8002 (2020 Session), (Accessed Feb. 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.

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. 56-7-1003 & HB 8002 (2020 Session), (Accessed Feb. 2021). 

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Texas

Last updated 02/28/2021

A health benefit plan must provide coverage for a covered …

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 Feb. 2021).

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 (Accessed Feb. 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 Feb. 2021).

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Utah

Last updated 02/28/2021

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 Feb. 2021).

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 (see statute for details).

SOURCE: UT Code, 31A-22-649. (Accessed Feb. 2021).

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Vermont

Last updated 02/28/2021

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.

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

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.

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

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Virginia

Last updated 02/28/2021

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.

SOURCE: VA Code Annotated Sec. 38.2-3418.16(C). (Accessed Feb. 2021).

Facility fee reimbursement is allowed, but not required.

SOURCE: VA Code Annotated Sec. 38.2-3418.16(D).  (Accessed Feb. 2021).

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

SOURCE: VA Code Annotated Sec. 38.2-3418.16(J). (Accessed Feb. 2021).

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Washington

Last updated 02/28/2021

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); and
  • 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.

SOURCE: RCW 48.43.735.(1) & Sec. 41.05.700.(1), (Accessed Feb. 2021).

Eligible Originating Sites

  • Hospital
  • Rural health clinic
  • Federally qualified health center
  • Physician’s or other health care provider’s office
  • Community mental health center
  • Skilled nursing facility
  • Renal dialysis center, except an independent renal dialysis center
  • Home or any location determined appropriate by the individual receiving the service

Originating sites may not distinguish between rural and urban originating sites

SOURCE: RCW 48.43.735.(3) & Sec. 41.05.700.(3), (Accessed Feb. 2021).

An originating site (other than a home) can charge a facility fee, but it is subject to a negotiated agreement between the originating site and the health carrier.

SOURCE: RCW 48.43.735.(4) & .Sec. 41.05.700.(4), (Accessed Feb. 2021).

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

SOURCE: Revised Code of WA Sec. 41.05700(5) (Accessed Feb. 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 Feb. 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 Feb. 2021).

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West Virginia

Last updated 02/28/2021

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 & 33-53-1 (HB 4003 – 2020 session). (Accessed Feb. 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. 33-53-3 (HB 4061 – 2020 Session), (Accessed Feb. 2021).

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Wisconsin

Last updated 02/28/2021

No Reference Found

No Reference Found

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Wyoming

Last updated 02/28/2021

No Reference Found

No Reference Found

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Private Payer

Requirements

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