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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Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Federal

Last updated 12/14/2023

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 Dec. 2023).

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 Dec. 2023).

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Alabama

Last updated 02/26/2024

No Reference Found

No Reference Found

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Alaska

Last updated 02/27/2024

A health care insurer that offers, issues for delivery, or …

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 occur between a health care provider and a patient before payment is made for covered services.

SOURCE: AK Statute, Sec. 21.42.422 (Accessed Feb. 2024).

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Arizona

Last updated 02/09/2024

All contracts issued, delivered or renewed in this state must …

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.
  • Except in an emergency, the contract may limit the coverage to those health care providers who are members of the corporation’s provider network.

Subsection A of this section does not:

  • Limit the ability of corporations to provide incentives to subscribers that are designed to improve health outcomes, increase adherence to a course of treatment or reduce risk.
  • Prevent corporations from offering network contracts to health care providers who employ value-based purchasing or bundled payment methodologies if otherwise allowed by law or prevent health care providers from voluntarily agreeing to enter into such contracts with a corporation.

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.

This section does not prevent a corporation from imposing deductibles or copayment or coinsurance requirements for a health care service provided through telehealth if the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to an in-person encounter for the same health care service.  If the corporation waives a deductible or copayment or coinsurance requirement that impacts a health care provider’s contracted reimbursement rate, the corporation shall reimburse the health care provider for the cost of the deductible or copayment or coinsurance requirement to ensure that the health care provider receives the contracted reimbursement rate if the service is covered and the claim meets other requirements of the network participation agreement.

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  (Accessed Feb. 2024).

Health Care Service Organizations (HCSO) are allowed, but not mandated, to provide access to covered services through:

  • Telephone calls and messages
  • Electronic mail
  • Communication with the physician’s or practitioner’s staff,
  • Coverage by another physician or practitioner, or
  • Telemedicine,

SOURCE: AZ Admin. Code Sec. R20-6-1915. Pg. 158 (Accessed Feb. 2024).

Worker’s Compensation

Reimbursement values for telehealth services are governed by the Fee Schedule and no reductions are justified unless specified by the Fee Schedule. Performance of telehealth services are governed by Arizona Revised Statutes, Title 36, Chapter 36. Bills for services performed via telehealth shall include the appropriate modifier and place of service code according to the incorporated AMA/CMS guidelines.

For purposes of the Fee Schedule, the Commission recognizes that direct supervision of a Physician Assistant or Nurse Practitioner by a Physician can be accomplished through the use modern technology and telecommunications (telemedicine) and may not require the on-site presence of the Physician when the Physician Assistant or Nurse Practitioner sees the patient. In all instances, however, and regardless of the extent to which telemedicine is used, the Physician must actively participate in and manage the patient’s care if services provided by a Physician Assistant or Nurse Practitioner are billed at 100% of the fee schedule under the “incident to” exception.

SOURCE: AZ Physicians and Pharmaceutical Fee Schedule, The Industrial Commission of Arizona, 2023/2024 Fee Schedule Introduction, Oct. 1, 2023, (Accessed Feb. 2024).

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Arkansas

Last updated 02/06/2024

A health benefit plan shall provide coverage and reimbursement for …

A health benefit plan shall provide coverage and reimbursement for healthcare services provided through telemedicine on the same basis as the health benefit plan provides coverage and reimbursement for health services provided in person, unless this subchapter specifically provides otherwise.  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 described in Sec. 23-79-1601(7)(C).

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;
  • A prior authorization requirement for services provided through telemedicine that exceeds the prior authorization requirement for in-person healthcare services under the health benefit plan
  • 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 Feb. 2024).

Screening for behavioral health conditions and behavioral health services provided as described in subsection (a) of this section may be provided via telemedicine and reimbursed as required under § 23-79-1601 et seq.

SOURCE: AR Code Sec. 23-79-2802, (Accessed Feb. 2024).

Network Adequacy

The Commissioner, pursuant to his or her discretion, may publish more detailed and specific network adequacy time/distance standards, as well as guidelines regarding the use of telemedicine to meet network adequacy standards, via SERFF Network Adequacy Data Submission Instructions, and/or annual bulletin for setting forth certification requirements for ACA submissions. Such new standards will become effective for review on January 1, of the following year.

SOURCE: AR Admin Code, Title 054, 00, Sec. 106, (Accessed Feb. 2024).

Ambulance Services

An ambulance service’s operators may triage and transport a patient to an alternative destination in this state or treat in place if the ambulance service is coordinating the care of the patient through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint.

SOURCE: AR Code 20-13-108, (Accessed Feb. 2024).

On and after January 1, 2024, a healthcare insurer [includes Medicaid] that offers, issues, or renews a health benefit plan in this state shall provide coverage for:

  • An ambulance service to:
    • Treat an enrollee in place if the ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint; or
    • Triage or triage and transport an enrollee to an alternative destination if the ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint; or
  • An encounter between an ambulance service and enrollee that results in no transport of the enrollee if:
    • The enrollee declines to be transported against medical advice; and
    • The ambulance service is coordinating the care of the enrollee through telemedicine with a physician for a medical-based complaint or with a behavioral health specialist for a behavioral-based complaint.

See statute for additional restrictions.

SOURCE: AR Code 23-79-2703, (Accessed Feb. 2024).

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California

Last updated 12/20/2023

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, and pursuant to Health & Safety Code Section 1374.14 & Insurance Code Section 10123.855.

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, and pursuant to Health & Safety Code Section 1374.14 & Insurance Code Section 10123.855.

Applies to Medi-Cal Managed Care.

SOURCE: CA Health & Safety Code Sec. 1374.13 & Insurance Code Sec. 10123.85. (Accessed Dec. 2023).

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. (Accessed Dec. 2023).

If a health care service plan or insurer offers a service via telehealth to an enrollee through a third-party corporate telehealth provider, all of the following conditions shall be met:

  • The health care service plan or insurer shall disclose to the enrollee in any promotion or coordination of the service both of the following:
    • The availability of receiving the service on an in-person basis or via telehealth, if available, from the patients’ primary care provider, treating specialist, or from another contracting individual health professional, contracting clinic, or contracting health facility consistent with the service and existing timeliness and geographic access standards in Sections 1367 and 1367.03 and regulations promulgated thereunder.
    • If the patient has coverage for out-of-network benefits, a reminder of the availability of receiving the service either via telehealth or on an in-person basis using the enrollee’s out-of-network benefits, and the cost sharing obligation for out-of-network benefits compared to in-network benefits and balance billing protections for services received from contracted providers.
  • After being notified pursuant to paragraph (1), the patient chooses to receive the service via telehealth through a third-party corporate telehealth provider.
  • The patient consents to the service consistent with Section 2290.5 of the Business and Professions Code.
  • If the patient is currently receiving specialty telehealth services for a mental or behavioral health condition, the enrollee is given the option of continuing to receive that service with the contracting individual health professional, a contracting clinic, or a contracting health facility.

If services are provided to an enrollee through a third-party corporate telehealth provider, a health care service plan or insurer shall comply with all of the following:

  • Notify the patient of their right to access their medical records.
  • Notify the patient that the record of any services provided to the enrollee through a third-party corporate telehealth provider shall be shared with their primary care provider, unless the patient objects.
  • Ensure that the records are entered into a patient record system shared with the patient’s primary care provider or are otherwise provided to the patient’s primary care provider, unless the patent objects, in a manner consistent with state and federal law.
  • Notify the patient that all services received through the third-party corporate telehealth provider are available at in-network cost-sharing and out-of-pocket costs shall accrue to any applicable deductible or out-of-pocket maximum.

A health care service plan or insurer shall include in its reports submitted to the department all of the following for each product type:

  • By specialty, the total number of services delivered via telehealth by third-party corporate telehealth providers.
  • The names of each third-party corporate telehealth provider contracted with the plan or insurer and, for each, the number of services provided by specialty.
  • For each third-party corporate telehealth provider with which it contracts, the percentage of the third-party corporate telehealth provider’s contracted providers available to the plan’s patients that are also contracting individual health professionals.
  • For each third-party corporate telehealth provider with which it contracts, the types of telehealth services utilized by patients, including frequency of use, gender, age, and any other information as determined by the department.
  • For each patient that has accessed services for a third-party corporate telehealth provider, patient demographic data, including gender and age, and any other information as determined by the department.

This section shall not apply when an enrollee seeks services directly from a third-party corporate telehealth provider or to Medicaid.

SOURCE: CA Health & Safety Code Sec. 1374.141 & Insurance Code 10123.856. (Accessed Dec. 2023).

A health care service plan or insurer that issues, sells, renews, or offers a plan contract covering dental services, including a specialized health care service plan contract covering dental services that offers a service via telehealth to an enrollee through a third-party corporate telehealth provider shall report to the department, in a manner specified by the department, all of the following for each product type:

  1. The total number of services delivered via telehealth by a third-party corporate telehealth provider.
  2. For each third-party corporate telehealth provider with which it contracts, the percentage of the third-party telehealth provider’s contracted providers available to the plan’s enrollees that are also network providers.
  3. For each third-party corporate telehealth provider with which it contracts, the types of telehealth services utilized by enrollees, including information on the gender and age of the enrollee, and any other information as determined by the department.

A health care service plan or insurer that issues, sells, renews, or offers a plan contract covering dental services, including a specialized health care service plan contract covering dental services that offers a service via telehealth to an enrollee through a third-party corporate telehealth provider, shall disclose to the enrollee the impact of third-party telehealth visits on the enrollee’s benefit limitations, including frequency limitations and the enrollee’s annual maximum.

For the purposes of this section, “third-party corporate telehealth provider” means a corporation that provides dental services exclusively through a telehealth technology platform and has no physical location at which a patient can receive services, and is directly contracted with a health care service plan, including a specialized health care service plan, that issues, sells, renews, or offers a plan contract covering dental services.

SOURCE: CA Health & Safety Code Sec. 1374.142 & Insurance Code 10123.857, as added by AB 1982 (2022 Session). (Accessed Dec. 2023).

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Colorado

Last updated 01/29/2024

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 or dental 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 Jan. 2024).

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. (Accessed Jan. 2024).

Workers’ Compensation

In addition to the healthcare services listed in Appendix P of CPT, and Division Z- codes (when appropriate), services aligning with the following CPT codes may be provided via telemedicine: G0396, G0397, G0406-G0408, G0425-G0427, G0447, G0459, G0508, G0509, 97129, 97130, 97150, 97542, and 97763. Additional services may be provided via telemedicine with prior authorization. The provider shall append modifier 95 to the appropriate code(s) to indicate synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.

All treatment provided through telemedicine shall comply with the applicable requirements found in the Colorado Medical Practice Act and Colorado Mental Health Practice Act, as well as the rules and policies adopted by the Colorado Medical Board and the Colorado Board of Psychologist Examiners and shall follow applicable laws, rules and regulations for informed consent.

HIPAA privacy and electronic security standards are required for the originating site and the rendering provider.

The rendering provider may be the only provider involved in the provision of telemedicine services. The rendering provider shall bill place of service (POS) code 02. Maximum allowance is the appropriate code’s non-facility relative weight from RBRVS multiplied by the appropriate CF, unless only a facility weight is established.

An originating site fee may only be billed when the injured worker is receiving services at an authorized originating site. The originating site is responsible for verifying the injured worker and rendering provider’s identities. Originating site must bill with the appropriate facility POS code. Authorized originating sites include:

  • A Hospital (inpatient or outpatient)
  • A Critical Access Hospital (CAH)
  • A Rural Health Clinic (RHC)
  • A federally qualified health center (FQHC)
  • A hospital based renal dialysis center (including satellites)
  • A Skilled Nursing Facility (SNF)
  • A community mental health center (CMHC)

Maximum allowance for Q3014 is $35.00 per 15 minutes. (Equipment, supplies, and professional fees of supporting providers at the originating site are not separately payable.)

Documentation requirements are the same as for a face-to-face encounter and shall also include the location of both the rendering provider and the injured worker at the time of service, and a statement on how the treatment was rendered through telemedicine (such as secured video).

Treating Physician Telephone or On-line Services – Minimum required documentation elements include: (a) Total time spent on medical discussion and date; (b) The injured worker, family member, or healthcare provider spoken with; and (c) Specific discussion and/or decision(s) made during the discussion. Telephone or on-line services may be billed even if performed within the one day and seven day timelines listed in CPT®. Reimbursement for coordination of care between medical professionals is limited to professionals outside of the Provider’s practice. Telephone services, including those listed in Appendix T and Telephone Services section of CPT®, shall be billed with a modifier 93. Modified RVUs are also listed.

Teledentistry – Synchronous and asynchronous teledentistry codes are also included on the Dental Fee Schedule within the workers’ compensation system.

SOURCE: CO Permanent Rules, Sec. 7 CCR 1101-3 Rule 18Exhibits. (Accessed Jan. 2024).

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Connecticut

Last updated 01/10/2024

Effective Now Until June 30, 2024

Insurers shall provide coverage …

Effective Now Until June 30, 2024

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.

Notwithstanding any provision of the general statutes, no health carrier shall reduce the amount of a reimbursement paid to a telehealth provider for covered health care or health services that the telehealth provider appropriately provided to an insured through telehealth during the period beginning on May 10, 2021, and ending on June 30, 2024, because the telehealth provider provided such health care or health services to the patient through telehealth and not in person.

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, 2024.

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, 2024, 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 the patient’s health coverage uses a provider network, the amount of such reimbursement, and such coinsurance, copayment, deductible or other out-of-pocket expense, shall not exceed the in-network amount regardless of the network status of such telehealth provider.

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) & SB 2 (2022 Session). (Accessed Jan. 2024).

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 licensed in the state. Such coverage 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 licensed in the state, 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.

Nothing in this section shall prohibit 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.

SOURCE: CT General Statute 38a, Sec. 499a. & 38a, Sec. 526a, as amended by SB 2 (2022 Session). (Accessed Jan. 2024).

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Delaware

Last updated 01/15/2024

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 least 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, Chapter 33, Sec. 3370; & Title 18, Chapter 35, Sec. 3571R. (Accessed Jan. 2024).

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, or requiring the use of technology permitting visual communication.

SOURCE: 18 DE Administrative Code 1409 (Accessed Jan. 2024).

No insurer may, in issuing or renewing an insurance policy to a health-care professional or health-care organization, increase the premium on such policy or take other adverse action against any health-care professional or health-care organization who performs or assists in the provision of reproductive health services, as that term is defined in § 1702 of Title 24, that is legal in this State to an individual who is from out of the state. This section applies to a policy that covers any medical professional who prescribes medication for the termination of human pregnancy to an out-of-state patient by means of telehealth.

SOURCE: DE Code Title 18, Chap. 25, Sec. 2535. (Accessed Jan. 2024).

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District of Columbia

Last updated 12/07/2023

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 Dec. 2023).

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Florida

Last updated 02/24/2024

Contracts between health insurers or health maintenance organizations and telehealth …

Contracts between health insurers or health maintenance organizations and telehealth providers must be voluntary and must be voluntary between the health maintenance organization and the provider 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 services provided without the use of telehealth must be initialed by the telehealth provider.

SOURCE: FL Statute 641.31 (45). & 627.42396. (Accessed Feb. 2024).

Effective January 1, 2024, the Division of State Group Insurance shall continue to allow service delivery through telehealth in its health benefits contracts.

SOURCE: FL Senate Bill 2500, (Accessed Feb. 2024.

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Georgia

Last updated 01/31/2024

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 Jan 2024).

Newly Passed Legislation

An insurer shall not:

  • Require prior authorization, medical review, or administrative clearance for a telehealth service that would not be required if such service were provided in person;
  • Require demonstration that it is necessary to provide a service to a covered person through telehealth;
  • Require a provider to be employed by another provider or agency in order to provide a telehealth service that would not be required if such service were provided in person;
  • Restrict or deny coverage of a telehealth service based solely on the communication technology or application used to deliver such service;
  • Require a provider to be part of a telehealth network;
  • Require a covered person to utilize telehealth or telemedicine in lieu of a nonparticipating provider accessible for in-person consultation or contact; or
  • Be required to pay a facility fee to a hospital for telehealth services unless the hospital is the originating site as defined in subsection (b) of Code Section 33-24-56.4.

SOURCE Official Code of GA Annotated Sec. 33-20E-24(e).  (Accessed Jan. 2024).

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Hawaii

Last updated 02/13/2024

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

Insurance plans, health maintenance organizations and mutual benefit society plans cannot require in-person 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. Amended by HB 907 (Will be repealed December 31, 2025).  (Accessed Feb. 2024).

Network Adequacy

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. 2024).

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Idaho

Last updated 02/13/2024

No Reference Found

No Reference Found

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Illinois

Last updated 02/27/2024

An individual or group policy of accident or health insurance …

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. (Accessed Feb. 2024).

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

Telehealth may be considered in meeting network adequacy standards.

SOURCE: IL Compiled Statutes, Chapter 215, 124/25. (Accessed Feb. 2024).

Network Adequacy

The print and electronic versions of the provider directories. The directories must include up-to-date, accurate, and complete provider/facility type, location, and contact information required under Section 25 of the Act. Providers available by telehealth or telemedicine must be clearly identified and include information required under the Act.

A description of how health care services to be rendered under the network plan are reasonably accessible and available to beneficiaries, including the type of health care services to be provided by the network plan. The description shall address all of the following:

  •  the availability of telehealth care, including how the use of telemedicine, telehealth, or mobile care services may be used to partially meet the network adequacy standards, if applicable (Section 10(b)(5) of the Act

SOURCE: IL Admin. Code Title 50, Chapter 1 Section 4540.40(c) & (p).  (Accessed Feb. 2024).

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Indiana

Last updated 12/05/2023

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.

This section does not do any of the following:

  • Require an individual contract or a group contract to provide coverage for a telehealth service that is not a covered health care service under the individual contract or group contract.
  • Require the use of telehealth services when the treating provider has determined that telehealth services are inappropriate.
  • Prevent the use of utilization review concerning coverage for telehealth services in the same manner as utilization review is used concerning coverage for the same health care services delivered to an enrollee 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. (Accessed Dec. 2023)

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Iowa

Last updated 01/15/2024

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.

Health care services that are delivered by telehealth must be appropriate and delivered in accordance with applicable law and generally accepted health care practices and standards prevailing at the time the health care services are provided, including all rules adopted by the appropriate professional licensing board, pursuant to chapter 147, having oversight of the health care professional providing the health care services.

A health carrier shall not exclude a health care professional who provides services for mental health conditions, illnesses, injuries, or diseases and who is physically located out-of-state from participating as a provider, via telehealth, under a policy, plan, or contract offered by the health carrier in the state if all of the following requirements are met:

  • The health care professional is licensed in this state by the appropriate professional licensing board and is able to deliver health care services for mental health conditions, illnesses, injuries, or diseases via telehealth in compliance with paragraph “a”.
  • The health care professional is able to satisfy the same criteria that the health carrier uses to qualify a health care professional who is located in the state, and who holds the same license as the out-of-state professional, to participate as a provider, via telehealth, under a policy, plan, or contract offered by the health carrier in the state.

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(2) and 4b (Accessed Jan. 2024).

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Kansas

Last updated 12/06/2023

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 Dec. 2023).

The same requirements for patient privacy and confidentiality under the health insurance portability and accountability act of 1996 and 42 C.F.R. § 2.13, as applicable, that apply to healthcare services delivered via in-person contact shall also apply to healthcare services delivered via telemedicine. Nothing in this section shall supersede the provisions of any state law relating to the confidentiality, privacy, security or privileged status of protected health information.

Telemedicine may be used to establish a valid provider-patient relationship.

The same standards of practice and conduct that apply to health-care services delivered via in-person contact shall also apply to healthcare services delivered via telemedicine.

A person authorized by law to provide and who provides telemedicine services to a patient shall provide the patient with guidance on appropriate follow-up care.

SOURCE:  KS Statute Ann. § 40-2,212.  (Accessed Dec. 2023).

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Kentucky

Last updated 12/11/2023

A health benefit plan, issued or renewed on or

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. (Accessed Dec. 2023).

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Louisiana

Last updated 02/15/2024

When the governor declares a state of emergency or a …

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

SOURCE: LA Revised Statute 22:11(C) (Accessed Feb. 2024).

Requirements in the event of a declared emergency

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

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

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

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

SOURCE: LA Admin Code, Sec. 37:XIII.17947, (Accessed Feb. 2024).

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

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

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

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

SOURCE: LA Revised Statute Sec. 22: 1842, as amended by Senate Bill 66 (2023 Session), (Accessed Feb. 2024).

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

 SOURCE: LA Revised Statute Sec. Sec. 22: 1843. (Accessed Feb. 2024).

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

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

SOURCE: LA Revised Statutes 22:1821(F). (Accessed Feb. 2024).

Physical Therapy

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

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

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

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

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

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

SOURCE: LA Revised Statute 22:1845.1, (Accessed Feb. 2024).

Occupational Therapy

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

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

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

This Act shall apply to any new health coverage plan issued on and after January 1, 2024. Any health coverage plan in effect prior to January 1, 2024, shall convert to conform to the provisions of this Act on or before the renewal date, but no later than January 1, 2025.

SOURCE: LA Revised Statute 22:1845.2, (Accessed Feb. 2024).

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Maine

Last updated 02/03/2024

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 were provided through in-person consultation between an enrollee and a provider and as long as the provider is 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 may not exclude a health care service from coverage solely because such health care service is provided only through a telehealth encounter, as long as telehealth is appropriate for the provision of such health care service.

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

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

A carrier shall provide coverage for telemonitoring if:

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

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

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, (Accessed Feb. 2024).

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Maryland

Last updated 02/21/2024

Insurers, nonprofit health service plans, and health maintenance organizations, shall …

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. (Accessed Feb. 2024).

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Massachusetts

Last updated 01/12/2024

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 General Laws, Part 1, Title XXII, Ch. 175, Sec. 47MM,  Ch. 176O, Sec. 6 & Ch. 260, Sec. 67  (Accessed Jan. 2024).

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

SOURCE: Massachusetts General Laws Part 1, Title IV, Ch. 32A, Section 30 & Part 1, Title XXII, Ch. 176A, Sec. 38, Ch. 176B, Sec. 25, Ch. 176G Sec. 33, Ch. 176I Sec. 13. (Accessed Jan. 2024).

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Michigan

Last updated 01/19/2024

An insurer that delivers, issues for delivery, or renews in …

An insurer that delivers, issues for delivery, or renews in this state a health insurance policy or a group or nongroup health care corporation certificate 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 health insurance policy agreed upon between the policy holder and the insurer or the certificate agreed upon between the certificate holder and the health care corporation, including, but not limited to, required copayments, coinsurances, deductibles, and approved amounts.

SOURCE: MI Compiled Law Services Sec. 500.3476(1), (Accessed Jan. 2024).

A group or nongroup health care corporation certificate must not require face-to-face contact between a health care professional and a patient for services appropriately provided through telemedicine, as determined by the 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 certificate agreed upon between the certificate holder and the health care corporation, including, but not limited to, required copayments, coinsurances, deductibles, and approved amounts.

SOURCE: Sec. 550.1401k(1), (Accessed Jan. 2024).

Worker’s Compensation

A health care professional billing for telemedicine services shall utilize procedure codes  92507, 92521-92524, 97110, 97112, 97116, 97161-97168, 97530, 97535 or those listed in  Appendix P of the CPT codebook, as adopted by reference in R 418.10107, excluding CPT codes  99241-99245 and 99251-99255. The provider shall append modifier -95 to the procedure code to  indicate synchronous telemedicine services rendered via a real-time interactive audio and video  telecommunications system with place of service code -02. All other applicable modifiers shall  be appended in addition to modifier -95. 

When modifier -95 is used with procedure code 92507, 92521-92524, 97110, 97112, 97116, 97161-97168, 97530, 97535, or those listed in Appendix P of the CPT codebook, as adopted by reference in R 418.10107, excluding CPT codes 99241-99245 and 99251-99255, the telemedicine services must be reimbursed according to all of the following:

  • The carrier shall reimburse the procedure code at the non-facility maximum allowable payment, or the billed charge, whichever is less.
  • Supplies and costs for the telemedicine data collection, storage, or transmission must not be unbundled and reimbursed separately.
  • Originating site facility fees must not be separately reimbursed.

Source: Admin Rule Sec. 418.10901 & 418.101004, (Accessed Jan. 2024).

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Minnesota

Last updated 02/29/2024

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

A health plan sold, issued, or renewed by a health carrier in Minnesota must (1) cover benefits delivered through telehealth in the same manner as any other benefits covered under the health plan, and (2) comply with this section.

overage 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 in this section 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.

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. (Accessed Feb. 2024).

Network Adequacy

The commissioner must determine network sufficiency in a manner that is consistent with the requirements of this section and may establish sufficiency by referencing any reasonable criteria, which may include but is not limited to: …

  • other health care service delivery system options, including telemedicine or telehealth, mobile clinics, centers of excellence, and other ways of delivering care

SOURCE: MN Revised Statute Sec. 62K.10, (accessed Feb. 2024).

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Mississippi

Last updated 12/23/2023

All health insurance and employee benefit plans in this state …

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. All health insurance and employee benefit plans in this state must reimburse providers who are out-of-network for telemedicine services under the same reimbursement policies applicable to other out-of-network providers of healthcare services.

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, but facility fees are not payable to the distant site. Health insurance and employee benefit plans shall not limit coverage to provider-to-provider consultations only. Patients in a patient-to-provider consultation shall not be entitled to receive a facility fee.

Nothing in this section shall be interpreted to create new standards of care for health care services delivered through the use of telemedicine.

The Commissioner of Insurance may adopt rules and regulations for the administration of this chapter.

* This section shall stand repealed from and after July 1, 2025.

SOURCE: MS Code Sec. 83-9-351. (Accessed Dec. 2023).

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. Store-and-forward telemedicine services shall be reimbursed to the same extent that the services would be covered if they were provided through in-person consultation.

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.

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

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.

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.
  • 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, that includes telemonitoring transmission frequency and duration of monitoring requested;
  • 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 telemedicine equipment and network used for remote patient monitoring services should meet the following requirements:

  • Comply with applicable standards of the United States Food and Drug Administration;
  • Telehealth equipment be maintained in good repair and free from safety hazards;
  • Telehealth equipment be new or sanitized before installation in the patient’s home setting;
  • Accommodate non-English language options; and
  • Have 24/7 technical and clinical support services available for the patient user.

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 Dec. 2023).

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Missouri

Last updated 01/20/2024

Each health carrier or health benefit plan that offers or …

Each health carrier or health benefit plan that offers or issues health benefit plans which are delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2014, 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 Jan. 2024). 

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

Telehealth services are covered for the diagnosis, consultation, or treatment of a member 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, 2022, (Accessed Jan. 2024).

Telehealth site origination fees or costs for the provision of telehealth services are not covered.

SOURCE: MO State Regulation Title 22, Sec. 10-3.061, & 2.061 (Accessed Jan. 2024).

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Montana

Last updated 02/13/2024

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

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 telehealth if the services are otherwise covered by the policy, certificate, contract, or agreement.

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.

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.

Nothing in this section may be construed to require:

  • a health insurance issuer to provide coverage for services that are not medically necessary, subject to the terms and conditions of the insured’s policy;
  • coverage of an otherwise noncovered benefit;
  • a health care provider to be physically present with a patient at the site where the patient is located unless the health care provider who is providing health care services by means of telehealth determines that the presence of a health care provider is necessary; or
  • except as provided in 16-12-509 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.

Coverage under this section may be subject to deductibles, coinsurance, and copayment provisions. Special deductible, coinsurance, copayment, or other limitations that are not generally applicable to other medical services covered under the plan may not be imposed on the coverage for services provided by means of telehealth.

This section does not apply to disability income, hospital indemnity, medicare supplement, specified disease, or long-term care policies.

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

SOURCE: MT Code Sec. 33-22-138, (Accessed Feb. 2024).

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Nebraska

Last updated 01/04/2024

Any insurer offering (a) any individual or group sickness and …

Any insurer offering (a) any individual or group sickness and accident insurance policy, certificate, or subscriber contract delivered, issued for delivery, or renewed in this state, (b) any hospital, medical, or surgical expense-incurred policy, or (c) any self-funded employee benefit plan to the extent not preempted by federal law, shall not exclude, in any policy, certificate, contract, or plan offered or renewed on or after August 24, 2017, 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 offering any policy, certificate, contract, or plan described in subsection (2) of this section for 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 Jan. 2024).

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 Statutes. Sec. 44-312(1), (Accessed Jan. 2024)

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

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

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

The Director of Insurance may disapprove any plan that the director determines to be inconsistent with the purposes of this section.

SOURCE: NE Revised Statute Section 44-793, (Accessed Jan. 2024).

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Nevada

Last updated 12/18/2023

Insurers shall not:

  • Require an insured to establish a relationship

Insurers shall not:

  • Require an insured to establish a relationship in person with a provider of health care or provide any additional consent to or reason for obtaining services through telehealth as a condition to providing the coverage described in subsection 1 or the reimbursement described in subsection 2;
  • Require a provider of health care to demonstrate that it is necessary to provide services to an insured through telehealth or receive any additional type of certification or license to provide services through telehealth as a condition to providing the coverage described in subsection 1 or the reimbursement described in subsection 2;
  • Refuse to provide the coverage described in subsection 1 or the reimbursement described in subsection 2 because of:
    • The distant site from which a provider of health care provides services through telehealth or the originating site at which an insured receives services through telehealth; or
    • The technology used to provide the services;
  • Require covered services to be provided through telehealth as a condition to providing coverage for such services; or
  • Categorize a service provided through telehealth differently for purposes relating to coverage than if the service had been provided in person or through other means.

A policy of health insurance must not require an insured to obtain prior authorization for any service provided through telehealth that is not required for the service when provided in person. A policy of health insurance may require prior authorization for a service provided through telehealth if such prior authorization would be required if the service were provided in person or by other means.

The provisions of this section do not require an insurer to:

  • Ensure that covered services are available to an insured 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; 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 Dec. 2023).

When making any determination concerning the availability and accessibility of the services of any network plan or proposed network plan pursuant to this section, the Commissioner shall consider services that may be provided through telehealth, as defined in NRS 629.515, pursuant to the network plan or proposed network plan to be available services.

SOURCE: NV Revised Statues Sec. 687B.490(7). (Accessed Dec. 2023).

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New Hampshire

Last updated 12/19/2023

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.

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.  There shall be no restriction on eligible originating or distant sites for telehealth services. An originating site means the location of the member at the time the service is being furnished via a telecommunication system. A distant site means the location of the provider at the time the service is being furnished via a telecommunication system.

There shall be no restriction on eligible originating or distant sites for telehealth services. An originating site means the location of the member at the time the service is being furnished via a telecommunication system. A distant site means the location of the provider at the time the service is being furnished via a telecommunication system.

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.

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.

Nothing in this section shall be construed to prohibit an insurer from providing coverage for only those services that are medically necessary and subject to the terms and conditions of the covered person’s policy.

SOURCE: NH Revised Statutes Annotated, 415-J:3, (Accessed Dec. 2023).

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New Jersey

Last updated 02/02/2024

A carrier that offers a health benefits plan in this …

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

A carrier may limit coverage to services that are delivered by health care providers in the health benefits plan’s network, but may not charge any deductible, copayment, or coinsurance for a health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation. In no case shall a carrier:

  • Impose any restrictions on the location or setting of the distant site used by a health care provider to provide services using telemedicine and telehealth or on the location or setting of the originating site where the patient is located when receiving services using telemedicine and telehealth, except to ensure that the services provided using telemedicine and telehealth meet the same standard of care as would be provided if the services were provided in person;
  • Restrict the ability of a provider to use any electronic or technological platform to provide services using telemedicine or telehealth, including, but not limited to, interactive, real-time, two-way audio, which may be used in combination with asynchronous store-and-forward technology without video capabilities, including audio-only telephone conversations, to provide services using telemedicine or telehealth, provided that the platform used:
    • Allows the provider to meet the same standard of care as would be provided if the services were provided in person; and
    • Is compliant with the requirements of the federal health privacy rule set forth at 45 CFR Parts 160 and 164;
  • Deny coverage for or refuse to provide reimbursement for routine patient monitoring performed using telemedicine and telehealth, including remote monitoring of a patient’s vital signs and routine check-ins with the patient to monitor the patient’s status and condition, if coverage and reimbursement would be provided if those services are provided in person, and the provider is able to meet the same standard of care as would be provided if the services were provided in person; or
  • Limit coverage only to services delivered by select third party telemedicine or telehealth organizations.

SOURCE: NJ Statute C.26:2S-29. (Accessed Feb. 2024).

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New Mexico

Last updated 02/26/2024

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 services when those services are provided via in-person consultation or contact.  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 by an insurer that health care services delivered through the use of telemedicine are not covered under the plan shall be subject to review and appeal.

The provisions of this section shall not apply in the event that federal law requires the state to make payments on behalf of enrollees to cover the costs of implementing this section.

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.

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

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

SOURCE: NM Statutes Annotated. Sec. 59A-22-49.3.  & 59A-23-7.12 (Accessed Feb. 2024).

A plan that provides a benefit conditioned on a covered person’s receipt of a health care service shall provide that benefit if the service is delivered in-person or virtually. No plan may offer a telemedicine only benefit.

SOURCE: NM Administrative Code Title 13, Ch. 10,  13.10.34.8. (Accessed Feb. 2024).

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New York

Last updated 11/18/2023

An insurer or corporation shall not exclude from coverage a …

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

An insurer or 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.

An insurer or 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.

Effective until April 1, 2024: 

An insurer or corporation that provides comprehensive coverage for hospital, medical, or surgical care with a network of health care providers shall ensure that such network is adequate to meet the telehealth needs of insured individuals for services covered under the policy when medically appropriate.

SOURCE: NY Insurance Law Article 32 Section 3217-h  & NY Insurance Law Article 43 Section 4306-g, as amended by A 9007 (2022 Session). (Accessed Nov. 2023).

No policy or contract delivered or issued for delivery in this State that provides comprehensive coverage for hospital, surgical, or medical care shall impose, and no insured shall be required to pay, copayments, coinsurance, or annual deductibles for in-network services delivered via telehealth when such service would have been covered under the policy if it had been delivered in person.

SOURCE: NY Codes, Rules, & Regs. Title 11, Sec. 52.16 (q). (Accessed Nov. 2023).

Workers’ Compensation

When rendering medical treatment or care via telehealth, an Authorized Medical Provider must be available for an in-person clinical encounter with the claimant should such in-person encounter be medically necessary. This means the Authorized Medical Provider must be able to meet the claimant at the Authorized Medical Provider’s office within a reasonable travel time and distance from the claimant’s residence. Telehealth must be used in accordance with this section and any applicable New York State Medical Treatment Guideline incorporated by reference under section 324.2 of this Title.

See regulations for billing and coding requirements.

SOURCE: Title 12 NYCRR Section. 325-1.26 as proposed to be added by Notice Of Adoption. (Accessed Nov. 2023).

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North Carolina

Last updated 12/12/2023

No Reference Found

No Reference Found

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North Dakota

Last updated 02/19/2024

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. p. 21 (Accessed Feb. 2024).

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) p. 34 (Accessed Feb. 2024).

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 Feb. 2024).

Comprehensive medication management services may be provided via telehealth as defined in section 26.1 – 36 – 09.15 and may be delivered into an enrollee’s residence.

SOURCE: ND Statute Sec. 26.1.11-02 (Accessed Feb. 2024).

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Ohio

Last updated 02/16/2024

A health benefit plan shall provide coverage for telehealth services …

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

A health benefit plan shall not impose any annual or lifetime benefit maximum in relation to telehealth services other than such a benefit maximum imposed on all benefits offered under the plan.

A health benefit plan shall not impose a cost-sharing requirement for telehealth services that exceeds the cost-sharing requirement for comparable in-person health care services.

A health benefit plan shall not impose a cost-sharing requirement for a communication when all of the following apply:

  •  The communication was initiated by the health care professional.
  • The patient consented to receive a telehealth service from that provider on any prior occasion.
  • The communication is conducted for the purposes of preventive health care services only.

This section shall not be construed as doing any of the following:

  • Requiring a health plan issuer to reimburse a health care professional for any costs or fees associated with the provision of telehealth services that would be in addition to or greater than the standard reimbursement for comparable in-person health care services;
  • Requiring a health plan issuer to reimburse a telehealth provider for telehealth services at the same rate as in-person services;
  • Requiring a health plan issuer to provide coverage for asynchronous communication that differs from the coverage described in the applicable health benefit plan.

The superintendent of insurance may adopt rules in accordance with Chapter 119. of the Revised Code as necessary to carry out the requirements of this section. Any such rules adopted by the superintendent are not subject to the requirements of division (F) of section 121.95 of the Revised Code.

SOURCE: OH Revised Code Annotated, 3902.30. (Accessed Feb. 2024).

Professional Regulation

A health care professional providing telehealth services may charge a health plan issuer for durable medical equipment used at a patient or client site.

A health care professional may negotiate with a health plan issuer to establish a reimbursement rate for fees associated with the administrative costs incurred in providing telehealth services as long as a patient is not responsible for any portion of the fee.

A health care professional providing telehealth services shall obtain a patient’s consent before billing for the cost of providing the services, but the requirement to do so applies only once.

SOURCE:  Ohio Revised code 4743.09, (Accessed Feb. 2024).

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Oklahoma

Last updated 12/04/2023

For services that a health care professional determines to be …

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

An insurer 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  (Accessed Dec. 2023).

If the beneficiary of a health benefit plan is unable to obtain covered behavioral health services from an in-network provider in a timely manner as defined in subsection A of this section, including medically appropriate telehealth services, such plan shall ensure coverage of the behavioral health services from an out-of-network provider by arranging a network exception with a negotiated rate from an out-of-network provider. Such an agreement between the health benefit plan and the out-of-network provider shall hold the beneficiary harmless for any amount greater than the in-network cost-sharing amount, including copayment, coinsurance, and deductible, that the beneficiary would have paid had the same services been rendered by an in-network provider. The negotiated rate in the network exception, in addition to the beneficiary’s in-network cost-sharing amount, shall be accepted as payment in full for the provided behavioral health services. In no instance shall the beneficiary pay more than the in-network cost-sharing amount for such services.

SOURCE: OK Statute Title 36, Ch. 2, Sec. 6060.11a, (Accessed Dec. 2023).

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Oregon

Last updated 12/20/2023

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:
    • The provider has an established practice within this state;
    • The provider’s employer operates health clinics or licensed health care facilities in this state;
    • The provider has an established relationship with the patient; or
    • The patient was referred to the provider by the patient’s primary care or specialty provider located in this state.
  • 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 Revised Statutes Ch. 743A.058. (Accessed Dec. 2023).

Treatment of Diabetes

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

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

A health benefit plan may not distinguish between rural and urban originating sites in providing coverage under subsection (2) of this section.

A health benefit plan may subject coverage of a telemedical health service under subsection (2) of this section to all terms and conditions of the plan, including but not limited to deductible, copayment or coinsurance requirements that are applicable to coverage of a comparable health service when provided in person.

SOURCE: OR Revised Statutes Sec. 743A.185(1)(c). (Accessed Dec. 2023).

Worker’s Compensation

All services must be appropriate, and the form of communication must be appropriate for the service provided.

Notwithstanding OAR 436-009-0004, medical services that may be provided through telemedicine are not limited to those listed in Appendix P of CPT® 2023.

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

  • Use the place of service (POS) code “02” (Telehealth Provided Other than in Patient’s Home) or “10” (Telehealth Provided in Patient’s Home); 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” (Telehealth Provided Other than in Patient’s Home) or “10” (Telehealth Provided in Patient’s Home); and
  • May not use modifier 95.

Originating site billing: 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 Dec. 2023).

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Pennsylvania

Last updated 01/22/2024

Will commercial insurers be required to reimburse for telemedicine services

Will commercial insurers be required to reimburse for telemedicine services and to  reimburse at the same rate as in person services after October 31, 2022?

Coverage for, and reimbursement of, services delivered via telemedicine will be dependent on each commercial insurer’s coverage and operational policies, as well as the terms of any applicable provider contracts.  This includes payment rates, as there are no insurance laws or regulations requiring payment parity.  The Pennsylvania Insurance Department (PID) surveyed the commercial insurers for updated information following the end of the COVID-19 Public Health Emergency (PHE). While the services covered by insurers have not been reduced, insurers across the board have reinstated cost-sharing for telehealth appointments following the end of the PHE. Reimbursement rates vary dependent upon the insurance company’s provider contracts and member’s plan. Insurers noted that they will continue to review their policies in terms of any state/federal guidance moving forward.

I provide school-based physical health and behavioral health services and continue to provide care via telemedicine. Will I be allowed to continue to provide services using telemedicine after October 31, 2022?

Coverage for, and reimbursement of, services delivered via telemedicine will continue to be dependent on each commercial insurer’s coverage and operational policies, as well as the terms of any applicable provider contracts. Insurers may have policy limitations that prohibit coverage for school-based services.  However, state law currently requires all fully insured health plans to cover certain autism services regardless of whether they are provided in a school setting.

SOURCE: PA Dept. of State, Professional Licensing, Telemedicine FAQs. (Accessed Jan. 2024).

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Puerto Rico

Last updated 12/18/2023

No reference found.

No reference found.

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Rhode Island

Last updated 02/01/2024

Each health insurer that issues individual or group accident and …

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.

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, (Accessed Feb. 2024).

“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.

SOURCE: RI General Law, Sec. 27-81-3, (Accessed Feb. 2024).

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. (Accessed Feb. 2024).

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South Carolina

Last updated 02/08/2024

No Reference Found

No Reference Found

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South Dakota

Last updated 12/21/2023

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. (Accessed Dec. 2023).

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Tennessee

Last updated 01/21/2024

Telehealth Services

“Qualified site” means the office of a healthcare …

Telehealth Services

“Qualified site” means 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, any facility licensed under title 33, or any other location deemed acceptable by the health insurance entity.

“Healthcare services provider” means an individual acting within the scope of a valid license issued pursuant to title 63 or any state-contracted crisis service provider employed by a facility licensed under title 33.

A health insurance entity:

  • Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through telehealth;
  • Shall reimburse a healthcare services provider for the diagnosis, consultation, and treatment of an insured patient for a healthcare service covered under a health insurance policy or contract that is provided through telehealth without any 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;
  • Shall not exclude from coverage a healthcare service solely because it is provided through telehealth and is not provided through an in-person encounter between a healthcare services provider and a patient; and
  • Shall reimburse healthcare services providers who are out-of-network for telehealth care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.

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 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 August 20, 2020, 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 (j).

Subsection (j): 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 August 20, 2020, by the federal centers for Medicare and Medicaid services.

SOURCE: TN Code Annotated, Sec. 56-7-1002 (Accessed Jan. 2024).

Provider-Based Telemedicine

“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:

  • Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine;
  • Shall reimburse a healthcare services provider for a healthcare service covered under an insured patient’s health insurance policy or contract that is provided through provider-based telemedicine without any 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;
  • Shall not exclude from coverage a healthcare service solely because it is provided through provider-based telemedicine and is not provided through an in-person encounter between a healthcare services provider and a patient; and
  • Shall reimburse healthcare services providers who are out-of-network for provider-based telemedicine care services under the same reimbursement policies applicable to other out-of-network healthcare services providers.
A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine 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 provider-based telemedicine 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.
This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.
This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.
A health insurance entity shall provide coverage for healthcare services provided during a provider-based telemedicine 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 provider-based telemedicine 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.
This section does not require a health insurance entity to pay total reimbursement for a provider-based telemedicine encounter in an amount that exceeds the amount that would be paid for the same service provided by a healthcare services provider for an in-person encounter.
This section does not require a health insurance entity to provide coverage for healthcare services that are not medically necessary, unless the terms and conditions of an applicable health insurance policy provide that coverage.
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.

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

This section does not require a health insurance entity to reimburse a healthcare services provider for healthcare services delivered by means of provider-based telemedicine if the applicable health insurance policy would not reimburse that healthcare services provider if the same healthcare services had been delivered by in-person means.

This section does not apply to accident-only, specified disease, hospital indemnity, plans described in § 1251 of the Patient Protection and Affordable Care Act, Public Law 111-148, as amended and § 2301 of the Health Care and Education Reconciliation Act of 2010, Public Law 111-152, as amended (both in 42 U.S.C. § 18011), plans governed by the Employee Retirement Income Security Act of 1974 (ERISA) (29 U.S.C. § 1001 et seq.), Medicare supplement, disability income, long-term care, or other limited benefit hospital insurance policies.

SOURCE: TN Code Annotated, Sec. 56-7-1003, (Accessed Jan. 2024).

Notwithstanding § 56-7-1002(e), a health insurance entity shall provide reimbursement 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.

Notwithstanding § 56-7-1003(e), a health insurance entity shall provide reimbursement for healthcare services provided during a provider-based telemedicine 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 provider-based telemedicine 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.

This section does not require a health insurance entity to provide reimbursement 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.

This section does not require a healthcare services provider to seek reimbursement from a health insurance entity for healthcare services provided by telehealth or provider-based telemedicine.

SOURCE:  Tennessee Annotated Code Sec. 56-7-1012, (Accessed Jan. 2024).

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

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

Remote patient monitoring services are subject to utilization review under the Health Care Service Utilization Review Act, compiled in chapter 6, part 7 of this title.

This section does not apply to a health incentive program operated by a health insurance entity that utilized an electronic device for physiological monitoring.

SOURCE: TN Code Annotated, Sec. 56-7-1011, (Accessed Jan. 2024).

Workers Compensation

Telehealth for workers’ compensation is an available option for medically appropriate healthcare services to be provided with the voluntary consent and agreement of the injured worker and the willingness of the healthcare services provider as provided in these rules.  Medically appropriate healthcare services do not include treatment where an in-person physical examination is necessary (see rule for examples).

Telehealth providers shall be held to the same standard of care as healthcare services providers providing the same healthcare services through in-person encounters.

An employer shall provide coverage for workers’ compensation medical services provided during a telehealth encounter in a manner that is consistent with what the workers’ compensation law requires for in-person encounters for the same healthcare service(s). Payment shall be in accordance with the Tennessee workers’ compensation medical fee schedule in Rule 0800-02-18 and corresponding rules for medical payments in Rule 0800-02- 17 in effect on the date of service.

Records/recordings requirements for telehealth services shall be the same as if the visit with the provider were in person and face-to-face. A telehealth provider shall be compliant with all federal and state of Tennessee laws for records/recordings. A recording shall not substitute for a written record.

Telehealth services are subject to any and all appropriate utilization review protocols or other protocols for healthcare treatment adopted by the bureau, shall be based on evidence-based guidelines, and shall be in accordance with the Tennessee standards of medical practice.

All services shall be delivered to the eligible employee at no cost to the employee in accordance with the provisions of section 50-6-204.

The provision of medical services via telehealth does not change or in any way affect the requirements for causation, date of maximum medical improvement, or permanent impairment ratings required of an authorized treating physician pursuant to the workers’ compensation law. In all workers’ compensation claims, statements of causation, date of maximum medical improvement, permanent restrictions, and permanent impairment rating(s) must be provided by a medical doctor, doctor of osteopathy, or doctor of chiropractic in accordance with the workers’ compensation law.

SOURCE:  TN Admin Code 0800-02-31.03, (Accessed Jan. 2024).

Telehealth: the definitions, licensing and processes for the purpose of these Rules shall be the same as adopted by the Tennessee Department of Health and Medicare. The maximum reimbursement for services provided via telehealth is the lesser of billed charges or the amounts listed in this fee schedule. Services that are eligible to be provided via telehealth are identified with a star (*) in the rate tables.

SOURCE:  TN Admin Code 0800-02-17.05, (Accessed Aug. 2023).

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Texas

Last updated 01/07/2024

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, 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. (Accessed Aug. 2023).

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. (Accessed Jan. 2024).

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 Jan. 2024).

Worker’s Compensation

A health care provider must bill for telemedicine, telehealth, and teledentistry services according to applicable:

  • Medicare payment policies, as defined in §134.203 of this title (relating to Medical Fee Guideline for Professional Services);
  • Medicaid payment policies, in accordance with the dental fee guideline in §134.303 of this title (relating to 2005 Dental Fee Guideline); and
  • provisions of Chapter 133 of this title.

A health care provider may bill and be reimbursed for telemedicine, telehealth, or teledentistry services regardless of where the injured employee is located at the time the telemedicine, telehealth, or teledentistry services are provided.

The provisions of this section take precedence over any conflicting provisions adopted or used by:

  •  the Centers for Medicare and Medicaid Services in administering the Medicare program; and
  • the Texas Health and Human Services Commission in administering the Texas Medicaid Program.

SOURCE: TX Admin. Code, Title 28 Sec. 2.133.30 (Accessed Jan. 2024).

In providing covered benefits to a child, a health plan provider must permit benefits to be provided through telemedicine medical services, teledentistry dental services, and telehealth services in accordance with policies developed by the commission.

The policies must provide for:

  • the availability of covered benefits appropriately provided through telemedicine medical services, teledentistry dental services, and telehealth services that are comparable to the same types of covered benefits provided without the use of telemedicine medical services, teledentistry dental services, and telehealth services; and
  • the availability of covered benefits for different services performed by multiple health care providers during a single session of telemedicine medical services, teledentistry dental services, or both services, or of telehealth services, if the executive commissioner determines that delivery of the covered benefits in that manner is cost-effective in comparison to the costs that would be involved in obtaining the services from providers without the use of telemedicine medical services, teledentistry dental services, or telehealth services, including the costs of transportation and lodging and other direct costs.

SOURCE: Health and Safety Code 62.1571, (Accessed Jan. 2024).

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Utah

Last updated 02/28/2024

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 26B-3-123 and terms associated with that coverage.

SOURCE: UT Code 31A-22-613.5(2)(f). (Accessed Feb. 2024).

A health benefit plan offered in the individual market, the small group market, or the large group market 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 Feb. 2024).

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.

A single telepsychiatric consultation includes all contacts, services, discussion, and information review required to complete an individual request from a referring physician for a patient.

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).

An insurer may receive a temporary waiver from the department from the requirements in this section if the insurer demonstrates to the department that the insurer is unable to provide the benefits described in this section due to logistical reasons.

An insurer that receives a waiver from the department under Subsection (6)(a) is subject to the requirements of this section beginning July 1, 2019.

This section does not limit an insurer from engaging in activities that ensure payment integrity or facilitate review and investigation of improper practices by health care providers.

SOURCE: UT Code, 31A-22-649. (Accessed Feb. 2024).

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Vermont

Last updated 12/05/2023

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 Dec. 2023).

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 may charge an otherwise permissible deductible, co-payment, or coinsurance for a health care service delivered by audio-only telephone, provided that it does not exceed the deductible, co-payment, or coinsurance applicable to an in-person consultation.

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. (Accessed Dec. 2023).

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Virgin Islands

Last updated 12/18/2023

A health care insurer that offers, issues for delivery, delivers, …

A health care insurer that offers, issues for delivery, delivers, executes, adjusts, uses, or renews a health care insurance plan shall provide coverage for the costs of telemedicine services and treatment that are medically necessary.

SOURCE: V.I. Code Tit. 22, § 1902 (2019).  (Accessed Dec. 2023).

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Virginia

Last updated 01/05/2024

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 Jan. 2024).

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Washington

Last updated 12/15/2023

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.

SOURCE: RCW 48.43.735 & Sec. 41.05.700, & WAC 284-170-433. (Accessed Dec. 2023).

“Established relationship” means the provider providing audio-only telemedicine has access to sufficient health records to ensure safe, effective, and appropriate care services and:

  • For health care services included in the essential health benefits category of mental health and substance use disorder services, including behavioral health treatment:
    • The covered person has had, within the past three years, at least one in-person appointment or at least one real-time interactive appointment using both audio and video technology, with the provider providing audio-only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system operated by a carrier licensed under chapter 48.44 or 48.46 RCW 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, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the covered person and has provided relevant medical information to the provider providing audio-only telemedicine;

SOURCE:  WA Rev. Code Sec. 284-170-130, RCW 48.43.735 & Sec. 41.05.700. (Accessed Dec. 2023).

For any other health care service:

  • The covered person has had, within the past two years, at least one in-person appointment, or, until January 1, 2024, at least one real-time interactive appointment using both audio and video technology, with:
    • The provider providing audio-only telemedicine; or
    • A provider employed at the same medical group, at the same clinic, or by the same integrated delivery system operated by a carrier licensed under chapter 48.44 or 48.46 RCW as the provider providing audio-only telemedicine; or
    • A locum tenens or other provider who is the designated back up or substitute provider for the provider providing audio-only telemedicine who is on leave and is not associated with an established medical group, clinic, or integrated delivery system operated by a carrier licensed under chapter 48.44 or 48.46 RCW; or
  • The covered person was referred to the provider providing audio-only telemedicine by another provider who has:
    • Had, within the past two years, at least one in-person appointment or, until January 1, 2024, at least one real-time interactive appointment using both audio and video technology, with the covered person; and
    • Provided relevant medical information to the provider providing audio-only telemedicine.
    • A referral includes circumstances in which the provider who has had at least one in-person appointment, or, until January 1, 2024, at least one real-time interactive appointment using both audio and video technology, with the covered person participating in the audio-only telemedicine encounter with the provider to whom the covered person has been referred.

SOURCE: WA Rev. Code Sec. 284-170-130. (Accessed Dec. 2023).

Effective July 23, 2023: For any other health care service:

  • The covered person has had, within the past two years, at least one in-person appointment, or, until July 1, 2024, at least one real-time interactive appointment using both audio and video technology, with the provider providing audio-only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system operated by a carrier licensed under chapter 48.44 or 48.46 RCW 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, within the past two years, at least one in-person appointment, or, until July 1, 2024, at least one real-time interactive appointment using both audio and video technology, with the covered person and has provided relevant medical information to the provider providing audio-only telemedicine;

SOURCE: RCW Sec. 41.05.700 & RCW 48.43.735, as amended by SB 5036 (2023 Legislative Session). (Accessed Dec. 2023).

Eligible Originating Sites:

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

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 & WAC 284-170-433, (Accessed Dec. 2023).

An originating site that is a home or location determined appropriate by the individual receiving the service includes, but is not limited to: a pharmacy or a school-based health center. If the site chosen by the individual receiving service is in a state other than the state of Washington, a provider’s ability to conduct a telemedicine encounter in that state is determined by the licensure status of the provider and the provider licensure laws of the other state.

SOURCE: WAC 284-170-433, as added by Permanent Rule. (Accessed Dec. 2023).

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 Dec. 2023).

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 Dec. 2023).

Printed and online provider directories must include information about any available telemedicine services, including any audio-only telemedicine services that are available, and specifically describe the services and how to access those services.

SOURCE: WAC 284-170-260. (Accessed Dec. 2023).

Every participating provider contract must, for health plans issued or renewed on or after July 25, 2021, and by July 1, 2022, ensure that access to telemedicine services is inclusive for those patients who may have disabilities or limited-English proficiency and for whom the use of telemedicine technology may be more challenging.

A health carrier is not required to reimburse:

  • An originating site for professional fees;
  • A provider for a health care service that is not a covered benefit under the plan; or
  • An originating site or provider when the site or provider is not a participating provider under the plan.

A health carrier may subject coverage of a telemedicine or store and forward technology health service under subsection (1) of this section to all terms and conditions of the plan in which the covered person is enrolled including, but not limited to, utilization review, prior authorization, deductible, copayment, or coinsurance requirements that are applicable to coverage of a comparable health care service provided in person.

A carrier may not deny, reduce, terminate or fail to make payment for the delivery of health care services using audio and visual technology solely because the communication between the patient and provider during the encounter shifted to audio-only due to unanticipated circumstances. In these instances, a carrier may not require a provider to obtain consent from the patient to continue the communication.

A carrier has no obligation to reimburse a provider for both an audio-visual and an audio-only encounter when both means of communication have been used during the encounter due to unforeseen circumstances.

Every participating provider contract must, effective July 25, 2021, provide that if a provider intends to bill a covered person or the covered person’s health plan for an audio-only telemedicine service, the provider must obtain patient consent from the covered person for the billing in advance of the service being delivered, consistent with the requirements of this subsection and state and federal laws applicable to obtaining patient consent.

A covered person’s consent must be obtained prior to initiation of the first audio-only encounter with a provider and may constitute consent to such encounters for a period of up to 12 months. If audio-only encounters continue beyond an initial 12-month period, consent must be obtained from the covered person for each prospective 12-month period.

Consent to be billed for audio-only telemedicine services must be obtained by the provider or auxiliary personnel under the general supervision of the provider.

A covered person may consent to a provider billing them or their health plan in writing or verbally. Consent to billing for an audio-only telemedicine encounter may be obtained and documented by the provider or auxiliary personnel under the general supervision of the provider as part of the process of making an appointment for an audio-only telemedicine encounter, recorded verbally as part of the audio-only telemedicine encounter record or otherwise documented in the patient record. Consent must be documented and retained by the provider for a minimum of five years. As needed, a carrier also may request documentation of the covered person’s consent as a condition of claim payment.

A patient may revoke consent granted under this subsection. Revocation of the patient’s consent must be communicated by the patient or their authorized representative to the provider or auxiliary personnel under the general supervision of the provider verbally or in writing and must be documented and retained by the provider for a minimum of five years. Once consent is revoked, the revocation must operate prospectively.

SOURCE: WAC 284-170-433, as added by Permanent Rule. (Accessed Dec. 2023).

Workers’ Compensation

Within the workers’ compensation system, when there is no approved examiner in the worker’s community or in a reasonably convenient location for the worker, the department or self-insurer may make alternate arrangements for the examination including, but not limited to, using telemedicine where appropriate.

The following exams may be conducted via telehealth:

  • Mental health;
  • Dermatology;
  • Speech when there is no documented hearing loss;
  • Kidney function;
  • Hematopoietic system;

The terms telehealth and telemedicine are used interchangeably and have the same requirements as in-person visits. Telemedicine may be appropriate to effectively conduct an independent medical exam when:

  • Face-to-face services by a qualified medical provider can be delivered through a real-time, two-way, audio video connection, and complies with all federal, state, and local rules and laws; and
  • A worker is able and willing to participate in an exam via telemedicine; and
  • The department or self-insured employer, and worker, have agreed a telemedicine IME is appropriate; these individuals should also agree to the location of the worker during the exam; and
  • The agreement is documented in the claim file; and
  • A physical or hands-on exam is not required.

Upon request of the department or self-insured employer and with the agreement of the worker, a telemedicine IME may be approved on a case-by-case basis for additional specialties not listed under subsection (1) of this section.

SOURCE: WAC 296-23-358; WAC 296-23-359, as added by Permanent Rule. (Accessed Dec. 2023).

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West Virginia

Last updated 02/15/2024

An insurer or health plan shall provide coverage of health …

An insurer or health plan 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 plan or insurer may not exclude a service for coverage solely because the service is provided through telehealth services.

An originating site may charge 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.

The Insurance Code sections specify that the statutory coverage requirements apply to insurers which issue or renew health insurance policies on or after July 1, 2020, and that reimbursement requirements apply to insurers which issue, renew, amend, or adjust a plan, policy, contact, or agreement on or after July 1, 2021.

SOURCE: WV Statute Public Employees Insurance Act Sec. 5-16-7b & WV Statute Ins. Code 33-57-1. (Accessed Feb. 2024).

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. 33-55-3. (Accessed Feb. 2024).

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 Feb. 2024).

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Wisconsin

Last updated 01/11/2024

No Reference Found

No Reference Found

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Wyoming

Last updated 01/31/2024

No Reference Found

No Reference Found

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Private Payer

Requirements

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