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Health Benefit Plans

Under current law, health benefit plans issued, amended, or renewed in this state cannot require in-person health care delivery for a person covered under the plan who resides in a county with 150,000 or fewer residents if the care can be appropriately delivered through telemedicine and the county has the technology necessary for care delivery via telemedicine.  Starting January 1, 2017, this Act removes the population restrictions and precludes a health benefit plan from requiring in-person care delivery when telehealth is appropriate, regardless of the geographic location of the health care provider and the recipient of care. A provider need not demonstrate that a barrier to in-person care exists for coverage of telehealth under a health benefit plan to apply. Additionally, the act specifies that delivery of care via telehealth is not required when a provider determines that telehealth is inappropriate or if the covered person chooses not to receive care through telehealth.

The act also specifies that carriers: (1) must reimburse a participating provider who delivers care through telehealth on the same basis that the carrier is responsible for reimbursing that provider for providing the same service in person; (2) cannot deny coverage of a health care service that is a covered benefit because the service is provided through telehealth if delivery of the service via telehealth is appropriate; (3) must include in the payment for telehealth interactions reasonable compensation for the transmission costs to the site where the covered person is receiving services, unless the covered person is located at a private residence when receiving services; (4) must charge the same deductible, copayment, or coinsurance amounts and durational benefit limitation or maximum benefits under the health benefit plan to the health care services delivered via telehealth that the carrier applies to the same health care services when performed through in-person care; and (5) cannot impose an annual or lifetime dollar maximum that applies separately to health care services delivered through telehealth.  “Telehealth” is defined as a mode of delivery of health care services through telecommunications systems to facilitate the assessment, diagnosis, consultation, treatment, education, care management, or self-management of a covered person’s health care while the covered person is located at one site and the health care provider is located at a distant site. The term excludes delivery of health care services via telephone, facsimile machine, or electronic mail systems.