Parity

SERVICE PARITY

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

Subject to the conditions and limitations set forth in this subpart, an MA organization offering an MA plan must provide enrollees in that plan with coverage of the basic benefits described in paragraph (c)(1) of this section (except that additional telehealth benefits may be, but are not required to be, offered by the MA plan) and, to the extent applicable, supplemental benefits as described in paragraph (c)(2) of this section, by furnishing the benefits directly or through arrangements, or by paying for the benefits.

Basic benefits are all items and services (other than hospice care or, beginning in 2021, coverage for organ acquisitions for kidney transplants) for which benefits are available under Parts A and B of Medicare, including additional telehealth benefits offered consistent with the requirements at § 422.135.

SOURCE:  42 CFR Sec. 422.100 (Jul. 2024).

PAYMENT PARITY

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

SOURCE:  42 CFR § 422.135 (Accessed Jul. 2024).

SERVICE PARITY

No Reference Found

PAYMENT PARITY

No Reference Found

SERVICE PARITY

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 Nov. 2024).

PAYMENT PARITY

No Reference Found

SERVICE PARITY

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

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

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

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

SOURCE:  AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05  (Accessed Oct. 2024).

PAYMENT PARITY

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

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

SOURCE:  AZ Rev. Statutes. Sec. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05  (Accessed Oct. 2024).

SERVICE PARITY

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

SOURCE: AR Code 23-79-1602(c). (Accessed Oct. 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 Oct. 2024).

PAYMENT PARITY

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

SOURCE: AR Code 23-79-1602(d)(2).  (Accessed Oct. 2024).

The reimbursement rate for an ambulance service whose operators triage, treat, and transport an enrollee to an alternative destination, or triage, treat, and do not transport an enrollee if the enrollee declines to be transported against medical advice, 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 under this section shall be at least at the rate:

• Contracted with a local government entity where the alternative destination is located; or
• Established by the Workers’ Compensation Commission under its schedule for emergency Advance Life Support Level 1.

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

SERVICE PARITY

A health care service plan or insurer shall not require that in-person contact occur between a health care provider and a patient before payment is made for the covered services appropriately provided through telehealth, subject to the terms and conditions of the contract entered into between the enrollee or subscriber and the health care service plan or insurer, and between the health care service plan or insurer and its participating providers or provider groups, and pursuant to Health and Safety Code Section 1374.14 and Insurance Code Section 10123.855.

A health care service plan or insurer shall not limit the type of setting where services are provided for the patient or by the health care provider before payment is made for the covered services appropriately provided through telehealth, subject to the terms and conditions of the contract entered into between the enrollee or subscriber and the health care service plan or insurer, and between the health care service plan or insurer and its participating providers or provider groups, and pursuant to Health and Safety Code Section 1374.14 and 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 Jul. 2024).

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

SOURCE: CA Health & Safety Code Sec. 1374.14 & Insurance Code 10123.855. (Accessed Jul. 2024).

PAYMENT PARITY

A contract between a health care service plan or insurer and a health care provider for the provision of health care services to an enrollee or subscriber shall specify that the health care service plan or insurer shall reimburse the treating or consulting health care provider for the diagnosis, consultation, or treatment of an enrollee or subscriber appropriately delivered through telehealth services on the same basis and to the same extent that the health care service plan or insurer is responsible for reimbursement for the same service through in-person diagnosis, consultation, or treatment.

Services that are the same, as determined by the provider’s description of the service on the claim, shall be reimbursed at the same rate whether provided in person or through telehealth. When negotiating a rate of reimbursement for telehealth services for which no in-person equivalent exists, a health care service plan or insurer and the provider shall ensure the rate is consistent with subdivision (h) of Section 1367.

Does not apply to Medi-Cal managed care.

SOURCE: CA Health & Safety Code Sec. 1374.14 & Insurance Code 10123.855. (Accessed Jul. 2024).

SERVICE PARITY

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

SOURCE: CO Revised Statutes 10-16-123(2)(b)(II). (Accessed Aug. 2024).

PAYMENT PARITY

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

SOURCE: CO Revised Statutes 10-16-123(2)(b)(I). (Accessed Aug. 2024).

According to Revised Bulletin No. B-4.89, the CO Division of Insurance interprets the above law to require reimbursement for telehealth services at no less than for in-person services, and states that carriers must continue to reimburse providers in parity with in-person rates post-COVID-19 public health emergency. In addition, the Bulletin states that payment parity applies to all medically necessary covered health care services that are appropriately provided through telehealth, including but not limited to behavioral health, mental health, substance use disorder, occupational therapy, speech therapy, physical therapy services, dental services, and remote monitoring of patients.

SOURCE: CO Division of Insurance Policy Directives for Telehealth. Aug. 18. 2021. (Accessed Aug. 2024).

SERVICE PARITY

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

SOURCE: CT General Statute 38a, Sec. 499a. & 38a, Sec. 526a. (Accessed Jul. 2024).

PAYMENT PARITY

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 because the telehealth provider provided such health care or health services to the patient through telehealth and not in person.

SOURCE: HB 5198 (Public Act 24-110 – 2024 Session), Sec. 3. (Accessed Jul. 2024).

SERVICE PARITY

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

SOURCE: Title 18, Chapter 33, Sec. 3370; & Title 18, Chapter 35, Sec. 3571R. (Accessed Jul. 2024).

PAYMENT PARITY

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

SOURCE: Title 18, Chapter 33, Sec. 3370; & Title 18, Chapter 35, Sec. 3571R. (Accessed Jul. 2024).

SERVICE PARITY

A health insurer offering a health benefits plan in the District may not deny coverage for a healthcare service on the basis that the service is provided through telehealth if the same service would be covered when delivered in person.

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

SOURCE: DC Code Sec. 31-3862. (Accessed Jun. 2024).

PAYMENT PARITY

No explicit payment parity.

SERVICE PARITY

A contract between a health maintenance organization [health insurer] issuing major medical individual or group coverage and a telehealth provider, as defined in s. 456.47, 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.

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

PAYMENT PARITY

A contract between a health maintenance organization [health insurer] issuing major medical individual or group coverage and a telehealth provider, as defined in s. 456.47, 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. & 641.42396. (Accessed Nov. 2024).

SERVICE PARITY

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

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

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

SOURCE: Official Code of GA Annotated Sec. 33-24-56.4. (Accessed May 2024).

PAYMENT PARITY

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

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

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

SOURCE: Official Code of GA Annotated Sec. 33-24-56.4. (Accessed May 2024).

SERVICE PARITY

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

SOURCE: HI Revised Statutes § 431:10A-116.3(b); 432D-23.5(b); & 432:1-601.5(b). Amended by HB 907 (Will be repealed December 31, 2025).(Accessed Jun. 2024).

PAYMENT PARITY

Reimbursement for services provided through telehealth via an interactive telecommunication system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and patient; provided that reimbursement for two-way, real-time audio-only communication technology for purpose of diagnosis, evaluation, or treatment of a mental health disorder to a patient in the patient’s home shall be equivalent to eighty per cent of the reimbursement for the same services provided via in-person contact between a health care provider and a patient. To be reimbursed for telehealth via an interactive telecommunications system using two-way, real-time audio-only communication technology in accordance with this subsection, the health care provider shall first conduct an in-person visit or a telehealth visit that is not audio-only, within six months prior to the initial audio-only visit, or within twelve months prior to any subsequent audio-only visit. The telehealth visit required prior to the initial or subsequent audio-only visit in this subsection shall not be provided using audio-only communication. Nothing in this section shall require the heath care provider to be physically present with the patient at an originating site unless a health care provider at a distant site deem sit necessary.

SOURCE: HI Revised Statutes § 431:10A-116.3(c); 432D-23.5(c); & 432:1-601.5 (c). Amended by HB 907. (Will be repealed December 31, 2025). (Accessed Jun. 2024).

Unless otherwise provided by law, reimbursement for behavioral health services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for two-way, real-time audio-only communication technology for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in the patient’s home shall be equivalent to eighty percent of the reimbursement for the same services provided via in-person contact between a health care provider and a patient. To be reimbursed for telehealth via an interactive telecommunications system using two-way, real-time audio-only communication technology in accordance with this subsection, the health care provider shall first conduct an in-person visit or a telehealth visit that is not audio-only, within six months prior to the initial audio-only visit, or within twelve months prior to any subsequent audio-only visit. The telehealth visit required prior to the initial or subsequent audio-only visit in this subsection shall not be provided using audio-only communication.

SOURCE:  HI Revised Statutes 453-1.3(h).  Amended by HB 907 (Will be repealed December 31, 2025).(Accessed Jun. 2024).

SERVICE PARITY

No Reference Found

PAYMENT PARITY

No Reference Found

SERVICE PARITY

SOURCE: IL Insurance Code. Sec. 356z.22.  (Accessed Jul. 2024).

A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed before January 1, 2026 shall provide coverage for medically necessary continuous glucose monitors for individuals who are diagnosed with any form of diabetes mellitus and require insulin for the management of their diabetes. A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall provide coverage for continuous glucose monitors, related supplies, and training in the use of continuous glucose monitors.  See Requirements section for criteria.

A group or individual policy of accident and health insurance or a managed care plan that is amended, delivered, issued, or renewed on or after January 1, 2026 shall not impose a deductible, coinsurance, copayment, or any other cost-sharing requirement on the coverage of a one-month supply of continuous glucose monitors, including one transmitter if necessary, as provided under this Section. The provisions of this subsection do not apply to coverage under this Section to the extent such coverage would disqualify a high-deductible health plan from eligibility for a health savings account pursuant to the federal Internal Revenue Code, 26 U.S.C. 23.

SOURCE: Senate Bill 3414 (2024 Session), (Accessed Jul. 2024).

PAYMENT PARITY

SERVICE PARITY

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

SOURCE: IN Code, 27-8-34-6 & 27-13-7-22. (Accessed Aug. 2024).

PAYMENT PARITY

No explicit payment parity.

SERVICE PARITY

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

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

SOURCE: IA Code 514C.34(3) & 4a (Accessed Dec. 2024).

PAYMENT PARITY

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

As a condition of reimbursement pursuant to paragraph “a”, 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(4a), (Accessed Dec. 2024).

SERVICE PARITY

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

SOURCE:  KS Statute Ann. § 40-2,213.  (Accessed Nov. 2024).

PAYMENT PARITY

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

Nothing in this section shall be construed to:

• Prohibit an individual or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society or health maintenance organization that provides coverage for telemedicine or the Kansas medical assistance program from providing coverage for only those services that are medically necessary, subject to the terms and conditions of the covered individual’s health benefits plan;
• mandate coverage for a healthcare service delivered via telemedicine if such healthcare service is not already a covered healthcare service, when delivered by a healthcare provider subject to the terms and conditions of the covered individual’s health benefits plan; or
• allow an individual or group health insurance policy, medical service plan, contract, hospital service corporation contract, hospital and medical service corporation contract, fraternal benefit society or health maintenance organization that provides coverage for telemedicine or the Kansas medical assistance program to require a covered individual to use telemedicine or in lieu of receiving an in-person healthcare service or consultation from an in-network provider.

SOURCE:  KS Statute Ann. § 40-2,213. (Accessed Nov. 2024).

SERVICE PARITY

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.

SOURCE: KY Revised Statute Sec. 304.17A-138. (Accessed Nov. 2024).

PAYMENT PARITY

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

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

SOURCE: KY Revised Statute Sec. 304.17A-138. (Accessed Nov. 2024).

SERVICE PARITY

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.

No reference found for distant-site physician reimbursement.

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

PAYMENT PARITY

Physical Therapy

A health coverage plan shall pay for covered physical 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.

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

Occupational Therapy

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.

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

SERVICE PARITY

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

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

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

A carrier shall provide coverage for telemonitoring if:

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

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 the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 and regulations promulgated under that Act.

SOURCE: Maine Revised Statutes Annotated, Title 24-A, Sec. 4316, (Accessed Oct. 2024).

PAYMENT PARITY

No explicit payment parity.

SERVICE PARITY

Effective until June 30, 2025

From July 1, 2021, to June 30, 2025, both inclusive, when a health care service is appropriately provided through telehealth, an insurer, nonprofit health service plan, and health maintenance organization shall provide reimbursement on the same basis as if the health care service were delivered by the health care provider in person.

Reimbursement required does not include:

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

SOURCE: Insurance Code 15-139. (Accessed Nov. 2024).

PAYMENT PARITY

Effective until June 30, 2025

From July 1, 2021, to June 30, 2025, both inclusive, when a health care service is appropriately provided through telehealth, an insurer, nonprofit health service plan, and health maintenance organization shall provide reimbursement at the same rate as if the health care service were delivered by the health care provider in person.

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

SOURCE: Insurance Code 15-139. (Accessed Nov. 2024).

SERVICE PARITY

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

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

provided, however, that 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.

SOURCE: Massachusetts General Laws, Part 1, Title XXII, Ch. 175, Sec. 47MM, (Accessed Dec. 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 Dec. 2024).

PAYMENT PARITY

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

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

SOURCE: Massachusetts General Laws, Part 1, Title XXII, Ch. 175, Sec. 47MM, (Accessed Dec. 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 Dec. 2024).

SERVICE PARITY

If a service is provided through telemedicine under this section, the insurer shall provide at least the same coverage for that service as if the service involved face-to-face contact between the health care professional and the patient.

SOURCE: MI Compiled Law Svcs. Sec. 500.3476(2)(b) as amended by HB 4579 and HB 4131, (Accessed Dec. 2024).

An insurer that delivers, issues for delivery, or renews in this state a health insurance policy 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.

SOURCE: MI Compiled Law Svcs. Sec. 500.3476(2)(b) as amended by HB 4579 and HB 4131, (Accessed Dec. 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.

SOURCE:  Sec. 550.1401k. (Accessed Dec. 2024).

PAYMENT PARITY

No explicit payment parity.

SERVICE PARITY

SOURCE: MN Statute Sec. 62A.673. (Accessed Nov. 2024).

PAYMENT PARITY

SOURCE: MN Statute Sec. 62A.673. (Accessed Nov. 2024).

SERVICE PARITY

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.

Remote patient monitoring is also reimbursed based on the criteria outlined in MS code.

A health insurance or employee benefit plan may charge a deductible, co-payment, or coinsurance for a health care service provided through store-and-forward telemedicine services or remote patient monitoring services so long as it does not exceed the deductible, co-payment, or coinsurance applicable to an in-person consultation.

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

SOURCE: MS Code Sec.  83-9-353. (Accessed Aug. 2024).

Recently Passed Legislation 

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

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

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 Aug. 2024). 

PAYMENT PARITY

No explicit payment parity.

SERVICE PARITY

A health carrier may not exclude an otherwise covered health care service from coverage solely because the service is provided through telehealth rather than face-to-face consultation or contact between a health care provider and a patient.

A health carrier or health benefit plan may limit coverage for health care services that are provided through telehealth to health care providers that are in a network approved by the plan or the health carrier.

SOURCE: MO Revised Statutes § 376.1900. (Accessed Sept. 2024).

PAYMENT PARITY

Missouri Consolidated Health Care Plan

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

SOURCE:  MO Consolidated State Reg. 22:10-2.053, 2.047 & 22:10-3.055, 3.058, 3.059 [mentioned in several sections] (Accessed Sept. 2024).

SERVICE PARITY

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

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

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

PAYMENT PARITY

No explicit payment parity.

SERVICE PARITY

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 Aug. 2024).

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

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

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

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

Except as otherwise provided in section 44-793, the reimbursement rate for any telehealth service shall, at a minimum, be the same as a comparable in-person health care service if the licensed provider providing the telehealth service also provides in-person health care services at a physical location in Nebraska or is employed by or holds medical staff privileges at a licensed facility in Nebraska and such facility provides in-person health care services in Nebraska.

SOURCE: NE Revised Statutes. Sec. 44-312(1), (Accessed Aug. 2024).

PAYMENT PARITY

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

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

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

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 Aug. 2024).

Except as otherwise provided in section 44-793, the reimbursement rate for any telehealth service shall, at a minimum, be the same as a comparable in-person health care service if the licensed provider providing the telehealth service also provides in-person health care services at a physical location in Nebraska or is employed by or holds medical staff privileges at a licensed facility in Nebraska and such facility provides in-person health care services in Nebraska.

SOURCE: NE Revised Statutes. Sec. 44-312(1), (Accessed Aug. 2024).

SERVICE PARITY

A policy of health insurance must include coverage for services provided to an insured through telehealth to the same extent as though provided in person or by other means.

SOURCE: NV Revised Statute Sec. 689A.0463; Sec. 689B.0369; Sec. 689C.195; Sec. 616C.730, Sec. 695A.265; Sec. 695B.1904; Sec. 695C.1708; Sec. 695D.216; & Sec. 695G.162. [variations exist between the various sections, read carefully]. (Accessed Dec. 2024).

PAYMENT PARITY

A policy of health insurance must include coverage for services provided to an insured through telehealth to the same extent as though provided in person or by other means.

SOURCE: NV Revised Statute Sec. 689A.0463; Sec. 689B.0369; Sec. 689C.195; Sec. 616C.730 Sec. 695A.265; Sec. 695B.1904; Sec. 695C.1708; Sec. 695D.216; & Sec. 695G.162, [variations exist between the various sections, read carefully]. (Accessed Dec. 2024).

SERVICE PARITY

For the purposes of this chapter, covered services include remote patient monitoring and store and forward.

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.

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

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.

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

An insurer shall not impose on coverage for health care services provided through telemedicine any additional benefit plan limitations to include annual or lifetime dollar maximums on coverage, deductibles, copayments, coinsurance, benefit limitation or maximum benefits that are not equally imposed upon similar services provided in-person.

SOURCE: NH Revised Statutes Annotated, 415-J:3, (Accessed Dec. 2024).

PAYMENT PARITY

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

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

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

Nothing in this section shall be construed to prohibit an insurer from paying reasonable compensation to a provider at a distant site in addition to a fee paid to the health care provider.

Nothing in this section shall be construed to allow an insurer to reimburse more for a health care service provided through telemedicine than would have been reimbursed if the health care service was provided in person.

SOURCE: NH Revised Statutes Annotated, 415-J:3, (Accessed Dec. 2024).

SERVICE PARITY

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

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

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

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

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

SOURCE: NJ Statute C.52:14-17.29w & C.52:14-17.46.6h. (Accessed Aug. 2024).

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

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

SOURCE: NJ S2559. (Accessed Aug. 2024).

PAYMENT PARITY

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

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

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

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

SOURCE: NJ Statute C.52:14-17.29w & C.52:14-17.46.6h. (Accessed Aug. 2024). 

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

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

SOURCE: NJ S2559. (Accessed Aug. 2024).

SERVICE PARITY

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

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

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

SOURCE: NM Statutes Annotated. Sec. 59A-22-49.3(A), (F) & (I)., 59A-46-50.3, 59A-47-45.3 & 59A-23-7.12 (Accessed Nov. 2024).

PAYMENT PARITY

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

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

SOURCE: NM Statutes Annotated. Sec. 59A-22-49.3 (H) & (I). , 59A-46-50.3, 59A-47-45.3 & 59A-23-7.12 (Accessed Nov. 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 Nov. 2024).

SERVICE PARITY

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.

SOURCE: NY Insurance Law Article 32 Section 3217-h  & NY Insurance Law Article 43 Section 4306-g. (Accessed Dec. 2024).

PAYMENT PARITY

Effective until April 1, 2026:

An insurer or corporation that provides comprehensive coverage for hospital, medical or surgical care shall reimburse covered services delivered by means of telehealth on the same basis, at the same rate, and to the same extent that such services are reimbursed when delivered in person; provided that reimbursement of covered services delivered via telehealth shall not require reimbursement of costs not actually incurred in the provision of the telehealth services, including charges related to the use of a clinic or other facility when neither the originating site nor distant site occur within the clinic or other facility.

SOURCE: NY Insurance Law Article 32 Section 3217-h  & NY Insurance Law Article 43 Section 4306-g, as amended by A 9007 (2022 Session) and extended by S 8307 (2024 Session). (Accessed Dec. 2024).

SERVICE PARITY

No Reference Found

PAYMENT PARITY

No Reference Found

SERVICE PARITY

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.

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

This section does not require:

SOURCE: ND Century Code Sec. 26.1-36-09.15(2)(3) & (5). p. 21 (Accessed Nov. 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 Nov. 2024).

PAYMENT PARITY

No explicit payment parity.  See above ‘coverage parity’ section for text regarding payment or reimbursement of expenses being negotiated by the insurer.

SERVICE PARITY

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

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

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

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

PAYMENT PARITY

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

SOURCE: OH Revised Code Annotated, 3902.30. (Accessed Nov. 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.

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

SERVICE PARITY

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

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

SOURCE: OK Statute, Title 36, Sec. 6803, (Accessed Nov. 2024).

PAYMENT PARITY

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

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

SOURCE: OK Statute, Title 36, Sec. 6803, (Accessed Nov. 2024).

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 Nov. 2024).

SERVICE PARITY

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

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

Plans may not:

• Distinguish between originating sites that are rural and urban in providing coverage.

The coverage under subsection (2) of this section is subject to:

• The terms and conditions of the health benefit plan or dental-only plan; and
• Subject to subsection (8) of this section, the reimbursement specified in the contract between the plan and the health professional.

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

SOURCE: OR Revised Statutes Sec. 743A.058, (Accessed Dec. 2024).

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 service is medically necessary;
• The telemedical health service relates to a specific patient; and
• One of the participants in the telemedical health service is a representative of an academic health center.

A health benefit plan may subject coverage of a telemedical health service 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. (Accessed Dec. 2024).

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® 2024.

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

SOURCE: OR Administrative Rules 436-009-0012, (Accessed Dec. 2024).

PAYMENT PARITY

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

Paragraph (a) of this subsection does not prohibit the use of value-based payment methods, including capitated, bundled, risk-based or other value-based payment methods, and does not require that any value-based payment method reimburse telemedicine health services based on an equivalent fee-for-service rate.

SOURCE: OR Revised Statutes Sec. 743A.058, (Accessed Dec. 2024).

Worker’s Compensation

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

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

The payment amount for code Q3014 is $35.70 per unit or the provider’s usual fee, whichever is lower. In calculating the units of time, 15 minutes, or any portion of 15 minutes, equals one unit.

Professional fees of supporting providers at the originating site are not separately payable.

Insurers are not required to pay a telehealth transmission fee (HCPCS code T1014).

SOURCE: OR Administrative Rules 436-009-0012, (Accessed Dec. 2024).

SERVICE PARITY

A health insurance policy offered, issued or renewed in this Commonwealth shall provide coverage for medically necessary health care services provided through telemedicine and delivered by a participating network provider who provides a covered health care service through telemedicine consistent with the insurer’s medical policies. A health insurance policy may not exclude a health care service from coverage solely because the health care service is provided through telemedicine.

SOURCE: PA Consolidated Statutes Title 40, Chapter 48, Section 4803(a)(1), Senate Bill 739, (2024 Session), PA Statute Sec. 4803, (Accessed Sept. 2024).

PAYMENT PARITY

Subject to paragraph (1), an insurer shall pay or reimburse a participating network provider for covered health care services delivered through telemedicine and pursuant to a health insurance policy in accordance with the terms and conditions of the contract as negotiated between the insurer and the participating network provider. A contract that includes payment or reimbursement for covered health care services delivered through telemedicine may not prohibit payment or reimbursement solely because a health care service is provided by telemedicine. Payment or reimbursement may not be conditioned upon the use of an exclusive or proprietary telemedicine technology or vendor.

SOURCE: PA Consolidated Statutes Title 40, Chapter 48, Section 4803(a)(2), Senate Bill 739, (2024 Session), PA Statute Sec. 4803, (Accessed Sept. 2024).

Service Parity

Any professional certified to offer their services through Telehealth (Cybertherapy) will be able to bill health insurance companies and the Insurance Administration of Health (ASES) for the services provided, and they will be obliged to pay the same with the same rate established in the contract, as if it were a service provided in person. For these purposes, insurance companies of health and ASES, will have to provide the professionals who request it with the corresponding codes for billing for the services provided through Telehealth.

SOURCE: Departmento De Salud, Reglamento Para El USO De La Telesalud En Puerto Rico, Numero 9518 (Dec. 1, 2023), Article 7., Departamento de Salud, Reglamento Para Regular La Ciberterapia en Puerto Rico, Numero 9517 (Dec. 2023), Article 7. (Accessed Sept. 2024).

Payment Parity

Any professional certified to offer their services through Telehealth (Cybertherapy) will be able to bill health insurance companies and the Insurance Administration of Health (ASES) for the services provided, and they will be obliged to pay the same with the same rate established in the contract, as if it were a service provided in person. For these purposes, insurance companies of health and ASES, will have to provide the professionals who request it with the corresponding codes for billing for the services provided through Telehealth.

SOURCE: Departmento De Salud, Reglamento Para El USO De La Telesalud En Puerto Rico, Numero 9518 (Dec. 1, 2023), Article 7., Departamento de Salud, Reglamento Para Regular La Ciberterapia en Puerto Rico, Numero 9517 (Dec. 2023), Article 7. (Accessed Sept. 2024).

SERVICE PARITY

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

SOURCE:  RI General Law, Sec. 27-81-4(b). (Accessed Oct. 2024).

PAYMENT PARITY

SERVICE PARITY

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PAYMENT PARITY

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SERVICE PARITY

No health insurer may exclude a service for coverage solely because the service is provided through telehealth and not provided through in-person consultation or contact between a health care professional and a patient. Health 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, including rules adopted by the appropriate professional licensing board having oversight of the health care professional providing the health care services. Health insurers are not required to provide coverage for health care services that are not medically necessary.

This section does not:

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

SOURCE: SD Codified Laws Ann. § 58-17-168. (Accessed Jul. 2024).

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

SOURCE:  SD Codified Laws Ann. Sec. 58-17-169. (Accessed Jul. 2024).

PAYMENT PARITY

No Reference Found

SERVICE PARITY

Provider-based Telemedicine

A health insurance entity:

• Shall provide coverage under a health insurance policy or contract for covered healthcare services delivered through provider-based telemedicine;
• 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.

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

Telehealth Services

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.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002.  (Accessed Aug. 2024).

Remote patient monitoring

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

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

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

Worker’s Compensation

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

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

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

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

SOURCE:  TN Admin Code 0800-02-31.05, (Accessed Aug. 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. 2024).

PAYMENT PARITY

Provider-based Telemedicine

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

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

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

A health insurance entity:

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

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

Telehealth Services

Subject to subsection (c), a health insurance entity: …

• 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 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.

SOURCE: TN Code Annotated, Title 56, Ch. 7, Part 1002. (Accessed Aug. 2024).

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

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

SERVICE PARITY

A health benefit plan 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

A health benefit plan is not required to provide coverage for a telemedicine medical service, a teledentistry dental service, or a telehealth service provided by only synchronous or asynchronous audio interaction, including:

• an audio-only telephone consultation;
• a text-only e-mail message; or
• a facsimile transmission.

SOURCE: TX Insurance Code 1455.004(a)  (Accessed Aug. 2024).

PAYMENT PARITY

No Reference Found

SERVICE PARITY

A health benefit plan shall provide coverage for:

• telemedicine services that are covered by Medicare; and
• treatment of a mental health condition through telemedicine services if:
  • the health benefit plan provides coverage for the treatment of the mental health condition through in-person services; and
  • the health benefit plan determines treatment of the mental health condition through telemedicine services meets the appropriate standard of care; and

• reimburse a network provider that provides the telemedicine services at a negotiated commercially reasonable rate.

SOURCE: UT Code, 31A-22-649.5. (Accessed Nov. 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 telepsychiatric consultant is not made available to a physician within seven business days after the initial request is made by an in-network provider of telepsychiatric consultations; and
• Reimburse for the services at the equivalent of the in-network or out-of-network rate set by the benefit plan after taking into account cost-sharing that may be required under the health benefit plan.

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

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

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

PAYMENT PARITY

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

SOURCE: UT Code, 31A-22-649.5 (2(b)) (Accessed Nov. 2024).

Telepsychiatric Consultations (provider to provider)

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

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

SERVICE PARITY

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

SOURCE: VT Statutes Annotated, Title 8 Sec. 4100k. (Accessed Nov. 2024).

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.

SOURCE: VT Statutes Annotated, Title 8 Sec. 41001. (Accessed Nov. 2024).

PAYMENT PARITY

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

Service Parity

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 Title 22, § 1902.  (Accessed Sept. 2024).

Payment Parity

No reference found.

SERVICE PARITY

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

SOURCE: VA Code Annotated Sec. 38.2-3418.16 (Accessed Aug. 2024).

PAYMENT PARITY

No explicit payment parity.

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

SOURCE: VA Code Annotated Sec. 38.2-3418.16 (Accessed Aug. 2024).

SERVICE PARITY

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

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

SOURCE: RCW 48.43.735 & Sec. 41.05.700 & WAC 284-170-433. (Accessed Jun. 2024).

PAYMENT PARITY

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

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

SOURCE: RCW 48.43.735 & Sec. 41.05.700 & WAC 284-170-433. (Accessed Jun. 2024).

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

SOURCE: WA Rev. Code Sec. 284-170-130. (Accessed Jun. 2024).

SERVICE PARITY

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

A plan or an insurer shall provide reimbursement for a telehealth service at a rate negotiated between the provider and the plan or insurance company for the virtual telehealth encounter.  They shall also provide reimbursement for a telehealth service for an established patient, or care rendered on a consulting basis to a patient located in an acute care facility whether inpatient or outpatient on the same basis and at the same rate under a contract, plan, agreement, or policy as if the service is provided through an in-person encounter rather than provided via telehealth.

The coverage required by this section shall include the use of telehealth technologies as it pertains to medically necessary remote patient monitoring services to the full extent that those services are available.

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 the 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 Nov. 2024).

PAYMENT PARITY

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

The plan or insurer shall provide reimbursement for a telehealth service for an established patient, or care rendered on a consulting basis to a patient located in an acute care facility whether inpatient or outpatient, on the same basis and at the same rate as if the service is provided through an in-person encounter rather than provided via telehealth.

The Insurance Code sections specify that the statutory 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 Sec. 5-16-7b & 33-57-1. (Accessed Nov. 2024).

SERVICE PARITY

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PAYMENT PARITY

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SERVICE PARITY

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PAYMENT PARITY

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