(1) It is the intent of the general
assembly to recognize the practice of telehealth as a legitimate means by which an
individual may receive health-care services from a provider without in-person
contact with the provider.
(2) (a) A health benefit plan or dental plan that is issued, amended, or
renewed in this state shall not require in-person contact between a provider and a
covered person for services appropriately provided through telehealth, subject to
all terms and conditions of the health benefit plan or dental plan. Nothing in this
section requires the use of telehealth when a provider determines that delivery of
care through telehealth is not appropriate or when a covered person chooses not to
receive care through telehealth. A provider is not obligated to document or
demonstrate that a barrier to in-person care exists to trigger coverage under a
health benefit plan or dental plan for services provided through telehealth.
(b) (I) 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.
(II) A carrier shall not restrict or deny coverage of a health-care service that
is a covered benefit solely:
(A) 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
(B) Based on the communication technology or application used to deliver
the telehealth services pursuant to this section.
(III) Section 10-16-704 applies to this subsection (2)(b), and the availability of
telehealth services does not modify the requirements imposed on carriers under
that section to provide a sufficient network of providers available in the community
to provide in-person health-care services.
(c) A carrier shall include in the payment for telehealth interactions
reasonable compensation to the originating site for the transmission cost incurred
during the delivery of health-care services through telehealth; except that, for
purposes of this subsection (2)(c), the carrier is not required to pay or reimburse for
any transmission costs the covered person incurred or originating site fees,
regardless of how or by whom the fees are billed, for the delivery of health-care
services through telehealth to or from the covered person's home or a private
residence.
(d) A carrier may offer a health coverage plan or dental plan containing a
deductible, copayment, or coinsurance requirement for a health-care service
provided through telehealth, but the deductible, copayment, or coinsurance amount
must not exceed the deductible, copayment, or coinsurance applicable if the same
health-care services are provided through in-person diagnosis, consultation, or
treatment.
(e) A carrier shall not:
(I) Impose an annual dollar maximum on coverage for health-care services
covered under the health benefit plan or dental plan that are delivered through
telehealth, other than an annual dollar maximum that applies to the same services
when performed by the same provider through in-person care;
(II) Impose specific requirements or limitations on the HIPAA-compliant
technologies that a provider uses to deliver telehealth services, including
limitations on audio or live video technologies;
(III) Require a covered person to have a previously established patient-provider relationship with a specific provider in order for the covered person to
receive medically necessary telehealth services from the provider; or
(IV) Impose additional certification, location, or training requirements on a
provider as a condition of reimbursing the provider for providing health-care
services through telehealth.
(f) If a covered person receives health-care services through telehealth, a
carrier shall apply the applicable copayment, coinsurance, or deductible amount to
the telehealth services under the health benefit plan or dental plan, which
copayment, coinsurance, or deductible amount shall not exceed the amounts
applicable to those health-care services when performed by the same provider
through in-person care.
(g) (I) Repealed.
(II) This section does not apply to:
(A) Short-term travel, accident-only, limited or specified disease, or
individual conversion policies or contracts; or
(B) Policies or contracts designed for issuance to persons eligible for
coverage under Title XVIII of the Social Security Act, as amended, or any other
similar coverage under state or federal governmental plans.
(h) Nothing in this section prohibits a carrier from providing coverage or
reimbursement for health-care services appropriately provided through telehealth
to a covered person who is not located at an originating site.
(3) A health benefit plan or dental plan is not required to pay for consultation
provided by a provider by telephone or facsimile unless the consultation is provided
through HIPAA-compliant interactive audio-visual communication or the use of a
HIPAA-compliant application via a cellular telephone.
(4) As used in this section:
(a) Distant site means a site at which a provider is located while providing
health-care services by means of telehealth.
(b) Originating site means a site at which a patient is located at the time
health-care services are provided to him or her by means of telehealth.
(b.5) Remote monitoring means the use of synchronous or asynchronous
technologies to collect or monitor medical and other forms of health data for
individuals at an originating site and electronically transmit that information to
providers at a distant site so providers can assess, diagnose, consult, treat, educate,
provide care management, suggest self-management, or make recommendations
regarding a covered person's health care.
(c) Store-and-forward transfer means the electronic transfer of a patient's
medical information or an interaction between providers that occurs between an
originating site and distant sites when the patient is not present.
(d) Repealed.
(e) Telehealth means a mode of delivery of health-care services through
HIPAA-compliant telecommunications systems, including information, electronic,
and communication technologies, remote monitoring technologies, and store-and-forward transfers, to facilitate the assessment, diagnosis, consultation, treatment,
education, care management, or self-management of a covered person's health
care while the covered person is located at an originating site and the provider is
located at a distant site.