§ 24-A §4316 — Coverage for telehealth services

Maine § 24-A §4316

• Jurisdiction: Maine
• Title 24-A: MAINE INSURANCE CODE
• Ch. 56-A: HEALTH PLAN IMPROVEMENT ACT

Text

1.
Definitions.
As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
2.
Parity for telehealth services.
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.
3.
Coverage for telehealth services.
Except as provided in this section, a carrier shall provide coverage for any medically necessary health care service delivered through telehealth as long as the following requirements are met.
4.
Telemonitoring requirements.
A carrier shall provide coverage for telemonitoring if:
5.
Coverage for telephonic services.
6.
Utilization review.
This section does not prohibit or limit a carrier from conducting a utilization review for telehealth services as long as the utilization review is conducted in the same manner and uses the same clinical review criteria as a utilization review for an in-person consultation for the same service.
7.
Provider eligibility.
In order to be eligible for reimbursement under this section, a provider providing health care services through telehealth must be acting within the scope of the provider's license. A carrier may not impose additional credentialing requirements or prior approval requirements for a provider as a condition of reimbursement for health care services provided under this section unless those credentialing requirements or prior approval requirements are the same as those imposed for a provider that does not provide health care services through telehealth.
8.
Telehealth equipment.
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.
9.
Medicare coverage policy.
A carrier may provide coverage for health care services delivered through telehealth that is consistent with the Medicare coverage policy for interprofessional Internet consultations. If a carrier provides coverage consistent with the Medicare coverage policy for interprofessional Internet consultations, the carrier may also provide coverage for interprofessional Internet consultations that are provided by a federally qualified health center or rural health clinic as defined in 42 United States Code, Section 1395x, subsection (aa)(1993).
10.
Network adequacy.
The availability of health care services through telehealth may not be considered for the purposes of demonstrating the adequacy of a carrier’s network pursuant to section 4303, subsection 1 and Bureau of Insurance Rule Chapter 850: Health Plan Accountability.

Legislative History

PL 2009, c. 169, §1 (NEW). PL 2019, c. 289, §2 (RPR). PL 2019, c. 289, §3 (AFF). PL 2019, c. 649, §§3, 4 (AMD). RR 2019, c. 2, Pt. A, §28 (COR). PL 2021, c. 291, Pt. A, §§4-8 (AMD). PL 2021, c. 293, Pt. A, §29 (AMD).