Maryland becomes 13th state to mandate telehealth services coverage
By Legal & Regulatory Affairs staff
May 10, 2012—On October 1, 2012, Maryland will become the 13th state to require private sector insurance companies to pay for telehealth services. Maryland joins California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, New Hampshire, Oklahoma, Oregon, Texas and Virginia in mandating that private payers cover telehealth services that are considered medically necessary and would otherwise be covered when provided face-to-face.
While reimbursement varies by insurer and state, this latest legislation seems to be part of a growing trend toward reimbursement for telehealth services.
Maryland’s law defines telemedicine (or telehealth) as “interactive audio, video or other telecommunications or electronic technology... to deliver a health care service.” As such, the law does not apply to audio-only phone conversations, email messages or faxes between providers and patients.
The law requires that health insurers and managed care organizations (MCOs) provide coverage for health care services provided appropriately using telehealth technology, and that coverage cannot be denied because services were provided through telehealth rather than in-person. Insurers are not required to cover telehealth services if the health services would not be a covered benefit even if provided in person, or if the provider is out-of-network.
Some additional key provisions of Maryland’s law are:
Insurers and MCOs may require deductibles, copayments or coinsurance for telehealth services as they would for in-person services.
Telehealth services may be subject to an annual dollar maximum (as permitted by federal law) but not a lifetime dollar maximum.
Insurers and MCOs may apply utilization review methods, such as preauthorizations, to telehealth services so long as those same methods are applied to reviewing in-person consultations.
Insurers and MCOs may not distinguish between rural and urban patients in determining coverage for telehealth services.
While these 13 states now mandate coverage, not all require reimbursement rates on par with rates for face-to-face services, and there is still no universal definition of what constitutes telehealth services. APA is part of the Joint Task Force on the Development of Telepsychology Guidelines for Psychologists, which is working to develop guidelines for the professional use of technology in the delivery of psychology services.
And while there seems to be growing coverage by payers for telehealth services, reimbursement policies still differ widely among Medicare, Medicaid and private payers (PDF, 792KB) across states, causing confusion for the health provider community.
Psychologists outside these 13 states should check with individual payers to see if reimbursement is provided for telehealth services and if so, what services are reimbursable. Practitioners should always check with any applicable payers to find out telehealth reimbursement policies before providing and billing for telehealth services.
For more information, contact the Legal & Regulatory Affairs department by email or at (202) 336-5886.