<?xml version='1.0' encoding='utf-8'?>
<section article="gin" article_name="Insurance" number="15-139" title_number="15" title_name="Health Insurance" subtitle_number="1" subtitle_name="General Provisions">
  <level label="a">
    <level label="1">
      <text>In this section, “telehealth” means, as it relates to the delivery of health care services, the use of interactive audio, video, or other telecommunications or electronic technology by a licensed health care provider to deliver a health care service within the scope of practice of the health care provider at a location other than the location of the patient.</text>
    </level>
    <level label="2">
      <text>“Telehealth” includes an audio–only telephone conversation between a health care provider and a patient that results in the delivery of a billable, covered health care service.</text>
    </level>
    <level label="3">
      <text>“Telehealth” does not include:</text>
      <level label="i">
        <text>except as provided in paragraph (2) of this subsection, an audio–only telephone conversation between a health care provider and a patient;</text>
      </level>
      <level label="ii">
        <text>an electronic mail message between a health care provider and a patient; or</text>
      </level>
      <level label="iii">
        <text>a facsimile transmission between a health care provider and a patient.</text>
      </level>
    </level>
  </level>
  <level label="b">
    <text>This section applies to:</text>
    <level label="1">
      <text>insurers and nonprofit health service plans that provide hospital, medical, or surgical benefits to individuals or groups on an expense–incurred basis under health insurance policies or contracts that are issued or delivered in the State; and</text>
    </level>
    <level label="2">
      <text>health maintenance organizations that provide hospital, medical, or surgical benefits to individuals or groups under contracts that are issued or delivered in the State.</text>
    </level>
  </level>
  <level label="c">
    <level label="1">
      <text>An entity subject to this section:</text>
      <level label="i">
        <text>shall provide coverage under a health insurance policy or contract for health care services appropriately delivered through telehealth regardless of the location of the patient at the time the telehealth services are provided;</text>
      </level>
      <level label="ii">
        <text>may not exclude from coverage a health care service solely because it is provided through telehealth and is not provided through an in–person consultation or contact between a health care provider and a patient; and</text>
      </level>
      <level label="iii">
        <text>may not exclude from coverage or deny coverage for a behavioral health care service that is a covered benefit under a health insurance policy or contract when provided in person solely because the behavioral health care service may also be provided through a covered telehealth benefit.</text>
      </level>
    </level>
    <level label="2">
      <text>The health care services appropriately delivered through telehealth shall include counseling and treatment for substance use disorders and mental health conditions.</text>
    </level>
  </level>
  <level label="d">
    <level label="1">
      <text>Subject to paragraph (2) of this subsection, an entity subject to this section:</text>
      <level label="i">
        <text>shall reimburse a health care provider for the diagnosis, consultation, and treatment of an insured patient for a health care service covered under a health insurance policy or contract that can be appropriately provided through telehealth;</text>
      </level>
      <level label="ii">
        <text>is not required to:</text>
        <level label="1">
          <text>reimburse a health care provider for a health care service delivered in person or through telehealth that is not a covered benefit under the health insurance policy or contract; or</text>
        </level>
        <level label="2">
          <text>reimburse a health care provider who is not a covered provider under the health insurance policy or contract; and</text>
        </level>
      </level>
      <level label="iii">
        <level label="1">
          <text>may impose a deductible, copayment, or coinsurance amount on benefits for health care services that are delivered either through an in–person consultation or through telehealth;</text>
        </level>
        <level label="2">
          <text>may impose an annual dollar maximum as permitted by federal law; and</text>
        </level>
        <level label="3">
          <text>may not impose a lifetime dollar maximum.</text>
        </level>
      </level>
    </level>
    <level label="2">
      <level label="i">
        <text>When a health care service is appropriately provided through telehealth, an entity subject to this section shall provide reimbursement in accordance with paragraph (1)(i) of this subsection on the same basis and at the same rate as if the health care service were delivered by the health care provider in person.</text>
      </level>
      <level label="ii">
        <text>The reimbursement required under subparagraph (i) of this paragraph does not include:</text>
        <level label="1">
          <text>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</text>
        </level>
        <level label="2">
          <text>any room and board fees.</text>
        </level>
      </level>
      <level label="iii">
        <text>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.</text>
      </level>
    </level>
  </level>
  <level label="e">
    <text>Subject to subsection (d)(1)(ii) of this section, an entity subject to this section may not impose as a condition of reimbursement of a covered health care service delivered through telehealth that the health care service be provided by a third–party vendor designated by the entity.</text>
  </level>
  <level label="f">
    <text>An entity subject to this section may undertake utilization review, including preauthorization, to determine the appropriateness of any health care service whether the service is delivered through an in–person consultation or through telehealth if the appropriateness of the health care service is determined in the same manner.</text>
  </level>
  <level label="g">
    <text>A health insurance policy or contract may not distinguish between patients in rural or urban locations in providing coverage under the policy or contract for health care services delivered through telehealth.</text>
  </level>
  <level label="h">
    <text>A decision by an entity subject to this section not to provide coverage for telehealth in accordance with this section constitutes an adverse decision, as defined in § 15–10A–01 of this title, if the decision is based on a finding that telehealth is not medically necessary, appropriate, or efficient.</text>
  </level>
</section>
