Health Plans in Connecticut Must Cover Telehealth Services

Foley & Lardner LLP

Connecticut marks the 28th state to enact a telemedicine commercial reimbursement statute. The legislation (SB-467) was sponsored by Senators Looney, Duff, Crisco and Gerratana with twenty co-sponsor senators, and was signed into law by Connecticut Governor Dannel Malloy on June 22, 2015, representing the culmination of a hard-fought effort to facilitate patient access to telemedicine services through private sector growth and development.

The law requires commercial insurers to cover services provided via telemedicine and telehealth to the same extent those services are covered though in-person visits. The law also protects patients against cost-shifting by requiring that telehealth coverage must be subject to the same terms and conditions applicable to all other benefits under the patient’s insurance policy (e.g., deductibles, co-insurance or other conditions for coverage).

The telehealth commercial insurance provisions take effect January 1, 2016 and apply to all policies delivered, issued, renewed, amended or continued after that date.

The Connecticut law contains a broad definition of telehealth, stating:

“Telehealth means the mode of delivering health care or other health services via information and communication technologies to facilitate the diagnosis, consultation and treatment, education, care management and self-management of a patient’s physical and mental health, and includes (A) interaction between the patient at the originating site and the telehealth provider at a distant site, and (B) synchronous interactions, asynchronous store and forward transfers or remote patient monitoring. Telehealth does not include the use of facsimile, audio-only telephone, texting or electronic mail.”

Following a potential trend starting to be seen in among telehealth statutes recently enacted in other states, the Connecticut law excludes from the definition of covered telehealth the use of facsimile, audio-only telephone, texting or electronic mail.

However, Connecticut’s broad definition of telehealth is important to note because it does not limit covered telehealth services exclusively to services performed by a “telehealth provider at a distant site”, but also includes “synchronous interactions, asynchronous store and forward transfers or remote patient monitoring.” The latter language does not restrict these remote services exclusively to “telehealth provider.” Moreover, the Connecticut law squarely addresses the issue of commercial coverage for these telehealth services, including remote patient monitoring. The law does not allow a health plan to exclude a service from coverage “solely because such service is provided only through telehealth and not through in-person consultation between the insured and a health care provider” provided telehealth is appropriate for the provision of such service. This requirement will help ensure Connecticut health plan members enjoy benefits of telehealth services such as remote patient monitoring and connected care technologies.

In contrast to the Connecticut law, the language in some other state statutes is less clear whether insurers are required to cover new telehealth services if those services are not currently covered under the health plan policy as in-person services. This is because some services, such as remote monitoring, do not naturally lend themselves to in-person encounters and are designed to be utilized via telehealth.

Nationwide, state legislatures are enacting laws stating that commercial health insurance companies must cover medical services provided via telemedicine to the same extent they cover medical services provided in-person. With Connecticut on board, 28 states plus the District of Columbia have enacted these telemedicine commercial insurance laws, with legislation currently under discussion or development in many more states. These laws are intended to promote innovation and care delivery in the private sector by catalyzing health care providers and plans to invest in and use the powerful telemedicine tools and technologies available in the marketplace.

Some Connecticut hospitals and health care providers have already taken the initiative and successfully embedded telehealth into their patient care delivery models. Surveys also show healthcare executives are bullish on the opportunities offered by telehealth. Results indicate significant increases in quality of care, patient satisfaction, and institutional cost-savings. With this step forward to drive the Connecticut commercial insurance market, these telehealth benefits will be enjoyed by patients across “the Constitution State.”

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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