N.Y. Public Health Law § 4406-g: Telehealth delivery of services

§ 4406-g. Telehealth delivery of services. 1. A health maintenance

organization shall not exclude from coverage a service that is otherwise

covered under an enrollee contract of a health maintenance organization

because the service is delivered via telehealth, as that term is defined

in subdivision two of this section; provided, however, that a health

maintenance organization may exclude from coverage a service by a health

care provider where the provider is not otherwise covered under the

enrollee contract. A health maintenance organization may subject the

coverage of a service delivered via telehealth to co-payments,

coinsurance or deductibles provided that they are at least as favorable

to the enrollee as those established for the same service when not

delivered via telehealth. A health maintenance organization may subject

the coverage of a service delivered via telehealth to reasonable

utilization management and quality assurance requirements that are

consistent with those established for the same service when not

delivered via telehealth.

2. For purposes of this section, "telehealth" means the use of

electronic information and communication technologies by a health care

provider to deliver health care services to an enrollee while such

enrollee is located at a site that is different from the site where the

health care provider is located.

* 3. A health maintenance organization that provides comprehensive

coverage for hospital, medical or surgical care shall reimburse covered

services delivered via telehealth on the same basis, at the same rate,

and to the extent that such services are reimbursed when delivered in

person; provided that reimbursement of covered services delivered by

means of telehealth shall not require reimbursement of costs not

actually incurred in the provision of the telehealth services, including

charges related to the use of a clinic or other facility when neither

the originating site nor the distant site occur within the clinic or

other facility. The commissioner, in consultation with the

superintendent, may promulgate regulations to implement the provisions

of this section.

* NB Repealed April 1, 2028

* 4. A health maintenance organization that provides comprehensive

coverage for hospital, medical, or surgical care with a network of

health care providers shall ensure that such network is adequate to meet

the telehealth needs of insured individuals for services covered under

the policy when medically appropriate.

* NB Repealed April 1, 2028