On July 31, 2020, Governor Ned Lamont signed into law House Bill No. 6001 (the "Act"), which temporarily modifies requirements relating to telehealth services, coverage, and reimbursement. These changes are limited and only apply to in-network providers of fully insured plans and providers enrolled in the Connecticut Medical Assistance Program ("CMAP"). Said changes took effect upon the Act's passage and remain in effect until March 15, 2021. Some of the key provisions of the Act are summarized below.
- Additional Health Care
Providers Authorized to Provide Telehealth Services
The Act expands the list of health care providers that are authorized to provide telehealth services in the state. Specifically, section 19a-906 of the Connecticut General Statutes authorizes the following health care providers to provide telehealth services: advanced practice registered nurses, alcohol and drug counselors, audiologists, certified dietician-nutritionists, chiropractors, clinical and master social workers, marital and family therapists, naturopaths, occupational or physical therapists, optometrists, paramedics, pharmacists, physicians, physician assistants, podiatrists, professional counselors, psychologists, registered nurses, respiratory care practitioners, and speech and language pathologists. The Act adds the following providers to the list: certified, licensed, or registered art therapists, athletic trainers, behavior analysts, dentists, genetic counselors, music therapists, nurse-midwives, and occupational or physical therapist assistants.
- Out-of-State Telehealth
Providers
The Act permits out-of-state providers to provide telehealth services in the state without a Connecticut license, so long as the provider: (i) is appropriately licensed, certified, or registered in another U.S. state or territory, or the District of Columbia, as one of the aforementioned providers; (ii) is authorized to practice telehealth under any relevant order issued by the Connecticut Department of Public Health ("DPH") commissioner; and (iii) maintains professional liability insurance or other indemnity against liability for professional malpractice in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut health care providers. Notably, the Act requires any Connecticut entity, institution or health care provider that engages or contracts with an out-of-state telehealth provider to do all of the following: (i) verify the credentials of such provider in the state in which he or she is licensed, certified or registered; (ii) ensure that such provider is in good standing in such state; and (iii) confirm that such provider maintains professional liability insurance or other indemnity against liability for professional malpractice in an amount that is equal to or greater than that required for similarly licensed, certified or registered Connecticut health care providers.
- Expansion of Scope of
Telehealth Delivery
Unlike under existing law, the Act permits in-network providers and providers enrolled in the CMAP providing services to CMAP recipients to provide telehealth services via audio-only telephone and authorizes the commissioner of the Department of Social Services to provide coverage under CMAP for such services. In addition, the Act permits telehealth providers to use additional information and communication technologies, such as Apple FaceTime, in accordance with HIPAA requirements for remote communication as directed by the U.S. Department of Health and Human Services' Office for Civil Rights ("OCR").
- Additional Qualifications and
Service Requirements for Telehealth Providers
The Act provides additional qualifications and service requirements for telehealth providers. Under existing law, a provider may only provide telehealth services to a patient when the provider: (i) is communicating through real-time, interactive, two-way communication technology or store and forward technologies; (ii) has access to, or knowledge of, the patient's medical history, as provided by the patient, and the patient's health record; (iii) conforms to the standard of care applicable to the telehealth provider's profession; and (iv) provides the patient with the telehealth's provider license number and contact information. In addition to these requirements under existing law, the Act requires that the provider determine whether (i) the patient has health coverage that is fully insured, not fully insured, or provided through CMAP and (ii) the coverage includes telehealth services. Moreover, at the time of the provider's first telehealth interaction with a patient, the provider must inform the patient concerning the treatment methods and limitations of treatment using a telehealth platform, including, but not limited to, the limited duration of the relevant provisions of the Act. The telehealth provider must document such notice and consent in the patient's health record. Finally, the Act clarifies that providers are permitted to provide telehealth services from any location.
The Act further provides the DPH commissioner the broad authority to temporarily waive, modify, or suspend any regulatory requirements that the commissioner deems necessary to reduce the spread of COVID-19 and to protect the public health.
- Reimbursement for Telehealth
Services
Consistent with existing law, telehealth providers are prohibited from charging a facility fee for a telehealth service provided during the period that the Act is in effect. Moreover, a telehealth provider providing services during this period must accept as full payment for such services: (i) an amount that is equal to the amount that Medicare reimburses for such service if the telehealth provider determines that the patient does not have health coverage; or (ii) the amount that the patient's health insurance reimburses, and any coinsurance, copayment, deductible, or other out-of-pocket expense imposed by the patient's health coverage. If the telehealth provider determines that a patient is unable to pay for services, the provider must offer to the patient financial assistance, if the provider is otherwise required to do so under any applicable state or federal law.
In addition, health carriers are prohibited from reducing the amount of a reimbursement paid to a telehealth provider for covered services because the telehealth provider provided such services to the patient through telehealth rather than in person.
- Insurance Coverage for
Telehealth Services
The Act requires individual and group health insurance policies in effect any time from the effective date until March 15, 2021 to provide coverage for medical advice, diagnosis, care, or treatment provided through telehealth to the same extent coverage is provided for such advice, diagnosis, care or treatment when provided to the insured in person. During the period the Act is in effect, such health insurance policies must not exclude coverage for a service that is appropriately provided through telehealth because such service is provided through telehealth or a telehealth platform selected by an in-network telehealth provider.
Originally published August 7, 2020.
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