Page 7 ATA State Telehealth Policy Toolkit Coverage and Reimbursement

MODEL STATE LEGISLATIVE LANGUAGE

Telemedicine for Quality Improvement and Healthcare Modernization Act
A bill to expand patient access to healthcare services, improve quality of care and reduce costs through the use
of telemedicine

PREAMBLE: Telemedicine can efficiently improve access and quality of care for underserved patients by
providing consultations and specialty care. Remote monitoring and home telehealth can help the chronically ill
stay at home and out of hospitals and emergency rooms, dramatically reducing costs. Today, more and more
people are taking advantage of telemedicine and e-health opportunities. But such services are not available for
everyone and action is needed in the states to assure that all Americans receive the benefits available through
telemedicine.

DEFINITION: Telemedicine or Telehealth means health care services provided to a patient from a provider
who is at a remote location.

PRIVATE COVERAGE: Health insurers, health care subscription plans, and health maintenance organizations
shall provide coverage for the cost of telemedicine services when the services are appropriately provided
through such means.

UTILIZATION REVIEW: Decisions denying coverage of services provided via telemedicine shall be subject to
utilization review procedures.

EXCEPTIONS: The requirements of the bill shall apply to all insurance policies, contracts, and plans delivered,
issued for delivery, reissued, or at any time thereafter when any term of the policy, contract, or plan is changed
or any premium adjustment is made. The bill does not apply to short-term travel, accident-only, limited or
specified disease, or individual conversion policies or contracts, or to policies or contracts designed for issuance
to persons eligible for coverage under Medicare, or any other similar coverage under state or federal
governmental plans.

MEDICAID: The state’s Medicaid plan shall not deny coverage on the basis that coverage is provided through
telemedicine if the health care service would be covered were it provided through in-person consultation
between the recipient and a health care provider. Coverage for health care services provided through
telemedicine must be determined in a manner consistent with coverage for health care services provided through
in-person consultation. Specifically included is statewide coverage, services originating from a recipients home
or wherever else they may be, all health professionals authorized to provide services by a telehealth method to
the extent otherwise covered in the State’s plan, and timely asynchronous telehealth services.

REPORTING: The state’s Department of Health shall lead an interagency study and report to the Legislature
within 12 months on comprehensive plans that include telehealth services and multi-payer coverage and
reimbursement for chronic care management, stroke diagnosis, high-risk pregnancies and premature births, and
emergency services.

PROFESSIONAL LICENSING: The state’s health professional licensing boards shall modify, as necessary,
requirements for telemedicine-provided practices to be the same as for in-person practices. Further, a
professional should be able to consult with an out-of-state peer professional, such as a sub-specialist, without the
need for an additional state license.

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American Telemedicine Association
www.americantelemed.org