After New York became the 22nd state to enact a telemedicine commercial coverage statute, Governor Andrew Cuomo signed an amendment changing the statute. The amendment makes sweeping changes to telehealth coverage under New York Medicaid and commercial health insurance. With an effective date of January 1, 2016, providers and insurers need to be ready and positioned for the patients who will want to enjoy this new coverage. Those providers who develop their business models, finalize their contractual arrangements, and timely deploy their telehealth offerings will have a significant strategic advantage come January.
New York Medicaid Telehealth Coverage
Under the amended law, the New York Medicaid program will reimburse for telehealth services. Providers should note the following key provisions:
New York Commercial Plan Telehealth Coverage
Effective January 1, 2016, the Insurance Law will require commercial health insurers to cover telehealth. Specifically, an insurer may not exclude from coverage a service that is otherwise covered in-person, simply because the service is delivered via telehealth. The law does allow plans to employ “reasonable utilization management and quality assurance” requirements consistent with those used with corresponding in-person services. Insurers may not impose higher co-pays or other patient responsibilities on telehealth services.
The commercial insurance law differs from the Medicaid law in three notable ways:
The New York State Department of Health is expected to release telehealth and telemedicine regulations later this year. We will continue to monitor for these forthcoming rules.
Nationwide, states are enacting laws requiring commercial health insurance companies must cover medical services provided via telemedicine to the same extent they cover medical services provided in-person. Currently, 29 states plus the District of Columbia have enacted telemedicine commercial insurance laws, with legislation under discussion or development in many more, including Massachusetts and Florida. 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 New York hospitals and innovative companies have already taken the initiative and successfully embedded telemedicine into their patient care delivery models. When coverage goes live in January 2016, patients in New York will be able to enjoy a powerful and convenient approach to healthcare.