Rhode Island marks the 31st state to enact a telemedicine commercial reimbursement statute. The Telemedicine Coverage Act (HB 7160B) was signed into law by Rhode Island Governor Gina Raimondo on June 28, 2016, representing a forward step for telehealth providers in a state that historically has held one of the lowest-rankings in the nation for telehealth coverage policy. The new law requires commercial health insurers in the Ocean State to cover treatment provided via telemedicine to the same extent the services are covered via in-person care. The law takes effect January 1, 2018 and applies to all policies delivered, issued, or reissued in the State after that date.
The law states as follows:
Each health insurer that issues individual or group accident and sickness insurance policies for health care services and/or provides a health care plan for health care services shall provide coverage for the cost of such covered health care services provided through telemedicine services. R.I. Gen. Laws §27-81-4(a).
Yet, the law contains some peculiar language that appears to incorporate terms and conditions of a “telemedicine agreement” between the insurer and the participating provider. Whether this will be interpreted as grounds for a health plan to limit coverage based on the terms of such “telemedicine agreement” is not yet known, and we may see further clarity in subsequent rulemaking. Until then, the law provides as follows:
“A health insurer shall not exclude a health care service for coverage solely because the health care service is provided through telemedicine and is not provided through in-person consultation or contact, so long as such health care services are medically appropriate to be provided through telemedicine services and as such may be subject to the terms and conditions of a telemedicine agreement between the insurer and the participating health care provider or provider group” (emphasis added). R.I. Gen. Laws §27-81-4(b).
Other highlights of the new law include the following:
With the enactment of Rhode Island’s new law, 31 states plus the District of Columbia have telehealth commercial insurance laws on the books. Continued expansion in coverage and reimbursement means providers can enhance telemedicine offerings, both for the immediate cost savings and growing opportunities for revenue generation, to say nothing of patient quality and satisfaction. Commercial insurance reimbursement is among the five telemedicine trends driving health care transformation in 2016 and beyond.
We will continue to monitor Rhode Island for any rule changes that affect or improve telemedicine opportunities in the state.
For more information on telemedicine, telehealth, and virtual care innovations, including the team, publications, and other materials, visit Foley’s Telemedicine Practice.
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