Telehealth services are now required to be covered by health plans in the Cornhusker State. Nebraska telemedicine providers, entrepreneurs, and patients can enjoy telehealth insurance coverage, joining the national majority. Championed earlier this year by Nebraska Senator Mark Kolterman (R) as LB92 and signed by Governor Pete Ricketts (R) in late April, the new law just recently became effective on August 24, 2017. While the law contains a telehealth coverage provision, it does not require payment parity for telehealth services.
Nebraska’s new telehealth insurance coverage law can be found under Nebraska Statutes Section 44-7,107 and states, in full, as follows:
Any insurer offering (1) any individual or group sickness and accident insurance policy, certificate, or subscriber contract delivered, issued for delivery, or renewed in this state, (2) any hospital, medical, or surgical expense-incurred policy, or (3) any self-funded employee benefit plan to the extent not preempted by federal law, shall not exclude, in any policy, certificate, contract, or plan offered or renewed on or after the effective date of this act, a service from coverage solely because the service is delivered through telehealth as defined in section 44-312 and is not provided through in-person consultation or contact between a licensed health care provider and a patient. This section does not apply to any policy, certificate, contract, or plan that provides coverage for a specified disease or other limited-benefit coverage.
Although LB92 expresses an intent to require health plans to cover telehealth services, the actual statutory language of Section 44-7,107 could have been drafted to more definitively state such, following preferred model language. The statute uses the proscriptive phrase “shall not exclude … a service from coverage solely because the service is delivered through telehealth.” Providers and patients may have found it easier if the statute instead used an affirmative phrase, stating insurers “shall cover any service offered through telehealth if that service is covered when delivered via in-person consultation or contact.” But to be fair, Nebraska lawmakers did far better than Michigan’s telehealth coverage law.
Hopefully, the language of the statute will not be misconstrued by insurers seeking to deny or avoid coverage of telehealth services. Fortunately, there is ample evidence in the official record reflecting the clear legislative intent of the statute, and providers can point to that in the event they find telehealth claims denied by insurers. Consider, for example, the following three documents.
The Legislature, in its Statement of Intent, expressed a clear purpose for the reasons for the new statute, stating:
“LB92 ensures a payer’s coverage of telemedicine services, regardless of the provider’s location in relation to the patient, as long as that provider is licensed within the state of Nebraska. A health carrier shall not exclude a service for coverage solely because the service is provided via telemedicine and is not provided through in-person consultation or contact between a licensed health care provider and patient.”
This mirrors the transcript of Senator Kolterman’s own statements to the Banking, Commerce and Insurance Committee, in which he said, “Language in LB92 requires health insurance companies to cover any service offered through telehealth that is already covered for an in-person consultation.”
The Legislature’s Fiscal Note for the budgetary impact of the bill further recognizes that the new statute requires coverage because it may have a fiscal impact on those health benefit plans that currently do not cover of telehealth services. The Note states:
LB 92 provides that health insurance plans offered in the state shall not exclude a service from coverage solely because the service is delivered through telehealth. The Department of Administrative Services and the University of Nebraska indicate that telehealth services are allowed under the health insurance benefit plans offered to state and university employees, so the bill has no fiscal impact for these entities. If benefit plans covering employees of political subdivisions do not offer such services, there may be an unknown fiscal impact in terms of the cost of health insurance benefits.
The enactment of Nebraska’s telehealth insurance coverage law brings the count to approximately 34 states plus D.C. as having laws requiring commercial insurance plans to cover telehealth services. Continued expansion in coverage and reimbursement means providers can enhance telehealth offerings, both for the immediate cost savings and growing opportunities for revenue generation, to say nothing of patient quality and satisfaction. We will continue to monitor states across the country on this important issue.
For more information on telemedicine, telehealth, virtual care, and other health innovations, including the team, publications, and other materials, visit Foley’s Telemedicine and Virtual Care Practice.