As the internet takes holds of items beyond your computer, tablet or smartphone, it was just a matter of time before medical care became intertwined. And as usual with any booming industry, we see new laws developing and with it confusion on how to apply old laws.
You might not know this, but telemedicine is here and growing fast. It may not be listed in you Certificate of Coverage, Summary Plan Description, or Summary of Benefits, but it is a developing system by which medical care is delivered. What is not always clear is how it is defined. Currently several different definitions exist for "telemedicine" and new entities are changing the names they operate under to provide these services. The American Telemedicine Association describes telemedicine as "the use of medical information exchanged from one site to another via electronic communications to improve a patient's clinical health status."
Telemedicine applies to a broad range of medical, including primary care, specialist referral, remote patient monitoring, and health education. It is not just traditional health care either. Dentistry, counseling, physical and occupational therapy, home health, chronic condition monitoring, disaster management, education and even veterinary services are now involved.
In Minnesota, two new laws will be coming into play for health care and telemedicine. This includes MN Statute 62A.67 which applies to commercial health insurance in the state and MN Statute 256B.0625 Subdivision 3 that applies to Medicaid in Minnesota. The commercial insurance requirements will be effective in 2017 and the Medicaid provisions are effective now in 2016. Both laws will make it easier for telemedicine to apply to health care programs and requires payment for telemedicine under these programs in certain cases. Even the federal health insurance program under Medicare allows some form of telemedicine, but it is more limited.
Several other laws can also come into play for employers that provide health benefits with telemedicine, especially under self-insured programs where the employer is responsible for compliance under the plan. This includes but is not limited to several requirements under the Affordable Care Act (ACA), Employee Retirement Income Security Act (ERISA), Consolidated Omnibus Budget Reconciliation Act (COBRA), Mental Health Parity Addiction Equity Act (MHPAEA), and the Health Insurance Portability and Accountability Act (HIPAA) to name a few. For example, if there is a copay, those copays must be applied to the out-of-pocket maximum limits under the ACA, be disclosed in plan materials, and the value of such coverage should be reported with the W2 reporting of health coverage from employers (if the value is separate than the reported premium). Several unique contracting requirements can also apply if you are working with a telemedicine vendor to add this coverage to existing programs.
If you have questions around the rules for implementing telemedicine benefits, please contact Kinney & Larson LLP.