Telemedicine Reimbursement Bills Advance in New York and Connecticut

Looking to join the 20 other states and the District of Columbia which already mandate such coverage, both the New York and Connecticut Legislatures are currently considering bills that would mandate health plan reimbursement for physician-patient encounters conducted via telemedicine.

Both the proposed New York legislation (A 09129/S 04337b) and Connecticut legislation (S 202) would require health plans to reimburse providers for a patient encounter conducted via telemedicine to the extent that the encounter would be a covered benefit if conducted in a bricks and mortar practice.  The proposed New York legislation would also mandate such coverage for the state Medicaid program.

Each bill takes a different approach on coverage.  The New York bill is more expansive, providing parity coverage for both “telemedicine” and “telehealth.”  “Telemedicine” is defined in the New York bill to be “[t]he delivery of clinical health care services by means of real time two-way electronic audio visual communications which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self management of a patient’s health care while such patient is at the originating site and the health care provider is at a distant site.”  “Telehealth” is more broadly defined and includes delivery of care via “telephones, remote patient monitoring devices and other electronic means” as well as “telemedicine” activities.  By adopting the broader definition of “telehealth”, the New York bill allows more opportunities for providers to be reimbursed for patient services that are currently not reimbursed by health plans.

In contrast, the Connecticut bill tracks the narrow CMS definition of telemedicine in defining it to be “the use of interactive audio, interactive video or interactive data communication in the delivery of medical advice, diagnosis, care or treatment” and explicitly excludes the use of  “telephones” from the definition. 

By mandating coverage, both bills hope to increase access to medical services, specifically in rural areas of both states, and encourage the adoption of telemedicine in order to foster greater efficiency and lower medical costs.  Potential passage of both bills in both states remains uncertain.  However the Connecticut telemedicine bill has been voted out of committee favorably in the Connecticut Senate.

~Submitted by P Squire