New Mexico OKs New Telemedicine Rules, Including Coverage Parity

The bill, awaiting the governor’s signature, would expand telemedicine and telehealth coverage to include remote patient monitoring and store-and-forward services and set coverage and payment guidelines for health plans.

 – New Mexico is set to become the latest state to expand access to telehealth and telemedicine by mandating coverage and payment parity for health plans.

By an almost unanimous vote, state lawmakers this week approved SB 354, which amends connected care laws passed in 2013 to include remote patient monitoring and asynchronous (store-and-forward) services and sets new guidelines for payer coverage.

Roughly 36 states and the District of Columbia now have legislation in place setting coverage guidelines for health plans, and 10 of those states also mandate payment parity, according to Nathaniel Lacktman, a partner in and chairman of the Telemedicine Industry Team at the Foley & Lardner law firm, which helped draft the New Mexico bill.

“If signed into law, the bill should bring New Mexico to the forefront of telehealth coverage, benefitting patients and helping catalyze the growth of these technologies throughout the state,” Lacktman said in a Health Care Law Today blog this week.

The bill, titled “Health Coverage for Telemedicine,” would prevent payers from imposing any “unique restrictions” on telehealth, including originating site restrictions, and would compel them to reimburse providers “on the same basis and at least the same rate” for comparable in-person care.

It would also enable payers to charge a deductible for virtual care as long as the deductible, co-payment or co-insurance doesn’t exceed that charged for in-person care, and it would prevent payers from setting an annual or lifetime dollar cap on telehealth coverage “other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the health insurance plan, policy or contract.” Also, the bill would prohibit payers from limiting that coverage to providers who are part of the health plan’s provider network where no in-network provider is available or accessible.

It would also expand telemedicine services to include two new platforms, both of which now qualify for some Medicare reimbursement.

“’Telemedicine’ allows health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications and information technology in real time or asynchronously, including the use of interactive simultaneous audio and video or store-and-forward technology, or remote patient monitoring and telecommunications in order to deliver health care services to a site where the patient is located, along with the use of electronic media and health information,” the bill states. “’Telemedicine’ allows patients in remote locations to access medical expertise without travel.”

The bill now heads to Gov. Michelle Lujan Grisham for her signature.

Source: New Mexico OKs New Telemedicine Rules, Including Coverage Parity