Telehealth News

Maine Approves Telehealth Coverage Parity, Embraces RPM Programs

Maine Gov. Janet Mills has signed into law new telehealth guidelines that require payers to cover any services that they would cover in person. The new law also opens the door to remote patient monitoring and allows doctors to use phone-based telehealth in certain situations.

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By Eric Wicklund

- Maine lawmakers have passed legislation establishing coverage parity for telehealth by private payers.

LD 1263, signed into law on June 13 by Gov. Janet Mills, also opens the door to more remote patient monitoring programs – an important consideration in a predominantly rural state with large areas of underserved residents. And it allows reimbursement for healthcare providers who use phone-based telehealth “when scheduled telehealth services are technologically unavailable at the time of the scheduled telehealth service for an existing enrollee and the telephonic services are medically appropriate for the corresponding covered health care services.”

Danielle Louder, program director for the Northeast Regional Telehealth Resource Center, offered praise for the new law when its passage was mentioned during this week’s Northeast Regional Telehealth Conference in Portland. She noted the legislation would targets gaps in care throughout the state.

“I think we’re going to see those gaps (get) smaller,” she pointed out.

Introduced by State Sen. Geoffrey Gatwick, the new law mandates that any health plans in the state cover a service offered through telehealth if that service is offered in person. It also orders that any copayment, deductible or coinsurance not exceed any similar fees for in-person care, and prevents payers from denying coverage for a service solely because it’s offered through connected health technology.

To qualify for coverage, a telehealth service must meet six conditions:

  1. The health care service is otherwise covered under an enrollee's health plan.
  2. The health care service delivered by telehealth is of comparable quality to the health care service delivered through in-person consultation.
  3. Prior authorization is required for telehealth services only if prior authorization is required for the corresponding covered health care service. An in-person consultation prior to the delivery of services through telehealth is not required.
  4. Coverage for telehealth services is not limited in any way on the basis of geography, location or distance for travel.
  5. The carrier shall require that a clinical evaluation is conducted either in person or through telehealth before a provider may write a prescription that is covered.
  6. The carrier shall provide coverage for the treatment of two or more persons who are enrolled in the carrier's health plan at the same time through telehealth, including counseling for substance use disorders involving opioids.

In addition, the bill sets guidelines for telemonitoring, which is defined as the “use of information technology to remotely monitor an enrollee's health status via electronic means through the use of clinical data while the enrollee remains in a residential setting, allowing the provider to track the enrollee's health data over time.” Also known as RPM, it can be delivered either in real time or as an asynchronous (store-and-forward) service.

Finally, the new law prohibits payers from requiring that a provider use a specific telemedicine technology as a condition of coverage.

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