Health coverage offered by a health carrier, the Public Employees Benefits Board, the School Employees Benefits Board, a Medicaid managed care plan, or a behavioral health administrative services organization must reimburse providers for health care services provided through telemedicine or store and forward technology if:

• the health care services are covered services;
• the health care services are medically necessary;
• the health care services are essential health benefits under the federal Patient Protection and Affordable Care Act;
• the health care services are determined to be safely and effectively provided through telemedicine or store-and-forward technology; and
• the technology meets state and federal standards governing the privacy and security of protected health information.

Additional requirements apply for audio-only telemedicine, including that the health care provider must have an established relationship with the patient.  For essential health benefits, other than those categorized as mental health and substance use disorder services, an established relationship exists if the patient has had, within the previous two years, an in-person appointment or, until January 1, 2024, a real-time interactive appointment using both audio and visual technology with the health care provider providing the health care services through audio-only telemedicine.  Alternatively, the in-person or audio-visual appointment may have been with either a health care provider in the same medical group, clinic, or integrated delivery system as the health care provider providing the health care services through audio-only telemedicine or with a health care provider referring the patient to the health care provider providing the health care services through audio-only telemedicine.

The date by which an interactive appointment using audio and visual technology may substitute for an in-person appointment for the purposes of creating an established relationship between a patient and a health care provider using audio-only telemedicine is extended from January 1, 2024, to July 1, 2024.  The extension also applies to appointments between the patient and a health care provider referring the patient to another health care provider for services through audio-only technology, as well as other health care providers in the same medical group, clinic, or integrated delivery system.  The extension applies to health coverage for services other than mental health or substance use disorder services offered by a health carrier, the Public Employees Benefits Board, the School Employees Benefits Board, or a Medicaid managed care plan.