Health plans, including plans offered to public employees, and the state Medicaid program, must cover telemedicine services if:

• the plan provides coverage for the service when provided in person;
• the service is medically necessary;
• the service is recognized as an essential health benefit;
• the service is determined to be safely and effectively provided through telemedicine; and
• for audio-only telemedicine services, the covered person has an established relationship with the provider.

Audio-only telemedicine means the delivery of health care services through the use of audio-only technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.

An established relationship means the provider has access to sufficient health records to ensure safe, effective, and appropriate care services and:

• for health care services included in the essential health benefits category of mental health and substance use disorder services, including behavioral health treatment:
  1. the covered person has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the provider providing audio-only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system as the provider providing audio-only telemedicine; or
  2. the covered person was referred to the provider providing audio-only telemedicine by another provider who has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the covered person and has provided relevant medical information to the provider providing audio-only telemedicine; and
• for any other health care service:
  1. the covered person has had, within the past two years, at least one in-person appointment, or, until July 1, 2024, at least one real-time interactive appointment using both audio and video technology, with the provider providing audio-only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system as the provider providing audio-only telemedicine; or
  2. the covered person was referred to the provider providing audio-only telemedicine by another provider who has had, within the past two years, at least one in-person appointment, or, until July 1, 2024, at least one real-time interactive appointment using both audio and video technology, with the covered person and has provided relevant medical information to the provider providing audio-only telemedicine.

The definition of established relationship for the purposes of audio-only telemedicine coverage is changed to create a single definition for all services.

An established relationship means the provider has access to sufficient health records to ensure safe, effective, and appropriate care services and:

• the covered person has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the provider providing audio-only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system as the provider providing audio-only telemedicine; or
• the covered person was referred to the provider providing audio-only telemedicine by another provider who has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the covered person and has provided relevant medical information to the provider providing audio-only telemedicine.