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.

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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 diagnosis, consultation, or treatment.

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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 audio-only telemedicine coverage is changed to create a single definition for all services.

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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.