It’s party time in the Big Apple as New York becomes the 22nd state to enact a telemedicine commercial reimbursement statute. The legislation was sponsored by Senator Catharine Young (R) and signed into law by New York Governor Andrew Cuomo (D), representing bi-partisan support to facilitate patient access to telemedicine services through private sector growth and development. The law requires commercial insurers to cover services provided via telemedicine and telehealth. The law also contains protections for patients by not allowing deductibles, co-insurance or other conditions for coverage of telemedicine that differ from those conditions applicable to in-person services. On its face, the law takes effect January 1, 2015 and applies to all policies and contracts issues, renewed, modified, altered or amended after that date. However, as a practical matter, it is expected that insurance policies will not likely be updated until later in the year in order to allow time to facilitate implementation of the new requirements.

The New York telemedicine law includes separate definitions for telehealth and telemedicine:

  • Telehealth is defined as “delivering health care services by means of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at a distant site.” Insurers and providers may agree to alternative siting arrangements as they deem appropriate.
  • Telemedicine is defined as “the delivery of clinical health care services by means of real time two-way electronic audio visual communications, including the application of secure video conferencing or store and forward technology to provide or support healthcare delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care while such patient is at the originating site and the health care provider is at a distant site.”

Although the New York law clearly requires commercial insurers to cover services provided via telemedicine and telehealth, the language of the legislation leaves it is unclear whether insurers will be required to cover new telehealth services if those services are not currently covered under the health plan policy as in-person services. Some services, such as remote monitoring, do not naturally lend themselves to in-person encounters and are designed to be utilized via telehealth. This issue may be addressed in subsequent rulemaking to reconcile the ambiguity.

Nationwide, state legislatures are enacting laws stating that commercial health insurance companies must cover medical services provided via telemedicine to the same extent they cover medical services provided in-person. Currently, 22 states plus the District of Columbia have enacted these telemedicine commercial insurance laws, with legislation under discussion or development in at least a dozen more states. These laws are intended to promote innovation and care delivery in the private sector by catalyzing health care providers and plans to invest in and use the powerful telemedicine tools and technologies available in the marketplace.

Some New York hospitals and health care providers have already taken the initiative and successfully embedded telemedicine into their patient care delivery models. Results have shown significant increases in quality of care, patient satisfaction, and institutional cost-savings. With this step forward to drive the New York market, these telemedicine benefits will not remain isolated to patients of a select few hospitals and providers. As a telemedicine lawyer, this is a great way for New York to celebrate the New Year.