Section 3902.30 | Coverage for telehealth services.
(A) As used in this section:
(1) "Cost sharing" means the cost to a covered individual under a health benefit plan according to any coverage limit, copayment, coinsurance, deductible, or other out-of-pocket expense requirements imposed by the plan.
(2) "Health benefit plan," "health care services," and "health plan issuer" have the same meanings as in section 3922.01 of the Revised Code.
(3) "Health care professional" has the same meaning as in section 4743.09 of the Revised Code.
(4) "In-person health care services" means health care services delivered by a health care professional through the use of any communication method where the professional and patient are simultaneously present in the same geographic location.
(5) "Telehealth services" has the same meaning as in section 4743.09 of the Revised Code.
(B)(1) A health benefit plan shall provide coverage for telehealth services on the same basis and to the same extent that the plan provides coverage for the provision of in-person health care services.
(2) A health benefit plan shall not exclude coverage for a service solely because it is provided as a telehealth service.
(3) A health plan issuer shall reimburse a health care professional for a telehealth service that is covered under a patient's health benefit plan. Division (B)(3) of this section shall not be construed to require a specific reimbursement amount.
(C) A health benefit plan shall not impose any annual or lifetime benefit maximum in relation to telehealth services other than such a benefit maximum imposed on all benefits offered under the plan.
(D)(1) A health benefit plan shall not impose a cost-sharing requirement for telehealth services that exceeds the cost-sharing requirement for comparable in-person health care services.
(2)(a) A health benefit plan shall not impose a cost-sharing requirement for a communication when all of the following apply:
(i) The communication was initiated by the health care professional.
(ii) The patient consented to receive a telehealth service from that provider on any prior occasion.
(iii) The communication is conducted for the purposes of preventive health care services only.
(b) If a communication described in division (D)(2)(a) of this section is coded based on time, then only the time the health care professional spends engaged in the communication is billable.
(E) This section shall not be construed as doing any of the following:
(1) Requiring a health plan issuer to reimburse a health care professional for any costs or fees associated with the provision of telehealth services that would be in addition to or greater than the standard reimbursement for comparable in-person health care services;
(2) Requiring a health plan issuer to reimburse a telehealth provider for telehealth services at the same rate as in-person services;
(3) Requiring a health plan issuer to provide coverage for asynchronous communication that differs from the coverage described in the applicable health benefit plan.
(F) The superintendent of insurance may adopt rules in accordance with Chapter 119. of the Revised Code as necessary to carry out the requirements of this section. Any such rules adopted by the superintendent are not subject to the requirements of division (F) of section 121.95 of the Revised Code.
Last updated January 27, 2022 at 3:14 PM