                                 CODE OF VIRGINIA

COVERAGE FOR TELEMEDICINE SERVICES (§ 38.2-3418.16)

A. Notwithstanding the provisions of &#xA7; 38.2-3419, each insurer proposing to
issue individual or group accident and sickness insurance policies providing
hospital, medical and surgical, or major medical coverage on an expense-incurred
basis; each corporation providing individual or group accident and sickness
subscription contracts; and each health maintenance organization providing a
health care plan for health care services shall provide coverage for the cost of
such health care services provided through telemedicine services, as provided in
this section.

B. As used in this section:
			&#8220;Originating site&#8221; means the location where the patient is
located at the time services are provided by a health care provider through
telemedicine services.
			&#8220;Remote patient monitoring services&#8221; means the delivery of home
health services using telecommunications technology to enhance the delivery of
home health care, including monitoring of clinical patient data such as weight,
blood pressure, pulse, pulse oximetry, blood glucose, and other
condition-specific data; medication adherence monitoring; and interactive video
conferencing with or without digital image upload.
			&#8220;Telemedicine services&#8221; as it pertains to the delivery of health
care services, means the use of electronic technology or media, including
interactive audio or video, for the purpose of diagnosing or treating a patient,
providing remote patient monitoring services, or consulting with other health
care providers regarding a patient&#8217;s diagnosis or treatment, regardless of
the originating site and whether the patient is accompanied by a health care
provider at the time such services are provided. &#8220;Telemedicine
services&#8221; does not include an audio-only telephone, electronic mail
message, facsimile transmission, or online questionnaire. Nothing in this
section shall preclude coverage for a service that is not a telemedicine
service, including services delivered through real-time audio-only telephone.

C. An insurer, corporation, or health maintenance organization shall not exclude
a service for coverage solely because the service is provided through
telemedicine services and is not provided through face-to-face consultation or
contact between a health care provider and a patient for services appropriately
provided through telemedicine services.

D. An insurer, corporation, or health maintenance organization shall not be
required to reimburse the treating provider or the consulting provider for
technical fees or costs for the provision of telemedicine services; however,
such insurer, corporation, or health maintenance organization shall reimburse
the treating provider or the consulting provider for the diagnosis,
consultation, or treatment of the insured delivered through telemedicine
services on the same basis that the insurer, corporation, or health maintenance
organization is responsible for coverage for the provision of the same service
through face-to-face consultation or contact. No insurer, corporation, or health
maintenance organization shall require a provider to use proprietary technology
or applications in order to be reimbursed for providing telemedicine services.

E. Nothing shall preclude the insurer, corporation, or health maintenance
organization from undertaking utilization review to determine the
appropriateness of telemedicine services, provided that such appropriateness is
made in the same manner as those determinations are made for the treatment of
any other illness, condition, or disorder covered by such policy, contract, or
plan. Any such utilization review shall not require pre-authorization of
emergent telemedicine services.

F. An insurer, corporation, or health maintenance organization may offer a
health plan containing a deductible, copayment, or coinsurance requirement for a
health care service provided through telemedicine services, provided that the
deductible, copayment, or coinsurance does not exceed the deductible, copayment,
or coinsurance applicable if the same services were provided through
face-to-face diagnosis, consultation, or treatment.

G. No insurer, corporation, or health maintenance organization shall impose any
annual or lifetime dollar maximum on coverage for telemedicine services other
than an annual or lifetime dollar maximum that applies in the aggregate to all
items and services covered under the policy, or impose upon any person receiving
benefits pursuant to this section any copayment, coinsurance, or deductible
amounts, or any policy year, calendar year, lifetime, or other durational
benefit limitation or maximum for benefits or services, that is not equally
imposed upon all terms and services covered under the policy, contract, or plan.

H. The requirements of this section shall apply to all insurance policies,
contracts, and plans delivered, issued for delivery, reissued, or extended in
the Commonwealth on and after January 1, 2021, or at any time thereafter when
any term of the policy, contract, or plan is changed or any premium adjustment
is made.

I. This section shall not apply to short-term travel, accident-only, or limited
or specified disease policies or contracts, nor to policies or contracts
designed for issuance to persons eligible for coverage under Title XVIII of the
Social Security Act, known as Medicare, or any other similar coverage under
federal governmental plans.

J. The coverage required by this section shall include the use of telemedicine
technologies as it pertains to medically necessary remote patient monitoring
services to the full extent that these services are available.

K. Prescribing of controlled substances via telemedicine shall comply with the
requirements of &#xA7; 54.1-3303 and all applicable federal law.

HISTORY: 2010, c. 222; 2014, c. 814; 2015, cc. 32, 115; 2019, cc. 211, 219;
2020, Sp. Sess. I, cc. 44, 53; 2021, Sp. Sess. I, cc. 301, 302.