Downey Introduces Bill Requiring Insurance Coverage of Telehealth

OCEAN TOWNSHIP - Legislation introduced by Assemblywoman Joann Downey on Thursday would require all New Jersey health benefits plans, Medicaid and NJ FamilyCare, and the State Health Benefits Programs (SHBP) and School Employees’ Health Benefits Program (SEHBP) to provide expanded coverage for services provided using telemedicine and telehealth.

Specifically, the bill (A4179) would require all health insurance plans to provide the same reimbursement to medical providers for telehealth or telemedicine services as they would receive for providing the same services in person.

The bill also prohibits health benefits plans, Medicaid and NJ FamilyCare, and the SHBP and SEHBP from imposing “place of service” requirements on services provided using telemedicine and telehealth, and expressly allows licensed health care providers to provide services using telemedicine and telehealth.

The bill prohibits health benefits plans, Medicaid and NJ FamilyCare, and the SHBP and SEHBP from placing restrictions on the electronic or technological platform used to provide telemedicine and telehealth, if the services provided when using that platform would meet the in-person standard of care for that service, and if the platform is otherwise compliant with the requirements of certain federal health privacy rules.

“If a doctor can provide the same quality of services virtually that they can in person, there’s no reason for insurance plans to discriminate by lowering that doctor’s reimbursement,” said Downey (D-Freehold). “We’ve seen throughout this pandemic that many services can be provided equally well through virtual means, often at lower cost or greater convenience to all parties involved. This can be especially meaningful for seniors or patients with disabilities who face real challenges when finding transportation to a doctor’s office. It’s time to move past an outdated model that punishes innovation and technology, and create a new paradigm that rewards efficiency and accessibility.”


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