Declaring “liberty and independence” from the constraints of brick and mortar health care, Delaware became the 29th state to enact a telemedicine commercial reimbursement statute. The legislation (HB-69) was sponsored by Representatives Short, Hall-Long, Barbieri, Briggs King, and Senators Ennis, Henry, Lopez and Townsend. It was signed into law by Delaware Gov. Jack Markell on July 7, 2015. The Legislation unanimously passed both the House and Senate, reflecting strong bi-partisan support for telehealth in Delaware. Indeed, the bill summary itself embraces virtual care services, stating “Delaware is well-positioned to embrace efforts that will encourage health insurers and health care providers to support the use of telemedicine and that will also encourage all state agencies to evaluate and amend their policies and rules to foster and promote telemedicine services.”

The law requires commercial insurers to cover services provided via telemedicine and telehealth to the same extent those services are covered through in-person visits. The law also protects patients against cost-shifting by requiring telehealth coverage must be subject to the same terms and conditions applicable to all other benefits under the patient’s insurance policy (e.g., deductibles, co-insurance, or other conditions for coverage).

The language of the Act states it takes effect immediately, and applies to all insurance policies, contracts, and plans delivered, issued for delivery, reissued, or extended on and after enactment of the Act or at any time when any term of the policy, contract, or plan is changed or any premium adjustment is made. As a practical matter, it may take health plans a bit of time to make the changes required by the Act, and Delaware might enact regulations underpinning the statutory changes.

The Act amends numerous provisions in Title 18 (insurance code) of the Delaware Code to account for changes to telemedicine and telehealth insurance coverage. The Delaware telemedicine law includes separate, but complementary, definitions for telehealth and telemedicine.

• Telehealth is defined as “the use of information and communications technologies consisting of telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.”

• Telemedicine is defined as “a form of telehealth which is the delivery of clinical health care services by means of real time two-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management and self-management of a patient’s health care by a health care provider practicing within his or her scope of practice as would be practiced in-person with a patient, and legally allowed to practice in the state, while such patient is at an originating site and the health care provider is at a distant site.”

Delaware Commercial Insurance Telehealth Requirements

The changes to Delaware’s Insurance Code (Title 18, Chapter 33, Section 3370) are more provider and patient-friendly than some other states because it mandates both coverage parity and payment parity. The law not only requires health plans to cover telehealth and telemedicine services for members, but health plans must pay the provider “on the same basis and at least at the rate” the plan is required to pay for the same service if provided in-person. Moreover, the payment for telemedicine interactions must include reasonable compensation to the originating or distant site for the transmission cost incurred during the delivery of health care services.

Other highlights of the Delaware telehealth commercial insurance law include:

• A health plan may not exclude coverage for a service solely because the service is provided through telemedicine and is not provided through in-person consultation or contact between a health care provider and a patient for services appropriately provided through telemedicine services. This requirement helps ensure Delaware health plan members enjoy benefits of the full scope of telehealth services, including remote patient monitoring and connected care technologies. Some services, such as remote monitoring, do not naturally lend themselves to in-person encounters, but are telehealth services nonetheless. The recently enacted Connecticut law includes a similar provision.

• Any deductibles, copayments or coinsurance for telemedicine services may not exceed the deductible, copayment, or coinsurance applicable if the same services were provided through in-person diagnosis, consultation, or treatment.

• Health plans may not impose any maximum or cap on coverage for telemedicine services that is not equally imposed upon all terms and services covered under the member’s policy.

• The Delaware coverage law does not apply to short-term travel, accident-only, limited or specified disease, or individual conversion policies or contracts, nor does it apply to health plan coverage under Medicare, Medicaid, or other state or federal programs.

Nationwide, state legislatures continue to enact laws requiring commercial health insurance companies to cover medical services provided via telemedicine to the same extent they cover medical services provided in-person. With Delaware’s bill signed into law, 29 states plus the District of Columbia have enacted these telemedicine commercial insurance laws. 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.

A number of Delaware hospitals and health care providers already offer telehealth services, and patients have been able to access virtual care as part of these health care delivery models. Surveys also indicate health care executives are optimistic on the benefits offered by telehealth. The new law is expected to drive the Delaware commercial insurance market, allowing telehealth benefits to be enjoyed by more patients across the State.