Maine June 2019 Fact Sheet

Governor Janet Mills signed LD1263 into law, officially establishing telehealth parity by private payors after various efforts were vetoed in 2017.  The law, effective January 1, 2020, institutes significant changes for state telemedicine policy by private payors, with no changes to Medicaid.

The new law replaces the existing telemedicine law for service/coverage parity, removes any possible restrictions on location, and makes reference to reimbursement; however, the new law does not require reimbursement/payment parity.  Reimbursement will vary based on negotiated rates between insurers and providers.

Statutes

Service Parity
“Except as provided in this section, a carrier shall provide coverage for any medically necessary health care service delivered through telehealth as long as the following requirements are met…….The health care service is otherwise covered under an enrollee’s health plan”

  • Implements complete telemedicine service parity for medically appropriate services in compliance with Maine State law.

Parity is Limited to Coverage Only
“Coverage for health care services provided through telehealth must be determined in a manner consistent with coverage for health care services provided through in-person consultation. If an enrollee is eligible for coverage and the delivery of the health care service through telehealth is medically appropriate, a carrier may not deny coverage for telehealth services”

  • Equal reimbursement for telemedicine is not established, and rates are determined by providers.  Deductibles and Fees may still apply.

Site Origination
“Coverage for telehealth services is not limited in any way on the basis of geography, location or distance for travel.”

  • The new law also makes a clear statement concerning location that is applicable to originating sites.  The home is an accepted location based on the new language.

Expands Definition of “Telehealth”
“”Telehealth,” as it pertains to the delivery of health care services, means the use of interactive real-time visual and audio or other electronic media for the purpose of consultation and education concerning and diagnosis, treatment, care management and self-management of an enrollee’s physical and mental health and includes realtime interaction between the enrollee and the telehealth provider, synchronous encounters, asynchronous encounters, store and forward transfers and telemonitoring.”

  • Includes physical and mental health, allowing for telebehavioral treatment options and includes both synchronous and asynchronous encounters.

Additional Definitions for Telecommunications Services
Telephonic services,” as it pertains to the delivery of health care services, means the use of telephone communication by a provider at a distance for the purpose of diagnosis, disease monitoring or treatment.”

  • Telephone communication, while not included in the definition of telehealth, is listed separately, and therefore allowed under various circumstances.
    • As it is outside of the telehealth definition, reimbursement is not guaranteed, however, coverage is offered when “scheduled telehealth services are technologically unavailable”.

“”Telemonitoring,” as it pertains to the delivery of health care services, means the use of information technology to remotely monitor an enrollee’s health status via electronic means through the use of clinical data while the enrollee remains in a residential setting, allowing the provider to track the enrollee’s health data over time. Telemonitoring may or may not take place in real time.

  • Allows for remote patient monitoring, store-and-forward, and other asynchronous services