Ohio August 2019 Fact Sheet

This summer, Ohio passed its FY 2020-2021 Operating Budget, HB166 (see p. 225), with an inclusion calling for telemedicine service parity across the state.  The Operating Budget in its entirety is effective January 1, 2020; however, “Telemedicine Services” (R.C. 3902.30, 4723.94, and 4731.2910) is effective starting January 1, 2021, for private insurers.

Service Parity

“The bill requires a health benefit plan to provide coverage for telemedicine services on the same basis and to the same extent that the plan provides coverage for in-person health care services.”

  • Ohio’s newly revised code requires coverage for telemedicine services equal to in-person services and this applies to all health benefit plans issued, offered, or renewed on or after the effective date.
Payment Parity Distinction

“..the bill does not require a health plan issuer to reimburse a physician for any costs or fees associated with the provision of telemedicine services that would be in addition to or greater than the standard reimbursement for comparable in-person health care services.”

  • Insurance plans are not required to reimburse a provider for telemedicine at an equal rate to in-person services.  However, health benefit plans have the option to assess cost-sharing requirements for telemedicine services, as long as they do not exceed in-person rates.
Asynchronous Services

“Telemedicine service” is defined as a health care service provided through synchronous or asynchronous information and communication technology by a health care professional, within the professional’s scope of practice, who is located at a site other than the site where the recipient is located.”

  • The definition of “telehealth services” is expanded to include asynchronous services.  While not explicitly mentioned, this could be interpreted to include store and forward and remote patient monitoring.
Originating Site

“The bill prohibits a physician, physician’s assistant, or advanced practice registered nurse from charging a health plan issuer a facility fee, origination fee, or any fee associated with the cost of equipment used to provide telemedicine services with regard to a covered telemedicine service.”

  • Currently, Ohio doesn’t reimburse for originating or facility fees, which HB166 reinforces.

For more information on telemedicine legislation in Ohio, visit their Telemedicine & Telehealth Reimbursement Overview.