Montana § 33-22-138 - Coverage For Telehealth Services -- Rulemaking

§ 33-22-138. Coverage For Telehealth Services -- Rulemaking

Coverage for telehealth services -- rulemaking. (1) Each group or individual policy, certificate of disability insurance, subscriber contract, membership contract, or health care services agreement that provides coverage for health care services must provide coverage for health care services provided by a health care provider or health care facility by means of telehealth if the services are otherwise covered by the policy, certificate, contract, or agreement. (2) A policy, certificate, contract, or agreement may not: (a) impose restrictions involving: (i) the site at which the patient is physically located and receiving health care services by means of telehealth; or (ii) the site at which the health care provider is physically located and providing the services by means of telehealth; or (b) distinguish between telehealth services provided to patients in rural locations and telehealth services provided to patients in urban locations. (3) Coverage under this section must be equivalent to the coverage for services that are provided in person by a health care provider or health care facility. (4) Nothing in this section may be construed to require: (a) a health insurance issuer to provide coverage for services that are not medically necessary, subject to the terms and conditions of the insured's policy; (b) coverage of an otherwise noncovered benefit; (c) a health care provider to be physically present with a patient at the site where the patient is located unless the health care provider who is providing health care services by means of telehealth determines that the presence of a health care provider is necessary; or (d) except as provided in 16-12-509 or as provided in Title 37 and related administrative rules, a patient to have a previously established patient-provider relationship with a specific health care provider in order to receive health care services by means of telehealth. (5) Coverage under this section may be subject to deductibles, coinsurance, and copayment provisions. Deductibles, coinsurance, copayment, or other limitations that are imposed on the coverage for services provided by means of telehealth may not be more than deductibles, coinsurance, copayment, or other limitations that are applicable to other medical services covered under the plan. (6) This section does not apply to disability income, hospital indemnity, medicare supplement, specified disease, or long-term care policies. (7) The commissioner may adopt rules necessary to implement the provisions of this section. (8) For the purposes of this section, the following definitions apply: (a) "Health care facility" means a critical access hospital, hospice, hospital, long-term care facility, mental health center, outpatient center for primary care, or outpatient center for surgical services licensed pursuant to Title 50, chapter 5. (b) "Health care provider" means an individual: (i) licensed pursuant to Title 37, chapter 3, 4, 6, 7, 10, 11, 15, 17, 20, 22, 23, 24, 25, 26, or 35; (ii) licensed pursuant to Title 37, chapter 8, to practice as a registered professional nurse or as an advanced practice registered nurse; (iii) certified by the American board of genetic counseling as a genetic counselor; or (iv) certified by the national certification board for diabetes educators as a diabetes educator. (c) (i) "Telehealth" means the use of audio, video, or other telecommunications technology or media, including audio-only communication, that is: (A) used by a health care provider or health care facility to deliver health care services; and (B) delivered over a secure connection that complies with state and federal privacy laws. (ii) The term does not include delivery of health care services by means of facsimile machines or electronic messaging alone. The use of facsimile and electronic message is not precluded if used in conjunction with other audio, video, or telecommunications technology or media. (iii) For physicians providing written certification of a debilitating medical condition pursuant to 16-12-509 , the term does not include audio-only communication unless the physician has previously established a physician-patient relationship through an in-person encounter.