New Mexico § 13-7-14 - Coverage for telemedicine services

§ 13-7-14. Coverage for telemedicine services

A. Group health coverage, including any form of self-insurance, offered, issued or

renewed under the Health Care Purchasing Act shall provide coverage for services provided

via telemedicine to the same extent that the group health plan covers the same services

when those services are provided via in-person consultation or contact. A group health plan shall not impose any unique condition for coverage of services

provided via telemedicine. B. A group health plan shall not impose an originating-site restriction with respect

to telemedicine services or distinguish between telemedicine services provided to

patients in rural locations and those provided to patients in urban locations; provided

that the provisions of this section shall not be construed to require coverage of

an otherwise noncovered benefit. C. A determination by a group health plan that health care services delivered through

the use of telemedicine are not covered under the plan shall be subject to review

and appeal pursuant to the Patient Protection Act. D. The provisions of this section shall not apply in the event that federal law requires

the state to make payments on behalf of enrollees to cover the costs of implementing

this section. E. Nothing in this section shall require a health care provider to be physically present

with a patient at the originating site unless the consulting telemedicine provider

deems it necessary. F. A group health plan shall not limit coverage of services delivered via telemedicine

only to those health care providers who are members of the group health plan provider

network where no in-network provider is available and accessible, as availability

and accessibility are defined in network adequacy standards issued by the superintendent

of insurance. G. A group health plan may charge a deductible, copayment or coinsurance for a health

care service delivered via telemedicine if it does not exceed the deductible, copayment

or coinsurance applicable to a service delivered via in-person consultation or contact. H. A group health plan shall not impose any annual or lifetime dollar maximum on coverage

for services delivered via telemedicine, other than an annual or lifetime dollar maximum

that applies in the aggregate to all items and services covered under the group health

plan, or impose upon any person receiving benefits pursuant to this section any copayment,

coinsurance or deductible amounts, or any plan year, calendar year, lifetime or other

durational benefit limitation or maximum for benefits or services, that is not equally

imposed upon all terms and services covered under the group health plan. I. A group health plan shall reimburse for health care services delivered via telemedicine

on the same basis and at least the same rate that the group health plan reimburses

for comparable services delivered via in-person consultation or contact. J. Telemedicine used to provide clinical services shall be encrypted and shall conform

to state and federal privacy laws. K. The provisions of this section shall not apply to group health coverage intended

to supplement major medical group-type coverage, such as medicare supplement, long-term

care, disability income, specified disease, accident-only, hospital indemnity or any

other limited-benefit health insurance policy. L. As used in this section: (1) “ consulting telemedicine provider ” means a health care provider that delivers telemedicine services from a location

remote from an originating site; (2) “ health care provider ” means a duly licensed hospital or other licensed facility, physician or other health

care professional authorized to furnish health care services within the scope of the

professional's license; (3) “ in real time ” means occurring simultaneously, instantaneously or within seconds of an event so

that there is little or no noticeable delay between two or more events; (4) “ originating site ” means a place at which a patient is physically located and receiving health care

services via telemedicine; (5) “ store-and-forward technology ” means electronic information, imaging and communication, including interactive audio,

video and data communications, that is transferred or recorded or otherwise stored

for asynchronous use; and (6) “ telemedicine ” means the use of telecommunications and information technology to provide clinical

health care at a site distinct from the patient. “Telemedicine” allows health care professionals to evaluate, diagnose and treat

patients in remote locations using telecommunications and information technology in

real time or asynchronously, including the use of interactive simultaneous audio and

video or store-and-forward technology, or remote patient monitoring and telecommunications

in order to deliver health care services to a site where the patient is located, along

with the use of electronic media and health information. “Telemedicine” allows patients in remote locations to access medical expertise without

travel.