Telehealth Coverage and Payment Parity Act

To amend the Public Health Service Act to require group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for services furnished via telehealth if such services would be covered if furnished in-person, and for other purposes. 1. Short title This Act may be cited as the Telehealth Coverage and Payment Parity Act 2. Requiring group health plans and health insurance issuers offering group or individual health insurance coverage to provide coverage for services furnished via telehealth if such services would be covered if furnished in-person (a) Public health service act Subpart II of part A of title XXVII of the Public Health Service Act ( 42 U.S.C. 300gg–11 et seq. 2730. Required coverage of telehealth services (a) In general A group health plan and a health insurance issuer offering group or individual health insurance coverage, including a grandfathered health plan (as defined in section 1251(e) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18011(e) (1) shall— (A) provide benefits under such plan or such coverage for any eligible service (as defined in subsection (b)), including a mental health and substance use disorder service, furnished via a qualifying telecommunications system (as defined in subsection (b)) by a health care provider to an individual who is a participant, beneficiary, or enrollee under such plan or such coverage, notwithstanding that such provider furnishing such service is not at the same location as the individual; (B) so provide such benefits for such service under the same terms and with application of the same cost-sharing requirements (including a deductible, copayment, or coinsurance) as would apply if such service were furnished by such provider to such individual in-person; (C) reimburse such provider for such service in an amount equal to the amount of reimbursement for such service had such service been furnished by such provider to such individual in-person; (D) not impose any requirement under such plan or coverage that such provider have a prior relationship with such individual; and (E) not restrict the ability of any health care provider with a contractual relationship for furnishing an eligible service under such plan or coverage from furnishing such service via a qualifying telecommunications system, and shall not establish incentives or penalties under such plan or coverage for receiving such an eligible service from such a provider via such a system; and (2) may waive any cost-sharing requirement (including application of a deductible, copayment, or coinsurance) for an item or service furnished for purposes of diagnosing or treating COVID–19, including any such service that is an eligible service furnished via a qualifying telecommunications system. (b) Definitions In this section: (1) Eligible service The term eligible service (A) for which benefits are provided under such plan or such coverage when such service is furnished in-person; (B) that is medically necessary (as determined by the health care provider furnishing such service); and (C) that is able to be safely and effectively furnished via a telecommunications system. (2) Qualifying telecommunications system The term qualifying telecommunications system . (b) Application The amendment made by subsection (a) shall apply with respect to plan years beginning on or after January 1, 2022.

Summary: Telehealth Coverage and Payment Parity Act This bill requires private health insurance plans to cover certain services provided via telecommunications systems (i.e., telehealth). Specifically, the telehealth services must be deemed medically necessary by a health care provider and covered under the plan if provided in person. Plans must apply the same cost-sharing and reimbursement amounts that would otherwise apply to such services and may waive cost-sharing requirements for any services to diagnose or treat COVID-19, including via telehealth.