An Act To Make Permanent the Telehealth Reimbursement Options Passed by Emergency Measures
Maine Legislature, Session 130, LD 0849
Committee: Health Coverage, Insurance and Financial Services
Sponsors: MATHIESON, BROOKS, GRAMLICH, SACHS, BRENNER
Amends: 22 MRSA §3173-H, 24 MRSA §2904, 24-A MRSA §4316

Legislative Document
No. 849
H.P. 617
House of Representatives, March 8, 2021
An Act To Make Permanent the Telehealth Reimbursement Options 
Passed by Emergency Measures
Reference to the Committee on Health Coverage, Insurance and Financial Services 
suggested and ordered printed.
ROBERT B. HUNT
Clerk
Presented by Representative MATHIESON of Kittery.
Cosponsored by Representatives: BROOKS of Lewiston, GRAMLICH of Old Orchard Beach, 
SACHS of Freeport, Senator: BRENNER of Cumberland.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA §3173-H, sub-§1, ¶D, as amended by PL 2019, c. 649, §1, is 
further amended to read:
D.  "Telehealth," as it pertains to the delivery of MaineCare services, means the use of 
interactive visual and audio or other electronic media for the purpose of consultation 
and education concerning and diagnosis, treatment, care management and self-
management of a patient's physical and mental health and includes real-time interaction 
between the patient and the patient's provider, electronic consultation between health 
professionals regarding the patient, synchronous encounters, asynchronous encounters, 
store and forward transfers and remote patient monitoring.  "Telehealth" includes 
telephonic services when interactive telehealth services are unavailable or when a 
telephonic service is medically appropriate for the underlying covered service.
Sec. 2.  22 MRSA §3173-H, sub-§5, ¶D, as amended by PL 2019, c. 649, §1, is 
further amended to read:
D.  Must include requirements for providers providing telehealth and telemonitoring 
services; and
Sec. 3.  22 MRSA §3173-H, sub-§5, ¶E, as enacted by PL 2019, c. 649, §1, is 
amended to read:
E.  Must allow at least some portion of case management services covered by the 
MaineCare program to be delivered through telehealth, without requiring qualifying 
criteria regarding a patient's risk of hospitalization or admission to an emergency 
room.; and
Sec. 4.  22 MRSA §3173-H, sub-§5, ¶F is enacted to read:
F.  Must provide for reimbursement to providers providing telehealth and 
telemonitoring services at the same reimbursement rate as comparable services 
provided through in-person consultation.
Sec. 5.  24 MRSA §2904, sub-§1, ¶A, as amended by PL 2019, c. 289, §1, is further 
amended to read:
A.  A licensed health care practitioner who voluntarily, without the expectation or 
receipt of monetary or other compensation either directly or indirectly, provides 
professional services, including services provided through telehealth as defined in Title 
24‑A, section 4316, subsection 1, paragraph E C, within the scope of that health care 
practitioner's licensure:
(1)  To a nonprofit organization;
(2)  To an agency of the State or any political subdivision of the State;
(3)  To members or recipients of services of a nonprofit organization or state or 
local agency;
(4)  To support the State's response to a public health threat as defined in Title 22, 
section 801, subsection 10;
(5)  To support the State's response to an extreme public health emergency as 
defined in Title 22, section 801, subsection 4‑A; or
(6)  To support the State's response to a disaster as defined in Title 37‑B, section 
703, subsection 2;
Sec. 6.  24-A MRSA §4316, sub-§1, ¶C, as enacted by PL 2019, c. 289, §2, is 
amended to read:
C.  "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 real-time 
interaction between the enrollee and the telehealth provider, synchronous encounters, 
asynchronous encounters, store and forward transfers, the use of audio-only telephone 
and telemonitoring.  "Telehealth" does not include the use of audio-only telephone, 
facsimile machine, e-mail or texting.
Sec. 7.  24-A MRSA §4316, sub-§1, ¶E, as enacted by PL 2019, c. 289, §2, is 
repealed.
Sec. 8.  24-A MRSA §4316, sub-§2, as corrected by RR 2019, c. 2, Pt. A, §28, is 
amended to read:
2.  Parity for telehealth services.  A carrier offering a health plan in this State may 
not deny coverage on the basis that the health care service is provided through telehealth if 
the health care service would be covered if it were provided through in-person consultation 
between an enrollee and a provider.  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.  A carrier shall reimburse a provider for the 
diagnosis, consultation with or treatment of an enrollee delivered through telehealth 
services on the same basis and at least at the rate of reimbursement at which the carrier 
reimburses a provider for the provision of the same, or substantially similar, service 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.  A carrier may not offer a health plan under which any deductible 
applied to health care services delivered through telehealth accumulates separately from 
the deductible that applies in the aggregate to all services covered under the health plan. A 
carrier may offer a health plan containing a provision for a deductible, copayment or 
coinsurance requirement for a health care service provided through telehealth as long as 
the deductible, copayment or coinsurance does not exceed the deductible, copayment or 
coinsurance applicable to a comparable service provided through in-person consultation.  
A carrier may not exclude a health care service from coverage solely because such health 
care service is provided only through a telehealth encounter, as long as telehealth is 
appropriate for the provision of such health care service.
Sec. 9.  24-A MRSA §4316, sub-§5, as enacted by PL 2019, c. 289, §2, is repealed.
Sec. 10.  Application.  The requirements of this Act apply to health plans, as defined 
in the Maine Revised Statutes, Title 24-A, section 4301-A, subsection 7, executed, 
delivered, issued for delivery, continued or renewed in this State on or after January 1, 
2022.  For the purposes of this Act, all health plan contracts are deemed to be renewed no 
later than the next yearly anniversary of the contract date.
SUMMARY
This bill makes permanent the authorization for the delivery of health care services 
through telehealth by telephone that was provided through executive order during the 
declared public health emergency related to COVID-19.
Under current law, health insurance carriers are required to reimburse for services 
delivered through telehealth at parity with the reimbursement that would be provided if the 
services were delivered through an in-person consultation, but the use of audio-only 
telephone to deliver those services is not permitted. This bill removes that prohibition. The 
bill also clarifies that reimbursement for telehealth services must be made on the same basis 
and at the same rate as if the services were delivered in person and that a carrier may not 
establish separate deductible limits for telehealth services that are not applied in the 
aggregate with other services covered under a health plan.
Under current law, telehealth services reimbursed under the MaineCare program for 
the delivery of service using the telephone are limited to when interactive telehealth 
services are unavailable or when a telephonic service is medically appropriate for the 
underlying covered service. This bill removes that limitation and also clarifies that services 
provided through telehealth must be reimbursed at the same rate as comparable services 
provided through an in-person consultation.
The requirements in the bill apply to health plans issued or renewed on or after January 
1, 2022.