Health coverage plans must cover and pay for covered occupational therapy provided via telehealth, with limits on cost-sharing and some plan restrictions.
§1845.2. Telehealth coverage and reimbursement for occupational therapy; prohibitions and limitations; exceptions; rulemaking A. A health coverage plan shall pay for covered occupational therapy services provided via telehealth to an insured person. Telehealth coverage and payment shall be equivalent to the coverage and payment for the same service provided in person unless the telehealth provider and the health coverage plan contractually agree to an alternative payment rate for telehealth services. B. Benefits for a service provided as telehealth may be subject to a deductible, copayment, or coinsurance. A deductible, copayment, or coinsurance applicable to a particular service provided through telecommunications technology shall not exceed the deductible, copayment, or coinsurance required by the health coverage plan for the same service when provided in person. C. A health coverage plan shall not impose an annual dollar maximum on coverage for healthcare services covered under the health coverage plan that are provided as telehealth, other than an annual dollar maximum that applies to the same services when provided in person by the same provider. D. A health coverage plan shall require a healthcare professional to be licensed or otherwise authorized to practice occupational therapy in this state to be eligible to receive payment for telehealth services. E. Payment made pursuant to this Section shall be consistent with any provider network arrangements that have been established for the health coverage plan. F. A health coverage plan shall not do any of the following: (1) Require a previously established in-person relationship or the provider to be physically present with a patient or client, unless the provider determines that it is necessary to perform that service in person. (2) Require prior authorization, medical review, or administrative clearance for telehealth that would not be required if that service were provided in person. (3) Require demonstration that it is necessary to provide services to a patient or client as telehealth. (4) Require a provider to be employed by another provider or agency in order to provide telehealth services that would not be required if that service were provided in person. (5) Restrict or deny coverage based solely on the communication technology or application used to provide the telehealth service; however, a health coverage plan may restrict occupational therapy services via telehealth when the services are being provided solely by telephone. (6) Impose specific requirements or limitations on the technologies used to provide telehealth services; however, a health coverage plan may require the provider to demonstrate that the technology used to provide telehealth services is both safe and secure. (7) Impose additional certification, location, or training requirements as a condition of payment for telehealth services; however, this Paragraph does not prohibit a health coverage plan from providing additional reimbursement incentives to providers with an enhanced certification, training, or accreditation. (8) Require a provider to be part of a telehealth network. G. Nothing in this Section shall be construed to require a health coverage plan to do either of the following: (1) Provide coverage for telehealth services that are not medically necessary. (2) Reimburse any fees charged by a telehealth facility for transmission of a telehealth encounter. H. A health coverage plan is not required to provide coverage or reimbursement for any of the following procedures or services provided via telehealth: (1) A modality that is a type of electrical, thermal, or mechanical energy. (2) Manual therapy, massage, dry needling, or other invasive procedures. I. The department may take any action authorized in this Title to enforce the provisions of this Section and the commissioner may, in compliance with the Administrative Procedure Act, R.S. 49:950 et seq., promulgate and adopt rules as are necessary or advisable to effectuate the provisions of this Section. J. For purposes of this Section, the following definitions apply: (1) "Health coverage plan" has the same meaning as provided for in R.S. 22:1841. (2) "Telehealth" has the same meaning as provided for in R.S. 40:1223.3. Acts 2023, No. 336, §1.