To improve the accessibility and affordability of health care delivered remotely, a measure sponsored by Assembly Democrats Joann Downey, Herb Conaway, Daniel Benson, Eric Houghtaling and Robert Karabinchak to provide expanded coverage for telemedicine and telehealth services was signed into law Tuesday.
Specifically, the law (formerly bill A-4179/4200/S-2559) will require carriers offering health benefit plans in New Jersey, the State Medicaid and NJ FamilyCare programs, the State Health Benefits Program and the School Employees’ Health Benefits Program to reimburse providers for all forms of health care services delivered via telehealth or telemedicine at a provider reimbursement rate that does not exceed the rate for equivalent in-person care, so long as the services are otherwise covered under the plan when delivered in-person.
“If a doctor can provide the same quality of services virtually that they can in person, there’s no reason for insurance plans to discriminate by lowering that doctor’s reimbursement,” said Assemblywoman Downey (D-Monmouth). “We’ve seen throughout the COVID-19 pandemic that many services can be provided equally well through virtual means, often at lower cost and greater convenience to all parties involved.”
Current law provides that telemedicine and telehealth services may be reimbursed up to the amount at which in-person service is reimbursed. This new law will ensure the reimbursement rate does not exceed the rate for in-person services in most circumstances.
“Our COVID-responsive expansions of telehealth and telemedicine were significant in spurring the implementation of remote care technologies,” said Assemblyman Conaway (D-Burlington). “Ensuring we can take advantage of this proliferation beyond the pandemic will be critical to providing better, well-rounded care.”
The law will also prohibit health plans from limiting where care can originate from when provided via telehealth/telemedicine, or limiting where the patient is located when receiving these services. It will also prevent carriers from restricting the use of electronic or technological platforms if services meet the in-person standard of care and comply with certain federal health privacy rules.
“The challenge to successful delivery of virtual care has always been its expense,” said Assemblyman Houghtaling (D-Monmouth). “Equalizing reimbursement rates as this law does allows more equitable costs to be passed on to patients making remote consultation a more cost-effective option.”
Patients will still be allowed to request an in-person meeting with their provider, if preferred, and will be clearly notified of their provider’s credentials if receiving telehealth or telemedicine services.
“This law paves the way for New Jersey to innovate and better address the broad spectrum of healthcare needs that exist,” said Assemblyman Benson (D-Mercer, Middlesex).
The law appropriates $5 million to the Department of Human Services for the purpose of reimbursing health care providers for providing patients enrolled in the State Medicaid program access to the devices, programs and technology they need to receive the telehealth or telemedicine services offered by the provider.
“Expanding access to different modes of care is critical to raising the quality of care provided in New Jersey,” said Assemblyman Karabinchak (D-Middlesex). “That is particularly true when it comes to underserved and aging communities, who may be especially challenged by the need to travel for an in-person doctor’s appointment.”