New York Laws
Article 44 - Health Maintenance Organizations
4406-G - Telehealth Delivery of Services.

§ 4406-g. Telehealth delivery of services. 1. A health maintenance
organization shall not exclude from coverage a service that is otherwise
covered under an enrollee contract of a health maintenance organization
because the service is delivered via telehealth, as that term is defined
in subdivision two of this section; provided, however, that a health
maintenance organization may exclude from coverage a service by a health
care provider where the provider is not otherwise covered under the
enrollee contract. A health maintenance organization may subject the
coverage of a service delivered via telehealth to co-payments,
coinsurance or deductibles provided that they are at least as favorable
to the enrollee as those established for the same service when not
delivered via telehealth. A health maintenance organization may subject
the coverage of a service delivered via telehealth to reasonable
utilization management and quality assurance requirements that are
consistent with those established for the same service when not
delivered via telehealth.

2. For purposes of this section, "telehealth" means the use of
electronic information and communication technologies by a health care
provider to deliver health care services to an enrollee while such
enrollee is located at a site that is different from the site where the
health care provider is located.

* 3. A health maintenance organization that provides comprehensive
coverage for hospital, medical or surgical care shall reimburse covered
services delivered via telehealth on the same basis, at the same rate,
and to the extent that such services are reimbursed when delivered in
person; provided that reimbursement of covered services delivered by
means of telehealth shall not require reimbursement of costs not
actually incurred in the provision of the telehealth services, including
charges related to the use of a clinic or other facility when neither
the originating site nor the distant site occur within the clinic or
other facility. The commissioner, in consultation with the
superintendent, may promulgate regulations to implement the provisions
of this section.

* NB Repealed April 1, 2024

* 4. A health maintenance organization that provides comprehensive
coverage for hospital, medical, or surgical care with a network of
health care providers shall ensure that such network is adequate to meet
the telehealth needs of insured individuals for services covered under
the policy when medically appropriate.

* NB Repealed April 1, 2024