RÉSUMÉ DIGEST
ACT 336 (HB 41) 2023 Regular Session Frieman
New law requires a health coverage plan (plan) to cover occupational therapy services
provided via telehealth to an insured person. Requires payment for services provided via
telehealth to be equal to the payment for services provided in person, unless the telehealth
provider and plan contractually agree to an alternative payment rate. Provides that services
via telehealth may be subject to a deductible, copayment, or coinsurance not in excess of the
deductible, copayment, or coinsurance required by the plan for in-person services.
New law prohibits a plan from imposing an annual dollar maximum on coverage for
healthcare services provided as telehealth, other than an annual dollar maximum that applies
to the same services when provided in person by the same provider.
New law requires a plan to provide payment for telehealth services to healthcare
professionals licensed or otherwise permitted to practice occupational therapy in this state.
Further requires telehealth payments to be consistent with provider network arrangements
that have been established for the plan.
New law prohibits a plan from doing any of the following:
(1) Requiring 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) Requiring prior authorization, medical review, or administrative clearance for
telehealth that would not be required if that service were provided in person.
(3) Requiring demonstration that it is necessary to provide services to a patient or client
as telehealth.
(4) Requiring 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) Restricting or denying coverage based solely on the communication technology or
application used to provide the telehealth service. However, new law authorizes a
plan to restrict occupational therapy services via telehealth when the services are
provided solely by telephone.
(6) Imposing specific requirements or limitations on the technologies used to provide
telehealth services. However, new law authorizes a plan to require a provider to
demonstrate that the technology used to provide telehealth services is both safe and
secure.
(7) Imposing additional certification, location, or training requirements as a condition of
payment for telehealth services. However, new law does not prohibit a plan from
providing additional reimbursement incentives to providers with an enhanced
certification, training, or accreditation.
(8) Requiring a provider to be part of a telehealth network.
New law does not require a plan to cover telehealth services that are not medically necessary
nor to reimburse fees charged by a telehealth facility for transmission of a telehealth service.
New law does not require a plan 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. New law authorizes the Dept. of Insurance to take any action authorized in the La. Insurance
Code to enforce the provisions of new law and further authorizes the commissioner of
insurance, in accordance with the APA, to promulgate and adopt rules as necessary or
advisable to effectuate new law.
New law defines "health coverage plan" and "telehealth".
New law applies to any new health coverage plan issued on or after Jan. 1, 2024. Further
requires any plan in effect prior to Jan. 1, 2024, to conform to the provisions of new law on
or before the renewal date, but no later than Jan. 1, 2025.
New law makes technical changes.
Effective August 1, 2023.
(Amends the heading of Subpart B-2 of Part II of Chapter 6 of Title 22 of the La. Revised
Statutes of 1950 and R.S. 22:1845.1(Section heading); Adds R.S. 22:1845.2)