Mandated Home Health Benefits
Group health plans issued or renewed on or after January 1, 2017 are mandated to provide coverage for home health benefits for persons seeking palliative care in conjunction with treatment or management of a serious or life-threatening illness.
Under S.B. 5165, persons seeking such palliative care services need not be home bound in order to be eligible for insurance coverage.
Mandated Coverage for Health Care Performed by Pharmacists
Group health plans issued or renewed on or after January 1, 2017 may not deny any health care service performed by a pharmacist as long as:
The service is within the pharmacist’s scope of practice;
The plan would have provided benefits if the service had been performed by a physician, advanced registered nurse practitioner, or physician assistant; and
The pharmacist is included in the plan’s network of participating providers.
Mandated Telemedicine Benefits
Group health plans issued or renewed on or after January 1, 2017 are mandated to provide coverage for telemedicine as well as “store and forward technology”.
“Store and forward technology” means use of an asynchronous transmission of a covered person’s medical information from an originating site to the health care provider at a distant site which results in medical diagnosis and management of the covered person.
Under S.B. 5175, 2017 group health care plans must reimburse health care providers for health care services provided through telemedicine or store and forward technology as long as:
The plan provides coverage of the health care service when provided in person by the provider;
The health care service is medically necessary; and
The health care service is a service recognized as an essential health benefit under the federal Patient Protection and Affordable Care Act.