New Jersey Insurers Required to Continue Covering Telehealth

06/24/20 | News

We have received many questions from constituents concerned that their insurance coverage for telehealth or telemedicine will be ending on or about June 30th, or on another date later this summer. After receiving information from the New Jersey Association of Health Plans (NJAHP), which represents Aetna, AmeriGroup, AmeriHealth, Cigna, Horizon Blue Cross Blue Shield of New Jersey, Oscar, UnitedHealthcare, and WellCare, we can share the following information:

Will my telehealth or telemedicine coverage end on June 30?
Currently, New Jersey-based carriers are providing coverage for telehealth services and will continue to do so under New Jersey law. Carriers do not currently have plans to terminate coverage for telehealth, and coverage till not terminate after the expiration of either the Declared State of Emergency or the Public Health Emergency related to COVID-19.

Why have I heard that coverage was due to end on June 30?
Some insurance companies used the date of June 30 as a placeholder in case the State of Emergency and Public Health Emergency was allowed to expire. Regardless of the date that these insurance companies set, they are required to cover specific extensions to telehealth and telemedicine coverage so long as the State of Emergency and Public Health Emergency are in effect. Even after the State of Emergency and Public Health Emergency end, all insurance carriers will be required to provide coverage for telehealth and telemedicine, though the specific expansions and special accommodations required by the State of Emergency may no longer may in effect.

On March 22, the state of New Jersey directed state-based carriers to take the following actions:

  • Review their telemedicine and telehealth networks to ensure adequacy, given the apparent increased demand, as well as grant any requested in-plan exceptions for individuals to access out-of-network telehealth providers if network telehealth providers are not available, including, but not limited to, mental health and behavioral health  providers, physical therapists, occupational therapists, and speech therapists, and any other health providers capable and authorized to provide telehealth or telemedicine services pursuant to State law or other State-issued guidance.
  • Cover, without cost-sharing any healthcare services or supplies delivered or obtained via telemedicine or telehealth.
  •  Encourage providers to utilize telemedicine or telehealth services to minimize exposure of provider staff and other patients to those who may have the COVID-19 virus.
  • Ensure that the rates of payment to in-network providers for services delivered via telemedicine or telehealth are not lower than the rates of payment established by the carrier for services delivered via traditional (i.e., in-person) methods.
  • Notify providers of any instructions that are necessary to facilitate billing for telehealth services.
  • Allow for telephonic telehealth services and flexibility in the specific technology used to deliver the services.
  • Eliminate (may not impose) prior authorization requirements on medically necessary treatment that is delivered via telemedicine or telehealth.
  • Disseminate information on their website, or other reasonable means, to notify individuals of these updates.

When will these additional requirements expire?
Unless a carrier voluntarily chooses otherwise, these additional telehealth requirements will currently expire at the end of the COVID-19 State of Emergency and Public Health Emergency. This State of Emergency is renewed by the Governor on a monthly basis, and currently is next up for renewal in July. We have received no indication from the Governor that the State of Emergency will not be renewed for at least another 30 days.

The State Legislature has recently introduced a bill (S2467) that, if passed into law, would keep these additional requirements in place for an additional 90 days after the current State of Emergency expires. The bill was passed unanimously by the Senate on June 15, and is now waiting for review by the Assembly. Once passed by the full Legislature, it will move to the Governor’s desk for approval.

Our office has also introduced additional legislation (A4179) that would permanently require all health insurance plans to provide the same reimbursement to medical providers for telehealth or telemedicine services as they would receive for providing the same services in person. You can click here to learn more about this legislation, which is awaiting committee approval in the Assembly and Senate.