(1) “Health benefits plan” shall have the same meaning as provided in § 31-3131(4).
(2) “Health insurer” shall have the same meaning as provided in § 31-3131(5).
(2A) "Postpartum" means the time after delivery when maternal physiological changes related to pregnancy return to the nonpregnant state, which may last for as long as 12 months after delivery.
(3) “Provider” shall have the same meaning as provided in § 31-3131(7).
(4) “Telehealth” means the delivery of healthcare services through the use of interactive audio, video, or other electronic media used for the purpose of diagnosis, consultation, or treatment; provided, that services delivered through email messages or facsimile transmissions are not included.
§ 31–3862. Private reimbursement.
(a) A health insurer offering a health benefits plan in the District may not deny coverage for a healthcare service on the basis that the service is provided through telehealth if the same service would be covered when delivered in person.
(b) A health insurer shall reimburse the provider for the diagnosis, consultation, or treatment of the insured when the service is delivered through telehealth.
(c) A health insurer shall not be required to:
(1) Reimburse a provider for healthcare service delivered through telehealth that is not a covered under the health benefits plan; and
(2) Reimburse a provider who is not a covered provider under the health benefits plan.
(d) A health insurer may require a deductible, copayment, or coinsurance amount for a healthcare service delivered through teleheath; provided, that the deductible, copayment, or coinsurance amount may not exceed the amount applicable to the same service when it is delivered in person.
(e) A health insurer shall not impose any annual or lifetime dollar maximum on coverage for telehealth services other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services under the health benefits plan.
(f) Nothing in this chapter shall preclude the health insurer from undertaking utilization review to determine the appropriateness of telehealth as a means of delivering a healthcare service; provided, that the determinations shall be made in the same manner as those regarding the same service when it is delivered in person.
§ 31–3862.01. Postpartum maternal health services.
Health insurance coverage through Medicaid or the D.C. Healthcare Alliance program shall cover and reimburse health care services and expenses for:
(1) Home visits via telehealth, face-to-face interaction, or digital health for a pregnant woman; and
(2) Provider delivered digital health interventions that are used to directly manage a patient's pregnancy.
§ 31–3863. Medicaid reimbursement.
Medicaid shall cover and reimburse for healthcare services appropriately delivered through telehealth if the same services would be covered when delivered in person.
§ 31–3864. Remote patient monitoring service providers; payment. [Repealed]
Repealed.
§ 31–3865. Right to synchronous interaction. [Repealed]
