Bulletin No. B-4.89 Telehealth and Cellular Telephones I.

Background and Purpose

The purpose of this bulletin is to provide carriers and consumers with information on the methods by which telehealth may be delivered. Bulletins are the Division of Insurance’s (Division) interpretations of existing insurance law or general statements of Division policy. Bulletins themselves establish neither binding norms nor finally determine issues or rights. II.

Applicability and Scope

This bulletin is intended for carriers who issue individual and group health benefit plans as defined in § 10-16-102(32), C.R.S., in the state of Colorado and consumers who purchase those plans. III.

Division Position

The Colorado General Assembly revised the statutes for telehealth and telemedicine, found at § 10-16123, C.R.S., through the passage of HB15-1029 during the 2015 legislative session. The statutory changes concerning telehealth contained in HB15-1029 are set to take effect on January 1, 2017, and will be reflected in health benefit plans issued or renewed on or after that date. A. Telehealth and Audio-Visual Communication It has come to the Division’s attention that the phrasing contained in § 10-16-123(4)(e), C.R.S., may be interpreted to limit the practice of telehealth in certain situations. The language contained in the definition of “telehealth” in § 10-16-123(4)(e), C.R.S., and more specifically the exclusion of “health care services via telephone” found in subparagraph (II), could be read to potentially limit the ability of a covered person to utilize a HIPAA-compliant application or audio-visual communication to obtain telehealth services from a provider. The definition of “telehealth” found at § 10-16-123(4)(e), C.R.S. is as follows: (I) "Telehealth" means a mode of delivery of health care services through telecommunications systems, including information, electronic, and communication technologies, to facilitate the assessment, diagnosis, consultation, treatment, education, care management, or self-management of a covered person's health care while the covered person is located at an originating site and the provider is located at a distant site. The term includes synchronous interactions and store-andforward transfers. (II) "Telehealth" does not include the delivery of health care services via telephone, facsimile machine, or electronic mail systems. The Division would like to clarify that the provision of health care services between a covered person and provider through audio-visual communication, or the use of a HIPAA-compliant application, via a

cellular telephone would constitute the provision of telehealth. However, voice-only communication or texting with a health care provider via a cellular telephone would not constitute the provision of telehealth, as neither method involves both audio and visual interaction between the patient and provider, consistent with the requirements of § 10-16-123(4)(e)(II), C.R.S. B. Telehealth and Network Adequacy It should be noted that the provisions found at § 10-16-704(1)(a), C.R.S., and revised by HB15-1029 (effective January 1, 2017), do allow a carrier to utilize providers accessed through telehealth, for services that may be appropriately provided through telehealth, in determining and ensuring the sufficiency of its networks when calculating provider-to-covered person ratios by specialty. Further, consistent with HB15-1029 and revised § 10-16-123(2)(a), C.R.S. (effective January 1, 2017), nothing requires the use of telehealth when a provider determines that telehealth is not the appropriate delivery mechanism for care, and nothing requires a covered person to use telehealth if they choose not to receive care through telehealth. IV.

Additional Division Resources

A.

For More Information Colorado Division of Insurance Consumer Services, Life and Health Section 1560 Broadway, Suite 850 Denver, CO 80202 Tel. 303-894-7490 Toll-free (in state): 800-930-3745 Internet: http://www.dora.colorado.gov/insurance

B.

Related Division Regulations Colorado Insurance Regulation 4-2-42

V.

History •

Issued March 31, 2016