20-1057.13. Telemedicine; coverage of health care services; definitions

(L18, Ch. 174, sec. 2. Eff. until 1/1/21)

A. An evidence of coverage issued, delivered or renewed by a health care services organization on or after January 1, 2018 must provide coverage for health care services that are provided through telemedicine if the health care service would be covered were it provided through in-person consultation between the enrollee and a health care provider and provided to an enrollee receiving the service in this state. The evidence of coverage may limit the coverage to those health care providers who are members of the health care services organization's provider network.

B. This section does not prevent a health care services organization from imposing deductibles, copayment or coinsurance requirements for a health care service provided through telemedicine if the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to an in-person consultation for the same health care service.

C. Services provided through telemedicine or resulting from a telemedicine consultation shall comply with Arizona licensure requirements, accreditation standards and any practice guidelines of a national association of medical professionals promoting access to medical care for consumers via telecommunications technology or other qualified medical professional societies to ensure quality of care.

D. This section does not apply to limited benefit coverage as defined in section 20-1137.

E. For the purposes of this section:

1. " Health care services" means services provided for the following conditions or in the following settings:

(a) Trauma.

(b) Burn.

(c) Cardiology.

(d) Infectious diseases.

(e) Mental health disorders.

(f) Neurologic diseases including strokes.

(g) Dermatology.

(h) Pulmonology.

(i) Beginning January 1, 2020, urology.

(j) Beginning January 1, 2019, pain medicine.

(k) Beginning January 1, 2019, substance abuse.

2. " Telemedicine" :

(a) Means the interactive use of audio, video or other electronic media for the purpose of diagnosis, consultation or treatment.

(b) Does not include the sole use of an audio-only telephone, a video-only system, a facsimile machine, instant messages or electronic mail.