March 17, 2020
DEPARTMENT OF FINANCIAL SERVICES ADOPTS NEW EMERGENCY REGULATION REQUIRING INSURANCE COMPANIES TO WAIVE COST-SHARING FOR IN-NETWORK TELEHEALTH VISITS
New Regulatory Actions State New Yorkers Do Not Have to Pay Copayments, Coinsurance, or Annual Deductibles for In-Network Telehealth Services
State Health Agencies Issue Guidance to Providers Following DFS Emergency Regulation for Consistent Regulatory Requirements for Telehealth Services to Ensure That There Are No Regulatory Barriers to Telehealth Visits
The Department of Financial Services (DFS) today announced it has adopted a new emergency regulation under New York Insurance Law requiring New York State insurance companies to waive cost-sharing, including, deductibles, copayments (copays), or coinsurance for in-network telehealth visits. Telehealth is the use of electronic information and communication technologies by a health care provider to deliver health care services to an insured while an insured is located at a site that is different from the site where the health care provider is located.
Following DFS’ regulatory action, state health agencies released respective guidance letters for consistent regulatory requirements for telehealth services to ensure that there are no regulatory barriers to telehealth visits for the insured and providers.
The new adopted emergency regulation follows Governor Cuomo’s announcement on Saturday, March 14th, 2020 that DFS will require insurance companies to waive co-pays for telehealth visits, whether or not related to coronavirus (COVID-19). This new regulatory action helps to encourage New Yorkers to seek medical attention from their homes rather than visit a hospital or doctor's office for health care services that may be unrelated to COVID-19 — ultimately reducing strain on the healthcare system and preventing further spread of COVID-19 or any other virus.
Superintendent of Financial Services Linda A. Lacewell said, “Today’s adopted regulation instructs insurance companies to provide telehealth services at zero cost for New York consumers. This not only applies for COVID-19, it applies for any other covered health care services including mental health and substance use disorder treatment needed by the consumer, ensuring access to quality, affordable care right in their own home.”
New York State Department of Health Commissioner Dr. Howard Zucker said, “With the COVID-19 pandemic spreading throughout our state, a simple act like going to a doctor’s office, may inadvertently expose you or others to the virus. Governor Cuomo’s latest expansion of telemedicine in New York State, requiring health insurance companies to waive cost sharing for in-network telehealth visits, will help us better address this rapidly evolving public health emergency and improve access to health care.”
OMH Commissioner Dr. Ann Sullivan said, “The measures taken by New York State are helping to ensure that our residents are able to receive the healthcare services they need even if they are unable to get to their doctors office or don’t want to risk exposure to the COVID-19 virus. Last week, OMH announced we are waiving certain telehealth regulations for the duration of this emergency, allowing more behavioral healthcare providers to utilize this important form of therapy. Governor Cuomo is taking the steps necessary to ensure New Yorkers can get the healthcare they need during this difficult time.”
OASAS Commissioner Arlene González-Sanchéz said, “Governor Cuomo’s measures to streamline the approval process for telehealth services is a crucial step in ensuring that individuals in need of mental health and addiction treatment services receive the professional help they need without comprising their well-being and the safety of others.”
OPWDD Commissioner Theodore A. Kastner said, “Under Governor Cuomo’s leadership, New York has led the nation in our response to COVID-19. The expansion of access to telehealth services will help people with intellectual and developmental disabilities gain access to needed consultations with their healthcare providers while minimizing the risk associated with visiting provider offices. The use of secure audio/video teleconferencing to communicate with physicians and other licensed providers is vitally important for thousands of people who may have difficulty physically accessing healthcare services during this challenging time.”
The adopted DFS emergency regulation for the waiver of cost-sharing of in-network telehealth services states:
- During the state of emergency declared by the governor of this State related to COVID-19, insurers that provide comprehensive health insurance coverage may not impose, and no insureds shall be required to pay, copayments, coinsurance, or annual deductibles for an in-network service otherwise covered under the policy when such service is delivered via telehealth.
- Insurers shall provide written notification to their in-network providers that they shall not collect any deductible, copayment, or coinsurance in accordance with this subdivision.
- The definition of “Telehealth” under New York Insurance Law means the use of electronic information and communication technologies by a health care provider to deliver health care services to an insured while such insured is located at a site that is different from the site where the health care provider is located, pursuant to Insurance Law §§ 3217-h and 4306-g.
- During the state of emergency declared by Governor Cuomo, electronic information and communication technologies include telephonic or video modalities (including technology commonly available on smart phones and other devices) when medically appropriate to deliver health care services for the assessment, diagnosis, consultation, treatment, care management, and self-management of a patient and if all other requirements for a covered health care service are met.
The DFS emergency regulation is issued under Sections 202 and 302 of the New York Financial Services Law and Sections 301, 3216, 3217, 3217-h, 3221, 4303, and 4306-g of the Insurance Law; Public Health Law § 2999-cc and Article 27-F; 45 C.F.R. Parts 160 and 164; 42 C.F.R. Part 2; and Mental Health Law § 33.13, and is now in effect. Read a copy of the DFS emergency regulation.
For up to date information on the novel COVID-19, visit: health.ny.gov/diseases/communicable/coronavirus.
For additional DFS regulatory actions on the novel COVID-19, visit:dfs.ny.gov/consumers/coronavirus.