Louisiana Department of Insurance Addresses Telemedicine Coverage Amid Escalating Coronavirus Outbreak

March 24, 2020

In the wake of Gov. John Bel Edwards’ March 22 stay-at-home order, the Louisiana Department of Insurance (DOI) issued its second emergency rule in less than a week. Emergency Rule 37 addresses telemedicine coverage and network adequacy amid the growing public health emergency in Louisiana due to the novel coronavirus disease (COVID-19). Here is a breakdown of the Rule:

When is the Rule effective?

Rule 37 became effective on March 23 and will continue until April 9, when the current State of issued by Gov. Edwards is set to expire.

To whom and what does the Rule apply?

Emergency Rule 37 applies to:

  • All health maintenance organizations, managed care organizations, preferred provider organizations, pharmacy benefit managers, third-party administrators and any other health insurance entity doing business in Louisiana and/or regulated by the Commissioner
  • All types of health insurance
  • All insureds with a policy that was in effect and who reside in Louisiana as of 12:01 a.m. on March 23, 2020.

What does the Rule do?

Emergency Rule 37 expands access to telemedicine services so Louisiana residents can continue receiving necessary care without a visit to a hospital or clinic. In particular, it requires all health insurance issuers in Louisiana to do the following:

  • Permit Telemedicine Visits to be Conducted by Phone or Personal Device: Under the rule, insurers must waive any limitations on the use of audio-only telephonic consultations or personal devices in the provision of telemedicine services and must allow telemedicine visits to be conducted through a patient’s phone or personal device.
  • Broaden Access to Telehealth Providers: Under the rule, insurers must waive coverage limitations that require patients to only conduct telemedicine visits with providers in the insurer’s existing telemedicine network. Insurers must also waive any requirement that the patient and provider have a prior relationship for the patient to receive telemedicine services from that provider.
  • Expand Coverage of Telemedicine Services: Under the rule, insurers must cover mental health services via telemedicine to the extent they would be covered in-person, except for treatments that are not appropriate for remote delivery. Insurers must also waive any requirement that limit coverage of telemedicine services to provider-to-provider consultations only. They also must cover telemedicine consultations between a patient and a provider to the same extent those services would be covered if they were provided in person.
  • Ensure Out-of-Network Cost Sharing is Reasonable: The rule specifically directs insurers to evaluate the difference in their in-network and out-of-network cost-sharing requirements. This ensures that patients are not unreasonably charged extra cost-sharing amounts under their insurance policy if access to in-network providers becomes limited during the COVID-19 outbreak.

Emergency Rule 37 also addresses network adequacy requirements by waiving the geographic accessibility rules of the Louisiana Insurance Code, provided that the insurer maintains adequate access for those same services and complies with all provisions of the rule. However, this waiver is limited and specifically does not apply:

  • In the case of emergency services, medical services not postponed by the State Health Officer in Notice #2020-COVID-19, medical services related to testing or treatment of COVID-19, and services ancillary to any of the above
  • To any insurers that do not comply with all facets of Emergency Rule 37 in providing a health benefit plan

Are there any sanctions or penalties for violating the Rule?

No specific fines or penalties are mentioned in the rule. However, Emergency Rule 37 does state that any health insurance issuer who violates the rule shall be subject to regulatory action by the Commissioner in accordance with the provisions of the Insurance Code.

Where can I read the Rule?

A copy of Emergency Rule 37 can be found on the Louisiana Department of Insurance website. Additionally, other COVID-19 resources can be found on the Louisiana DOI website.

Where can I learn about other Emergency Rules issued by the Louisiana DOI in response to COVID-19?

The Louisiana DOI released Emergency Rule 36 on March 17. The Phelps Health Care team has provided a breakdown of Emergency Rule 36 and what it means for health insurance issuers.

The Phelps Health Care team will continue to monitor Louisiana’s legislative and regulatory responses to COVID-19 and provide periodic updates.