2022 Colorado Code
Title 10 - Insurance
Article 16 - Health-Care Coverage
Part 1 - General Provisions
§ 10-16-123. Telehealth - Definitions

1. It is the intent of the general assembly to recognize the practice of telehealth as a legitimate means by which an individual may receive health-care services from a provider without in-person contact with the provider.
2. 1. A health benefit plan or dental plan that is issued, amended, or renewed in this state shall not require in-person contact between a provider and a covered person for services appropriately provided through telehealth, subject to all terms and conditions of the health benefit plan or dental plan. Nothing in this section requires the use of telehealth when a provider determines that delivery of care through telehealth is not appropriate or when a covered person chooses not to receive care through telehealth. A provider is not obligated to document or demonstrate that a barrier to in-person care exists to trigger coverage under a health benefit plan or dental plan for services provided through telehealth.
   2. 1. Subject to all terms and conditions of the health benefit plan or dental plan, a carrier shall reimburse the treating participating provider or the consulting participating provider for the diagnosis, consultation, or treatment of the covered person delivered through telehealth on the same basis that the carrier is responsible for reimbursing that provider for the provision of the same service through in-person consultation or contact by that provider.
      2. A carrier shall not restrict or deny coverage of a health-care service that is a covered benefit solely:
         1. Because the service is provided through telehealth rather than in-person consultation or contact between the participating provider or, subject to section 10-16-704, the nonparticipating provider and the covered person where the health-care service is appropriately provided through telehealth; or
         2. Based on the communication technology or application used to deliver the telehealth services pursuant to this section.

      3. Section 10-16-704 applies to this subsection (2)(b), and the availability of telehealth services does not modify the requirements imposed on carriers under that section to provide a sufficient network of providers available in the community to provide in-person health-care services.

   3. A carrier shall include in the payment for telehealth interactions reasonable compensation to the originating site for the transmission cost incurred during the delivery of health-care services through telehealth; except that, for purposes of this subsection (2)(c), the carrier is not required to pay or reimburse for any transmission costs the covered person incurred or originating site fees, regardless of how or by whom the fees are billed, for the delivery of health-care services through telehealth to or from the covered person's home or a private residence.
   4. A carrier may offer a health coverage plan or dental plan containing a deductible, copayment, or coinsurance requirement for a health-care service provided through telehealth, but the deductible, copayment, or coinsurance amount must not exceed the deductible, copayment, or coinsurance applicable if the same health-care services are provided through in-person diagnosis, consultation, or treatment.
   5. A carrier shall not:
      1. Impose an annual dollar maximum on coverage for health-care services covered under the health benefit plan or dental plan that are delivered through telehealth, other than an annual dollar maximum that applies to the same services when performed by the same provider through in-person care;
      2. Impose specific requirements or limitations on the HIPAA-compliant technologies that a provider uses to deliver telehealth services, including limitations on audio or live video technologies;
      3. Require a covered person to have a previously established patient-provider relationship with a specific provider in order for the covered person to receive medically necessary telehealth services from the provider; or
      4. Impose additional certification, location, or training requirements on a provider as a condition of reimbursing the provider for providing health-care services through telehealth.

   6. If a covered person receives health-care services through telehealth, a carrier shall apply the applicable copayment, coinsurance, or deductible amount to the telehealth services under the health benefit plan or dental plan, which copayment, coinsurance, or deductible amount shall not exceed the amounts applicable to those health-care services when performed by the same provider through in-person care.
   7. 1. Repealed.
      2. This section does not apply to:
         1. Short-term travel, accident-only, limited or specified disease, or individual conversion policies or contracts; or
         2. Policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the "Social Security Act", as amended, or any other similar coverage under state or federal governmental plans.

   8. Nothing in this section prohibits a carrier from providing coverage or reimbursement for health-care services appropriately provided through telehealth to a covered person who is not located at an originating site.

3. A health benefit plan or dental plan is not required to pay for consultation provided by a provider by telephone or facsimile unless the consultation is provided through HIPAA-compliant interactive audio-visual communication or the use of a HIPAA-compliant application via a cellular telephone.
4. As used in this section:
   1. "Distant site" means a site at which a provider is located while providing health care services by means of telehealth.
   2. "Originating site" means a site at which a patient is located at the time health-care services are provided to him or her by means of telehealth.
   3. "Remote monitoring" means the use of synchronous or asynchronous technologies to collect or monitor medical and other forms of health data for individuals at an originating site and electronically transmit that information to providers at a distant site so providers can assess, diagnose, consult, treat, educate, provide care management, suggest self-management, or make recommendations regarding a covered person's health care.
   4. "Store-and-forward transfer" means the electronic transfer of a patient's medical information or an interaction between providers that occurs between an originating site and distant sites when the patient is not present.
   5. Repealed.
   6. "Telehealth" means a mode of delivery of health-care services through HIPAA-compliant telecommunications systems, including information, electronic, and communication technologies, remote monitoring technologies, and store-and-forward transfers, 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.

Source: L. 2001: Entire section added, p. 1153, § 3, effective January 1, 2002. L. 2015: (1) and (2) amended and (4) added, (HB 15-1029), ch. 38, p. 93, § 1, effective January 1, 2017. L. 2017: (2)(b), (2)(c), (2)(f), (3), and (4)(e) amended, (HB 17-1094), ch. 36, p. 108, § 1, effective March 16. L. 2020: (2)(e) and (4)(e) amended, (4)(b.5) added, and (4)(d) repealed, (SB 20-212), ch. 235, p. 1139, § 2, effective July 6. L. 2021: (2)(a), (2)(b)(I), (2)(d), (2)(e)(I), (2)(f), and (3) amended and (2)(g)(I) repealed, (SB 21-139), ch. 113, p. 442, § 1, effective May 7.

Editor's note: Section 3 of chapter 113 (SB 21-139), Session Laws of Colorado 2021, provides that the act changing this section applies to dental plans issued or renewed on or after May 7, 2021.

Cross references: For the legislative declaration contained in the 2001 act enacting this section, see section 1 of chapter 300, Session Laws of Colorado 2001. For the legislative declaration in SB 20-212, see section 1 of chapter 235, Session Laws of Colorado 2020.