Code of the District of Columbia

Chapter 38D. Telehealth Reimbursement.


§ 31–3861. Definitions.

For the purposes of this chapter, the term:

(1) “Health benefits plan” shall have the same meaning as provided in § 31-3131(4).

(2) “Health insurer” shall have the same meaning as provided in § 31-3131(5).

(2A) Not Funded.

(3) “Provider” shall have the same meaning as provided in § 31-3131(7).

(4) “Telehealth” means the delivery of healthcare services through the use of interactive audio, video, or other electronic media used for the purpose of diagnosis, consultation, or treatment; provided, that services delivered through email messages or facsimile transmissions are not included.


(Oct. 17, 2013, D.C. Law 20-26, § 2, 60 DCR 11117; July 3, 2018, D.C. Law 22-126, § 2(a), 65 DCR 5110; Oct. 20, 2020, D.C. Law 23-132, § 2(a), 67 DCR 9887; Dec. 3, 2020, D.C. Law 23-149, §§ 5042, 7105, 67 DCR 10493.)

Applicability

Applicability of D.C. Law 23-132: § 4 of D.C. Law 23-132 provided that the change made to this section by § 2(a) of D.C. Law 23-132 is subject to the inclusion of the law’s fiscal effect in an approved budget and financial plan. Therefore that amendment has not been implemented.

Applicability of D.C. Law 22-126: § 3 of D.C. Law 22-126 provided that the change made to this section by § 2(a) of D.C. Law 22-126 is subject to the inclusion of the law’s fiscal effect in an approved budget and financial plan. Therefore that amendment has not been implemented.


§ 31–3862. Private reimbursement.

(a) A health insurer offering a health benefits plan in the District may not deny coverage for a healthcare service on the basis that the service is provided through telehealth if the same service would be covered when delivered in person.

(b) A health insurer shall reimburse the provider for the diagnosis, consultation, or treatment of the insured when the service is delivered through telehealth.

(c) A health insurer shall not be required to:

(1) Reimburse a provider for healthcare service delivered through telehealth that is not a covered under the health benefits plan; and

(2) Reimburse a provider who is not a covered provider under the health benefits plan.

(d) A health insurer may require a deductible, copayment, or coinsurance amount for a healthcare service delivered through teleheath; provided, that the deductible, copayment, or coinsurance amount may not exceed the amount applicable to the same service when it is delivered in person.

(e) A health insurer shall not impose any annual or lifetime dollar maximum on coverage for telehealth services other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services under the health benefits plan.

(f) Nothing in this chapter shall preclude the health insurer from undertaking utilization review to determine the appropriateness of telehealth as a means of delivering a healthcare service; provided, that the determinations shall be made in the same manner as those regarding the same service when it is delivered in person.


(Oct. 17, 2013, D.C. Law 20-26, § 3, 60 DCR 11117.)


§ 31–3862.01. Postpartum maternal health services. [Not Funded]

Not Funded.


(Oct. 17, 2013, D.C. Law 20-26, § 3a; as added Oct. 20, 2020, D.C. Law 23-132, § 2(b), 67 DCR 9887.)

Applicability

Applicability of D.C. Law 23-132: § 4 of D.C. Law 23-132 provided that the creation of this section by § 2(b) of D.C. Law 23-132 is subject to the inclusion of the law’s fiscal effect in an approved budget and financial plan. Therefore that amendment has not been implemented.


§ 31–3863. Medicaid reimbursement.

Medicaid shall cover and reimburse for healthcare services appropriately delivered through telehealth if the same services would be covered when delivered in person.


(Oct. 17, 2013, D.C. Law 20-26, § 4, 60 DCR 11117; July 3, 2018, D.C. Law 22-126, § 2(b), 65 DCR 5110; Dec. 3, 2020, D.C. Law 23-149, § 7105, 67 DCR 10493.)

Applicability

Applicability of D.C. Law 22-126: § 3 of D.C. Law 22-126 provided that the change made to this section by § 2(b) of D.C. Law 22-126 is subject to the inclusion of the law’s fiscal effect in an approved budget and financial plan. Therefore that amendment has not been implemented.


§ 31–3864. Remote patient monitoring service providers; payment. [Repealed]

Repealed.


(Oct. 17, 2013, D.C. Law 20-26, § 4a; as added July 3, 2018, D.C. Law 22-126, § 2(c), 65 DCR 5110; Dec. 3, 2020, D.C. Law 23-149, § 7105, 67 DCR 10493.)

Applicability

Applicability of D.C. Law 22-126: § 3 of D.C. Law 22-126 provided that the creation of this section by § 2(c) of D.C. Law 22-126 is subject to the inclusion of the law’s fiscal effect in an approved budget and financial plan. Therefore that amendment has not been implemented.


§ 31–3865. Right to synchronous interaction. [Repealed]

Repealed.


(Oct. 17, 2013, D.C. Law 20-26, § 4b; as added July 3, 2018, D.C. Law 22-126, § 2(c), 65 DCR 5110; Dec. 3, 2020, D.C. Law 23-149, § 7105, 67 DCR 10493.)

Applicability

Applicability of D.C. Law 22-126: § 3 of D.C. Law 22-126 provided that the creation of this section by § 2(c) of D.C. Law 22-126 is subject to the inclusion of the law’s fiscal effect in an approved budget and financial plan. Therefore that amendment has not been implemented.


§ 31–3866. Facility fees. [Repealed]

Repealed.


(Oct. 17, 2013, D.C. Law 20-26, § 4c; as added July 3, 2018, D.C. Law 22-126, § 2(c), 65 DCR 5110; Dec. 3, 2020, D.C. Law 23-149, § 7105, 67 DCR 10493.)

Applicability

Applicability of D.C. Law 22-126: § 3 of D.C. Law 22-126 provided that the creation of this section by § 2(c) of D.C. Law 22-126 is subject to the inclusion of the law’s fiscal effect in an approved budget and financial plan. Therefore that amendment has not been implemented.


§ 31–3867. Federal authorization. [Repealed]

Repealed.


(Oct. 17, 2013, D.C. Law 20-26, § 4d; as added July 3, 2018, D.C. Law 22-126, § 2(c), 65 DCR 5110; Dec. 3, 2020, D.C. Law 23-149, § 7105, 67 DCR 10493.)

Applicability

Applicability of D.C. Law 22-126: § 3 of D.C. Law 22-126 provided that the creation of this section by § 2(c) of D.C. Law 22-126 is subject to the inclusion of the law’s fiscal effect in an approved budget and financial plan. Therefore that amendment has not been implemented.


§ 31–3868. Rules. [Repealed]

Repealed.


(Oct. 17, 2013, D.C. Law 20-26, § 4e; as added July 3, 2018, D.C. Law 22-126, § 2(c), 65 DCR 5110; Dec. 3, 2020, D.C. Law 23-149, § 7105, 67 DCR 10493.)

Applicability

Applicability of D.C. Law 22-126: § 3 of D.C. Law 22-126 provided that the creation of this section by § 2(c) of D.C. Law 22-126 is subject to the inclusion of the law’s fiscal effect in an approved budget and financial plan. Therefore that amendment has not been implemented.