Health Law Alert by Lamb McErlane attorneys Vasilios J. Kalogredis, Esq. and Sonal Parekh, Esq.

On July 3, 2024 Governor Josh Shapiro signed into law legislation expanding access to telemedicine services for residents across Pennsylvania. In an effort to increase accessibility and affordability of health care in rural communities and throughout the Commonwealth, Senate Bill 739 (“SB 739”) requires health insurers and managed care plans participating in the Medical Assistance (“MA”) and Children’s Health Insurance Programs (“CHIP”) to pay for or reimburse, as applicable, covered health care services provided through telemedicine.

SB 739 provides that if a commercial health insurer provides coverage for a health care service performed in-person, it must also cover the same service via telemedicine, so long as the required standard of care is met. Insurers are to pay or reimburse a participating network provider for covered health care services delivered via telemedicine in accordance with (i) the terms and conditions of the contract between the health insurance company and the participating network provider (the “Provider Contract”) and (ii) the Agreement with the Department of Human Services to manage the purchase and provision of services. Specifically, SB 739 provides that a Provider Contract may not prohibit payment or reimbursement solely because the covered health care services are provided by telemedicine.

MA and CHIP managed care plans, also known as managed care organizations (“MCOs”) are required to make payments for medically necessary health care services provided to enrolled individuals and delivered through telemedicine if all of the following requirements apply.

1. 1. The health care services would be covered through an in-person encounter.
   2. The provision of health care services through telemedicine is consistent with federal and state requirements.
   3. Upon federal approval (if required).

The legislation will take effect in 90 days upon enactment, and the requirements set forth therein will take effect for MA and CHIP MCOs beginning on or after January 1, 2026.

Republican Senator John DiSanto has stated that the legislation will bring “a statutory framework and legal clarity to the provision of and insurance coverage for these critical medical services when an in-person consultation isn’t essential, ensuring that the convenience and cost-efficiency of telemedicine will continue for patients.” Governor Shapiro’s Administration has further expressed its commitment to work across party lines to continue to expand access to health care for all Pennsylvanians.

If you have any questions or if we may be of further assistance regarding compliance, or other health law matters, please feel free to contact Bill Kalogredis, Esq. or Sonal Parekh, Esq.

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Vasilios J. (Bill) Kalogredis, Esq. has been advising physicians, dentists, and other healthcare professionals and their businesses as to contractual, regulatory and transactional matters for 50 years. He is Chairman of Lamb McErlane PC’s Health Law Department. Bill can be reached by email at bkalogredis@lambmcerlane.com or by phone at 610-701-4402.

Sonal Parekh, Esq., is an associate at Lamb McErlane PC who focuses on healthcare transactional matters and a broad range of healthcare regulatory-related issues on behalf of healthcare systems, physicians, dentists, and other healthcare providers, and is a pharmacist by education and training. Sonal can be reached by email at sparekh@lambmcerlane.com or by phone at 610-701-4416.

*This alert is for educational purposes only and is not intended to be legal advice. Should you require legal advice on this topic, any health care matter, or have any questions or concerns, please contact Vasilios J. (Bill) Kalogredis, Esq. or Sonal Parekh, Esq.