Effective immediately, all health plans in the state of California shall comply with the following:
- Health plans shall reimburse providers at the same rate, whether a service is
provided in-person or through telehealth, if the service is the same regardless of
the modality of delivery, as determined by the provider’s description of the
service on the claim. For example, if a health plan reimburses a mental health
provider $100 for a 50-minute therapy session conducted in-person, the health
plan shall reimburse the provider $100 for a 50-minute therapy session done via
- For services provided via telehealth, a health plan may not subject enrollees to
cost-sharing greater than the same cost-sharing if the service were provided in-person.
- Health plans shall provide the same amount of reimbursement for a service
rendered via telephone as they would if the service is rendered via video, provided the modality by which the service is rendered (telephone versus video is medically appropriate for the enrollee.