This bill has been amended

Bill S4337A-2013

Requires insurers and medical assistance for needy persons to provide coverage for the provision of telehealth services

Requires insurers and medical assistance for needy persons to provide coverage for the provision of telehealth services.

Details

Actions

  • Jan 23, 2014: PRINT NUMBER 4337A
  • Jan 23, 2014: AMEND AND RECOMMIT TO HEALTH
  • Jan 8, 2014: REFERRED TO HEALTH
  • Jan 8, 2014: returned to senate
  • Jan 8, 2014: died in assembly
  • Jun 13, 2013: referred to health
  • Jun 13, 2013: DELIVERED TO ASSEMBLY
  • Jun 13, 2013: PASSED SENATE
  • Jun 12, 2013: ORDERED TO THIRD READING CAL.1342
  • Jun 12, 2013: COMMITTEE DISCHARGED AND COMMITTED TO RULES
  • Jun 3, 2013: PRINT NUMBER 4337A
  • Jun 3, 2013: AMEND AND RECOMMIT TO HEALTH
  • Mar 21, 2013: REFERRED TO HEALTH

Votes

Memo

BILL NUMBER:S4337A

TITLE OF BILL: An act to amend the public health law, the insurance law and the social services law, in relation to the provision of telehealth services

PURPOSE:

Requires insurers and medical assistance for needy persons to provide coverage for the provision of telehealth services.

SUMMARY OF PROVISIONS:

Section one would amend subdivision 1 of section 2 of the public health law to provide definitions for "distant site," "health care provider," "originating site," "telehealth" and "telemedicine."

Section two, three, four, and five would amend various provisions of the insurance law to require individual accident and health insurance, group or blanket accident and health insurance, and medical expense indemnity corporations or hospital service corporations that provide hospital, medical or surgical care to also provide coverage for telehealth and telemedicine services, provided that the telemedicine services meet federal Medicare program requirements, and telehealth services are covered to the same extent as the home telehealth program provides under paragraph 3-c of subdivision 3614 of the public health law. Such coverage is subject to contractual limits including annual deductibles, coinsurance, utilization management, and other managed care tools on par with the same services when not provided via telemedicine or telehealth.

Section six would amend the social services law to prohibit the exclusion of telehealth services from reimbursement under Medicaid solely because the otherwise covered service was delivered by telehealth.

Section seven states the enactment date.

JUSTIFICATION:

Telehealth, including telemedicine, can benefit patients, especially rural patients, hampered by economic or geographic restrictions, in many ways.

Due to significant quality and fiscal improvements, patients see fewer hospitalizations and costly visits to emergency rooms; expanded access to providers; faster, more convenient and timely treatment; better continuity of care; better coordination of care; reduction of lost work time and travel costs; and the ability to remain within support networks and age in place at home.

Persons of all ages who suffer from chronic diseases will have the opportunity to stay in their homes longer, abnormal events may be detected before they turn into a hospital visit, vital signs can be monitored remotely by registered nurses, patients can get help with medication adherence and be encouraged to take ownership of their own

well-being by better understanding the correlation between their choices and their health outcomes.

Patients can receive consultations at a provider's office, not just from that provider, but from doctors, nurse practitioners, physician assistants, dentists and psychiatrists across the state and world.

However, to ensure that the field of telehealth and telemedicine can reach its full potential, these services must be reimbursed in the same manner as those provided face to face. Any individual who would otherwise be entitled to receive coverage for in-person encounter-based monitoring or consulting services should be entitled to receive such services through the use of remote monitoring or remote consults using real-time audio-visual telecommunications.

Enabling health care professionals to make use of available technology will empower them to better serve their patients and enhance health patient outcomes.

Cost-efficient quality healthcare will be preserved by permitting telemedicine and telehealth services to be subject to the same limitations as those same services would be when not given via telemedicine or telehealth.

LEGISLATIVE HISTORY:

2012: S.6969-A PASSED SENATE: A.9833-A Committed to Health Committee

FISCAL IMPLICATIONS:

Undetermined.

EFFECTIVE DATE:

Effective January 1, 2014 and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date.


Text

STATE OF NEW YORK ________________________________________________________________________ 4337--A 2013-2014 Regular Sessions IN SENATE March 21, 2013 ___________
Introduced by Sens. YOUNG, O'MARA, RITCHIE, ROBACH, VALESKY -- (at request of the Legislative Commission on Rural Resources) -- read twice and ordered printed, and when printed to be committed to the Committee on Health -- committee discharged, bill amended, ordered reprinted as amended and recommitted to said committee AN ACT to amend the public health law, the insurance law and the social services law, in relation to the provision of telehealth services THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. Subdivision 1 of section 2 of the public health law is amended by adding five new paragraphs (o), (p), (q), (r) and (s) to read as follows: (O) DISTANT SITE. THE TERM "DISTANT SITE" MEANS A SITE AT WHICH A HEALTH CARE PROVIDER IS LOCATED WHILE PROVIDING HEALTH CARE SERVICES BY MEANS OF A FEDERAL FOOD AND DRUG ADMINISTRATION APPROVED AND INTEROPERA- BLE TELECOMMUNICATIONS SYSTEM. (P) HEALTH CARE PROVIDER. THE TERM "HEALTH CARE PROVIDER" MEANS A PERSON LICENSED PURSUANT TO ARTICLE ONE HUNDRED THIRTY-ONE, ONE HUNDRED THIRTY-ONE-B, ONE HUNDRED THIRTY-THREE, ONE HUNDRED THIRTY-NINE, ONE HUNDRED FORTY, ONE HUNDRED FORTY-ONE, ONE HUNDRED FORTY-THREE, ONE HUNDRED FORTY-FOUR, ONE HUNDRED FIFTY-THREE, ONE HUNDRED FIFTY-FOUR OR ONE HUNDRED FIFTY-NINE OF THE EDUCATION LAW; A PHYSICIANS PRACTICE GROUP; A HOSPITAL; A CERTIFIED HOME HEALTH AGENCY; A LONG TERM HOME HEALTH CARE PROGRAM; A FEDERALLY QUALIFIED HEALTH CENTER AS DEFINED IN 42 U.S.C. 1395X (AA)(4); AND A LICENSED HOME CARE SERVICE AGENCY. (Q) ORIGINATING SITE. THE TERM "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 A FEDERAL FOOD AND DRUG ADMINISTRATION APPROVED AND INTEROPERABLE TELECOMMUNICATIONS SYSTEM. (R) TELEHEALTH. THE TERM "TELEHEALTH" MEANS THE MODE OF DELIVERING HEALTH CARE SERVICES BY MEANS OF INFORMATION AND COMMUNICATIONS TECHNOL-
OGIES CONSISTING OF TELEPHONES, REMOTE PATIENT MONITORING DEVICES OR OTHER ELECTRONIC MEANS WHICH FACILITATE THE ASSESSMENT, DIAGNOSIS, CONSULTATION, TREATMENT, EDUCATION, CARE MANAGEMENT AND SELF MANAGEMENT OF A PATIENT'S HEALTH CARE WHILE SUCH PATIENT IS AT THE ORIGINATING SITE AND THE HEALTH CARE PROVIDER IS AT A DISTANT SITE. SUCH TERM SHALL INCLUDE TELEMEDICINE. (S) TELEMEDICINE. THE TERM "TELEMEDICINE" MEANS THE DELIVERY OF CLIN- ICAL HEALTH CARE SERVICES BY MEANS OF REAL TIME TWO-WAY ELECTRONIC AUDIO VISUAL COMMUNICATIONS WHICH FACILITATE THE ASSESSMENT, DIAGNOSIS, CONSULTATION, TREATMENT, EDUCATION, CARE MANAGEMENT AND SELF MANAGEMENT OF A PATIENT'S HEALTH CARE WHILE SUCH PATIENT IS AT THE ORIGINATING SITE AND THE HEALTH CARE PROVIDER IS AT A DISTANT SITE. S 2. Subsection (i) of section 3216 of the insurance law is amended by adding a new paragraph 30 to read as follows: (30) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH PROVIDES COVERAGE FOR HOSPITAL, MEDICAL OR SURGICAL CARE SHALL MAKE AVAILABLE, AND IF REQUESTED BY A POLICY HOLDER, PROVIDE COVERAGE FOR SERVICES WHICH ARE OTHERWISE COVERED UNDER THE POLICY THAT ARE PROVIDED VIA TELEMEDICINE, AS DEFINED IN SECTION TWO OF THE PUBLIC HEALTH LAW, PROVIDED THAT SUCH SERVICES MEET THE REQUIREMENTS OF FEDERAL LAW, RULES AND REGULATIONS FOR MEDICARE, AND FOR THOSE TELEHEALTH SERVICES THAT ARE REQUIRED TO BE PROVIDED PURSUANT TO SUBDIVISION THREE-C OF SECTION THIR- TY-SIX HUNDRED FOURTEEN OF THE PUBLIC HEALTH LAW. SUCH COVERAGE REQUIRED BY THIS PARAGRAPH MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE, AND OTHER TERMS AND CONDITIONS OF COVERAGE, INCLUDING, BUT NOT LIMITED TO, UTILIZATION MANAGEMENT AND OTHER MANAGED CARE TOOLS, AS ARE CONSISTENT WITH THOSE ESTABLISHED FOR THE SAME SERVICES WHEN NOT PROVIDED VIA TELEMEDICINE OR TELEHEALTH. S 3. Subsection (k) of section 3221 of the insurance law is amended by adding a new paragraph 19 to read as follows: (19) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE WHICH PROVIDES COVERAGE FOR HOSPITAL, MEDICAL OR SURGICAL CARE SHALL MAKE AVAILABLE, AND IF REQUESTED BY THE GROUP POLICYHOLDER, PROVIDE COVERAGE FOR SERVICES WHICH ARE OTHERWISE COVERED UNDER THE POLICY THAT ARE PROVIDED VIA TELEMEDICINE, AS DEFINED IN SECTION TWO OF THE PUBLIC HEALTH LAW, PROVIDED THAT SUCH SERVICES MEET THE REQUIREMENTS OF FEDERAL LAW, RULES AND REGULATIONS FOR MEDICARE, AND FOR TELEHEALTH SERVICES THAT ARE, AT A MINIMUM, THOSE REQUIRED TO BE PROVIDED PURSUANT TO SUBDIVISION THREE-C OF SECTION THIRTY-SIX HUNDRED FOURTEEN OF THE PUBLIC HEALTH LAW. SUCH COVERAGE REQUIRED BY THIS PARAGRAPH MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE, AND OTHER TERMS AND CONDITIONS OF COVERAGE, INCLUDING, BUT NOT LIMITED TO, UTILIZATION MANAGEMENT AND OTHER MANAGED CARE TOOLS, AS ARE CONSISTENT WITH THOSE ESTABLISHED FOR THE SAME SERVICES WHEN NOT PROVIDED VIA TELEMEDICINE OR TELEHEALTH. S 4. Paragraph 2 of subsection (a) of section 3229 of the insurance law, as amended by chapter 659 of the laws of 1997, is amended to read as follows: (2) a home care benefit with personal care, nursing care, adult day health care [and], respite care services, TELEMEDICINE SERVICES, AS DEFINED IN SECTION TWO OF THE PUBLIC HEALTH LAW, PROVIDED THAT SUCH TELEMEDICINE SERVICES ARE PURSUANT TO AN AGREEMENT BETWEEN A PROVIDER PARTICIPATING IN THE INSURER'S NETWORK AND THE INSURER, AND MEET THE REQUIREMENTS OF FEDERAL LAW, RULES AND REGULATIONS FOR MEDICARE, AND THOSE TELEHEALTH SERVICES THAT ARE REQUIRED TO BE PROVIDED PURSUANT TO SUBDIVISION THREE-C OF SECTION THIRTY-SIX HUNDRED FOURTEEN OF THE PUBLIC
HEALTH LAW, which shall provide total benefits in an amount determined by regulations of the superintendent; S 5. Section 4303 of the insurance law is amended by adding a new subsection (oo) to read as follows: (OO) EVERY CONTRACT ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPORATION, A HOSPITAL SERVICE CORPORATION OR A HEALTH SERVICE CORPORATION WHICH PROVIDES COVERAGE FOR HOSPITAL, MEDICAL OR SURGICAL CARE SHALL MAKE AVAILABLE, IF REQUESTED BY A CONTRACT HOLDER, PROVIDE COVERAGE FOR SERVICES WHICH ARE OTHERWISE COVERED UNDER THE POLICY THAT ARE PROVIDED VIA TELEMEDICINE, AS DEFINED IN SECTION TWO OF THE PUBLIC HEALTH LAW, PROVIDED THAT SUCH SERVICES MEET THE REQUIREMENTS OF FEDERAL LAW, RULES AND REGULATIONS FOR MEDICARE, AND FOR THOSE TELEHEALTH SERVICES THAT ARE REQUIRED TO BE PROVIDED PURSUANT TO SUBDIVISION THREE-C OF SECTION THIR- TY-SIX HUNDRED FOURTEEN OF THE PUBLIC HEALTH LAW. SUCH COVERAGE REQUIRED BY THIS SUBSECTION MAY BE SUBJECT TO ANNUAL DEDUCTIBLES AND COINSURANCE, AND OTHER TERMS AND CONDITIONS OF COVERAGE, INCLUDING, BUT NOT LIMITED TO, UTILIZATION MANAGEMENT AND OTHER MANAGED CARE TOOLS, AS ARE CONSISTENT WITH THOSE ESTABLISHED FOR THE SAME SERVICES WHEN NOT PROVIDED VIA TELEMEDICINE OR TELEHEALTH. S 6. The opening paragraph of section 367-u of the social services law is designated subdivision 1 and a new subdivision 2 is added to read as follows: 2. SUBJECT TO THE APPROVAL OF THE DIRECTOR OF THE BUDGET, THE COMMIS- SIONER SHALL NOT EXCLUDE FROM THE PAYMENT OF MEDICAL ASSISTANCE FUNDS THE PROVISION OF MEDICAL CARE THROUGH TELEMEDICINE SERVICES, AS DEFINED IN SECTION TWO OF THE PUBLIC HEALTH LAW, PROVIDED THAT SUCH SERVICES MEET THE REQUIREMENTS OF FEDERAL LAW, RULES AND REGULATIONS FOR THE PROVISION OF MEDICAL ASSISTANCE PURSUANT TO THIS TITLE, AND FOR TELE- HEALTH SERVICES THAT ARE, AT A MINIMUM, THOSE REQUIRED TO BE PROVIDED PURSUANT TO SUBDIVISION THREE-C OF SECTION THIRTY-SIX HUNDRED FOURTEEN OF THE PUBLIC HEALTH LAW. S 7. This act shall take effect January 1, 2014 and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date.

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