Provides for the credentialing of health care providers providing telemedicine services. Legislative Commission on Rural Resources Bill.
TITLE OF BILL: An act to amend the public health law, in relation to the granting of hospital privileges to providers of telemedicine services
PURPOSE: To provide for the credentialing of health care providers providing telemedicine services
SUMMARY OF PROVISIONS: Section 1 amends section 2805-u of the public health law to permit a hospital where a patient is receiving telemedicine services to enter into an agreement with a distant site hospital for credentialing, privileging and peer review of a distant site healthcare practitioner. The distant site hospital must be licensed and if from another state, must comply with federal Medicare regulations.
The agreement requires the distant site hospital where a consulting physician is located to collect information and perform all required verification, quality assurance and peer review activities imposed upon the originating site hospital. The agreement must, at a minimum, provide that the originating site hospital is ultimately responsible for physician credentialing. The agreement must also enumerate: the categories of healthcare providers eligible for appointment to the originating site hospital medical staff, the credentialing information collected and verification activities performed by the distant site hospital; that the distant site provider is licensed in New York state and credentialed at the distant site hospital, the privileges held by the distant site provider at the distant site hospital; and that the distant site hospital is required to conduct periodic reviews in accordance with requirements applicable to the distant site hospital and share the findings of such reviews with the originating site hospital. In addition, the distant site hospital must immediately notify the originating site hospital of any suspension, revocation, or limitations to the distant site health care practitioners privileges at the distant site hospital.
The originating hospital is required to conduct periodic internal reviews, at least every two years, of the distant site health care practitioner's performance of telemedicine services and provide such report to the distant site hospital. In addition, the originating site hospital must report all adverse events resulting from a distant site health care provider's telemedicine services to the distant site hospital.
JUSTIFICATION: Hospitals are required by the New York State Public Health Law to credential practitioners before granting them privileges to treat patients. The required credentialing involves verification of
training, experience and licensure as well as performance. The assessment of practitioner performance is known as "peer review. II Peer review refers to an assessment of a practitioner's performance by his or her peers, normally meaning by physicians who practice in the same or similar areas of specialty. Peer review is normally conducted as a part of the hospital's overall quality assurance program.
The New York State Department of Health has determined, consistent with CMS requirements, that the credentials verification portion of the credentialing process for telemedicine purposes can be fulfilled by the distant site hospital where the physician providing the telemedicine consult resides. This part of credentialing is basically a documentation review that verifies medical school graduation, residency training in the area of specialty in which the physician practices and that the physician is currently licensed in New York State.
However, the originating site hospital receiving the consult via telemedicine (which is required to credential the physician in order to grant them the privilege of providing consultations) has an obligation to conduct a peer review/ performance assessment of that physician's practice in recommending treatment of patients at the originating site hospital to ensure the services provided are of high quality. Unfortunately, in situations where telemedicine is used, there are often no peers on the medical staff at the originating site hospital, thus requiring a telemedicine consult with a distant-site hospital to access the services of a specialist.
This requirement forces the originating site hospital to either rely on the limited information they have at the originating site hospital or to seek expert assistance elsewhere, with an additional cost to the originating site hospital. This phenomenon creates a barrier to the expansion of telemedicine.
This legislation would remove that barrier by allowing the originating site hospital to rely upon the hospital where the physician who provides the telemedicine consult resides to be able to fulfill the peer review responsibility of the hospital where the consultation is received by virtue of the peer review already being conducted at the site providing the consultation.
LEGISLATIVE HISTORY: New Bill.
FISCAL IMPLICATIONS: None.
EFFECTIVE DATE: Effective immediately.
STATE OF NEW YORK ________________________________________________________________________ S. 6970 A. 9834 S E N A T E - A S S E M B L Y April 18, 2012 ___________IN SENATE -- Introduced by Sens. YOUNG, BRESLIN, O'MARA, RITCHIE, VALE- SKY -- (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 IN ASSEMBLY -- Introduced by M. of A. GUNTHER -- Multi-Sponsored by -- M. of A. BURLING, LIFTON, PALMESANO -- read once and referred to the Committee on Health AN ACT to amend the public health law, in relation to the granting of hospital privileges to providers of telemedicine services THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: Section 1. The public health law is amended by adding a new section 2805-u to read as follows: S 2805-U. CREDENTIALING AND PRIVILEGING OF HEALTH CARE PRACTITIONERS PROVIDING TELEMEDICINE SERVICES. 1. FOR PURPOSES OF THIS SECTION: (A) "DISTANT SITE HOSPITAL" MEANS A HOSPITAL LICENSED PURSUANT TO THIS ARTICLE OR A HOSPITAL LICENSED BY ANOTHER STATE, THAT HAS ENTERED INTO AN AGREEMENT WITH AN ORIGINATING HOSPITAL TO MAKE AVAILABLE ONE OR MORE HEALTH CARE PRACTITIONERS THAT ARE MEMBERS OF ITS CLINICAL STAFF TO THE ORIGINATING HOSPITAL FOR THE PURPOSES OF PROVIDING TELEMEDICINE SERVICES. TO QUALIFY AS A DISTANT SITE HOSPITAL FOR PURPOSES OF THIS ARTICLE, A HOSPITAL LICENSED BY ANOTHER STATE MUST COMPLY WITH THE FEDERAL REGULATIONS GOVERNING PARTICIPATION BY HOSPITALS IN MEDICARE. (B) "HEALTH CARE PRACTITIONER" SHALL MEAN 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, OR AS OTHERWISE AUTHORIZED BY THE COMMISSIONER. (C) "ORIGINATING HOSPITAL" MEANS THE HOSPITAL AT WHICH A PATIENT IS LOCATED AT THE TIME TELEMEDICINE SERVICES ARE PROVIDED TO HIM OR HER. (D) "TELEMEDICINE" MEANS THE DELIVERY OF CLINICAL HEALTH CARE SERVICES BY MEANS OF REAL TIME TWO-WAY ELECTRONIC AUDIO-VISUAL COMMUNICATIONSEXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD15253-02-2 S. 6970 2 A. 9834
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. 2. WHEN TELEMEDICINE SERVICES ARE PROVIDED TO AN ORIGINATING HOSPI- TAL'S PATIENTS PURSUANT TO AN AGREEMENT WITH A DISTANT SITE HOSPITAL, THE ORIGINATING HOSPITAL MAY, IN LIEU OF SATISFYING THE REQUIREMENTS SET FORTH IN SECTION TWENTY-EIGHT HUNDRED FIVE-K OF THIS ARTICLE, RELY ON THE CREDENTIALING AND PRIVILEGING DECISIONS MADE BY THE DISTANT SITE HOSPITAL IN GRANTING OR RENEWING PRIVILEGES TO A HEALTH CARE PRACTITION- ER WHO IS A MEMBER OF THE CLINICAL STAFF OF THE DISTANT SITE HOSPITAL, PROVIDED THAT: (A) THE DISTANT SITE HOSPITAL PARTICIPATES IN MEDICARE AND MEDICAID; (B) EACH HEALTH CARE PRACTITIONER PROVIDING TELEMEDICINE IS LICENSED TO PRACTICE IN THIS STATE; (C) THE DISTANT SITE HOSPITAL, IN ACCORDANCE WITH REQUIREMENTS OTHER- WISE APPLICABLE TO THAT HOSPITAL, COLLECTS AND EVALUATES ALL CREDENTIAL- ING INFORMATION CONCERNING EACH HEALTH CARE PRACTITIONER PROVIDING TELE- MEDICINE SERVICES, PERFORMS ALL REQUIRED VERIFICATION ACTIVITIES, AND ACTS ON BEHALF OF THE ORIGINATING SITE HOSPITAL FOR SUCH CREDENTIALING PURPOSES; (D) THE DISTANT SITE HOSPITAL REVIEWS PERIODICALLY, AT LEAST EVERY TWO YEARS, AND AS OTHERWISE WARRANTED BASED ON OUTCOMES, COMPLAINTS OR OTHER CIRCUMSTANCES, THE CREDENTIALS, PRIVILEGES, PHYSICAL AND MENTAL CAPACI- TY, AND COMPETENCE IN DELIVERING HEALTH CARE SERVICES OF EACH HEALTH CARE PRACTITIONER PROVIDING TELEMEDICINE SERVICES, CONSISTENT WITH REQUIREMENTS OTHERWISE APPLICABLE TO THAT HOSPITAL; REPORTS THE RESULTS OF SUCH REVIEW TO THE ORIGINATING HOSPITAL; AND NOTIFIES THE ORIGINATING HOSPITAL IMMEDIATELY UPON ANY SUSPENSION, REVOCATION, OR LIMITATION OF SUCH PRIVILEGES; (E) WITH RESPECT TO EACH DISTANT SITE HEALTH CARE PRACTITIONER WHO HOLDS PRIVILEGES AT THE ORIGINATING HOSPITAL, THE ORIGINATING HOSPITAL CONDUCTS A PERIODIC INTERNAL REVIEW, AT LEAST EVERY TWO YEARS, OF THE DISTANT SITE PRACTITIONER'S PERFORMANCE OF THESE PRIVILEGES AND PROVIDES THE DISTANT SITE HOSPITAL WITH SUCH PERFORMANCE INFORMATION FOR USE IN THE DISTANT HOSPITAL'S PERIODIC APPRAISAL OF THE DISTANT SITE PHYSICIAN OR HEALTH CARE PRACTITIONER. SUCH INFORMATION SHALL INCLUDE, AT A MINI- MUM, ALL ADVERSE EVENTS THAT RESULT FROM THE TELEMEDICINE SERVICES PROVIDED BY THE DISTANT SITE HEALTH CARE PRACTITIONER TO THE ORIGINATING HOSPITAL'S PATIENTS, ALL COMPLAINTS THE ORIGINATING HOSPITAL HAS RECEIVED ABOUT THE DISTANT SITE PRACTITIONER, AND ANY REVOCATION, SUSPENSION OR LIMITATION OF THE DISTANT SITE PRACTITIONER'S PRIVILEGES BY THE ORIGINATING HOSPITAL; AND (F) THE AGREEMENT ENTERED INTO BETWEEN THE ORIGINATING SITE HOSPITAL AND DISTANT SITE HOSPITAL SHALL BE IN WRITING AND SHALL, AT A MINIMUM: (I) PROVIDE THE CATEGORIES OF HEALTH CARE PRACTITIONERS THAT ARE ELIGIBLE CANDIDATES FOR APPOINTMENT TO THE ORIGINATING HOSPITAL'S CLIN- ICAL STAFF, (II) REQUIRE THE GOVERNING BODY OF THE DISTANT SITE HOSPITAL TO COMPLY WITH THE MEDICARE CONDITIONS OF PARTICIPATION GOVERNING THE APPOINTMENT OF MEDICAL STAFF WITH REGARD TO THE HEALTH CARE PRACTITIONERS PROVIDING TELEMEDICINE SERVICES, (III) ITEMIZE THE CREDENTIALING INFORMATION TO BE COLLECTED AND THE REQUIRED VERIFICATION ACTIVITIES TO BE PERFORMED BY THE DISTANT SITE HOSPITAL AND RELIED UPON BY THE ORIGINATING HOSPITAL IN CONSIDERING THE RECOMMENDATIONS OF THE DISTANT SITE HOSPITAL,S. 6970 3 A. 9834
(IV) REQUIRE EACH DISTANT SITE HEALTH CARE PRACTITIONER PROVIDING TELEMEDICINE SERVICES TO BE LICENSED TO PRACTICE IN THIS STATE AND PRIV- ILEGED AT THE DISTANT SITE HOSPITAL, (V) REQUIRE THE DISTANT SITE HOSPITAL TO PROVIDE TO THE ORIGINATING HOSPITAL A CURRENT LIST OF EACH DISTANT SITE HEALTH CARE PRACTITIONER'S PRIVILEGES AT THE DISTANT SITE HOSPITAL, AND (VI) REQUIRE THE DISTANT SITE HOSPITAL TO CONDUCT A PERIODIC REVIEW CONSISTENT WITH REQUIREMENTS OTHERWISE APPLICABLE TO THAT HOSPITAL, AT LEAST EVERY TWO YEARS, AND AS OTHERWISE WARRANTED BASED ON OUTCOMES, COMPLAINTS OR OTHER CIRCUMSTANCES, THE CREDENTIALS, PRIVILEGES, PHYSICAL AND MENTAL CAPACITY, AND COMPETENCE IN DELIVERING HEALTH CARE SERVICES OF EACH HEALTH CARE PRACTITIONER PROVIDING TELEMEDICINE SERVICES; TO PROVIDE THE ORIGINATING HOSPITAL WITH THE RESULTS OF SUCH REVIEW; AND TO NOTIFY THE ORIGINATING HOSPITAL IMMEDIATELY UPON ANY SUSPENSION, REVOCA- TION, OR LIMITATION OF SUCH PRIVILEGES. 3. NOTHING IN THIS SECTION SHALL BE CONSTRUED AS ALLOWING AN ORIGINAT- ING HOSPITAL TO DELEGATE ITS AUTHORITY OVER AND RESPONSIBILITY FOR DECI- SIONS CONCERNING THE CREDENTIALING AND GRANTING STAFF MEMBERSHIP OR PROFESSIONAL PRIVILEGES TO HEALTH CARE PRACTITIONERS PROVIDING TELEMEDI- CINE SERVICES. 4. NOTWITHSTANDING ANY CONTRARY PROVISION OF LAW, AN ORIGINATING HOSPITAL SHALL NOT BE REQUIRED TO PROVIDE A PHYSICAL EXAMINATION OR TO MAINTAIN RECORDED MEDICAL HISTORY INCLUDING IMMUNIZATIONS FOR A HEALTH CARE PROVIDER PROVIDING CONSULTATIONS SOLELY THROUGH TELEMEDICINE FROM A DISTANT SITE HOSPITAL. S 2. This act shall take effect immediately.