S6970-2011 - NY Senate Open Legislation - Provides for the credentialing of health care providers providing telemedicine services

Provides for the credentialing of health care providers providing telemedicine services. Legislative Commission on Rural Resources Bill.

Sponsor: YOUNG

Co-sponsor(s): BRESLIN, GALLIVAN, KLEIN, LIBOUS, O'MARA, RANZENHOFER, RITCHIE, VALESKY

Law Section: Public Health Law
Law: Add S2805-u, Pub Health L

S6970-2011 Actions

May 30, 2012: SUBSTITUTED BY A9834
May 21, 2012: ADVANCED TO THIRD READING
May 16, 2012: 2ND REPORT CAL.
May 15, 2012: 1ST REPORT CAL.817
Apr 18, 2012: REFERRED TO HEALTH

S6970-2011 Meetings

Health: May 15, 2012

S6970-2011 Calendars

Active List: May 30, 2012 , Floor Calendar: May 16, 2012 , Floor Calendar: May 21, 2012 , Floor Calendar: May 22, 2012 , Floor Calendar: May 23, 2012 , Floor Calendar: May 30, 2012

S6970-2011 Votes

VOTE: COMMITTEE VOTE: - Health - May 15, 2012

Ayes (15): Hannon, Ball, Farley, Fuschillo, Golden, Larkin, McDonald, Seward, Young, Duane, Adams, Gianaris, Montgomery, Smith, Stewart-Cousins
Ayes W/R (2): Rivera, Peralta

S6970-2011 Memo

BILL NUMBER:S6970

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.

S6970-2011 Text


                      S T A T E   O F   N E W   Y O R K
  ________________________________________________________________________

      S. 6970                                                  A. 9834

                        SENATE - ASSEMBLY

                               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  COMMUNICATIONS

   EXPLANATION--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.

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S6970-2011: Provides for the credentialing of health care providers providing telemedicine services