Amd §§3217-h, 3216, 3221, 4303 & 4306-g, Ins L; amd §2999-cc, Pub Health L; amd §365-a, Soc Serv L
Requires insurers to provide coverage for delivery through store and forward technology; requires prescription drug policies to cover the cost of contraceptive care delivered via telemedicine.
NEW YORK STATE ASSEMBLY MEMORANDUM IN SUPPORT OF LEGISLATION submitted in accordance with Assembly Rule III, Sec 1(f)
BILL NUMBER: A365
SPONSOR: Rosenthal L TITLE OF BILL:
An act to amend the insurance law, the public health law and the social
services law, in relation to requiring coverage for delivery through
store and forward technology
PURPOSE:
To ensure coverage of contraceptive care delivered through store and
forward technology.
SUMMARY OF SPECIFIC PROVISIONS:
Section one provides the legislative findings and declaration.
Section two amends subsection (a) of section 3217-h of the insurance
law.
Section three amends subsection (i) of section 3216 of the insurance law
by adding a new paragraph 36. Section four amends subsection (1) of
section 3221 of the insurance law by adding a new paragraph 22.
Section five amends section 4303 of the insurance law by adding a new
subsection (ss).
Section six amends section 4306-g of the insurance law.
Section seven amends subdivision 6 of section 2999-cc of the public
health law.
Section eight amends subdivision 2 of section 365-a of the social
services law by adding a new paragraph (ii).
Section nine establishes the effective date.
JUSTIFICATION:
Before and during the COV1D-19 pandemic, accessing contraceptive care
through store and forward telemedicine, also known as asynchronous tele-
medicine, grew in popularity. Store and forward technology allows a
patient to answer questions and provide medical information that is
later reviewed by a doctor who will coordinate with the patient to
devise an appropriate treatment plan. Using this method, doctors and
patients do not need to be on the phone or computer at the same time to
development a treatment plan.
This method has been relied upon by many individuals accessing contra-
ceptive care and has allowed them to obtain their birth control
prescriptions and have their medications shipped to them without needing
to visit a doctor's office or pharmacy in-person. The ease of the trans-
action and the privacy it provides has allowed many individuals to
access birth control who would not otherwise have such access. Despite
the ease of use and the growth in popularity, numerous private insurers
continue to deny store and forward telemedicine claims. Nowhere is this
more prevalent than in women's health. While it is easy to receive most
medications through the mail, or through store and forward telemedicine,
contraceptives continue to be denied by insurers. This bill would ensure
that women across New York State are able to receive contraceptive care
continuously and reliably by requiring that every policy that provides
coverage for prescription drugs also cover contraceptive care delivered
using store and forward technology.
FISCAL IMPLICATIONS: Undetermined.
PRIOR LEGISLATIVE HISTORY:
2021-22: A.6741 - Referred to Insurance
EFFECTIVE DATE:
This act shall take effect immediately.
STATE OF NEW YORK
________________________________________________________________________
365
2023-2024 Regular Sessions
IN ASSEMBLY
January 6, 2023
___________
Introduced by M. of A. L. ROSENTHAL -- read once and referred to the
Committee on Insurance
AN ACT to amend the insurance law, the public health law and the social
services law, in relation to requiring coverage for delivery through
store and forward technology
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Legislative findings and declaration. The Legislature here-
2 by finds that there is a serious health concern in insurance policies
3 denying coverage for contraceptive care. The Legislature also finds that
4 throughout the COVID-19 pandemic, telemedicine has been essential for
5 patients across the state to receive care safely.
6 This Act enacts various provisions requiring that insurance policies
7 cover services provided through telemedicine, including requirements
8 that insurers provide coverage for contraceptive care, that will allow
9 patients across the state to receive care and limit the risk of
10 infection of COVID-19 throughout the pandemic.
11 § 2. Subsection (a) of section 3217-h of the insurance law, as amended
12 by section 3 of part V of chapter 57 of the laws of 2022, is amended to
13 read as follows:
14 (a) (1) An insurer shall not exclude from coverage a service that is
15 otherwise covered under a policy that provides comprehensive coverage
16 for hospital, medical or surgical care, or prescription drugs because
17 the service is delivered via telehealth or through store and forward
18 technology, as [that term is] such terms are defined in subsection (b)
19 of this section[; provided, however, that an insurer may exclude from
20 coverage a service by a health care provider where the provider is not
21 otherwise covered under the policy] and in section twenty-nine hundred
22 ninety-nine-cc of the public health law. An insurer may subject the
23 coverage of a service delivered via telehealth to co-payments, coinsu-
24 rance or deductibles provided that they are at least as favorable to the
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD01398-02-3
A. 365 2
1 insured as those established for the same service when not delivered via
2 telehealth. An insurer may subject the coverage of a service delivered
3 via telehealth to reasonable utilization management and quality assur-
4 ance requirements that are consistent with those established for the
5 same service when not delivered via telehealth.
6 (2) An insurer that provides comprehensive coverage for hospital,
7 medical or surgical care shall reimburse covered services delivered by
8 means of telehealth on the same basis, at the same rate, and to the same
9 extent that such services are reimbursed when delivered in person;
10 provided that reimbursement of covered services delivered via telehealth
11 shall not require reimbursement of costs not actually incurred in the
12 provision of the telehealth services, including charges related to the
13 use of a clinic or other facility when neither the originating site nor
14 distant site occur within the clinic or other facility.
15 (3) An insurer that provides comprehensive coverage for hospital,
16 medical, or surgical care with a network of health care providers shall
17 ensure that such network is adequate to meet the telehealth needs of
18 insured individuals for services covered under the policy when medically
19 appropriate.
20 § 2-a. Subsection (a) of section 3217-h of the insurance law, as added
21 by chapter 6 of the laws of 2015, is amended to read as follows:
22 (a) An insurer shall not exclude from coverage a service that is
23 otherwise covered under a policy that provides comprehensive coverage
24 for hospital, medical or surgical care, or prescription drugs because
25 the service is delivered via telehealth or through store and forward
26 technology, as [that term is] such terms are defined in subsection (b)
27 of this section [; provided, however, that an insurer may exclude from
28 coverage a service by a health care provider where the provider is not
29 otherwise covered under the policy] and in section twenty-nine hundred
30 ninety-nine-cc of the public health law. An insurer may subject the
31 coverage of a service delivered via telehealth to co-payments, coinsu-
32 rance or deductibles provided that they are at least as favorable to the
33 insured as those established for the same service when not delivered via
34 telehealth. An insurer may subject the coverage of a service delivered
35 via telehealth to reasonable utilization management and quality assur-
36 ance requirements that are consistent with those established for the
37 same service when not delivered via telehealth.
38 § 3. Subsection (i) of section 3216 of the insurance law is amended by
39 adding a new paragraph 39 to read as follows:
40 (39) Every policy which provides coverage for prescription drugs shall
41 include coverage for the cost of contraceptive care delivered through
42 store and forward technology as authorized by section twenty-nine
43 hundred ninety-nine-cc of the public health law.
44 § 4. Subsection (l) of section 3221 of the insurance law is amended by
45 adding a new paragraph 22 to read as follows:
46 (22) Every policy which provides coverage for prescription drugs shall
47 include coverage for the cost of contraceptive care delivered through
48 store and forward technology in accordance with section twenty-nine
49 hundred ninety-nine-cc of the public health law.
50 § 5. Section 4303 of the insurance law is amended by adding a new
51 subsection (uu) to read as follows:
52 (uu) Every contract issued by a hospital service corporation or a
53 health service corporation which provides coverage for prescription
54 drugs shall include coverage for the cost of contraceptive care deliv-
55 ered through store and forward technology as that term is defined in
56 section twenty-nine hundred ninety-nine-cc of the public health law.
A. 365 3
1 § 6. Subsection (a) of section 4306-g of the insurance law, as amended
2 by section 4 of part V of chapter 57 of the laws of 2022, is amended to
3 read as follows:
4 (a) (1) A corporation shall not exclude from coverage a service that
5 is otherwise covered under a contract that provides comprehensive cover-
6 age for hospital, medical or surgical care, or prescription drugs
7 because the service is delivered via telehealth[,] or through store and
8 forward technology as [that term is] such terms are defined in
9 subsection (b) of this section[; provided, however, that a corporation
10 may exclude from coverage a service by a health care provider where the
11 provider is not otherwise covered under the contract] and in section
12 twenty-nine hundred ninety-nine-cc of the public health law. A corpo-
13 ration may subject the coverage of a service delivered via telehealth to
14 co-payments, coinsurance or deductibles provided that they are at least
15 as favorable to the insured as those established for the same service
16 when not delivered via telehealth. A corporation may subject the cover-
17 age of a service delivered via telehealth to reasonable utilization
18 management and quality assurance requirements that are consistent with
19 those established for the same service when not delivered via tele-
20 health.
21 (2) A corporation that provides comprehensive coverage for hospital,
22 medical or surgical care shall reimburse covered services delivered by
23 means of telehealth on the same basis, at the same rate, and to the same
24 extent that such services are reimbursed when delivered in person;
25 provided that reimbursement of covered services delivered via telehealth
26 shall not require reimbursement of costs not actually incurred in the
27 provision of the telehealth services, including charges related to the
28 use of a clinic or other facility when neither the originating site nor
29 the distant site occur within the clinic or other facility. The super-
30 intendent may promulgate regulations to implement the provisions of this
31 section.
32 (3) A corporation that provides comprehensive coverage for hospital,
33 medical, or surgical care with a network of health care providers shall
34 ensure that such network is adequate to meet the telehealth needs of
35 insured individuals for services covered under the policy when medically
36 appropriate.
37 § 6-a. Subsection (a) of section 4306-g of the insurance law, as added
38 by chapter 6 of the laws of 2015, is amended to read as follows:
39 (a) A corporation shall not exclude from coverage a service that is
40 otherwise covered under a contract that provides comprehensive coverage
41 for hospital, medical or surgical care, or prescription drugs because
42 the service is delivered via telehealth[,] or through store and forward
43 technology as [that term is] such terms are defined in subsection (b) of
44 this section [; provided, however, that a corporation may exclude from
45 coverage a service by a health care provider where the provider is not
46 otherwise covered under the contract] and in section twenty-nine hundred
47 ninety-nine-cc of the public health law. A corporation may subject the
48 coverage of a service delivered via telehealth to co-payments, coinsu-
49 rance or deductibles provided that they are at least as favorable to the
50 insured as those established for the same service when not delivered via
51 telehealth. A corporation may subject the coverage of a service deliv-
52 ered via telehealth to reasonable utilization management and quality
53 assurance requirements that are consistent with those established for
54 the same service when not delivered via telehealth.
55 § 7. Subdivision 6 of section 2999-cc of the public health law, as
56 added by chapter 6 of the laws of 2015, is amended to read as follows:
A. 365 4
1 6. "Store and forward technology" means the asynchronous, electronic
2 transmission of a patient's health information [in the form of patient-
3 specific digital images and/or pre-recorded videos from a provider at]
4 from an originating site to a telehealth provider at a distant site.
5 § 8. Subdivision 2 of section 365-a of the social services law is
6 amended by adding a new paragraph (kk) to read as follows:
7 (kk) care and services provided by a telehealth provider pursuant to
8 section twenty-nine hundred ninety-nine-cc of the public health law.
9 § 9. This act shall take effect immediately; provided that the amend-
10 ments to subsection (a) of section 3217-h of the insurance law made by
11 section two of this act shall be subject to the expiration and reversion
12 of such subdivision pursuant to section 7 of part V of chapter 57 of the
13 laws of 2022, as amended, when upon such date the provisions of section
14 two-a of this act shall take effect; provided, further, the amendments
15 to subsection (a) of section 4306-g of the insurance law made by section
16 six of this act shall be subject to the expiration and reversion of such
17 subsection pursuant to section 7 of part V of chapter 57 of the laws of
18 2022, as amended, when upon such date the provisions of section six-a of
19 this act shall take effect.
