A08200 Summary:

BILL NO    A08200 

SAME AS    SAME AS S05852

SPONSOR    Russell

COSPNSR    

MLTSPNSR   

Amd SS2999-cc & 4406-g, Pub Health L; amd SS1117, 3217-h, 3229 & 4306-g, Ins L

Provides for the delivery and insurance coverage of telehealth services by
means of home care services.
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A08200 Actions:

BILL NO    A08200 

06/11/2015 referred to health
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A08200 Text:

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

                                         8200

                              2015-2016 Regular Sessions

                                 I N  A S S E M B L Y

                                     June 11, 2015
                                      ___________

       Introduced  by M. of A. RUSSELL -- read once and referred to the Commit-
         tee on Health

       AN ACT to amend the public health law and the insurance 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:

    1    Section  1. Subdivision 4 of section 2999-cc of the public health law,
    2  as added by chapter 6 of the  laws  of  2015,  is  amended  to  read  as
    3  follows:
    4    4.  "Telehealth"  means the use of electronic information and communi-
    5  cation technologies by  telehealth  providers  to  deliver  health  care
    6  services,  which  shall include the assessment, diagnosis, consultation,
    7  treatment,  education,  care  management  and/or  self-management  of  a
    8  patient.  Telehealth  shall not include delivery of health care services
    9  by means of audio-only telephone communication, facsimile  machines,  or
   10  electronic  messaging  alone,  though  use  of these technologies is not
   11  precluded if used in conjunction with telemedicine,  store  and  forward
   12  technology,  or remote patient monitoring. For purposes of this section,
   13  telehealth shall be limited to telemedicine, store and forward technolo-
   14  gy, and remote patient monitoring. This subdivision shall  not  preclude
   15  OR  IN  ANY  WAY  LIMIT the delivery of health care services by means of
   16  "home telehealth" as used in section thirty-six hundred fourteen of this
   17  chapter. HEALTH SERVICES, DEFINED  AS  "HOME  CARE  SERVICES"  REQUIRING
   18  LICENSURE  OR  CERTIFICATION  UNDER  ARTICLE THIRTY-SIX OF THIS CHAPTER,
   19  DELIVERED VIA TELEHEALTH AS SET FORTH IN THIS SUBDIVISION OR IN  SECTION
   20  THIRTY-SIX HUNDRED FOURTEEN OF THIS CHAPTER SHALL BE DELIVERED SOLELY BY
   21  A PROVIDER LICENSED, CERTIFIED OR EXEMPT UNDER SUCH ARTICLE.
   22    S  2.  Paragraph  3 of subsection (b) of section 1117 of the insurance
   23  law, as amended by chapter 572 of the laws of 2008, is amended  to  read
   24  as follows:

        EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                             [ ] is old law to be omitted.
                                                                  LBD11547-02-5
       A. 8200                             2

    1    (3) the plan's benefit structure provides options for use of long term
    2  care services, INCLUDING TELEHEALTH AS PROVIDED FOR IN SUBPARAGRAPHS (A)
    3  AND (B) OF THIS PARAGRAPH.
    4    (A) A PLAN SHALL NOT EXCLUDE FROM COVERAGE A SERVICE THAT IS OTHERWISE
    5  COVERED  UNDER THE PLAN BECAUSE THE SERVICE IS DELIVERED VIA TELEHEALTH,
    6  AS THAT TERM IS DEFINED IN SUBPARAGRAPH (B) OF THIS PARAGRAPH; PROVIDED,
    7  HOWEVER, THAT AN INSURER MAY EXCLUDE FROM COVERAGE A SERVICE BY A HEALTH
    8  CARE PROVIDER WHERE THE PROVIDER IS  NOT  OTHERWISE  COVERED  UNDER  THE
    9  ENROLLEE  CONTRACT.  AN  INSURER  MAY  SUBJECT THE COVERAGE OF A SERVICE
   10  DELIVERED VIA TELEHEALTH  TO  CO-PAYMENTS,  COINSURANCE  OR  DEDUCTIBLES
   11  PROVIDED  THAT  THEY  ARE AT LEAST AS FAVORABLE TO THE ENROLLEE AS THOSE
   12  ESTABLISHED FOR THE SAME SERVICE WHEN NOT DELIVERED VIA  TELEHEALTH.  AN
   13  INSURER  MAY  SUBJECT THE COVERAGE OF A SERVICE DELIVERED VIA TELEHEALTH
   14  TO REASONABLE UTILIZATION MANAGEMENT AND QUALITY ASSURANCE  REQUIREMENTS
   15  THAT ARE CONSISTENT WITH THOSE ESTABLISHED FOR THE SAME SERVICE WHEN NOT
   16  DELIVERED VIA TELEHEALTH;
   17    (B)  FOR  PURPOSES  OF  THIS  PARAGRAPH, "TELEHEALTH" MEANS THE USE OF
   18  ELECTRONIC INFORMATION AND COMMUNICATION TECHNOLOGIES BY A  HEALTH  CARE
   19  PROVIDER  TO DELIVER HEALTH CARE SERVICES TO AN INSURED INDIVIDUAL WHILE
   20  SUCH INDIVIDUAL IS LOCATED AT A SITE THAT IS  DIFFERENT  FROM  THE  SITE
   21  WHERE THE HEALTH CARE PROVIDER IS LOCATED;
   22    S  3.  Subsection (a) of section 3217-h of the insurance law, as added
   23  by chapter 6 of the laws of 2015, is amended to read as follows:
   24    (a) An insurer shall not exclude  from  coverage  a  service  that  is
   25  otherwise  covered  under  a policy that provides comprehensive coverage
   26  for hospital, medical or surgical care because the service is  delivered
   27  via  telehealth,  as  that  term  is  defined  in subsection (b) of this
   28  section; provided, however, that an insurer may exclude from coverage  a
   29  service  by  a  health care provider where the provider is not otherwise
   30  covered under the policy. An insurer  may  subject  the  coverage  of  a
   31  service  delivered via telehealth to co-payments, coinsurance or deduct-
   32  ibles provided that they are at least as favorable  to  the  insured  as
   33  those  established  for  the  same  service when not delivered via tele-
   34  health. An insurer may subject the coverage of a service  delivered  via
   35  telehealth  to  reasonable  utilization management and quality assurance
   36  requirements that are consistent with those  established  for  the  same
   37  service when not delivered via telehealth. REMOTE PATIENT MONITORING VIA
   38  TELEHEALTH  DELIVERED  BY A HOME CARE AGENCY CERTIFIED OR LICENSED UNDER
   39  ARTICLE THIRTY-SIX OF THE PUBLIC HEALTH LAW SHALL NOT BE CONSTRUED AS  A
   40  "VISIT"  UNDER ANY VISIT NUMBER LIMITATION THAT A POLICY MAY CONTAIN FOR
   41  HOME CARE VISITS BY A HOME CARE SERVICES AGENCY.
   42    S 4. Paragraph 2 of subsection (a) of section 3229  of  the  insurance
   43  law,  as  amended by chapter 6 of the laws of 2015, is amended and a new
   44  paragraph 2-a is added to read as follows:
   45    (2) a home care benefit with personal care, nursing  care,  adult  day
   46  health  care  and respite care services, which shall provide total bene-
   47  fits in an amount  determined  by  regulations  of  the  superintendent;
   48  PROVIDED  HOWEVER  THAT  AN  INSURER  SHALL  NOT EXCLUDE FROM COVERAGE A
   49  SERVICE THAT IS OTHERWISE COVERED UNDER THE POLICY BECAUSE  THE  SERVICE
   50  IS  DELIVERED  VIA TELEHEALTH AS THAT TERM IS DEFINED IN PARAGRAPH TWO-A
   51  OF THIS SUBSECTION, PROVIDED, FURTHER, THAT AN INSURER MAY EXCLUDE  FROM
   52  COVERAGE  A  SERVICE BY A HEALTH CARE PROVIDER WHERE THE PROVIDER IS NOT
   53  OTHERWISE COVERED UNDER THE ENROLLEE CONTRACT. AN  INSURER  MAY  SUBJECT
   54  THE COVERAGE OF A SERVICE DELIVERED VIA TELEHEALTH TO CO-PAYMENTS, COIN-
   55  SURANCE,  OR DEDUCTIBLES PROVIDED THAT THEY ARE AT LEAST AS FAVORABLE TO
   56  THE ENROLLEE AS THOSE ESTABLISHED FOR THE SAME SERVICE WHEN  NOT  DELIV-
       A. 8200                             3

    1  ERED  VIA  TELEHEALTH.  AN INSURER MAY SUBJECT THE COVERAGE OF A SERVICE
    2  DELIVERED VIA TELEHEALTH TO REASONABLE UTILIZATION MANAGEMENT AND QUALI-
    3  TY ASSURANCE REQUIREMENTS THAT ARE CONSISTENT WITH THOSE ESTABLISHED FOR
    4  THE SAME SERVICE WHEN NOT DELIVERED VIA TELEHEALTH;
    5    (2-A)  FOR  PURPOSES OF PARAGRAPH TWO OF THIS SUBSECTION, "TELEHEALTH"
    6  MEANS THE USE OF ELECTRONIC INFORMATION AND  COMMUNICATION  TECHNOLOGIES
    7  BY  A HEALTH CARE PROVIDER TO DELIVER HEALTH CARE SERVICES TO AN INSURED
    8  INDIVIDUAL WHILE SUCH INDIVIDUAL IS LOCATED AT A SITE THAT IS  DIFFERENT
    9  FROM THE SITE WHERE THE HEALTH CARE PROVIDER IS LOCATED;
   10    S  5.  Subsection (a) of section 4306-g of the insurance law, as added
   11  by chapter 6 of the laws of 2015, is amended to read as follows:
   12    (a) A corporation shall not exclude from coverage a  service  that  is
   13  otherwise  covered under a contract that provides comprehensive coverage
   14  for hospital, medical or surgical care because the service is  delivered
   15  via  telehealth,  as  that  term  is  defined  in subsection (b) of this
   16  section; provided, however, that a corporation may exclude from coverage
   17  a service by a health care provider where the provider is not  otherwise
   18  covered under the contract.  A corporation may subject the coverage of a
   19  service  delivered via telehealth to co-payments, coinsurance or deduct-
   20  ibles provided that they are at least as favorable  to  the  insured  as
   21  those  established  for  the  same  service when not delivered via tele-
   22  health. A corporation may subject the coverage of  a  service  delivered
   23  via  telehealth  to reasonable utilization management and quality assur-
   24  ance requirements that are consistent with  those  established  for  the
   25  same  service when not delivered via telehealth. REMOTE PATIENT MONITOR-
   26  ING VIA TELEHEALTH DELIVERED BY A HOME CARE AGENCY CERTIFIED OR LICENSED
   27  UNDER ARTICLE THIRTY-SIX OF THE PUBLIC HEALTH LAW SHALL NOT BE CONSTRUED
   28  AS A "VISIT" UNDER ANY VISIT NUMBER LIMITATION THAT A POLICY MAY CONTAIN
   29  FOR HOME CARE VISITS BY A HOME CARE SERVICES AGENCY.
   30    S 6. Subdivision 1 of section 4406-g of  the  public  health  law,  as
   31  added by chapter 6 of the laws of 2015, is amended to read as follows:
   32    1. A health maintenance organization shall not exclude from coverage a
   33  service that is otherwise covered under an enrollee contract of a health
   34  maintenance  organization  because  the  service  is delivered via tele-
   35  health, as that term is defined in  subdivision  two  of  this  section;
   36  provided,  however,  that  a health maintenance organization may exclude
   37  from coverage a service by a health care provider where the provider  is
   38  not  otherwise covered under the enrollee contract. A health maintenance
   39  organization may subject the coverage of a service delivered  via  tele-
   40  health to co-payments, coinsurance or deductibles provided that they are
   41  at  least as favorable to the enrollee as those established for the same
   42  service when not delivered via telehealth. A health  maintenance  organ-
   43  ization  may  subject the coverage of a service delivered via telehealth
   44  to reasonable utilization management and quality assurance  requirements
   45  that are consistent with those established for the same service when not
   46  delivered  via  telehealth.  REMOTE  PATIENT  MONITORING  VIA TELEHEALTH
   47  DELIVERED BY A HOME CARE AGENCY  CERTIFIED  OR  LICENSED  UNDER  ARTICLE
   48  THIRTY-SIX OF THIS CHAPTER SHALL NOT BE CONSTRUED AS A "VISIT" UNDER ANY
   49  VISIT  NUMBER  LIMITATION THAT A POLICY MAY CONTAIN FOR HOME CARE VISITS
   50  BY A HOME CARE SERVICES AGENCY.
   51    S 7. This act shall take effect on the  same  date  and  in  the  same
   52  manner as chapter 550 of the laws of 2014, as amended, takes effect.
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