A09129 Summary:

BILL NOA09129A
 
SAME ASSAME AS S07852
 
SPONSORRussell
 
COSPNSRSantabarbara, Stirpe, Roberts, Barrett, Lifton, Brindisi, Gunther, Lupardo
 
MLTSPNSRDuprey, Kolb, Lopez P, Palmesano
 
Amd S2, Pub Health L; amd SS3216, 3221, 3229 & 4303, Ins L; amd S367-u, Soc Serv L
 
Requires insurers and medical assistance for needy persons to provide coverage for the provision of telehealth services.
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A09129 Actions:

BILL NOA09129A
 
03/19/2014referred to health
06/16/2014amend and recommit to health
06/16/2014print number 9129a
06/16/2014reported referred to ways and means
06/19/2014reported referred to rules
06/19/2014reported
06/19/2014rules report cal.554
06/19/2014substituted by s7852
 S07852 AMEND= YOUNG
 06/13/2014REFERRED TO RULES
 06/16/2014ORDERED TO THIRD READING CAL.1423
 06/16/2014PASSED SENATE
 06/16/2014DELIVERED TO ASSEMBLY
 06/16/2014referred to health
 06/19/2014substituted for a9129a
 06/19/2014ordered to third reading rules cal.554
 06/19/2014passed assembly
 06/19/2014returned to senate
 12/17/2014DELIVERED TO GOVERNOR
 12/29/2014SIGNED CHAP.550
 12/29/2014APPROVAL MEMO.35
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A09129 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A9129A
 
SPONSOR: Russell
  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 tele- health services   PURPOSE: Requires insurers and medical assistance for needy persons to provide coverage for the provision of telehealth and telemedicine 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 cover- age is subject to contractual limits including annual deductibles, coin- surance, 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 exclu- sion of telemedicine and telehealth services from reimbursement under Medicaid solely because the otherwise covered service was delivered by telemedicine or 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, and vital signs can be monitored remotely by registered nurses. Moreover, patients can get help with medication adherence, and can 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 practitioners across the state and world. However, to ensure that the field of telehealth and telemedicine can reach its full potential, these services cannot be denied reimbursement solely based on the manner through which they were provided. Any indi- vidual 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 specified technologies. Enabling health care profes- sionals to make use of available technology will empower them to better serve their patients and enhance health patient outcomes.   LEGISLATIVE HISTORY: New Bill.   FISCAL IMPLICATIONS: This bill will have no fiscal implications as the provided services are those otherwise covered under the relevant policy. All Medicaid provisions are subject to the approval of the Director of the Budget.   EFFECTIVE DATE: Effective January 1, 2015 and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date.
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A09129 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                         9129--A
 
                   IN ASSEMBLY
 
                                     March 19, 2014
                                       ___________
 
        Introduced  by M. of A. RUSSELL, SANTABARBARA, STIRPE, ROBERTS, BARRETT,
          LIFTON, BRINDISI, GUNTHER, LUPARDO -- Multi-Sponsored by -- M.  of  A.
          DUPREY,  P. LOPEZ -- read once and referred 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:
 
     1    Section  1.    Subdivision  1 of section 2 of the public health law is
     2  amended by adding five new paragraphs (o), (p), (q), (r) and (s) to read
     3  as follows:
     4    (o) Distant site. The term "distant site" means  a  site  at  which  a
     5  health  care provider is located while providing health care services by
     6  means of telemedicine  or  telehealth;  unless  the  term  is  otherwise
     7  defined with respect to the provision in which it is used.
     8    (p)  Health  care  provider.  The  term "health care provider" means a
     9  person licensed pursuant to article one hundred thirty-one, one  hundred

    10  thirty-one-B,  one  hundred  thirty-three,  one hundred thirty-nine, one
    11  hundred forty, one  hundred  forty-one,  one  hundred  forty-three,  one
    12  hundred  forty-four,  one hundred fifty-three, one hundred fifty-four or
    13  one hundred fifty-nine of the education law, acting within  his  or  her
    14  scope  of  practice, including any lawful practice entity of such health
    15  care practitioners; a hospital as defined  in  article  twenty-eight  of
    16  this chapter; home care services agency as defined in article thirty-six
    17  of  this chapter; or a hospice as defined in article forty of this chap-
    18  ter; unless the term is otherwise defined by law  with  respect  to  the
    19  provision in which it is used.

    20    (q)  Originating  site.  The  term  "originating site" means a site at
    21  which a patient is located at the time health care services are provided
    22  to him or her by means of telemedicine or telehealth, unless the term is
    23  otherwise defined with respect to the provision in  which  it  is  used.
    24  Provided,  however, notwithstanding any other provision of law, insurers
    25  and providers may agree to alternative siting arrangements deemed appro-
    26  priated by the parties.
    27    (r) Telehealth. The term "telehealth"  means  delivering  health  care
    28  services   by  means  of  information  and  communications  technologies
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.

                                                                   LBD02532-11-4

        A. 9129--A                          2
 
     1  consisting of telephones, remote patient  monitoring  devices  or  other
     2  electronic  means  which facilitate the assessment, diagnosis, consulta-
     3  tion, treatment, education, care management and  self  management  of  a
     4  patient's  health care while such patient is at the originating site and
     5  the health care provider is at a distant site; consistent with  applica-
     6  ble federal law and regulations; unless the term is otherwise defined by
     7  law with respect to the provision in which it is used.
     8    (s)  Telemedicine. The term "telemedicine" means the delivery of clin-

     9  ical health care services by means of real time two-way electronic audio
    10  visual communications, including the application of secure video confer-
    11  encing or store and forward technology to provide or support  healthcare
    12  delivery,  which  facilitate  the  assessment,  diagnosis, consultation,
    13  treatment, education, care management and self management of a patient's
    14  health care while such patient is at the originating site and the health
    15  care provider is at a distant site; consistent with  applicable  federal
    16  law  and  regulations;  unless the term is otherwise defined by law with
    17  respect to the provision in which it is used.
    18    § 2. Subsection (i) of section 3216 of the insurance law is amended by
    19  adding a new paragraph 30 to read as follows:

    20    (30) Every policy delivered or issued for delivery in this state which
    21  provides comprehensive coverage for hospital, medical or  surgical  care
    22  shall  make  available  and,  if  requested  by a policy holder, provide
    23  coverage for services which are otherwise covered under the policy  that
    24  are  provided  (A)  via  telemedicine,  as defined in section two of the
    25  public health law, provided that such services meet the requirements  of
    26  federal  law,  rules and regulations for Medicare (other than any origi-
    27  nating site restriction requirements); or (B)  telehealth  services,  as
    28  defined  in  section  two  of  the public health law, provided that such
    29  services are consistent with subdivision three-c of  section  thirty-six

    30  hundred fourteen of the public health law. The provider of such services
    31  shall meet the terms and conditions (to the extent not inconsistent with
    32  this  paragraph) of his or her contract with the insurer.  Such coverage
    33  required by this paragraph may be  subject  to  annual  deductibles  and
    34  coinsurance,  and other terms and conditions of coverage, including, but
    35  not limited to, utilization management and other managed care tools,  as
    36  are  consistent  with  those  established for the same services when not
    37  provided via telemedicine or telehealth.
    38    § 3. Subsection (k) of section 3221 of the insurance law is amended by
    39  adding a new paragraph 19 to read as follows:
    40    (19) Every group or blanket policy delivered or issued for delivery in

    41  this state which provides comprehensive coverage for  hospital,  medical
    42  or  surgical  care  shall  make available and, if requested by the group
    43  policyholder, provide coverage for services which are otherwise  covered
    44  under  the  policy that are provided (A) via telemedicine, as defined in
    45  section two of the public health law, provided that such  services  meet
    46  the  requirements  of  federal  law,  rules and regulations for Medicare
    47  (other than any originating site restriction requirements); or (B) tele-
    48  health services, as defined in section two of  the  public  health  law,
    49  provided  that  such services are consistent with subdivision three-c of
    50  section thirty-six hundred  fourteen  of  the  public  health  law.  The

    51  provider  of  such  services shall meet the terms and conditions (to the
    52  extent not inconsistent with this paragraph) of his or her contract with
    53  the insurer. Such coverage required by this paragraph may be subject  to
    54  annual  deductibles  and  coinsurance, and other terms and conditions of
    55  coverage, including, but not  limited  to,  utilization  management  and

        A. 9129--A                          3
 
     1  other  managed  care tools, as are consistent with those established for
     2  the same services when not provided via telemedicine or telehealth.
     3    §  4.   Paragraph 2 of subsection (a) of section 3229 of the insurance
     4  law, as amended by chapter 659 of the laws of 1997, is amended  to  read
     5  as follows:

     6    (2)  a  home  care benefit with personal care, nursing care, adult day
     7  health care [and], respite  care  services,  telemedicine  services,  as
     8  defined  in  section  two  of  the public health law, provided that such
     9  telemedicine services are pursuant to an agreement  between  a  provider
    10  participating  in  the  insurer's  network and the insurer, and meet the
    11  requirements of federal law, rules  and  regulations  for  Medicare,  or
    12  telehealth services, as defined by section two of the public health law,
    13  provided  that  such services are consistent with subdivision three-c of
    14  section thirty-six hundred  fourteen  of  the  public  health  law.  The
    15  provider  of  such  services shall meet the terms and conditions (to the

    16  extent not inconsistent with this paragraph) of his or her contract with
    17  the insurer, which shall provide total benefits in an amount  determined
    18  by regulations of the superintendent;
    19    §  5.  Section  4303  of  the insurance law is amended by adding a new
    20  subsection (oo) to read as follows:
    21    (oo) Every contract issued by a medical expense indemnity corporation,
    22  a hospital service corporation or a  health  service  corporation  which
    23  provides  comprehensive  coverage for hospital, medical or surgical care
    24  shall make available and, if requested by  a  contract  holder,  provide
    25  coverage  for services which are otherwise covered under the policy that
    26  are provided (1) via telemedicine, as defined  in  section  two  of  the

    27  public  health law, provided that such services meet the requirements of
    28  federal law, rules and regulations for Medicare (other than  any  origi-
    29  nating  site  restriction  requirements); or (2) telehealth services, as
    30  defined in section two of the public  health  law,  provided  that  such
    31  services  are  consistent with subdivision three-c of section thirty-six
    32  hundred fourteen of the public health law. The provider of such services
    33  shall meet the terms and conditions (to the extent not inconsistent with
    34  this subsection) of his or her contract with the insurer. Such  coverage
    35  required  by  this  subsection  may be subject to annual deductibles and
    36  coinsurance, and other terms and conditions of coverage, including,  but

    37  not  limited to, utilization management and other managed care tools, as
    38  are consistent with those established for the  same  services  when  not
    39  provided via telemedicine or telehealth.
    40    §  6.    The opening paragraph of section 367-u of the social services
    41  law is designated subdivision 1 and a new subdivision 2 is added to read
    42  as follows:
    43    2. Subject to the approval of the director of the budget, the  commis-
    44  sioner  shall  not  exclude from the payment of medical assistance funds
    45  the provision of medical care through telemedicine services, as  defined
    46  in  section  two  of  the public health law, provided that such services
    47  meet the requirements of federal law,  rules  and  regulations  for  the

    48  provision  of  medical  assistance pursuant to this title, and for tele-
    49  health services, as defined by section two of  the  public  health  law,
    50  that are, at a minimum, those required to be provided pursuant to subdi-
    51  vision  three-c  of  section  thirty-six  hundred fourteen of the public
    52  health law.
    53    § 7.  This act shall take effect January 1, 2015 and  shall  apply  to
    54  all policies and contracts issued, renewed, modified, altered or amended
    55  on or after such date.
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