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S07852 Summary:

BILL NOS07852
 
SAME ASSAME AS A09129-A
 
SPONSORYOUNG
 
COSPNSR
 
MLTSPNSR
 
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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S07852 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          7852
 
                    IN SENATE
 
                                      June 13, 2014
                                       ___________
 
        Introduced  by  Sen.  YOUNG  -- read twice and ordered printed, and when
          printed to be committed to the Committee on Rules
 
        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.
                                                                   LBD02532-10-4

        S. 7852                             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

        S. 7852                             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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