Section 1. Title. This act shall be known as and may be cited as the Telemedicine

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(1)

IN THE GENERAL ASSEMBLY STATE OF ____________

Telemedicine Reimbursement Act

Be it enacted by the People of the State of , represented in the General 1

Assembly: 2

Section 1. Title. This act shall be known as and may be cited as the Telemedicine

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Reimbursement Act. 4

Section 2. Purpose.

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The Legislature hereby finds and declares that: 6

(A) The advancements and continued development of medical and communications 7

technology have had a profound impact on the practice of medicine and offer opportunities for 8

improving the delivery and accessibility of health care, particularly in the area of telemedicine. 9

(B) Geography, weather, availability of specialists, transportation, and other factors can 10

create barriers to accessing appropriate health care, including behavioral health care, and one 11

way to provide, ensure, or enhance access to care given these barriers is through the appropriate 12

use of technology to allow health care consumers access to qualified health care providers. 13

(C) There is a need in this state to embrace efforts that will encourage health insurers and 14

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agencies to evaluate and amend their policies and rules to remove any regulatory barriers 1

prohibiting the use of telemedicine services. 2

Section 3. Definitions.

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(A) “Telemedicine” means the delivery of clinical health care services by means of real 4

time two-way electronic audio visual communications, including the application of secure video 5

conferencing or store and forward technology to provide or support healthcare delivery, which 6

facilitate the assessment, diagnosis, consultation, treatment, education, care management and 7

self-management of a patient’s health care while such patient is at an originating site and the 8

health care provider is at a distant site; consistent with applicable federal law and regulations; 9

unless the term is otherwise defined by law with respect to the provision in which it is used. 10

(B) “Telehealth” means delivering health care services by means of information and 11

communications technologies consisting of telephones, remote patient monitoring devices or 12

other electronic means which facilitate the assessment, diagnosis, consultation, treatment, 13

education, care management and self-management of a patient’s health care while such patient is 14

at the originating site and the health care provider is at the distant site; consistent with applicable 15

federal law and regulations; unless the term is otherwise defined by law with respect to the 16

provision in which it is used. 17

(C) “Store and forward” transfer means the transmission of a patient’s medical 18

information from an originating site to the provider at the distant site without the patient being 19

present. 20

(D) “Distant site” means a site at which a health care provider is located while providing 21

health care services by means of telemedicine or telehealth; unless the term is otherwise defined 22

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(E) “Originating site” means a site at which a patient is located at the time health care 1

services are provided to him or her by means of telemedicine or telehealth, unless the term is 2

otherwise defined with respect to the provision in which it is used; provided, however, 3

notwithstanding any other provision of law, insurers and providers may agree to alternative siting 4

arrangements deemed appropriate by the parties. 5

Section 4. Coverage of telemedicine services.

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(A) Each insurer proposing to issue individual or group accident and sickness insurance 7

policies providing hospital, medical and surgical, or major medical coverage on an expense-8

incurred basis; each corporation providing individual or group accident and sickness subscription 9

contracts; and each health maintenance organization providing a health care plan for health care 10

services shall provide coverage for the cost of such health care services provided through 11

telemedicine services, as provided in this section. 12

(B) An insurer, corporation, or health maintenance organization shall not exclude a 13

service for coverage solely because the service is provided through telemedicine services and is 14

not provided through in-person consultation or contact between a health care provider and a 15

patient for services appropriately provided through telemedicine services. 16

(C) An insurer, corporation, or health maintenance organization shall reimburse the 17

treating provider or the consulting provider for the diagnosis, consultation, or treatment of the 18

insured delivered through telemedicine services on the same basis that the insurer, corporation, 19

or health maintenance organization is responsible for coverage for the provision of the same 20

service through in-person consultation or contact. Payment for telemedicine interactions shall 21

include reasonable compensation to the originating site for the transmission cost incurred during 22

(4)

(D) An insurer, corporation, or health maintenance organization may offer a health plan 1

containing a deductible, copayment, or coinsurance requirement for a health care service 2

provided through telemedicine services, provided that the deductible, copayment, or coinsurance 3

does not exceed the deductible, copayment, or coinsurance applicable if the same services were 4

provided through in-person diagnosis, consultation, or treatment. 5

(E) No insurer, corporation, or health maintenance organization shall impose any annual 6

or lifetime dollar maximum on coverage for telemedicine services other than an annual or 7

lifetime dollar maximum that applies in the aggregate to all items and services covered under the 8

policy, or impose upon any person receiving benefits pursuant to this section any copayment, 9

coinsurance, or deductible amounts, or any policy year, calendar year, lifetime, or other 10

durational benefit limitation or maximum for benefits or services, that is not equally imposed 11

upon all terms and services covered under the policy, contract, or plan. 12

(F) The requirements of this section shall apply to all insurance policies, contracts, and 13

plans delivered, issued for delivery, reissued, or extended in [State] on and after January 1, 20__, 14

or at any time thereafter when any term of the policy, contract, or plan is changed or any 15

premium adjustment is made. 16

(G) This section shall not apply to short-term travel, accident-only, limited or specified 17

disease, or individual conversion policies or contracts, nor to policies or contracts designed for 18

issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as 19

Medicare, or any other similar coverage under state or federal governmental plans. 20

Drafting Note re: Utilization Review and Prior Authorization—States may wish to

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include the following provision regarding utilization review and prior authorization:

(5)

(H) Nothing shall preclude the insurer, corporation, or health maintenance organization

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from undertaking utilization review to determine the appropriateness of telemedicine services,

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provided that such appropriateness is made in the same manner as those determinations are

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made for the treatment of any other illness, condition, or disorder covered by such policy,

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contract, or plan, and provided all adverse determinations are made by a physician who

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possesses a current and valid non-restricted license to practice medicine in [State in which the

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services are provided] and is board certified or eligible in the same specialty as the health care

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provider who typically manages the medical condition or disease or provides the health care

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service. Any such utilization review shall not require prior authorization of emergent

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telemedicine services.

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Section 5. Effective. This Act shall become effective immediately upon being enacted into law.

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Section 6. Severability. If any provision of this Act is held by a court to be invalid, such

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invalidity shall not affect the remaining provisions of this Act, and to this end the provisions of 13

this Act are hereby declared severable. 14

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