Requires insurers and medical assistance for needy persons to provide coverage for the provision of telehealth services

BILL NUMBER:S7852 REVISED 6/16/14

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 telehealth 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 coverage is subject to contractual limits including annual deductibles, coinsurance, 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 exclusion 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 individual 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 professionals 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.