Relates to telehealth delivery of services; repealer

Summary of provisions

Section one would repeal superseded paragraphs of subdivision 1 of section 2 of the public health law.

Section two would add a new article 29-G to the public health law to provide definitions for "distant site," "telehealth provider," "originating site," "telehealth," "telemedicine," "store and forward technology," and "remote patient monitoring."

Section three would repeal superseded paragraph 30 of subsection (1) of section 3216 of the insurance law.

Section four would add a new section 3217-h to the insurance law to require insurers to provide coverage for services delivered via telehealth, as long as such services and providers of the services are otherwise covered under the instant contract or policy. 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 telehealth.

Section five would repeal superseded paragraph 19 of subsection (k) of section 3221.

Section six would amend the insurance law to remove a contingency that services delivered via telehealth under a long term care plan are only reimbursable pursuant to an agreement.

Section seven would repeal superseded subsection (oo) of section 4303 of the insurance law.

Section eight would add a new section 4306-g to the insurance law to require non-profit medical and dental indemnity or health and hospital service corporations to provide coverage for services delivered via telehealth, as long as such services and providers of the services are otherwise covered under the instant contract or policy. 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 telehealth.

Section nine would add a new section 4406-g to the public health law to require health maintenance organizations to provide coverage for

services delivered via telehealth, as long as such services and providers of the services are otherwise covered under the instant contract or policy. 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 telehealth.

Section ten would provide for the provision of coverage of services delivered via telehealth under Medicaid.

Section eleven would amend the effective date of chapter 550 of the laws of 2014.

Section twelve would establish the effective date and authorize the commissioner of health to promulgate regulations necessary to implement the provisions of the act.

Justification

Telehealth can dramatically increase access to health services for patients who face challenges in accessing health care providers in-person, whether due to geographic distance, provider shortage, weather, or restricted patient mobility.

With the provision of health services via telehealth, 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.

The instant bill defines telehealth as the use of electronic information and telecommunications technologies by telehealth providers to deliver health care services, which shall include the assessment, diagnosis, consultation, treatment, education, care management and/or self-management of a patient.

Health insurers, including Medicaid, would provide coverage for services delivered via telehealth, as long as such services and providers of the services are otherwise covered under the patient's contract or policy. Providers include physicians, physician assistants, dentists, nurse practitioners, registered professional nurses, podiatrists, optometrists, psychologists, social workers, speech pathologists, midwives, diabetes educators, asthma educators, genetic counselors, hospitals, home care services agencies, hospices, or other providers as determined by the commissioner of health.

This bill does not require that services delivered via telehealth be covered if such services are not already covered under the existing contract or policy. Further, coverage would remain subject to contractual limits including annual deductibles, coinsurance,

utilization management, and other managed care tools at least as favorable as the same services not provided via telehealth.

Telehealth is a vital tool in improving the continuity, coordination, and efficiency of care, especially as New York moves toward population health and value-based models of health care. Thus, this bill will help bring much-needed and often vital health care services to rural and underserved populations.

Legislative history

This bill amends chapter 550 of the laws of 2014.

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, 2016, and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date.