What's happening
This bill expands and clarifies telehealth coverage and protections under New York health and insurance laws, especially for home care services.
Why it matters
Ensures telehealth parity for home care. The bill mandates that health insurers cannot deny coverage for home care services just because they are delivered via telehealth, helping to modernize care and make it more accessible for patients who may have mobility or transportation challenges.
Protects against restrictive insurance practices. By clarifying that remote patient monitoring by certified home care agencies does not count against visit limits in insurance policies, the bill prevents insurers from using technicalities to restrict access to needed at-home care.
Maintains quality and provider standards. The bill requires that any "home care services" delivered via telehealth must be provided by agencies or providers properly licensed or certified under state law, helping to ensure patient safety and service quality.
Sets fair cost-sharing rules. Insurers can apply co-pays, deductibles, and utilization management to telehealth services, but only if these terms are at least as favorable as for in-person services, ensuring telehealth does not become more expensive or harder to access than traditional care.
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Who cares
Licensed and certified home care agencies
The bill would reserve telehealth delivery of home care services requiring Article 36 licensure or certification to providers licensed, certified or exempt under that article.
- Watching
Patients receiving home care
Remote patient monitoring delivered by licensed or certified home care agencies would not count toward home care visit limits under the coverage provisions amended by the bill.
Long-term care insurers and policyholders
The bill would bar exclusions of otherwise covered services solely because they are delivered through telehealth and require cost-sharing at least as favorable as for the same services delivered without telehealth.
- Watching
Health insurers and HMOs
The bill would require them to keep qualifying home care remote patient monitoring separate from visit counts when applying home care visit limits.
Headline styles
Cover Telehealth Home Care
Plain English, a few words. Used as the page title.
Sponsors
No co-sponsors yet.
History
- Recommit, enacting clause stricken
- Referred to health
Full text
3 pagesUnderlined is new[Struck] is removedOfficial text on nysenate.gov ↗
STATE OF NEW YORK
888
2019-2020 Regular Sessions
IN SENATE
January 9, 2019
Introduced by Sen. YOUNG -- read twice and ordered printed, and when printed to be committed to the Committee on Health
AN ACT to amend the public health law and the insurance law, in relation to the provision of telehealth services
The People of the State of New York, represented in Senate and Assembly, do enact as follows:
Section 1. Subdivision 4 of section 2999-cc of the public health law, as added by chapter 6 of the laws of 2015, is amended to read as follows:
4. "Telehealth" means the use of electronic information and communication 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. Telehealth shall not include delivery of health care services by means of audio-only telephone communication, facsimile machines, or electronic messaging alone, though use of these technologies is not precluded if used in conjunction with telemedicine, store and forward technology, or remote patient monitoring. For purposes of this section, telehealth shall be limited to telemedicine, store and forward technology, and remote patient monitoring. This subdivision shall not preclude or in any way limit the delivery of health care services by means of "home telehealth" as used in section thirty-six hundred fourteen of this chapter. Health services, defined as "home care services" requiring licensure or certification under article thirty-six of this chapter, delivered via telehealth as set forth in this subdivision or in section thirty-six hundred fourteen of this chapter shall be delivered solely by a provider licensed, certified or exempt under such article.
§ 2. Paragraph 3 of subsection (b) of section 1117 of the insurance law, as amended by chapter 572 of the laws of 2008, is amended to read as follows:
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD04138-01-9
S. 888 2
(3) the plan's benefit structure provides options for use of long term care services, including telehealth as provided for in subparagraphs (A) and (B) of this paragraph.
(A) a plan shall not exclude from coverage a service that is otherwise covered under the plan because the service is delivered via telehealth, as that term is defined in subparagraph (B) of this paragraph; provided, however, that an insurer may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the enrollee contract. An insurer may subject the coverage of a service delivered via telehealth to co-payments, coinsurance or deductibles provided that they are at least as favorable to the enrollee as those established for the same service when not delivered via telehealth. An insurer may subject the coverage of a service delivered via telehealth to reasonable utilization management and quality assurance requirements that are consistent with those established for the same service when not delivered via telehealth;
(B) for purposes of this paragraph, "telehealth" means the use of electronic information and communication technologies by a health care provider to deliver health care services to an insured individual while such individual is located at a site that is different from the site where the health care provider is located;
§ 3. Subsection (a) of section 3217-h of the insurance law, as added by chapter 6 of the laws of 2015, is amended to read as follows:
(a) An insurer shall not exclude from coverage a service that is otherwise covered under a policy that provides comprehensive coverage for hospital, medical or surgical care because the service is delivered via telehealth, as that term is defined in subsection (b) of this section; provided, however, that an insurer may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the policy. An insurer may subject the coverage of a service delivered via telehealth to co-payments, coinsurance or deductibles provided that they are at least as favorable to the insured as those established for the same service when not delivered via telehealth. An insurer may subject the coverage of a service delivered via telehealth to reasonable utilization management and quality assurance requirements that are consistent with those established for the same service when not delivered via telehealth. Remote patient monitoring via telehealth delivered by a home care agency certified or licensed under article thirty-six of the public health law shall not be construed as a "visit" under any visit number limitation that a policy may contain for home care visits by a home care services agency.
§ 4. Paragraph 2 of subsection (a) of section 3229 of the insurance law, as amended by chapter 6 of the laws of 2015, is amended and a new paragraph 2-a is added to read as follows:
(2) a home care benefit with personal care, nursing care, adult day health care and respite care services, which shall provide total benefits in an amount determined by regulations of the superintendent; provided however that an insurer shall not exclude from coverage a service that is otherwise covered under the policy because the service is delivered via telehealth as that term is defined in paragraph two-a of this subsection, provided, further, that an insurer may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the enrollee contract. An insurer may subject the coverage of a service delivered via telehealth to co-payments, coinsurance, or deductibles provided that they are at least as favorable to the enrollee as those established for the same service when not deliv-
S. 888 3
ered via telehealth. An insurer may subject the coverage of a service delivered via telehealth to reasonable utilization management and quality assurance requirements that are consistent with those established for the same service when not delivered via telehealth;
(2-a) for purposes of paragraph two of this subsection, "telehealth" means the use of electronic information and communication technologies by a health care provider to deliver health care services to an insured individual while such individual is located at a site that is different from the site where the health care provider is located;
§ 5. Subsection (a) of section 4306-g of the insurance law, as added by chapter 6 of the laws of 2015, is amended to read as follows:
(a) A corporation shall not exclude from coverage a service that is otherwise covered under a contract that provides comprehensive coverage for hospital, medical or surgical care because the service is delivered via telehealth, as that term is defined in subsection (b) of this section; provided, however, that a corporation may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the contract. A corporation may subject the coverage of a service delivered via telehealth to co-payments, coinsurance or deductibles provided that they are at least as favorable to the insured as those established for the same service when not delivered via telehealth. A corporation may subject the coverage of a service delivered via telehealth to reasonable utilization management and quality assurance requirements that are consistent with those established for the same service when not delivered via telehealth. Remote patient monitoring via telehealth delivered by a home care agency certified or licensed under article thirty-six of the public health law shall not be construed as a "visit" under any visit number limitation that a policy may contain for home care visits by a home care services agency.
§ 6. Subdivision 1 of section 4406-g of the public health law, as added by chapter 6 of the laws of 2015, is amended to read as follows:
1. A health maintenance organization shall not exclude from coverage a service that is otherwise covered under an enrollee contract of a health maintenance organization because the service is delivered via telehealth, as that term is defined in subdivision two of this section; provided, however, that a health maintenance organization may exclude from coverage a service by a health care provider where the provider is not otherwise covered under the enrollee contract. A health maintenance organization may subject the coverage of a service delivered via telehealth to co-payments, coinsurance or deductibles provided that they are at least as favorable to the enrollee as those established for the same service when not delivered via telehealth. A health maintenance organization may subject the coverage of a service delivered via telehealth to reasonable utilization management and quality assurance requirements that are consistent with those established for the same service when not delivered via telehealth. Remote patient monitoring via telehealth delivered by a home care agency certified or licensed under article thirty-six of this chapter shall not be construed as a "visit" under any visit number limitation that a policy may contain for home care visits by a home care services agency.
§ 7. This act shall take effect immediately.
Reflowed for reading: line numbers and page breaks removed. Cite the official text.
Sponsor's memo
Title of bill
An act to amend the public health law and the insurance law, in relation to the provision of telehealth services
Purpose or general idea of bill
To make clarifications to chapter 6 of the laws of 2015 and to expand access to telehealth under long term care insurances plans
Summary of specific provisions
Section one makes amendments to the newly enacted definition of tele- health under the public health law to clarify that: 1) the new law is not intended to interfere with the longstanding home telehealth provisions under article 36 of the public health law, and 2) home care services will continue to be delivered via telehealth by providers that are licensed or certified by the state as home care providers, or that are otherwise exempt from licensure (e.g., physicians).
Sections two and four create telehealth parity within long term care insurance policies, similar to the telehealth provisions enacted by chapter 6 for hospital, medical, and surgical care policies.
Sections three, five, and six amend the insurance law and public health law coverage provisions for telehealth enacted by chapter 6, clarifying that remote patient monitoring provided via telehealth conducted by a home care agency is not a "visit" subject to "on-site visit" limits that might otherwise be contained in a policy.
Section seven establishes that the bill shall be effective immediately.
Justification
Chapter 6 of the laws of 2015, is a landmark law that increases access to health services delivered via telehealth. Under this new law, services that are otherwise covered under a private insurance policy may not be excluded solely because the service is provided via telehealth, and coverage of health care services delivered via telehealth is now, for the first time, enunciated under Medicaid provisions. Telehealth continues to emerge as an important method of monitoring, managing, and improving patient health, and increases access to care in remote or otherwise difficult to serve areas.
Prior to the passage of Chapter 6 in 2015, the home care industry has been actively providing telehealth services throughout the State, pursu- ant to a 2007 telehealth statute that has been a national benchmark in telehealth. It was the intent of chapter 6 of the laws of 2015, and continues to be the intent of this legislation, that home telehealth provisions under article 36 not be precluded or limited in any way, and be supported and allowed to continue to flourish, to remain vital and relevant within the spectrum of health care services offered within New York State.
To this end, the instant legislation contains a series of clarifications and complementary provisions in furtherance of the intent of Chapter 6. It further clarifies that: the new telehealth provisions shall not preclude or limit the delivery of home care services under article 36 of the public health law; article 36-defined home care services delivered via telehealth will continue to be delivered by either article 36-li- censed or exempt providers; and home care telehealth provided via remote patient monitoring will not be counted against any "on-site visit" limits that a policy might contain. The legislation also mirrors within long term care policies, the same telehealth parity coverage as chapter 6 provides for regular hospital, medical, and surgical policies.
Prior legislative history
2017,2018: S.3937 Referred to Health 2015,2016: S.5852 Advanced to Third Reading
Fiscal implications
None. Contributes to cost-efficiency of the health care system.
Effective date
Immediately.
Summaries, headlines and scores are AI-generated from the official bill text. How we score bills. Source: NYS Open Legislation.