Senate Bill #4 (2021)

AN ACT RELATING TO INSURANCE -- THE TELEMEDICINE COVERAGE ACT

Amends the provisions of the telemedicine coverage act and provide coverage for telemedicine under Rhode Island Medicaid.

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  • 2021 – S 0004
  • 2021 – S 0004 SUBSTITUTE A
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  • LC000597
  • LC000597/SUB A
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  • S T A T E O F R H O D E I S L A N D
  • IN GENERAL ASSEMBLY
  • JANUARY SESSION, A.D. 2021
  • S T A T E O F R H O D E I S L A N D
  • IN GENERAL ASSEMBLY
  • JANUARY SESSION, A.D. 2021
  • ____________
  • A N A C T
  • RELATING TO INSURANCE – THE TELEMEDICINE COVERAGE ACT
  • Introduced By: Senators Miller, Goldin,Valverde, Goodwin, Felag, Coyne, Burke, Cano,
  • Seveney, Lawson, and Kallman
  • Introduced By: Senators Miller, Goldin, Valverde, Goodwin, and Felag
  • Date Introduced: January 11, 2021
  • Referred To: Senate Health & Human Services
  • It is enacted by the General Assembly as follows:
  • SECTION 1. Sections 27-81-3 and 27-81-4 of the General Laws in Chapter 27-81 entitled "The Telemedicine Coverage Act" are hereby amended to read as follows:
  • 27-81-3. Definitions.
  • As used in this chapter:
  • (1) "Distant site" means a site at which a healthcare provider is located while providing healthcare services by means of telemedicine.
  • (2) "Healthcare facility" means an institution providing healthcare services or a healthcare setting, including, but not limited to: hospitals and other licensed, inpatient centers; ambulatory surgical or treatment centers; skilled nursing centers; residential treatment centers; diagnostic, laboratory and imaging centers; and rehabilitation and other therapeutic-health settings.
  • (3) "Healthcare professional" means a physician or other healthcare practitioner licensed, accredited, or certified to perform specified healthcare services consistent with state law.
  • (4) "Healthcare provider" means a healthcare professional or a healthcare facility.
  • (5) "Healthcare services" means any services included in the furnishing to any individual of medical, podiatric, or dental care, or hospitalization, or incident to the furnishing of that care or hospitalization, and the furnishing to any person of any and all other services for the purpose of preventing, alleviating, curing, or healing human illness, injury, or physical disability.
  • (6) "Health insurer" means any person, firm, or corporation offering and/or insuring healthcare services on a prepaid basis, including, but not limitedto, a nonprofit service corporation, a health maintenance organization,oranentityofferinga policyof accident and sickness insurance.
  • (7)"Healthmaintenanceorganization" meansahealthmaintenanceorganizationasdefined in chapter 41 of this title.
  • (8) "Nonprofit service corporation" means a nonprofit hospital-service corporation as defined in chapter 19 of this title, or a nonprofit medical-service corporation as defined in chapter 20 of this title.
  • (9) "Originating site" means a site at which a patient is located at the time healthcare services are provided to them by means of telemedicine, which can be include a patient's home where medically appropriate; provided, however, notwithstanding any other provision of law, health insurers and healthcare providers may agree to alternative siting arrangements deemed appropriate by the parties.
  • (9) "Originating site" means a site at which a patient is located at the time healthcare services are provided to them by means of telemedicine, which can be include a patient's home where medically clinically appropriate; provided, however, notwithstanding any other provision of law, health insurers and healthcare providers may agree to alternative siting arrangements deemed appropriate by the parties.
  • (10) "Policy of accident and sickness insurance" means a policy of accident and sickness insurance as defined in chapter 18 of this title.
  • (11)"Store-and-forwardtechnology" meansthetechnologyusedtoenablethetransmission of a patient's medical information from an originating site to the healthcare provider at the distant site without the patient being present.
  • (12) "Telemedicine" means the delivery of clinical healthcare services by means of real time, two-way electronic audiovisual communications, including the application of secure video conferencing or store-and-forward technology or telephone-audio-only communications to provide or support healthcare delivery, which facilitate the assessment, diagnosis, treatment, and care management of a patient's health care while such patient is at an originating site and the healthcare provider is at a distant site, consistent with applicable federal laws and regulations and guidance. Telemedicine does not include an audio-only telephone conversation, email message, text message or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.
  • (11)"Store-and-forwardtechnology" means thetechnologyusedtoenablethetransmission of a patient's medical information from an originating site to the healthcare provider at the distant site without the patient being present.
  • (12) "Telemedicine" means the delivery of clinical healthcare services by means of real time, two-way telephone-audio-only communications or electronic audiovisual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, which facilitate the assessment, diagnosis, treatment, and care management of a patient's health care while such patient is at an originating site and the healthcare provider is at a distant site, consistent with applicable federal laws regulations. "Telemedicine" does not include an audio-only telephone conversation, email message, or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.
  • 27-81-4. Coverage of telemedicine services.
  • (a) Each health insurer that issues individual or group accident and sickness insurance policies for healthcare services and/or provides a healthcare plan for healthcare services shall provide coverage for the cost of such covered healthcare services provided through telemedicine services, as provided in this section.
  • (b) A health insurer shall not exclude a healthcare service for coverage solely because the healthcare service is provided through telemedicine and is not provided through in-person consultationorcontact,solongassuchhealthcareservicesaremedicallyappropriatetobeprovided through telemedicine services and, as such, may be subject to the terms and conditions of a telemedicine agreement between the insurer and the participating healthcare provider or provider group. The determination of the medical appropriateness of a health-care service to be provided through telemedicine shall include taking into consideration any existing public health emergency. The determination of the medical appropriateness of a health care service to be provided through telemedicine may vary for health care services provided through audio-visual telemedicine versus health care services provided through audio-only telemedicine.
  • (c) Benefit plans offered by a health insurer may impose a deductible, copayment, or coinsurance requirement for a healthcare service provided through telemedicine in excess of what would normally be charged for the same service when performed in-person.
  • (d) Medically appropriate telemedicine services delivered by in-network primary care and behavioral health providers shall not be subject to prior authorization. No more stringent medical or benefit determination and utilization review requirements shall be imposed on any telemedicine service than is imposed upon the same service when performed in-person.
  • (e) Medically appropriate telemedicine services delivered by in-network providers shall be reimbursed at rates not lower than the reimbursement rates for the same services delivered through traditional (in-person) methods.
  • (f) Except for requiring compliance with applicable state and federal laws, regulations and/or guidance, no health insurer shall impose any specific requirements as to the technologies used to deliver medically appropriate telemedicine services.
  • (b) A health insurer shall not exclude a healthcare service for coverage solely because the healthcare service is provided through telemedicine and is not provided through in-person consultation or contact, so long as such healthcare services are medically clinically appropriate to be provided through telemedicine services and, as such, may be subject to the terms and conditions of a telemedicine agreement between the insurer and the participating healthcare provider or provider group. The determination of the clinical appropriateness of a healthcare service to be provided through telemedicine:
  • (i) Shall include taking into consideration any existing public health emergency;
  • (ii) May vary for healthcare services provided through audio-visual telemedicine versus healthcare services provided through audio-only telemedicine; and
  • (iii) Shall not include restrictions on the types of healthcare providers that can render services through telemedicine so longas the serviceis clinicallyappropriate to be provided through telemedicine and can be performed under the practitioner's license and scope of practice, as defined by the Rhode Island department of health, is medically necessary, and is a covered service when rendered in person by that healthcare provider type.
  • (c) Benefit plans offered by a health insurer may impose a deductible, copayment, or coinsurance requirement for a healthcare service provided through telemedicine shall not impose a deductible, copayment, or coinsurance requirement for a healthcare service delivered through telemedicine in excess of what would normally be charged for the same healthcare service when performed in-person.
  • (d) Prior authorization requirements for clinically appropriate telemedicine services shall not be more stringent than prior authorization requirements for in-person care. No more stringent medical or benefit determination and utilization review requirements shall be imposed on any telemedicine service than is imposed upon the same service when performed in-person.
  • (e) Clinically appropriate telemedicine services delivered by in-network primary care and behavioral healthcare providers shall be reimbursed at rates not lower than the reimbursement rates for the same services delivered in-person.
  • (f) Except for requiring compliance with applicable state and federal laws, regulations and/or guidance, no health insurer shall impose any specific requirements as to the technologies used to deliver clinically appropriate telemedicine services.
  • (d)(g) The requirements of this section shall apply to all policies and health plans issued, reissued, or delivered in the state of Rhode Island on and after January 1, 2018.
  • (e)(h) This chapter shall not apply to: short-term travel, accident-only, limited or specified disease; or individual conversion policies or health plans; nor to policies or health plans designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare; or any other similar coverage under state or federal governmental plans.
  • SECTION 2. Chapter 27-81 of the General Laws entitled "The Telemedicine Coverage Act" is hereby amended by adding thereto the following section:
  • 27-81-6. Rules and regulations.
  • The health insurance commissioner may promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for the efficient administration and enforcement of this chapter.
  • SECTION 3. Chapter 27-18.9 of the General Laws entitled "Benefit Determination and Utilization Review Act" is hereby amended by adding thereto the following section:
  • 27-18.9-16. Temporary benefit determination review requirement during the COVID-19 pandemic.
  • (a) Through June 30, 2023, health care entities and, where applicable, review agents shall suspend prior authorization requirements for all in-network non-pharmacy COVID-19 related diagnostic and treatment services, including behavioral health services reasonably related to the COVID-19 pandemic;
  • (b) Through June 30, 2023, health care entities and, where applicable, review agents shall not replace prior authorization requirements suspended pursuant to subsection (a) of this section with new retrospective review requirements;
  • SECTION 4. Chapter 42-7.2 of the General Laws entitled "Office of Health and Human Services" is hereby amended by adding thereto the following section:
  • 27-81-6. Rules and regulations.
  • The health insurance commissioner may promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for the efficient administration and enforcement of this chapter.
  • SECTION 3. Chapter 42-7.2 of the General Laws entitled "Office of Health and Human Services" is hereby amended by adding thereto the following section:
  • 42-7.2-21. Telemedicine.
  • (a) Statement of intent. Rhode Island Medicaid shall cover medically necessary, non- experimental, and cost-effective telemedicine services provided by Medicaid providers. There are no geographic restrictions for telemedicine; services delivered via telemedicine are covered statewide. Rhode Island Medicaid and its contracted managed care entities shall promote the use of telemedicine to support an adequate provider network.
  • (b) "Telemedicine" shall mean thedeliveryof clinical health-care servicesby means of real time, two-way electronic audiovisual communications, including the application of secure video conferencing or store-and-forward technology or telephone-audio-only communications to provide or support health-care delivery, which facilitate the assessment, diagnosis, treatment, and care management of a patient's health care while such patient is at an originating site and the health-care provider is at a distant site, consistent with applicable federal laws, regulations and guidance. "Telemedicine" does not include an email message, text message, or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.
  • (c) Coverage of telemedicine services. Rhode Island Medicaid and its contracted managed care entities shall provide coverage for the cost of such covered health-care services provided through telemedicine services, as provided in this section.
  • (1) Rhode Island Medicaid and its contracted managed care entities shall not exclude a health-care service for coverage solely because the health-care service is provided through telemedicine and is not provided through in-person consultation or contact, so long as such health- care services are medically appropriate to be provided through telemedicine services. The determination of the medical appropriateness of a health-care service to be provided through telemedicine shall include taking into consideration any existing public health emergency. The determination of the medical appropriateness of a health-care service to be provided through telemedicine may vary for health care services provided through audio-visual telemedicine versus health care services provided through audio-only telemedicine.
  • (2) Medically appropriate telemedicine services delivered by in-network primary care and behavioral health providers shall not be subject to prior authorization. No more stringent medical or benefit determination and utilization review requirements shall be imposed on any telemedicine service than is imposed upon the same service when performed in-person.
  • (3) Medically appropriate telemedicine services delivered by Rhode Island Medicaid and its contracted managed care entities shall be reimbursed at rates not lower than the reimbursement rates for the same services delivered through traditional (in-person) methods.
  • (4) Except for requiring compliance with applicable state and federal laws, regulations and/or guidance, Rhode Island Medicaid and its contracted managed care entities shall not impose any specific requirements as to the technologies used to deliver medically appropriate telemedicine services.
  • (d) Rules and Regulations. The secretary may promulgate such rules and regulations as are necessary and proper to effectuate the purpose and for the efficient administration and enforcement of this chapter.
  • SECTION 5. This act shall take effect upon passage.
  • (a) Statement of intent. Rhode Island Medicaid shall cover medically necessary, clinically appropriate, non-experimental, and cost-effective telemedicine services provided by Medicaid providers. There are no geographic restrictions for telemedicine; services delivered via telemedicine are covered statewide. Rhode Island Medicaid and its contracted managed care entities shall promote the use of telemedicine to support an adequate provider network.
  • (b) Definition: "Telemedicine" means the delivery of clinical healthcare services by means of real time, two-way telephone-audio-only communications or electronic audiovisual communications, including the application of secure video conferencing or store-and-forward technology to provide or support healthcare delivery, which facilitate the assessment, diagnosis, treatment, and care management of a patient's health care while such patient is at an originating site and the healthcare provider is at a distant site, consistent with applicable federal laws and regulations. "Telemedicine" does not include an email message, or facsimile transmission between the provider and patient, or an automated computer program used to diagnose and/or treat ocular or refractive conditions.
  • (c) Coverage of telemedicine services. Rhode Island Medicaid and its contracted managed care entities shall provide coverage for the cost of such covered healthcare services provided through telemedicine services, as provided in this section.
  • (1) Rhode Island Medicaid and its contracted managed care entities shall not exclude a healthcare service for coverage solely because the healthcare service is provided through telemedicine and is not provided through in-person consultation or contact, so long as such healthcare services are medically necessary, and clinically appropriate to be provided through telemedicine services. The determination of the clinical appropriateness of a healthcare service to be provided through telemedicine:
  • (i) Shall include taking into consideration any existing public health emergency;
  • (ii) May vary for healthcare services provided through audio-visual telemedicine versus healthcare services provided through audio-only telemedicine; and
  • (iii) Shall not include restrictions on the types of healthcare providers that can render services through telemedicine so longas the serviceis clinicallyappropriate to be provided through telemedicineandcanbeperformed under the practitioner'slicense andscope of practice,as defined by the Rhode Island department of health, is medically necessary, and is a covered service when rendered in person by that healthcare provider type.
  • (2) Benefit plans offered by a Medicaid managed care entity shall not impose a copayment, or coinsurance requirement for a healthcare service delivered through telemedicine in excess of what would normally be charged for the same healthcare service when performed in-person.
  • (3) Prior authorization requirements for medically necessary and clinically appropriate telemedicine services shall not be more stringent than prior authorization requirements for in- person care. No more stringent medical or benefit determination and utilization review requirements shall be imposed on any telemedicine service than is imposed upon the same service when performed in person.
  • (4) Medically necessary and clinically appropriate telemedicine services delivered by in- network primary care and behavioral healthcare providers, for both fee-for-service and managed care delivery systems, shall be reimbursed at rates not lower than the reimbursement rates for the same services delivered through in-person methods.
  • (5) Except for requiring compliance with applicable state and federal laws, regulations and/or guidance, Rhode Island Medicaid and its contracted managed care entities shall not impose any specific requirements as to the technologies used to deliver medically necessary and clinically appropriate telemedicine services.
  • (d) Telemedicine data reporting. Each of Rhode Island Medicaid's contracted managed care entities shall collect and provide to the executive office of health and human services (EOHHS),inaformandfrequencyacceptabletothe executive off,informationanddatareflecting its telemedicine policies, practices, and experience.
  • (e) Rules and Regulations. The secretary of EOHHS may promulgate such rules and regulationsasarenecessaryandpropertoeffectuatethepurposeandfortheefficient administration and enforcement of this chapter.
  • SECTION 4. This act shall take effect upon passage.
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  • LC000597
  • LC000597/SUB A
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  • EXPLANATION
  • BY THE LEGISLATIVE COUNCIL
  • OF
  • A N A C T
  • RELATING TO INSURANCE – THE TELEMEDICINE COVERAGE ACT
  • ***
  • Thisactwouldamendtheprovisionsofthetelemedicinecoverageactandprovidecoverage for telemedicine under Rhode Island Medicaid.
  • This act would take effect upon passage. ======== LC000597 ========
  • This act would take effect upon passage. ======== LC000597/SUB A ========

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