2015 -- H 5422

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LC000993

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2015

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A N   A C T

RELATING TO INSURANCE -- TELEMEDICINE REIMBURSEMENT ACT

     

     Introduced By: Representatives Kennedy, Shekarchi, Marshall, Azzinaro, and Keable

     Date Introduced: February 12, 2015

     Referred To: House Corporations

     It is enacted by the General Assembly as follows:

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     SECTION 1. Title 27 of the General Laws entitled "INSURANCE" is hereby amended

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by adding thereto the following chapter:

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CHAPTER 81

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THE TELEMEDICINE REIMBURSEMENT ACT

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     27-81-1. Title. – This act shall be known as and may be cited as the "telemedicine

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reimbursement act".

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     27-81-2. Purpose. -- The general assembly hereby finds and declares that:

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     (1) The advancements and continued development of medical and communications

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

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

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

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

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

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

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

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health care providers to support the use of telemedicine and that will also encourage all state

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

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prohibiting the use of telemedicine services.

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     27-81-3. Definitions. – As used in this chapter, the following words have the meanings

 

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indicated:

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     (1) "Distant site" means a site at which a health care provider is located while providing

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health care services by means of telemedicine or telehealth.

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     (2) "Health care facility" means an institution providing health care services or a health

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care setting, including, but not limited to, hospitals and other licensed impatient centers,

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ambulatory surgical or treatment centers, skilled nursing centers, residential treatment centers,

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diagnostic, laboratory and imaging centers, and rehabilitation and other therapeutic health

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settings.

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     (3) "Health care professional" means a physician or other health care practitioner

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licensed, accredited or certified to perform specified health care services consistent with state

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law.

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     (4) "Health care provider" means a health care professional or a heath care facility

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     (5) "Health care services" means any services included in the furnishing to any individual

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of medical, podiatric, or dental care, or hospitalization, or incident to the furnishing of that care or

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hospitalization, and the furnishing to any person of any and all other services for the purpose of

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preventing, alleviating, curing, or healing human illness, injury, or physical disability.

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     (6) "Health insurer" means any person, firm or corporation offering and/or insuring health

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care services on a prepaid basis, including, but not limited to, a nonprofit service corporation, a

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health maintenance organization, or an entity offering a policy of accident and sickness insurance.

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It includes all persons, firm, or corporations providing health benefits coverage for employees on

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a self-insurance basis without the intervention of other entities.

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     (7) "Health maintenance organization" means a health maintenance organization as

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defined in chapter 41 of this title.

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     (8) "Nonprofit service corporation means a nonprofit hospital service corporation as

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defined in chapter 19 of this title or a nonprofit medical service corporation as defined in chapter

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20 of this title.

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     (9) "Originating site" means a site at which a patient is located at the time health care

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services are provided to him or her by means of telemedicine or telehealth; provided, however,

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notwithstanding any other provision of law, health insurers and health care providers may agree

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to alternative siting arrangements deemed appropriate by the parties.

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     (10) "Policy of accident and sickness insurance" means a policy of accident and sickness

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insurance as defined in chapter 18 of this title.

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     (11) "Store-and-forward technology" means the technology used to enable the

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transmission of a patient’s medical information from an originating site to the health care

 

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provider at the distant site without the patient being present.

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     (12) "Telehealth" means delivering health care services by means of information and

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communications technologies consisting of telephones, remote patient monitoring devices or

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other electronic means that facilitate the assessment, diagnosis, consultation, treatment,

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

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at the originating site and the health care provider is at the distant site, consistent with federal

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laws and regulations.

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     (13) "Telemedicine" means the delivery of clinical health care services by means of real

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time two-way electronic audiovisual communications, including the application of secure video

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conferencing or store-and-forward technology to provide or support health care delivery, which

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facilitate the assessment, diagnosis, consultation, treatment education, care management and self-

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

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care provider is at a distant site, consistent with applicable federal laws and regulations.

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     27-81-4. Coverage of telemedicine services. – (a) Each health insurer that issues

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individual or group accident and sickness insurance policies for health care services and/or

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provides a health care plan for health care services shall provide coverage for the cost of such

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health care services provided through telemedicine services, as provided in this section.

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     (b) A health insurer shall not exclude a health care service for coverage solely because

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the health care service is provided through telemedicine and is not provided through in-person

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consultation or contact, so long as such health care services appropriately provided through

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telemedicine services.

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     (c) A health insurer shall reimburse the treating health care provider or the consulting

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health care provider for the diagnosis, consultation, or treatment of the insured delivered through

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telemedicine services on the same basis that the health insurer is responsible for coverage for the

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provision of the same service through in-person consultation or contact.

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     (d) A health insurer may offer a health plan contain a deductible, copayment or

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coinsurance requirement for a health care service provided through telemedicine, provided that

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such deductible, copayment, or coinsurance does not exceed the deductible, copayment, or

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coinsurance applicable if the same health care services were provided through in-person

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diagnosis, consultation, or treatment.

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     (e) No health insurer shall impose any annual or lifetime dollar maximum on coverage

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for telemedicine services other than an annual or lifetime dollar maximum that applies in the

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aggregate to all items and services covered under the policy or health plan, or impose upon any

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person receiving benefits pursuant to this section any copayment, coinsurance, or deductible

 

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amounts, or any policy year, calendar year, lifetime, or other durational benefit limitation or

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maximum for benefits or service, that is not equally imposed upon all terms and services covered

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under the policy or health plan.

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     (f) The requirements of this section shall apply to all policies and health plans issued,

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reissued, or extended in the state of Rhode Island on and after the effective date of this chapter, or

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at any time thereafter when any term of the policy or health plan is changed or any premium

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adjustment is made.

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     (g) This chapter shall not apply to short-term travel, accident-only, limited or specified

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disease, or individual conversion policies or health plans, nor to policies or health plans designed

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for issuance to persons eligible for coverage under title XVIII of the Social Security Act, known

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

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     27-81-5. Severability. – If any provision of this chapter is held by a court to be invalid,

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such invalidity shall not affect the remaining provisions of this chapter.

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO INSURANCE -- TELEMEDICINE REIMBURSEMENT ACT

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     This act would require health insurance policies, plans or contracts to include provisions

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for the reimbursement of telemedicine services in the same manner as such policies, plans or

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contracts reimburse for health care services provided through in-person consultation or contact.

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     This act would take effect upon passage.

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