2016 -- H 7160 SUBSTITUTE A

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2016

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A N   A C T

RELATING TO INSURANCE -- THE TELEMEDICINE COVERAGE ACT

     

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

     Date Introduced: January 14, 2016

     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 COVERAGE 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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Coverage 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, cost, and accessibility of health care, particularly in the area of

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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. -- (a) As used in this chapter:

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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.

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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 inpatient 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 health 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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     (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 them by means of telemedicine, which can be a patient's home where

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medically appropriate; provided, however, notwithstanding any other provision of law, health

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insurers and health care providers may agree to alternative siting arrangements deemed

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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 provider

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at the distant site without the patient being present.

 

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     (12) "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, treatment, and care management of a patient's health care

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while such patient is at an originating site and the health care provider is at a distant site,

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consistent with applicable federal laws and regulations. Telemedicine does not include an audio-

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only telephone conversation, email message or facsimile transmission between the provider and

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patient, or an automated computer program used to diagnose and/or treat ocular or refractive

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conditions.

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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 treatment provided

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through telemedicine to the extent that coverage is provided and paid for when provided through

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in-person consultation between the insured and a health care provider. Such coverage shall be

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subject to the same terms and conditions applicable to all other health benefits under the same

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policy.

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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 are medically appropriate to be

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provided through telemedicine services and as may be subject to the terms and conditions of a

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telemedicine agreement between the insurer and the participating health care provider or provider

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group.

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     (c) Benefit plans offered by a health insurer may impose a deductible, copayment, or

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coinsurance requirement for a health care service provided through telemedicine.

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

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reissued, or delivered in the state of Rhode Island on and after January 1, 2018.

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     (e) 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 or of any rule or regulation

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made under this chapter, or its application to any person or circumstance is held invalid by a court

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of competent jurisdiction, the remainder of the chapter, rule, or regulation and the application of

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the provision to other persons or circumstances shall not be affected by this invalidity. The

 

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invalidity of any section or sections or parts of any section or sections shall not affect the validity

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of the remainder of the 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 -- THE TELEMEDICINE COVERAGE ACT

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     This act would require health insurance policies, plans or contracts issued, reissued or

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delivered on or after January 1, 2018, to include provisions for the reimbursement of telemedicine

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services in the same manner as such policies, plans or contracts reimburse for health care services

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provided through in-person consultation or contact.

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     This act would take effect upon passage.

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