2021 -- S 0004 SUBSTITUTE A AS AMENDED

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LC000597/SUB A/2

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2021

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A N   A C T

RELATING TO INSURANCE -- THE TELEMEDICINE COVERAGE ACT

     Introduced By: Senators Miller, Goldin, Valverde, Goodwin, Felag, Coyne, Burke, Cano,

     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 limited to, a nonprofit service corporation,

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

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

in chapter 41 of this title.

     (8) "Medically necessary" shall mean medical, surgical, or other services required for the

prevention, diagnosis, cure, or treatment of a health related condition, including such services

necessary to prevent a decremental change in either medical or mental health status. Medically

necessary services must be provided in the most cost effective and appropriate setting and shall not

be provided solely for the convenience of the beneficiary, caretaker or service provider. Providing

a service through telemedicine, shall in no circumstance be considered "solely for the convenience

of the beneficiary, caretaker or service provider" for purposes of determining health insurance

coverage.

     (8) (9) "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) (10) "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 necessary; 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) (11) "Policy of accident and sickness insurance" means a policy of accident and

sickness insurance as defined in chapter 18 of this title.

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

transmission of a patient's medical information from an originating site to the healthcare provider

at the distant site without the patient being present.

     (12) (13) "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.

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     (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)(1) 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 appropriate necessary 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.

     (2) As is in effect on January 1, 2021, all such, medically necessary telemedicine services

delivered by in-network providers shall be reimbursed at rates not lower than services delivered

through in-person methods. This shall remain in effect as long as the state of emergency that was

in effect on January 1, 2021 is still active. Once the state of emergency has been rescinded this

provision will remain in effect unless or until the office of the health insurance commissioner

revises which service categories shall be reimbursed at rates not lower than the reimbursement rates

for the same service categories delivered through in-person methods based on recommendations

described under § 27-81-7.

     (c) Notwithstanding subsection (b) of this section, medically necessary 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.

     (c)(d) 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.

     (e) Prior authorization requirements for medically necessary 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.

     (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 necessary telemedicine services.

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     (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 sections:

     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.

     27-81-7. Telemedicine data reporting and telemedicine advisory committee.

     (a) Each health insurer shall collect and provide to the office of the health insurance

commissioner (OHIC), in a form and frequency acceptable to OHIC, information and data

reflecting its telemedicine policies, practices, and experience. OHIC shall provide this information

and data to the general assembly on or before January 1, 2022, and on or before each January 1

thereafter.

     (b)(1)Upon the expiration of the state of emergency that was in effect on January 1, 2021,

OHIC will use data reporting required under subsection (a) of this section to help determine, with

the advice and participation of the executive office of health and human services, the department

of health, the health insurance advisory council, and the Rhode Island office of the attorney

general's office of the health care advocate, a list of in-network telemedicine service categories that

shall be reimbursed at rates not lower than the reimbursement rates for the same service categories

delivered through in-person methods. This list of service categories may be revised annually should

OHIC deem necessary.

     (2) Notwithstanding subsection (b)(1) of this section, medically necessary 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.

     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-

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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, as long as such health

care services are medically necessary to be provided through telemedicine services.

     (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 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) As is in effect on January 1, 2021, all such, medically necessary telemedicine services

delivered by in-network providers shall be reimbursed at rates not lower than services delivered

through in-person methods. This shall remain in effect as long as the state of emergency that was

in effect on January 1, 2021 is still active. Once the state of emergency has been rescinded this

provision will remain in effect unless or until Rhode Island Medicaid revises which service

categories shall be reimbursed at rates not lower than the reimbursement rates for the same service

categories delivered through in-person methods based on recommendations described under

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subsection (e) of this section.

     (5) Notwithstanding subsection (c)(4) of this section medically necessary 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.

     (6) 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 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), in

a form and frequency acceptable to the executive office, information and data reflecting its

telemedicine policies, practices, and experience. This information and data shall be provided to the

general assembly on or before January 1, 2022, and on or before each January 1 thereafter. When

available, the information and data EOHHS provides shall include, but not be limited to:

     (1) Any savings experienced in Medicaid covered services and/or any savings experienced

in government funded programs, such as potential changes in expenditures for non-emergency

medical transportation services or child care, due to expanded access and increased use of

telemedicine;

     (2) Any correlations in non-Medicaid benefit use and costs for individuals who have

received telemedicine services; and

     (3) Any additional expenditure changes experienced by patients or state agencies that

correlate with, or occur due to, expanded access and increased use of telemedicine.

     (e) Upon the expiration of the state of emergency that was in effect on January 1, 2021,

EOHHS will use data reporting required under subsection(d) of this section to help determine, with

the advice and participation of the office of the health insurance commissioner, the department of

health, the health insurance advisory council, and the Rhode Island office of the attorney general's

office of the health care advocate, a list of in-network telemedicine service categories that shall be

reimbursed at rates not lower than the reimbursement rates for the same service categories delivered

through in-person methods. This list of service categories may be revised annually should EOHHS

deem necessary.

     (f) Rules and regulations. The secretary of EOHHS 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.

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     SECTION 4. 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 amend the provisions of the telemedicine coverage act and provide coverage

for telemedicine under Rhode Island Medicaid.

     This act would take effect upon passage.

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