2012 -- H 7796

=======

LC01845

=======

STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2012

____________

A N A C T

RELATING TO INSURANCE - TELEHEALTH SERVICES

     Introduced By: Representative Joseph M. McNamara

     Date Introduced: February 28, 2012

     Referred To: House Corporations

It is enacted by the General Assembly as follows:

1-1

     SECTION 1. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service

1-2

Corporations" is hereby amended by adding thereto the following section:

1-3

     27-19-62. Telehealth services. – (a) The general assembly finds and declares the

1-4

following:

1-5

     (1) Chronic health conditions cause Rhode Island residents to have high rehospitalization

1-6

rates, which are a major driver of spiraling healthcare costs.

1-7

     (2) It is the intent of the general assembly to create a parity of telehealth with other health

1-8

care delivery modes, to actively promote telehealth as a tool to advance stakeholders’ goals

1-9

regarding health status and health system improvement, and to create opportunities and flexibility

1-10

for telehealth to be used in new models of care and system improvements.

1-11

     (3) Telehealth is a mode of delivering health care services and public health utilizing

1-12

information and communication technologies to enable the diagnosis, consultation, treatment,

1-13

education, care management, and self-management of patients at a distance from health care

1-14

providers.

1-15

     (4) Significant data exists that demonstrate the effectiveness and cost efficiency of using

1-16

technology to help manage chronic conditions allowing intervention prior to symptom

1-17

exasperation thus avoiding more costly intervention.

1-18

     (5) The use of information and telecommunication technologies to deliver health services

1-19

has the potential to reduce costs, improve quality, change the conditions of practice, and improve

1-20

access to health care, particularly in medically underserved areas.

2-1

     (6) Telehealth will assist in maintaining or improving the physical and economic health

2-2

of medically underserved communities by keeping the source of medical care in the local area,

2-3

strengthening the health infrastructure, and preserving health care related jobs.

2-4

     (7) Consumers of health care will benefit from telehealth in many ways, including

2-5

expanded access to providers, faster and more convenient treatment, better continuity of care,

2-6

reduction of lost work time and travel costs, and the ability to remain with support networks.

2-7

     (8) It is the intent of the general assembly that the fundamental health care provider-

2-8

patient relationship cannot only be preserved, but can also be augmented and enhanced, through

2-9

the use of telehealth as a tool to be integrated into practices.

2-10

     (9) Without the assurance of payment and the resolution of legal and policy barriers, the

2-11

full potential of telehealth will not be realized.

2-12

     (b) As used in this section:

2-13

     (1) “Asynchronous store and forward” means the transmission of a patient’s medical

2-14

information from an originating site to the health care provider at a distant site without the

2-15

presence of the patient.

2-16

     (2) “Distant site” means a site where a health care provider who provides health care

2-17

services is located while providing these services via a telecommunications system.

2-18

     (3) “Health care provider” means a person who is licensed under this section.

2-19

     (4) “Originating site” means a site where a patient is located at the time health care

2-20

services are provided via a telecommunications system or where the asynchronous store and

2-21

forward service originates.

2-22

     (5) “Synchronous interaction” means a real-time interaction between a patient and a

2-23

health care provider located at a distant site.

2-24

     (6) “Telehealth” means the mode of delivering health care services and public health via

2-25

information and communication technologies to facilitate the diagnosis, consultation, treatment,

2-26

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

2-27

at the originating site and the health care provider is at a distant site. Telehealth facilitates patient

2-28

self-management and caregiver support for patients and includes synchronous interactions and

2-29

asynchronous store and forward transfers.

2-30

     (c) All state and federal laws regarding the confidentiality of health care information and

2-31

a patient’s rights to his or her medical information shall apply to telehealth interactions.

2-32

     (d) It is the intent of the general assembly to recognize the practice of telehealth as a

2-33

legitimate means by which an individual may receive health care services from a health care

2-34

provider without in-person contact with the health care provider.

3-1

     (e) Every individual or group health insurance contract, plan or policy delivered, issued

3-2

for delivery or renewed in this state on or after January 1, 2013, which provides medical coverage

3-3

that includes coverage for physician services in a physician's office and every policy, which

3-4

provides major medical or similar comprehensive type coverage shall provide coverage for

3-5

telehealth services as defined in this section.   

3-6

     (f) A health insurance contract, plan or policy may require prior authorization for

3-7

telehealth services in the same manner that prior authorization is required for any other covered

3-8

benefit.

3-9

     (g) Notwithstanding any other provision, this section shall not be interpreted to authorize

3-10

a health care service plan to require the use of telehealth when the health care provider has

3-11

determined that it is not appropriate.

3-12

3-13

     SECTION 2. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service

3-14

Corporations" is hereby amended by adding thereto the following section:

3-15

     27-20-57. Telehealth services. – (a) The general assembly finds and declares the

3-16

following:

3-17

     (1) Chronic health conditions cause Rhode Island residents to have high rehospitalization

3-18

rates, which are a major driver of spiraling healthcare costs.

3-19

     (2) It is the intent of the general assembly to create a parity of telehealth with other health

3-20

care delivery modes, to actively promote telehealth as a tool to advance stakeholders’ goals

3-21

regarding health status and health system improvement, and to create opportunities and flexibility

3-22

for telehealth to be used in new models of care and system improvements.

3-23

     (3) Telehealth is a mode of delivering health care services and public health utilizing

3-24

information and communication technologies to enable the diagnosis, consultation, treatment,

3-25

education, care management, and self-management of patients at a distance from health care

3-26

providers.

3-27

     (4) Significant data exists that demonstrate the effectiveness and cost efficiency of using

3-28

technology to help manage chronic conditions allowing intervention prior to symptom

3-29

exasperation thus avoiding more costly intervention.

3-30

     (5) The use of information and telecommunication technologies to deliver health services

3-31

has the potential to reduce costs, improve quality, change the conditions of practice, and improve

3-32

access to health care, particularly in medically underserved areas.

3-33

     (6) Telehealth will assist in maintaining or improving the physical and economic health

3-34

of medically underserved communities by keeping the source of medical care in the local area,

3-35

strengthening the health infrastructure, and preserving health care related jobs.

4-1

     (7) Consumers of health care will benefit from telehealth in many ways, including

4-2

expanded access to providers, faster and more convenient treatment, better continuity of care,

4-3

reduction of lost work time and travel costs, and the ability to remain with support networks.

4-4

     (8) It is the intent of the general assembly that the fundamental health care provider-

4-5

patient relationship cannot only be preserved, but can also be augmented and enhanced, through

4-6

the use of telehealth as a tool to be integrated into practices.

4-7

     (9) Without the assurance of payment and the resolution of legal and policy barriers, the

4-8

full potential of telehealth will not be realized.

4-9

     (b) As used in this section:

4-10

     (1) “Asynchronous store and forward” means the transmission of a patient’s medical

4-11

information from an originating site to the health care provider at a distant site without the

4-12

presence of the patient.

4-13

     (2) “Distant site” means a site where a health care provider who provides health care

4-14

services is located while providing these services via a telecommunications system.

4-15

     (3) “Health care provider” means a person who is licensed under this section.

4-16

     (4) “Originating site” means a site where a patient is located at the time health care

4-17

services are provided via a telecommunications system or where the asynchronous store and

4-18

forward service originates.

4-19

     (5) “Synchronous interaction” means a real-time interaction between a patient and a

4-20

health care provider located at a distant site.

4-21

     (6) “Telehealth” means the mode of delivering health care services and public health via

4-22

information and communication technologies to facilitate the diagnosis, consultation, treatment,

4-23

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

4-24

at the originating site and the health care provider is at a distant site. Telehealth facilitates patient

4-25

self-management and caregiver support for patients and includes synchronous interactions and

4-26

asynchronous store and forward transfers.

4-27

     (c) All state and federal laws regarding the confidentiality of health care information and

4-28

a patient’s rights to his or her medical information shall apply to telehealth interactions.

4-29

     (d) It is the intent of the general assembly to recognize the practice of telehealth as a

4-30

legitimate means by which an individual may receive health care services from a health care

4-31

provider without in-person contact with the health care provider.

4-32

     (e) Every individual or group health insurance contract, plan or policy delivered, issued

4-33

for delivery or renewed in this state on or after January 1, 2013, which provides medical coverage

4-34

that includes coverage for physician services in a physician's office and every policy, which

5-1

provides major medical or similar comprehensive type coverage shall provide coverage for

5-2

telehealth services as defined in this section.   

5-3

     (f) A health insurance contract, plan or policy may require prior authorization for

5-4

telehealth services in the same manner that prior authorization is required for any other covered

5-5

benefit.

5-6

     (g) Notwithstanding any other provision, this section shall not be interpreted to authorize

5-7

a health care service plan to require the use of telehealth when the health care provider has

5-8

determined that it is not appropriate.

5-9

     SECTION 3. Chapter 27-18 of the General Laws entitled "Accident and Sickness

5-10

Insurance Policies" is hereby amended by adding thereto the following section:

5-11

     27-18-71. Telehealth services. -- (a) The general assembly finds and declares the

5-12

following:

5-13

     (1) Chronic health conditions cause Rhode Island residents to have high rehospitalization

5-14

rates, which are a major driver of spiraling healthcare costs.

5-15

     (2) It is the intent of the general assembly to create a parity of telehealth with other health

5-16

care delivery modes, to actively promote telehealth as a tool to advance stakeholders’ goals

5-17

regarding health status and health system improvement, and to create opportunities and flexibility

5-18

for telehealth to be used in new models of care and system improvements.

5-19

     (3) Telehealth is a mode of delivering health care services and public health utilizing

5-20

information and communication technologies to enable the diagnosis, consultation, treatment,

5-21

education, care management, and self-management of patients at a distance from health care

5-22

providers.

5-23

     (4) Significant data exists that demonstrate the effectiveness and cost efficiency of using

5-24

technology to help manage chronic conditions allowing intervention prior to symptom

5-25

exasperation thus avoiding more costly intervention.

5-26

     (5) The use of information and telecommunication technologies to deliver health services

5-27

has the potential to reduce costs, improve quality, change the conditions of practice, and improve

5-28

access to health care, particularly in medically underserved areas.

5-29

     (6) Telehealth will assist in maintaining or improving the physical and economic health

5-30

of medically underserved communities by keeping the source of medical care in the local area,

5-31

strengthening the health infrastructure, and preserving health care related jobs.

5-32

     (7) Consumers of health care will benefit from telehealth in many ways, including

5-33

expanded access to providers, faster and more convenient treatment, better continuity of care,

5-34

reduction of lost work time and travel costs, and the ability to remain with support networks.

6-1

     (8) It is the intent of the general assembly that the fundamental health care provider-

6-2

patient relationship cannot only be preserved, but can also be augmented and enhanced, through

6-3

the use of telehealth as a tool to be integrated into practices.

6-4

     (9) Without the assurance of payment and the resolution of legal and policy barriers, the

6-5

full potential of telehealth will not be realized.

6-6

     (b) As used in this section:

6-7

     (1) “Asynchronous store and forward” means the transmission of a patient’s medical

6-8

information from an originating site to the health care provider at a distant site without the

6-9

presence of the patient.

6-10

     (2) “Distant site” means a site where a health care provider who provides health care

6-11

services is located while providing these services via a telecommunications system.

6-12

     (3) “Health care provider” means a person who is licensed under this section.

6-13

     (4) “Originating site” means a site where a patient is located at the time health care

6-14

services are provided via a telecommunications system or where the asynchronous store and

6-15

forward service originates.

6-16

     (5) “Synchronous interaction” means a real-time interaction between a patient and a

6-17

health care provider located at a distant site.

6-18

     (6) “Telehealth” means the mode of delivering health care services and public health via

6-19

information and communication technologies to facilitate the diagnosis, consultation, treatment,

6-20

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

6-21

at the originating site and the health care provider is at a distant site. Telehealth facilitates patient

6-22

self-management and caregiver support for patients and includes synchronous interactions and

6-23

asynchronous store and forward transfers.

6-24

     (c) All state and federal laws regarding the confidentiality of health care information and

6-25

a patient’s rights to his or her medical information shall apply to telehealth interactions.

6-26

     (d) It is the intent of the general assembly to recognize the practice of telehealth as a

6-27

legitimate means by which an individual may receive health care services from a health care

6-28

provider without in-person contact with the health care provider.

6-29

     (e) Every individual or group health insurance contract, plan or policy delivered, issued

6-30

for delivery or renewed in this state on or after January 1, 2013, which provides medical coverage

6-31

that includes coverage for physician services in a physician's office and every policy, which

6-32

provides major medical or similar comprehensive type coverage shall provide coverage for

6-33

telehealth services as defined in this section.

7-34

     (f) A health insurance contract, plan or policy may require prior authorization for

7-35

telehealth services in the same manner that prior authorization is required for any other covered

7-36

benefit.

7-37

     (g) Notwithstanding any other provision, this section shall not be interpreted to authorize

7-38

a health care service plan to require the use of telehealth when the health care provider has

7-39

determined that it is not appropriate.

7-40

     SECTION 4. This act shall take effect upon passage.

=======

LC01845

========

EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N A C T

RELATING TO INSURANCE - TELEHEALTH SERVICES

***

8-1

     This act would create and establish “telehealth services” to be used as a tool to improve

8-2

and supplement health system services provided by non-profit hospital service corporations, non-

8-3

profit medical service corporations and accident and sickness insurance providers.

8-4

     This act would take effect upon passage.

=======

LC01845

=======