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:

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

by adding thereto the following chapter:

CHAPTER 81

THE TELEMEDICINE REIMBURSEMENT ACT

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

reimbursement act".

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

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

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

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

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

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

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

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

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

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

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

prohibiting the use of telemedicine services.

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

indicated:

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

health care services by means of telemedicine or telehealth.

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

care setting, including, but not limited to, hospitals and other licensed impatient 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) "Health care professional" means a physician or other health care practitioner

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

law.

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

     (5) "Health care 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 health

care 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.

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

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

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

defined 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 health care

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

notwithstanding any other provision of law, health insurers and health care 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-forward technology" means the technology used to enable the

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.

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

communications technologies consisting of telephones, remote patient monitoring devices or

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

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

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

laws and regulations.

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

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

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

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

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 and regulations.

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

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

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

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

     (b) A health insurer 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 appropriately provided through

telemedicine services.

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

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

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

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

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

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

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

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

diagnosis, consultation, or treatment.

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

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

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

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

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

under the policy or health plan.

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

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

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

adjustment is made.

     (g) 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.

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

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

     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

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

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

     This act would take effect upon passage.

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