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:

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

by adding thereto the following chapter:

CHAPTER 81

THE TELEMEDICINE COVERAGE ACT

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

Coverage 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, cost, 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. -- (a) As used in this chapter:

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

health care services by means of telemedicine.

     (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 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) "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 health 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.

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

medically appropriate; 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 provider

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

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, treatment, and care 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. 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. -- (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 treatment provided

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

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

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

policy.

     (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 are medically appropriate to be

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

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

group.

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

coinsurance requirement for a health care service provided through telemedicine.

     (d) 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) 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 or of any rule or regulation

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

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

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

of the remainder of the 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 -- THE TELEMEDICINE COVERAGE ACT

***

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

delivered on or after January 1, 2018, 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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