S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   1535
 
                        2017-2018 Regular Sessions
 
                           I N  A S S E M B L Y
 
                             January 12, 2017
                                ___________
 
 Introduced  by M. of A. JENNE -- read once and referred to the Committee
   on Health
 
 AN ACT to amend the public health law and the insurance law, in relation
   to the provision of telehealth services
 
   THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
 BLY, DO ENACT AS FOLLOWS:

   Section  1. Subdivision 4 of section 2999-cc of the public health law,
 as added by chapter 6 of the  laws  of  2015,  is  amended  to  read  as
 follows:
   4.  "Telehealth"  means the use of electronic information and communi-
 cation technologies by  telehealth  providers  to  deliver  health  care
 services,  which  shall include the assessment, diagnosis, consultation,
 treatment,  education,  care  management  and/or  self-management  of  a
 patient.  Telehealth  shall not include delivery of health care services
 by means of audio-only telephone communication, facsimile  machines,  or
 electronic  messaging  alone,  though  use  of these technologies is not
 precluded if used in conjunction with telemedicine,  store  and  forward
 technology,  or remote patient monitoring. For purposes of this section,
 telehealth shall be limited to telemedicine, store and forward technolo-
 gy, and remote patient monitoring. This subdivision shall  not  preclude
 OR  IN  ANY  WAY  LIMIT the delivery of health care services by means of
 "home telehealth" as used in section thirty-six hundred fourteen of this
 chapter. HEALTH SERVICES, DEFINED  AS  "HOME  CARE  SERVICES"  REQUIRING
 LICENSURE  OR  CERTIFICATION  UNDER  ARTICLE THIRTY-SIX OF THIS CHAPTER,
 DELIVERED VIA TELEHEALTH AS SET FORTH IN THIS SUBDIVISION OR IN  SECTION
 THIRTY-SIX HUNDRED FOURTEEN OF THIS CHAPTER SHALL BE DELIVERED SOLELY BY
 A PROVIDER LICENSED, CERTIFIED OR EXEMPT UNDER SUCH ARTICLE.
   §  2.  Paragraph  3 of subsection (b) of section 1117 of the insurance
 law, as amended by chapter 572 of the laws of 2008, is amended  to  read
 as follows:

  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
                                                            LBD06615-01-7
              

 A. 1535                             2
 
   (3) the plan's benefit structure provides options for use of long term
 care services, INCLUDING TELEHEALTH AS PROVIDED FOR IN SUBPARAGRAPHS (A)
 AND (B) OF THIS PARAGRAPH.
   (A) A PLAN SHALL NOT EXCLUDE FROM COVERAGE A SERVICE THAT IS OTHERWISE
 COVERED  UNDER THE PLAN BECAUSE THE SERVICE IS DELIVERED VIA TELEHEALTH,
 AS THAT TERM IS DEFINED IN SUBPARAGRAPH (B) OF THIS PARAGRAPH; PROVIDED,
 HOWEVER, THAT AN INSURER MAY EXCLUDE FROM COVERAGE A SERVICE BY A HEALTH
 CARE PROVIDER WHERE THE PROVIDER IS  NOT  OTHERWISE  COVERED  UNDER  THE
 ENROLLEE  CONTRACT.  AN  INSURER  MAY  SUBJECT THE COVERAGE OF A SERVICE
 DELIVERED VIA TELEHEALTH  TO  CO-PAYMENTS,  COINSURANCE  OR  DEDUCTIBLES
 PROVIDED  THAT  THEY  ARE AT LEAST AS FAVORABLE TO THE ENROLLEE AS THOSE
 ESTABLISHED FOR THE SAME SERVICE WHEN NOT DELIVERED VIA  TELEHEALTH.  AN
 INSURER  MAY  SUBJECT THE COVERAGE OF A SERVICE DELIVERED VIA TELEHEALTH
 TO REASONABLE UTILIZATION MANAGEMENT AND QUALITY ASSURANCE  REQUIREMENTS
 THAT ARE CONSISTENT WITH THOSE ESTABLISHED FOR THE SAME SERVICE WHEN NOT
 DELIVERED VIA TELEHEALTH;
   (B)  FOR  PURPOSES  OF  THIS  PARAGRAPH, "TELEHEALTH" MEANS THE USE OF
 ELECTRONIC INFORMATION AND COMMUNICATION TECHNOLOGIES BY A  HEALTH  CARE
 PROVIDER  TO DELIVER HEALTH CARE SERVICES TO AN INSURED INDIVIDUAL WHILE
 SUCH INDIVIDUAL IS LOCATED AT A SITE THAT IS  DIFFERENT  FROM  THE  SITE
 WHERE THE HEALTH CARE PROVIDER IS LOCATED;
   §  3.  Subsection (a) of section 3217-h of the insurance law, as added
 by chapter 6 of the laws of 2015, is amended to read as follows:
   (a) An insurer shall not exclude  from  coverage  a  service  that  is
 otherwise  covered  under  a policy that provides comprehensive coverage
 for hospital, medical or surgical care because the service is  delivered
 via  telehealth,  as  that  term  is  defined  in subsection (b) of this
 section; provided, however, that an insurer may exclude from coverage  a
 service  by  a  health care provider where the provider is not otherwise
 covered under the policy. An insurer  may  subject  the  coverage  of  a
 service  delivered via telehealth to co-payments, coinsurance or deduct-
 ibles provided that they are at least as favorable  to  the  insured  as
 those  established  for  the  same  service when not delivered via tele-
 health. An insurer may subject the coverage of a service  delivered  via
 telehealth  to  reasonable  utilization management and quality assurance
 requirements that are consistent with those  established  for  the  same
 service when not delivered via telehealth. REMOTE PATIENT MONITORING VIA
 TELEHEALTH  DELIVERED  BY A HOME CARE AGENCY CERTIFIED OR LICENSED UNDER
 ARTICLE THIRTY-SIX OF THE PUBLIC HEALTH LAW SHALL NOT BE CONSTRUED AS  A
 "VISIT"  UNDER ANY VISIT NUMBER LIMITATION THAT A POLICY MAY CONTAIN FOR
 HOME CARE VISITS BY A HOME CARE SERVICES AGENCY.
   § 4. Paragraph 2 of subsection (a) of section 3229  of  the  insurance
 law,  as  amended by chapter 6 of the laws of 2015, is amended and a new
 paragraph 2-a is added to read as follows:
   (2) a home care benefit with personal care, nursing  care,  adult  day
 health  care  and respite care services, which shall provide total bene-
 fits in an amount  determined  by  regulations  of  the  superintendent;
 PROVIDED  HOWEVER  THAT  AN  INSURER  SHALL  NOT EXCLUDE FROM COVERAGE A
 SERVICE THAT IS OTHERWISE COVERED UNDER THE POLICY BECAUSE  THE  SERVICE
 IS  DELIVERED  VIA TELEHEALTH AS THAT TERM IS DEFINED IN PARAGRAPH TWO-A
 OF THIS SUBSECTION, PROVIDED, FURTHER, THAT AN INSURER MAY EXCLUDE  FROM
 COVERAGE  A  SERVICE BY A HEALTH CARE PROVIDER WHERE THE PROVIDER IS NOT
 OTHERWISE COVERED UNDER THE ENROLLEE CONTRACT. AN  INSURER  MAY  SUBJECT
 THE COVERAGE OF A SERVICE DELIVERED VIA TELEHEALTH TO CO-PAYMENTS, COIN-
 SURANCE,  OR DEDUCTIBLES PROVIDED THAT THEY ARE AT LEAST AS FAVORABLE TO
 THE ENROLLEE AS THOSE ESTABLISHED FOR THE SAME SERVICE WHEN  NOT  DELIV-

 A. 1535                             3
 
 ERED  VIA  TELEHEALTH.  AN INSURER MAY SUBJECT THE COVERAGE OF A SERVICE
 DELIVERED VIA TELEHEALTH TO REASONABLE UTILIZATION MANAGEMENT AND QUALI-
 TY ASSURANCE REQUIREMENTS THAT ARE CONSISTENT WITH THOSE ESTABLISHED FOR
 THE SAME SERVICE WHEN NOT DELIVERED VIA TELEHEALTH;
   (2-A)  FOR  PURPOSES OF PARAGRAPH TWO OF THIS SUBSECTION, "TELEHEALTH"
 MEANS THE USE OF ELECTRONIC INFORMATION AND  COMMUNICATION  TECHNOLOGIES
 BY  A HEALTH CARE PROVIDER TO DELIVER HEALTH CARE SERVICES TO AN INSURED
 INDIVIDUAL WHILE SUCH INDIVIDUAL IS LOCATED AT A SITE THAT IS  DIFFERENT
 FROM THE SITE WHERE THE HEALTH CARE PROVIDER IS LOCATED;
   §  5.  Subsection (a) of section 4306-g of the insurance law, as added
 by chapter 6 of the laws of 2015, is amended to read as follows:
   (a) A corporation shall not exclude from coverage a  service  that  is
 otherwise  covered under a contract that provides comprehensive coverage
 for hospital, medical or surgical care because the service is  delivered
 via  telehealth,  as  that  term  is  defined  in subsection (b) of this
 section; provided, however, that a corporation may exclude from coverage
 a service by a health care provider where the provider is not  otherwise
 covered under the contract.  A corporation may subject the coverage of a
 service  delivered via telehealth to co-payments, coinsurance or deduct-
 ibles provided that they are at least as favorable  to  the  insured  as
 those  established  for  the  same  service when not delivered via tele-
 health. A corporation may subject the coverage of  a  service  delivered
 via  telehealth  to reasonable utilization management and quality assur-
 ance requirements that are consistent with  those  established  for  the
 same  service when not delivered via telehealth. REMOTE PATIENT MONITOR-
 ING VIA TELEHEALTH DELIVERED BY A HOME CARE AGENCY CERTIFIED OR LICENSED
 UNDER ARTICLE THIRTY-SIX OF THE PUBLIC HEALTH LAW SHALL NOT BE CONSTRUED
 AS A "VISIT" UNDER ANY VISIT NUMBER LIMITATION THAT A POLICY MAY CONTAIN
 FOR HOME CARE VISITS BY A HOME CARE SERVICES AGENCY.
   § 6. Subdivision 1 of section 4406-g of  the  public  health  law,  as
 added by chapter 6 of the laws of 2015, is amended to read as follows:
   1. A health maintenance organization shall not exclude from coverage a
 service that is otherwise covered under an enrollee contract of a health
 maintenance  organization  because  the  service  is delivered via tele-
 health, as that term is defined in  subdivision  two  of  this  section;
 provided,  however,  that  a health maintenance organization may exclude
 from coverage a service by a health care provider where the provider  is
 not  otherwise covered under the enrollee contract. A health maintenance
 organization may subject the coverage of a service delivered  via  tele-
 health to co-payments, coinsurance or deductibles provided that they are
 at  least as favorable to the enrollee as those established for the same
 service when not delivered via telehealth. A health  maintenance  organ-
 ization  may  subject the coverage of a service delivered via telehealth
 to reasonable utilization management and quality assurance  requirements
 that are consistent with those established for the same service when not
 delivered  via  telehealth.  REMOTE  PATIENT  MONITORING  VIA TELEHEALTH
 DELIVERED BY A HOME CARE AGENCY  CERTIFIED  OR  LICENSED  UNDER  ARTICLE
 THIRTY-SIX OF THIS CHAPTER SHALL NOT BE CONSTRUED AS A "VISIT" UNDER ANY
 VISIT  NUMBER  LIMITATION THAT A POLICY MAY CONTAIN FOR HOME CARE VISITS
 BY A HOME CARE SERVICES AGENCY.
   § 7. This act shall take effect immediately.