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A06256 Summary:

BILL NOA06256
 
SAME ASSAME AS S05505
 
SPONSORWoerner
 
COSPNSRGottfried, Simon, Bronson, Rozic, Seawright, Hevesi, Burdick, Galef, Englebright, McDonald
 
MLTSPNSR
 
Amd §§2999-cc & 2999-dd, Pub Health L
 
Enacts specific provisions regarding the delivery of health care services via telehealth including requiring coverage and setting reimbursement rates under certain health care plans.
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A06256 Actions:

BILL NOA06256
 
03/11/2021referred to insurance
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A06256 Memo:

NEW YORK STATE ASSEMBLY
MEMORANDUM IN SUPPORT OF LEGISLATION
submitted in accordance with Assembly Rule III, Sec 1(f)
 
BILL NUMBER: A6256
 
SPONSOR: Woerner
  TITLE OF BILL: An act to amend the public health law in relation to the delivery of health care services via telehealth   PURPOSE: To provide for payment parity between the delivery of health care services via telehealth and services delivered in a traditional in-per- son environment and to provide for patient protections   SUMMARY OF PROVISIONS: Section 1: amends section 2999-cc of the public health law to add a new subdivision 8, to define and explain the role of a "health care plan" for the purposes of this section. Section 2: amends section 2999-dd of the public health law to require patient consent for the use of telehealth services; to require that the reimbursement rate for the delivery of such services shall be the same as if such services were delivered in person; to require that a health care plan ensure that enrollees have access to all covered services; and to specify authority for violations. Section 3: to provide that if an' provisions of this act are found to be in violation of, or inconsistent with, federal law or regulations, such provisions and applications of this act will be severable. Section 4: establishes the effective date.   JUSTIFICATION: Even prior to the COVID-19 pandemic it was clear that many parts of the state lack access to basic healthcare services. In many communities the nearest family physician, dentist, OBGYN, mental health practitioner, or pediatrician may be as far as an hour away. In rural communities, the issue is exacerbated by a lack of reliable and functional public trans- portation. For the people living in these communities, telehealth is an effective tool to ensure that they can access basic healthcare services. The COVID-19 Pandemic has underlined these shortcomings in our health- care system. In the face of the pandemic, New Yorkers have been asked to stay home and follow strict social distancing guidelines; we have asked employees to work from home where possible, students to transition to online learning, and we have encouraged the use of telehealth for the delivery of healthcare services. Additionally, accessing healthcare services via telehealth has proven to be critical in ensuring the safety of residents for whom being in a healthcare setting may expose them to disease such as seniors, immuno- compromised individuals, and people with chronic conditions. However, as we push New Yorkers to use telehealth services, we have not ensured that these services are re-imbursed at the same rate as a typical doctor's visit, financially disadvantaging physicians who would like to offer delivery of services through this mode. This bill will require that a telehealth visit be re-imbursed at the same rate as a traditional in-person visit and provides for patient protections. Such protections include requiring consent for the use of telehealth as a delivery modality for health services in place of an in-person visit.   LEGISLATIVE HISTORY: New bill.   FISCAL IMPLICATIONS: None to the state.   EFFECTIVE DATE: This act shall take January 1, 2022 and shall apply to all policies and contracts issued, renewed, modified, altered or amended on or after such date. Effective immediately, the commissioner of health, the superinten- dent of the department of financial services, the commissioner of the office of mental health, the commissioner of the office of alcoholism and substance abuse services, and the commissioner of the office for people with developmental disabilities shall make regulations and take other actions reasonably necessary to implement this act on that date.
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A06256 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          6256
 
                               2021-2022 Regular Sessions
 
                   IN ASSEMBLY
 
                                     March 11, 2021
                                       ___________
 
        Introduced  by  M. of A. WOERNER, GOTTFRIED -- read once and referred to
          the Committee on Insurance
 
        AN ACT to amend the public health law in relation  to  the  delivery  of
          health care services via telehealth
 
          The  People of the State of New York, represented in Senate and Assem-
        bly, do enact as follows:

     1    Section 1. Section 2999-cc of the public  health  law  is  amended  by
     2  adding a new subdivision 8 to read as follows:
     3    8.  "Health  care  plan"  means  an  entity  (other than a health care
     4  provider) that approves, provides, arranges for, or pays for health care
     5  services, including but not limited to:
     6    (a) a health maintenance organization licensed  under  article  forty-
     7  three of the insurance law;
     8    (b)  a health maintenance organization or other organization certified
     9  under article forty-four of this chapter;
    10    (c) an insurer or corporation subject to the insurance law; and
    11    (d) the medical assistance program under title eleven of article  five
    12  of  the  social services law ("medicaid"); the child health plus program
    13  under title one-A of article twenty-five of this chapter, and the  basic
    14  health  program  under section three hundred sixty-nine-gg of the social
    15  services law.
    16    § 2. Section 2999-dd of the public health law, as amended by section 4
    17  of subpart C of Part S of chapter 57 of the laws of 2018, subdivision  1
    18  as  amended  by chapter 124 of the laws of 2020, subdivisions 3 and 4 as
    19  added by chapter 328 of the laws of 2020, is amended to read as follows:
    20    § 2999-dd. Telehealth delivery of services. 1. [Health  care  services
    21  delivered  by  means  of  telehealth  shall be entitled to reimbursement
    22  under section three hundred sixty-seven-u of the  social  services  law;
    23  provided  however,  reimbursement  for  additional  modalities, provider
    24  categories and originating sites specified in  accordance  with  section
    25  twenty-nine hundred ninety-nine-ee of this article, and audio-only tele-

         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD09895-01-1

        A. 6256                             2

     1  phone  communication  defined  in  regulations  promulgated  pursuant to
     2  subdivision four of section twenty-nine hundred ninety-nine-cc  of  this
     3  article,  shall be contingent upon federal financial participation.] (a)
     4  A health care service may be delivered by means of telehealth by a tele-
     5  health  provider  otherwise authorized to perform that service. A health
     6  care service delivered by telehealth shall be with the  consent  of  the
     7  patient  or a person authorized to consent for the patient.  The consent
     8  shall be documented in the patient's medical record.
     9    (b) In-person contact between a  telehealth  provider  and  a  patient
    10  prior  to  the delivery of health care services via telehealth shall not
    11  be required, unless the provider determines it to be  clinically  neces-
    12  sary.
    13    2. (a) A health care plan shall cover a service, regardless of whether
    14  it is provided by telehealth,  if the service would otherwise be covered
    15  by  the  health  care plan and  the provider is otherwise covered by the
    16  health care plan.
    17    (b) A health care plan shall reimburse a treating or consulting health
    18  care provider for health care services appropriately delivered by  tele-
    19  health  on the same basis, at the same rate, and to the same extent that
    20  the health care plan reimburses for the service  when  provided  through
    21  in-person diagnosis, consultation, or treatment.
    22    (c)  A  health  care  plan  may  subject  the coverage of a telehealth
    23  service to copayments, coinsurance or deductibles if they are  at  least
    24  as  favorable  to  the  enrollee  as  would  apply if the service is not
    25  provided by telehealth.
    26    (d)  This article does not alter any obligation a health care plan may
    27  have to ensure that  enrollees  have  access  to  all  covered  services
    28  through an adequate network of contracted providers.
    29    (e)  With respect to health care plans under paragraph (d) of subdivi-
    30  sion eight of section 2999-cc of this article  (medicaid,  child  health
    31  plus,  and  the  basic health plan), this article shall only apply where
    32  there is federal financial participation.  The commissioner  shall  make
    33  state  plan  amendments  and seek federal waivers as necessary to obtain
    34  that federal financial participation.
    35    3. The department of health, the office of mental health,  the  office
    36  of  [alcoholism  and  substance  abuse  services] addiction services and
    37  supports, and the office  for  people  with  developmental  disabilities
    38  shall  coordinate  on  the issuance of a single guidance document, to be
    39  updated as appropriate, that shall:  (a)  identify  any  differences  in
    40  regulations  or  policies issued by the agencies, including with respect
    41  to reimbursement [pursuant to section three hundred sixty-seven-u of the
    42  social services law]; and (b) be designed to assist  consumers,  provid-
    43  ers,  and health care plans in understanding and facilitating the appro-
    44  priate use of telehealth in addressing barriers to care.
    45    [3.] 4. The authority of  the  department  of  financial  services  to
    46  establish  and  enforce minimum standards for accident and health insur-
    47  ance under articles thirty-two and  forty-three  of  the  insurance  law
    48  shall  include  enforcement  of  telehealth  standards set forth in this
    49  article.
    50    5. (a) Dental telehealth services shall adhere  to  the  standards  of
    51  appropriate  patient care required in other dental health care settings,
    52  including but not limited to appropriate patient examination, taking  of
    53  x-rays, and review of a patient's medical and dental history. All dental
    54  telehealth  providers  shall  identify themselves to patients, including
    55  providing the professional's New York state license  number.  No  dental
    56  telehealth  provider shall attempt to waive liability for its telehealth

        A. 6256                             3
 
     1  services in advance of delivering such telehealth services and no dental
     2  telehealth provider shall attempt to prevent a patient from  filing  any
     3  complaint with any governmental agency or authority.
     4    (b)  This  subdivision shall not be construed to diminish requirements
     5  for other telehealth services.
     6    [4.] 6. Nothing in this article shall be deemed to allow any person to
     7  provide any service for which a license, registration, certification  or
     8  other  authorization  under title eight of the education law is required
     9  and which the person does not possess.
    10    § 3. If any provision of this act, or any application of any provision
    11  of this act, is held to be invalid, or to  violate  or  be  inconsistent
    12  with  any  federal law or regulation, that shall not affect the validity
    13  or effectiveness of any other provision of this act,  or  of  any  other
    14  application  of  any  provision  of  this act, which can be given effect
    15  without that provision or application; and to that end,  the  provisions
    16  and applications of this act are severable.
    17    § 4. This act shall take effect January 1, 2022 and shall apply to all
    18  policies  and contracts issued, renewed, modified, altered or amended on
    19  or after such date.  Effective immediately, the commissioner of  health,
    20  the  superintendent of the department of financial services, the commis-
    21  sioner of the office of mental health, the commissioner of the office of
    22  addiction services and supports, and the commissioner of the office  for
    23  people  with  developmental disabilities shall make regulations and take
    24  other actions reasonably necessary to implement this act on that date.
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