S0780B1448A06924 BIL:NLG 04/24/18 #90 A06924
AMENDMENTS TO SENATE BILL NO. 780
Sponsor: SENATOR VOGEL
Printer's No. 1448
Amend Bill, page 1, line 1, by striking out all of said line
and inserting
Relating to telemedicine; authorizing the practice of
telemedicine by health care providers; and providing for
insurance coverage of telemedicine.
Amend Bill, page 1, lines 4 through 16; pages 2 through 8,
lines 1 through 30; page 9, lines 1 through 7; by striking out
all of said lines on said pages and inserting
Section 1. Short title.
This act shall be known and may be cited as the Telemedicine
Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Audio-only medium." A prerecorded audio presentation or
recording.
"Consultation." The act of seeking assistance from another
health care provider for diagnostic studies, therapeutic
interventions or other services that may benefit the patient of
a health care provider who has an ongoing provider-patient
relationship with the individual.
"Health care provider" or "provider." Any of the following:
(1) A health care practitioner as defined in section 103
of the act of July 19, 1979 (P.L.130, No.48), known as the
Health Care Facilities Act.
(2) A federally qualified health center as defined in
section 1861(aa)(4) of the Social Security Act (49 Stat. 620,
42 U.S.C. § 1395x(aa)(4)).
(3) A rural health clinic as defined in section 1861(aa)
(2) of the Social Security Act (42 U.S.C. § 1395x(aa)(2)).
(4) A pharmacist licensed under the act of September 27,
1961 (P.L.1700, No.699), known as the Pharmacy Act.
(5) An occupational therapist licensed under the act of
June 15, 1982 (P.L.502, No.140), known as the Occupational
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Therapy Practice Act.
(6) A speech-language pathologist licensed under the act
of December 21, 1984 (P.L.1253, No.238), known as the Speech-
Language Pathologists and Audiologists Licensure Act.
(7) An audiologist licensed under the Speech-Language
Pathologists and Audiologists Licensure Act.
(8) A dental hygienist licensed under the act of May 1,
1933 (P.L.216, No.76), known as The Dental Law.
(9) A social worker, clinical social worker, marriage
and family therapist or professional counselor licensed under
the act of July 9, 1987 (P.L.220, No.39), known as the Social
Workers, Marriage and Family Therapists and Professional
Counselors Act.
(10) A registered nurse licensed under the act of May
22, 1951 (P.L.317, No.69), known as The Professional Nursing
Law.
"Health care services." Services for the diagnosis,
prevention, treatment, cure or relief of a health condition,
injury, disease or illness.
"Health insurance policy." As follows:
(1) An individual or group health insurance policy,
contract or plan that provides coverage for services provided
by a health care facility or health care provider that is
offered by a health insurer.
(2) The term includes an individual or group health
insurance policy, contract or plan that provides dental or
vision coverage through a provider network.
(3) Except as provided in paragraph (2), the term does
not include accident only, fixed indemnity, limited benefit,
credit, dental, vision, specified disease, Medicare
supplement, Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS) supplement, long-term care or
disability income, workers' compensation or automobile
medical payment insurance.
"Health insurer." An entity licensed by the Insurance
Department with accident and health authority to issue a health
insurance policy and governed under any of the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, including section 630 and
Article XXIV.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations).
(4) 40 Pa.C.S. Ch. 63 (relating to professional health
services plan corporations).
"Interactive audio and video." Real-time two-way or
multiple-way communication between a health care provider and a
patient.
"Licensure board." Each licensing board within the Bureau of
Professional and Occupational Affairs of the Department of State
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with jurisdiction over a professional licensee identified as a
health care provider under this act.
"Medical emergency." A condition wherein an individual is
unconscious or the probability of harm to an individual because
of failure to treat is great and surpasses any threatened harm
from the treatment itself.
"On-call or cross-coverage services." The provision of
telemedicine by a health care provider designated by another
provider with a provider-patient relationship to deliver
services so long as the designated provider is in the same group
or health system, has access to the patient's prior medical
records and is in a position to coordinate care.
"Store-and-forward." Technology that stores and transmits or
grants access to a patient's clinical information for review by
a health care provider who is at a different location.
"Telemedicine." The delivery of health care services
provided through technology, including, but not limited to,
interactive audio or video, store-and-forward and remote patient
monitoring, to a patient by a health care provider who is at a
different location. The term does not include the use of audio-
only medium, voicemail, facsimile, e-mail, instant messaging,
text messaging, online questionnaire or any combination thereof.
Section 3. Practice of telemedicine by health care providers.
(a) Requirements.--
(1) A health care provider licensed, certified or
registered by a Commonwealth professional licensure board
shall be authorized to practice telemedicine in accordance
with this act and the corresponding licensure board
regulations.
(2) A health care provider who engages in telemedicine
in a manner that does not comply with the standards of care
or rules of practice shall be subject to discipline by the
appropriate licensure board, as provided by law.
(b) Regulations.--Each licensure board shall within 24
months of the effective date of this section promulgate
regulations consistent with this act to provide for and regulate
telemedicine within the scope of practice and standard of care
regulated by the board. The regulations shall:
(1) Consider model policies for the appropriate use of
telemedicine technologies.
(2) Include patient privacy and data security standards
that are in compliance with the Federal Health Insurance
Portability and Accountability Act of 1996 (Public Law 104-
191, 110 Stat. 1936) and the Health Information Technology
for Economic and Clinical Health Act (Public Law 111-5, 123
Stat. 226-279 and 467-496).
(c) Temporary regulations.--In order to facilitate the
prompt implementation of this act, the licensure boards shall
publish temporary regulations regarding implementation of this
act in the Pennsylvania Bulletin within 60 days of the effective
date of this section. Temporary regulations are not subject to:
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(1) Sections 201, 202, 203, 204 and 205 of the act of
July 31, 1968 (P.L.769, No.240), referred to as the
Commonwealth Documents Law.
(2) Sections 204(b) and 301(10) of the act of October
15, 1980 (P.L.950, No.164), known as the Commonwealth
Attorneys Act.
(3) The act of June 25, 1982 (P.L.633, No.181), known as
the Regulatory Review Act.
(4) Section 612 of the act of April 9, 1929 (P.L.177,
No.175), known as The Administrative Code of 1929.
(d) Expiration.--Temporary regulations shall expire no later
than 24 months following publication of temporary regulations.
Regulations adopted after this period shall be promulgated as
provided by law.
(e) Construction.--The provisions of this act shall be in
full force and effect even if the licensure boards have not yet
published temporary regulations or implemented the regulations
required under this section.
Section 4. Compliance.
A health care provider engaging in telemedicine shall comply
with all applicable Federal and State laws and regulations.
Section 5. Evaluation and treatment.
(a) Requirements.--Except as provided in subsection (c), a
health care provider who provides telemedicine to an individual
located in this Commonwealth shall, prior to treatment of the
individual, establish a provider-patient relationship with the
individual that includes the following:
(1) Verifying the location and identity of the
individual receiving care each time telemedicine is provided.
(2) Disclosing the health care provider's identity,
geographic location and medical specialty or applicable
credentials.
(3) Obtaining informed consent regarding the use of
telemedicine technologies from the individual or other person
acting in a health care decision-making capacity for the
individual. The individual or other person acting in a health
care decision-making capacity, including the parent or legal
guardian of a child in accordance with the act of February
13, 1970 (P.L.19, No.10), entitled "An act enabling certain
minors to consent to medical, dental and health services,
declaring consent unnecessary under certain circumstances,"
has the right to choose the form of service delivery, which
includes the right to refuse telemedicine services without
jeopardizing the individual's access to other available
services.
(4) Providing an appropriate virtual examination or
assessment using telemedicine technologies and any
peripherals and diagnostic tests necessary for an accurate
diagnosis or care management if the examination or assessment
would otherwise be medically appropriate in an in-person
encounter. The health care provider may utilize interactive
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audio without the requirement of interactive video if, after
access and review of the patient's medical records, the
provider determines that the provider is able to meet the
same standards of care as if the health care services were
provided in person. The provider shall inform the patient
that the patient has the option to request interactive audio
and video.
(5) Establishing a diagnosis and treatment plan or
executing a treatment plan.
(6) Creating and maintaining an electronic medical
record or updating an existing electronic medical record for
the patient within 24 hours. An electronic medical record
shall be maintained in accordance with electronic medical
records privacy rules under the Federal Health Insurance
Portability and Accountability Act of 1996 (Public Law 104-
191, 110 Stat. 1936).
(7) Providing a visit summary to the individual if
requested.
(8) Having an emergency action plan in place for medical
and behavioral health emergencies and referrals.
(b) Disclosures.--Providers offering online refractive
services shall inform patients that the service is not an ocular
health exam. This subsection shall not be construed to prohibit
online refractive services if the information notice is clearly
and conspicuously communicated to the patient prior to the
online refractive service.
(c) Exceptions to provider-patient relationship
requirements.--Subsection (a) does not apply to the following:
(1) Consultations.
(2) On-call or cross-coverage services.
(3) Medical emergency.
Section 6. Insurance coverage of telemedicine.
(a) Insurance coverage and reimbursement.--
(1) A health insurance policy issued, delivered,
executed or renewed in this Commonwealth after the effective
date of this section shall provide coverage for telemedicine
delivered by a participating network provider consistent with
the insurer's medical policies. A health insurance policy may
not exclude a health care service for coverage solely because
the service is provided through telemedicine with the same
provider.
(2) A health insurer shall reimburse a health care
provider that is a participating provider in its network for
telemedicine if the health insurer reimburses the same
participating provider for the same service through an in-
person encounter. The standard of care and rules of practice
applicable to an in-person encounter shall apply to a
telemedicine encounter. Payment for telemedicine encounters
shall be established between the health care provider and
health insurer.
(b) Applicability.--This section applies as follows:
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(1) Subsection (a)(2) does not apply if the
telemedicine-enabling device, technology or service fails to
comply with applicable law and regulatory guidance regarding
the secure transmission and maintenance of patient
information.
(2) For a health insurance policy for which either rates
or forms are required to be filed with the Federal Government
or the Insurance Department, this section shall apply to a
policy for which a form or rate is first filed on or after
the effective date of this section.
(3) For a health insurance policy for which neither
rates nor forms are required to be filed with the Federal
Government or the Insurance Department, this section shall
apply to a policy issued or renewed on or after 180 days
after the effective date of this section.
(c) Construction.--Nothing in this act shall prohibit a
health insurer from providing reimbursement for telemedicine
where the same or similar service is not otherwise eligible for
reimbursement when provided through an in-person encounter or
other contact between a health care provider and an individual.
Section 7. Medicaid program reimbursement.
The Department of Human Services shall provide medical
assistance coverage and payment for telemedicine in accordance
with this act. Nothing in this act shall require the Department
of Human Services to provide coverage for services that would
not be covered if delivered through an in-person encounter or
for services that are inconsistent with Federal financial
participation requirements for the specific service or for
telemedicine.
Section 8. Effective date.
This act shall take effect as follows:
(1) The following provisions shall take effect in 90
days:
(i) Section 6.
(ii) Section 7.
(2) The remainder of this act shall take effect
immediately.
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See A06924 in
the context
of SB0780