PRINTER'S NO. 2032
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
1342
Session of
2015
INTRODUCED BY VOGEL, STEFANO, TEPLITZ, ARGALL, RAFFERTY,
BARTOLOTTA, AUMENT, YAW, YUDICHAK, VULAKOVICH, BAKER,
SCAVELLO, MENSCH, SCHWANK, WARD, DINNIMAN AND KILLION,
AUGUST 5, 2016
REFERRED TO BANKING AND INSURANCE, AUGUST 5, 2016
AN ACT
Providing for telemedicine and for insurance coverage.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
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:
"Health care practitioner." The term has the same meaning as
is given in section 103 of the act of July 19, 1979 (P.L.130,
No.48), known as the Health Care Facilities Act.
"Health care services." Services for the diagnosis,
prevention, treatment, cure or relief of a health condition,
injury, disease or illness.
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"Health insurance policy." As follows:
(1) An individual or group health insurance policy,
contract or plan that provides medical or health care
coverage by a health care facility or health care
practitioner that is offered by an entity subject to any of
the following:
(i) The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921.
(ii) The act of December 29, 1972 (P.L.1701,
No.364), known as the Health Maintenance Organization
Act.
(iii) Article XXIV of The Insurance Company Law of
1921.
(iv) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations).
(v) 40 Pa.C.S. Ch. 63 (relating to professional
health services plan corporations).
(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.
"Telemedicine." The delivery of health care services
provided through telecommunications technology to a patient by a
health care practitioner who is at a different location. The
term includes an encounter between the patient and provider and
the acquisition, evaluation and transmission of patient
information outside of a real-time interaction, including remote
patient monitoring of medical data. The term does not include
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the use of audio-only telephone conversation, facsimile, e-mail,
instant messaging, phone text, answers to an online
questionnaire or any combination thereof.
Section 3. Licensure of health care practitioner.
(a) Requirements.--Except as provided in section 5, the
Commonwealth's health professional boards shall maintain
consistent licensure or certification and standards of care
requirements between in-person and telemedicine-provided
practices. A health care practitioner who delivers services
through the use of telemedicine shall be subject to the laws of
this Commonwealth that require licensure, certification or other
authorization to practice a health care profession, held to the
same standard of professional practice as a similar licensee of
the same practice area or specialty that is providing the same
healthcare services through in-person encounters. Nothing in
this section is intended to create any new standards of care.
(b) Restriction.--The board or licensing entity governing
any health care practitioner covered by this section shall not
establish a more restrictive standard of professional practice
for the practice of telemedicine than that specifically
authorized by the practitioner's practice act or other
specifically applicable statute, including prescribing and
dispensing controlled substances.
Section 4. Professional liability coverage.
(a) General requirements.--A health care practitioner who
provides a health care service to an individual located in this
Commonwealth through telemedicine shall be subject to the laws
of this Commonwealth that require health care practitioners to
maintain professional liability insurance, pay assessments to
the Medical Care Availability and Reduction of Error (Mcare)
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Fund or otherwise obtain coverage for medical professional
liability. The requirements shall be the same as the
requirements that are applicable to a health care practitioner
who provides the service through an in-person encounter with the
individual receiving the service or otherwise while located in
this Commonwealth.
(b) Telecommunications.--A health care practitioner who
makes a medical treatment recommendation or issues a
prescription to an individual located in this Commonwealth
through a telephone consultation, online platform, Internet
service or mobile application shall be subject to the laws of
this Commonwealth that require health care practitioners to
maintain professional liability insurance, pay assessments to
the Medical Care Availability and Reduction of Error (Mcare)
Fund or obtain coverage for medical professional liability. The
requirements shall be the same as the requirements that are
applicable to a health care practitioner who provides the
service through an in-person encounter with the individual
receiving the service or otherwise while located in this
Commonwealth.
(c) Applicable statutes.--Statutes applicable to health care
practitioners under subsections (a) and (b) shall include:
(1) Chapter 7 of the act of March 20, 2002 (P.L.154,
No.13), known as the Medical Care Availability and Reduction
of Error (Mcare) Act.
(2) Sections 8.5(e) and 8.7 of the act of May 22, 1951
(P.L.317, No.69), known as The Professional Nursing Law.
(3) Any law enacted after the effective date of this
section that mandates a health care practitioner to maintain
professional liability insurance, pay assessments to the
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Medical Care Availability and Reduction of Error (Mcare) Fund
or otherwise obtain coverage for medical professional
liability.
Section 5. Evaluation and treatment.
(a) Requirements.--Except as provided in subsection (c), a
health care practitioner who provides a health care service to
an individual located in this Commonwealth through telemedicine
shall be subject to and comply with the following:
(1) A health care practitioner shall:
(i) establish and maintain a practitioner-patient
relationship with the individual in accordance with
subsection (d);
(ii) prior to treatment of the individual, provide
an appropriate virtual examination initiated through or
face-to-face consultation using telemedicine technologies
and any peripherals and diagnostic tests necessary to
provide an accurate diagnosis, if an in-person
examination would otherwise be medically appropriate in
the provision of the same service not delivered via
telemedicine, as reasonably determined by the
professional independent judgment, decision making and
discretion of the health care practitioner; or
(iii) establish a telemedicine practitioner-patient
relationship that meets standards included in evidence-
based telemedicine clinical practice guidelines developed
by a nationally recognized major medical association for
a specialty whose board is a member of the American Board
of Medical Specialties or the American Osteopathic
Association.
(2) The same standards of practices applicable to
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traditional, in-person health care services shall apply to
treatment and consultation recommendations made via
telemedicine.
(3) The health care practitioner shall have an emergency
action plan in place for medical emergencies and referrals
when needed.
(b) Compliance.--Except as provided in subsection (c), a
health care practitioner who issues a medical care
recommendation or prescription to an individual located in this
Commonwealth through a telephone consultation, online platform,
Internet service or mobile application shall be subject to
subsection (a)(1).
(c) Exceptions.--This section shall not apply to the
following:
(1) Consultation by a health care practitioner with
another health care practitioner who has an ongoing
practitioner-patient relationship with the individual that
was established through an in-person or appropriate virtual
examination and agrees to supervise the individual's care.
(2) The provision of on-call or cross-coverage health
care services to the active patients of another health care
practitioner in the same specialty, provided that the health
care practitioner whose active patients are being provided
the health care services has designated the exempted health
care practitioner as an on-call or cross-coverage health care
practitioner for his or her active patients.
(d) Practitioner-patient relationship.--For purposes of
subsection (a)(1), a practitioner-patient relationship is not
established and maintained unless the health care practitioner
satisfies each of the following:
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(1) Verifies the location and identity of the individual
receiving care each time health care services are provided
through telemedicine.
(2) Discloses the health care practitioner's identity
and applicable credentials.
(3) Obtains informed consent regarding the use of
telemedicine technologies under section 6 from the individual
or other person acting in a health care decision-making
capacity for the individual.
(4) Establishes a diagnosis and treatment plan, as
reasonably determined by the professional independent
judgment, decision making and discretion of the health care
practitioner through the use of patient history, mental
status examination, physical examination or appropriate
virtual face-to-face examination using telecommunications
technology consistent with the definition of "telemedicine"
in section 2, unless prevented by the individual's condition,
appropriate diagnostic and laboratory testing and
identification of underlying condition or contraindications.
(5) Recommends one or more options for the individual to
obtain appropriate follow-up care.
(6) Provides a visit summary to the individual and
primary care practitioner at the direction of the health care
practitioner or the individual.
(e) Prescriptions.--
(1) A provider with an established provider-patient
relationship may issue prescription drug orders using
telemedicine with the scope of the provider's license and
according to any applicable laws and regulations, including
the applicable legal standard of care.
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(2) A prescription drug order issued through
telemedicine-provided services shall be considered a legally
valid prescription drug order.
(3) A provider may not prescribe a controlled substance
unless it is prescribed in compliance with section 102(54)(a)
of the Comprehensive Drug Abuse Prevention and Control Act of
1970 (Public Law 91-513, 84 Stat. 1236).
(f) Construction.--Nothing in this act shall be construed to
expand the prescriptive authority of any provider beyond what is
authorized by the provider's licensing agency or board.
Section 6. Informed consent.
The health care practitioner utilizing telemedicine to
provide a health care service to an individual located in this
Commonwealth shall comply with applicable Federal and State laws
relating to informed consent. A separate consent for
telemedicine may not be required.
Section 7. Privacy practices.
A health care practitioner utilizing telemedicine to provide
a health care service to an individual located in this
Commonwealth shall comply with applicable Federal and State laws
relating to medical record documentation and maintenance, as
well as privacy and security of record retention of individually
identifiable health information, including compliance with the
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 115-
5, 123 Stat. 226-279 and 467-496).
Section 8. Fraud and abuse.
A health care practitioner utilizing telemedicine when
providing a health care service to an individual located in this
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Commonwealth must follow applicable Federal and State laws
relating to fraud and abuse.
Section 9. Coverage of telemedicine services.
(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 covered
health care services consistent with the insurer's medical
criteria for clinical services under the provider's contract.
An insurer, corporation or health maintenance organization
shall reimburse the treating provider or the consulting
provider for the diagnosis, consultation or treatment of the
insured delivered through telemedicine services on the same
basis that the insurer, corporation or health maintenance
organization is responsible for coverage for the provision of
the same service through in-person consultation. Payment for
telemedicine interactions shall include compensation to the
originating site for the transmission cost incurred during
the delivery of health care services.
(2) A health insurance policy in effect on the effective
date of this section shall, upon renewal, be amended to
provide coverage for health care services delivered through
telemedicine and on the same basis as the insurer,
corporation or health maintenance organization is responsible
for coverage for the provision of the same service through
in-person consultation or contact under this act.
(b) Inclusion.--A health insurance policy may not exclude a
service for coverage solely because the service is provided
through telemedicine and is not provided through in-person
consultation or other contact between a health care practitioner
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and an individual.
(c) Deductibles, copayments and coinsurance.--A health
insurance policy may contain a deductible, copayment or
coinsurance requirement for a health care service provided
through telemedicine.
(d) Selection of practitioner.--A health insurance policy
must do the following:
(1) Allow the policyholder to choose the participating
health care practitioner that provides covered service
through telemedicine.
(2) Disclose to covered individuals their cost-sharing
responsibilities to use telemedicine.
(e) Imposition prohibited.--A health insurance policy shall
not impose an annual or lifetime dollar maximum on coverage for
telemedicine-provided service other than an annual or lifetime
dollar maximum that applies in the aggregate to all items and
services covered under the policy, and shall not impose upon a
person receiving benefits under this section any deductible,
copayment or coinsurance amounts or any policy year, calendar
year, lifetime or other durational benefit limitation or maximum
for benefits or services that is not equally imposed upon all
terms and services covered under the policy.
(f) Utilization review.--Nothing in this act shall preclude
an entity offering a health insurance policy from undertaking a
utilization review to determine the appropriateness of
telemedicine-provided services, provided that the following
requirements are satisfied:
(1) The determination is made in the same manner as
utilization review determinations are made for the treatment
of an illness, condition or disorder covered by a policy.
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(2) A utilization review shall not require prior
authorization of the telemedicine services.
Section 10. Expansion.
Nothing in this act shall expand a health care practitioner's
scope of practice subject to State licensure laws.
Section 11. Medicaid program reimbursement.
The Department of Human Services shall provide Medical
Assistance coverage and reimbursement, including, but not
limited to, Medical Assistance fee-for-service and HealthChoices
Managed Care, to cover the costs of covered health care services
delivered through telemedicine in accordance with this act.
Section 12. Effective date.
This act shall take effect in 90 days.
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