PRINTER'S NO. 2207
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1648
Session of
2017
INTRODUCED BY M. QUINN, BAKER, BARRAR, BRIGGS, R. BROWN,
V. BROWN, CAUSER, CORBIN, DALEY, DAVIDSON, DAVIS, DAWKINS,
EVERETT, FRITZ, HARKINS, PHILLIPS-HILL, MACKENZIE, MENTZER,
D. MILLER, MURT, MUSTIO, ORTITAY, C. QUINN, READSHAW, ROZZI,
SCHLOSSBERG, TOBASH, TOOHIL, TOPPER AND WARD, JULY 7, 2017
REFERRED TO COMMITTEE ON INSURANCE, JULY 7, 2017
AN ACT
Providing for telemedicine, for insurance coverage of
telemedicine services and for Medicaid program reimbursement.
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:
"Ancillary service plans." An individual or group health
insurance plan, subscriber contract or certificate that provides
exclusive coverage for dental services or vision services.
"Health care practitioner." Any of the following:
(1) A health care practitioner as defined in section 103
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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 (49 Stat. 620, 42 U.S.C. §
1395x(aa)(2)).
"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 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) Article XXIV of The Insurance Company Law of
1921.
(iii) The act of December 29, 1972 (P.L.1701,
No.364), known as the Health Maintenance Organization
Act.
(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, specified disease,
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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.
"Interactive audio." The use of asynchronous store and
forward technology in conjunction with synchronous audio
interaction between a health care practitioner and a patient.
"Store and forward technology." Technology that stores and
transmits or grants access to a patient's clinical information
for review by a health care practitioner who is at a different
location.
"Telemedicine" or "telehealth." The delivery of health care
services provided through technology to a patient by a health
care practitioner who is at a different location. The term
includes a real-time encounter between the patient and health
care practitioner through interactive audio, video or other
telecommunications or electronic technology and the acquisition,
evaluation and transmission of patient information outside of a
real-time encounter, including store and forward technology and
remote patient monitoring of medical data. The term does not
include the use of audio-only telephone conversation, voicemail,
facsimile, e-mail, instant messaging, text messaging, an online
questionnaire or any combination thereof, nor an automated
computer program used to diagnose or treat ocular or refractive
conditions.
Section 3. Licensure of health care practitioner.
(a) Requirements.--
(1) The Commonwealth's health professional licensure
boards shall maintain consistent licensure or certification
and standards of care requirements between in-person and
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telemedicine-provided practices for health care
practitioners.
(2) Nothing in this section is intended to create a new
standard of care.
(b) Rules and regulations.--
(1) The board or licensing entity governing a health
care practitioner covered by this section may promulgate
regulations consistent with this act to provide for and
regulate the use of telemedicine in the delivery of health
care services within the scope of practice regulated by the
board or licensing entity.
(2) The board or licensing entity may not establish a
more restrictive standard of professional practice for the
practice of telemedicine than that specifically authorized by
the health care practitioner's practice act or other
specifically applicable statute, including prescribing and
dispensing controlled substances.
Section 4. Compliance.
A health care practitioner shall comply with all applicable
Federal and State laws and regulations that would apply if the
practitioner were located in this Commonwealth.
Section 5. Evaluation and treatment.
(a) Requirements.--Except as provided in subsection (b), 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) The health care practitioner shall:
(i) establish a practitioner-patient relationship
with the individual in accordance with subsection (c);
(ii) prior to treatment of the individual, provide
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an appropriate virtual examination initiated through a
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 of the health care practitioner; or
(iii) establish a telemedicine practitioner-patient
relationship that meets standards included in evidence-
based telemedicine clinical practice guidelines.
(2) The same standards of care applicable to
traditional, in-person health care services shall apply to
treatment and consultation recommendations made via
telemedicine.
(3) The health care practitioner while practicing
telemedicine may utilize interactive audio without the
requirement of video if, after access and review of the
patient's medical records, the practitioner determines that
the practitioner is able to meet the same standard of care as
if the health care services were provided in person. The
practitioner shall inform the patient that the patient has
the option to request telemedicine services that include
video.
(4) The health care practitioner shall have an emergency
action plan in place for medical emergencies and referrals
when needed.
(b) Exceptions.--This section shall not apply to the
following:
(1) Consultation by a health care practitioner with
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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 the health care practitioner's active
patients.
(c) Practitioner-patient relationship.--For purposes of
subsection (a)(1), a practitioner-patient relationship is
established when the health care practitioner satisfies each of
the following:
(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,
geographic location and medical specialty or applicable
credentials.
(3) Obtains 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.
(4) Establishes a diagnosis and treatment plan, as
reasonably determined by the professional independent
judgment of the health care practitioner.
(5) Creates and maintains an electronic medical record
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or updates an existing electronic medical record for the
patient within 24 hours. The 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).
(6) Provides a visit summary to the individual.
Section 6. Coverage of telemedicine services.
(a) Insurance coverage and reimbursement.--
(1) A health insurance policy or ancillary service plan
issued, delivered, executed or renewed in this Commonwealth
after the effective date of this section shall provide
coverage for health care services consistent with the
insurer's medical policy. A health insurance policy or
ancillary service plan may not exclude a health care service
for coverage solely because the service is provided through
telemedicine.
(2) An insurer, corporation or health maintenance
organization shall reimburse the health care practitioner for
health care services delivered through telemedicine if the
insurer, corporation or health maintenance organization
reimburses for the same service through in-person
consultation. Payment for telemedicine encounters shall be
established between the health care practitioner and insurer.
(b) Construction of law.--Nothing in this act shall be
construed to prohibit a health insurance policy or ancillary
service plan from providing reimbursement for a health care
service delivered through telemedicine where the same or similar
service is not otherwise eligible for reimbursement when
provided through in-person consultation or other contact between
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a health care practitioner and an individual.
Section 7. Expansion.
Nothing in this act shall be construed to expand a health
care practitioner's scope of practice subject to State licensure
laws.
Section 8. Medicaid program reimbursement.
(a) General rule.--The Department of Human Services shall
provide medical assistance coverage and reimbursement, including
medical assistance fee-for-service and managed care programs,
for health care services delivered through telemedicine in
accordance with this act.
(b) Construction of law.--Nothing in this act shall be
construed to require the department to provide reimbursement for
health care services ineligible for reimbursement under medical
assistance fee-for-service and managed care program guidelines
established under 42 CFR Ch. IV Subch. C (relating to medical
assistance programs).
Section 9. Effective date.
This act shall take effect in 90 days.
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