PRIOR PRINTER'S NO. 1001
PRINTER'S NO. 1448
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
780
Session of
2017
INTRODUCED BY VOGEL, YAW, BARTOLOTTA, BREWSTER, MARTIN, AUMENT,
KILLION, COSTA, VULAKOVICH, RAFFERTY, YUDICHAK, MENSCH,
BAKER, ARGALL, LANGERHOLC, WHITE, WARD, STEFANO, BLAKE,
LEACH, GREENLEAF AND BROWNE, JUNE 22, 2017
SENATOR WHITE, BANKING AND INSURANCE, AS AMENDED,
JANUARY 30, 2018
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:
"Ancillary service plans." Any 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
of the act of July 19, 1979 (P.L.130, No.48), known as the
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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 INCLUDES AN INDIVIDUAL OR GROUP HEALTH
INSURANCE POLICY, CONTRACT OR PLAN THAT PROVIDES DENTAL OR
VISION COVERAGE THROUGH A PROVIDER NETWORK.
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(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.
"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 SYNCHRONOUS OR ASYNCHRONOUS
TECHNOLOGY, INCLUDING, BUT NOT LIMITED TO, REMOTE PATIENT
MONITORING, 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.
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Section 3. Licensure of health care practitioner PRACTITIONERS.
(a) Requirements.--The Commonwealth's health professional
(A) REQUIREMENTS.--
(1) HEALTH CARE PRACTITIONERS PRACTICING TELEMEDICINE IN
THIS COMMONWEALTH SHALL BE LICENSED, CERTIFIED OR REGISTERED
BY THE APPROPRIATE COMMONWEALTH HEALTH PROFESSIONAL LICENSURE
BOARD.
(2) THE COMMONWEALTH'S HEALTH PROFESSIONAL licensure
boards shall maintain consistent licensure or, certification
OR REGISTRATION and standards of care requirements between
in-person and telemedicine-provided practices for health care
practitioners. Nothing in this section is intended to create
any new standards of care.
(3) NOTHING IN THIS ACT IS INTENDED TO EXPAND A HEALTH
CARE PRACTITIONER'S SCOPE OF PRACTICE SUBJECT TO STATE
LICENSURE LAWS.
(b) Rules and regulations.--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. The board or licensing entity shall
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 USING TELEMEDICINE shall comply
with all applicable Federal and State laws and regulations that
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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
TELEMEDICINE 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 a practitioner-patient relationship
with the individual in accordance with subsection (c);
(ii) prior ESTABLISH A PRACTITIONER-PATIENT
RELATIONSHIP WITH THE INDIVIDUAL AS PART OF THE
TELEMEDICINE SERVICE IN ACCORDANCE WITH SUBSECTION (C)
AND SHALL, PRIOR to treatment of the individual, provide
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 STANDARD of care applicable to
traditional, in-person health care services shall apply to
treatment and consultation recommendations made via
telemedicine.
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(3) A health care practitioner 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.
(4) PRACTITIONERS PROVIDING ONLINE REFRACTIVE SERVICES
SHALL INFORM PATIENTS THAT THE SERVICE IS NOT AN OCULAR
HEALTH EXAM. THIS PARAGRAPH SHALL NOT BE CONSTRUED TO
PROHIBIT ONLINE REFRACTIVE SERVICES IF THE INFORMATION IS
CLEARLY AND CONSPICUOUSLY COMMUNICATED TO THE PATIENT PRIOR
TO THE ONLINE REFRACTIVE SERVICE.
(b) 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
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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 IS PROVIDED.
(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
or updates 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).
(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
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issued, delivered, executed or renewed in this Commonwealth
after the effective date of this section shall provide
coverage for health care services TELEMEDICINE consistent
with the insurer's medical policy. A health insurance policy
or ancillary service plan shall 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 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 a health care
practitioner and an individual.
Section 7. Expansion.
Nothing in this act shall expand a health care practitioner's
scope of practice subject to State licensure laws.
Section 8 7. Medicaid program reimbursement.
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. Nothing in this act shall require the department to
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provide reimbursement for health care services TELEMEDICINE THAT
IS 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 8. Effective date.
This act shall take effect in 90 days.
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