PRIOR PRINTER'S NO. 790
PRINTER'S NO. 949
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
705
Session of
2021
INTRODUCED BY VOGEL, LANGERHOLC, ARGALL, STREET, BARTOLOTTA,
MARTIN, MENSCH, J. WARD, YUDICHAK, YAW, BAKER, COSTA,
GORDNER, STEFANO, AUMENT AND HAYWOOD, MAY 21, 2021
SENATOR DISANTO, BANKING AND INSURANCE, AS AMENDED,
JUNE 23, 2021
AN ACT
Relating to telemedicine; authorizing the regulation of
telemedicine by professional licensing boards; and providing
for insurance coverage of telemedicine.
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:
"Asynchronous interaction." An exchange of information
between a patient and a health care provider that does not occur
in real time, including the secure collection and transmission
of a patient's medical information, clinical data, clinical
images, laboratory results and self-reported medical history.
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"Emergency medical condition." A medical condition
manifesting itself by acute symptoms of sufficient severity,
including severe pain, such that the absence of immediate
medical attention could reasonably be expected to result in
placing the health of the individual in serious jeopardy,
serious impairment to bodily functions or serious dysfunction of
a bodily organ or part.
"Health care provider" or "provider." Any of the following:
(1) An individual who is licensed, certified,
registered, permitted or otherwise authorized by law
REGULATED to provide health care services in UNDER THE LAWS
OF this Commonwealth.
(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)).
(4) A general, mental, chronic disease or other type of
hospital licensed in this Commonwealth.
"Health care services." Services for the diagnosis,
prevention, treatment, HABILITATION, REHABILITATION, cure or
relief of a health condition, injury, disease or illness.
"Health Information Technology for Economic and Clinical
Health Act." The Health Information Technology for Economic and
Clinical Health Act (Public Law 111-5, 123 Stat. 226-279 and
467-496).
"Health insurance policy." As follows:
(1) An individual or group health insurance policy,
contract or plan that provides coverage for services provided
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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 under 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 Insurance Portability and Accountability Act of
1996." The Health Insurance Portability and Accountability Act
of 1996 (Public Law 104-191, 110 Stat. 1936).
"Health insurer." An entity that holds a valid license 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).
"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 health care provider under this act.
"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 on a temporary basis so long as the designated provider
is in the same group or health system, has access to the
patient's prior medical records, holds a valid license in this
Commonwealth and is in a position to coordinate care.
"Participating network provider." A health care provider
who has a network participation agreement with an insurer.
"Provider-to-provider consultation." The act of seeking
advice and recommendations from another health care provider for
diagnostic studies, therapeutic interventions or other services
that may benefit the patient of the initiating health care
provider.
"Remote patient monitoring." The collection of physiological
data from a patient in one location, which is transmitted via
electronic communication technologies to a provider in a
different location for use in care and related support of the
patient.
"Synchronous interaction." A two-way or multiple-way
exchange of information between a patient and a health care
provider that occurs in real time via audio or video
conferencing.
"Telemedicine." The delivery of health care services to a
patient by a health care provider who is at a different
location, through synchronous interactions, asynchronous
interactions or remote patient monitoring that meet the
requirements of the Health Insurance Portability and
Accountability Act of 1996, the Health Information Technology
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for Economic and Clinical Health Act or other applicable Federal
or State law regarding the privacy and security of electronic
transmission of health information. The term does not include
any of the following:
(1) The provision of health care services solely through
the use of voicemail, facsimile, e-mail or instant messaging
or a combination thereof.
(2) A provider-to-provider consultation.
Section 3. Regulation of telemedicine by professional licensure
boards.
Each licensure board shall promulgate regulations that are
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 and clinical guidelines for
the appropriate use of synchronous interactions, asynchronous
interactions and remote patient monitoring.
(2) Include patient privacy and data security standards
that comply with Federal and State law, including the Health
Insurance Portability and Accountability Act of 1996 and the
Health Information Technology for Economic and Clinical
Health Act.
Section 4. Compliance.
A health care provider providing telemedicine services to an
individual located within this Commonwealth shall comply with
all applicable Federal and State laws and regulations. Failure
to comply with applicable laws and regulations shall subject the
health care provider to discipline by the respective licensure
board.
Section 5. Evaluation and treatment.
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(a) Requirements.--A health care provider who provides
healthcare HEALTH CARE services via telemedicine to an
individual located in this Commonwealth shall comply with the
following:
(1) For a telemedicine encounter in which the provider
does not have an established provider-patient relationship,
the provider shall:
(i) verify the location and identity of the
individual receiving care; and
(ii) disclose the health care provider's identity,
geographic location and medical specialty or applicable
credentials.
(2) Obtain oral or written consent regarding the use of
telemedicine 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.
(3) Perform a clinical evaluation that is appropriate
for the patient and the condition with which the patient
presents before providing treatment or issuing a prescription
through the use of telemedicine. A healthcare HEALTH CARE
provider may use a synchronous telemedicine interaction or an
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asynchronous telemedicine interaction to perform the clinical
evaluation.
(4) Establish a diagnosis and treatment plan or execute
a treatment plan. IF DEEMED APPROPRIATE IN THE HEALTH CARE
PROVIDER'S CLINICAL JUDGMENT.
(5) Create and maintain an electronic medical record or
update 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 Health Insurance Portability and
Accountability Act of 1996.
(6) Provide a visit summary to the individual if
requested.
(7) Have an emergency action plan in place for medical
and behavioral health emergencies and referrals.
(b) Disclosures.--Providers offering online refractive
services OR ONLINE DENTAL EVALUATIONS shall inform patients that
the service is not an ocular health exam OR A COMPREHENSIVE
DENTAL EXAMINATION. This subsection shall not be construed to
prohibit online refractive services OR ONLINE DENTAL EVALUATIONS
if the information notice is clearly and conspicuously
communicated to the patient prior to the online refractive
service OR ONLINE DENTAL EVALUATION.
(c) Applicability.--
(1) Subsection (a)(1) shall not apply to on-call or
cross-coverage services.
(2) Subsection (a)(1) and (2) shall not apply to an
emergency medical condition.
(d) Standard of care.--A health care provider providing
health care services through telemedicine shall be subject to
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the standard of care that would apply to the provision of the
same health care services in an in-person setting.
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 medically
necessary telemedicine delivered by a participating network
provider who provides a covered service via telemedicine
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.
(2) Subject to paragraph (1), a health insurer shall
reimburse a health care provider that is a participating
network provider for both in-person and telemedicine services
in accordance with the terms and conditions of the network
participation agreement as negotiated between the insurer and
the participating provider, the form of which shall be filed
with and subject to review by the Department of Health. The
network participation agreement may not prohibit
reimbursement solely because a health care service is
provided by telemedicine. Reimbursement shall not be
conditioned upon the use of an exclusive or proprietary
telemedicine technology or vendor.
(3) Payment for a covered service provided via
telemedicine by any participating network provider shall be
negotiated between the health care PARTICIPATING NETWORK
provider and health insurer.
(b) Applicability.--This section shall apply as follows:
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(1) Subsection (a)(1) and (2) shall not apply if the
telemedicine service is facilitated via a medical device or
other technology that provides clinical data or information,
excluding existing information in an electronic medical
records system, other than that independently provided
through synchronous or asynchronous interactions OR REMOTE
PATIENT MONITORING with the patient.
(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
180 days 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 under this section shall be
construed to:
(1) Prohibit a health insurer from reimbursing other
providers for covered services provided via telemedicine.
(2) Require a health insurer to reimburse an out-of-
network provider for telemedicine.
(3) REQUIRE A HEALTH INSURER TO REIMBURSE A
PARTICIPATING NETWORK PROVIDER IF THE PROVISION OF THE
SERVICE USING TELEMEDICINE WOULD BE INCONSISTENT WITH THE
STANDARD OF CARE.
Section 7. Medicaid program reimbursement.
(a) Medical assistance payment.--Medical assistance payments
shall be made on behalf of eligible individuals for
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telemedicine, consistent with Federal law, as specified under
this act if the service would be covered through an in-person
encounter.
(b) Applicability.--Subsection (a) does not apply if:
(1) 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; or
(2) the provision of the service using telemedicine
would be inconsistent with the standard of care.
Section 8. Effective date.
This act shall take effect as follows:
(1) Section 7 shall take effect in 90 days.
(2) The remainder of this act shall take effect
immediately.
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