A07424
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, BROWNE, STREET AND SCHWANK, JUNE 22, 2017
AS AMENDED ON SECOND CONSIDERATION, APRIL 24, 2018
AN ACT
Providing for telemedicine and for insurance coverage.
RELATING TO TELEMEDICINE; AUTHORIZING THE PRACTICE OF
TELEMEDICINE BY HEALTH CARE PROVIDERS; AND PROVIDING FOR
INSURANCE COVERAGE OF TELEMEDICINE.
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:
"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.
"Telemedicine" or "telehealth." The delivery of health care
services provided through 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 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.
Section 3. Licensure of health care practitioners.
(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, 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.
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(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 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.
Section 4. Compliance.
A health care practitioner using telemedicine 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 telemedicine to an
individual located in this Commonwealth shall be subject to and
comply with the following:
(1) A health care practitioner shall
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
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service not delivered via telemedicine, as reasonably
determined by the professional independent judgment of
the health care practitioner
.
(2) The same standard of care applicable to traditional,
in-person health care services shall apply to treatment and
consultation recommendations made via telemedicine.
(3) A health care practitioner may utilize 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) 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
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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 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.
(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.
(a) Insurance coverage and reimbursement.--
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(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
consistent with the insurer's medical policy. A health
insurance policy 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
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 from providing reimbursement for
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. 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
telemedicine in accordance with this act. Nothing in this act
shall require the department to provide reimbursement for
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).
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Section 8. Effective date.
This act shall take effect in 90 days.
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
THERAPY PRACTICE ACT.
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(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
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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
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
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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.
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(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:
(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.
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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
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WOULD OTHERWISE BE MEDICALLY APPROPRIATE IN AN IN-PERSON
ENCOUNTER. THE HEALTH CARE PROVIDER MAY UTILIZE INTERACTIVE
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:
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(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:
(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
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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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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.
"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) 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 who holds a valid license under the act
of September 27, 1961 (P.L.1700, No.699), known as the
Pharmacy Act.
(5) An occupational therapist who holds a valid license
under the act of June 15, 1982 (P.L.502, No.140), known as
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the Occupational Therapy Practice Act.
(6) A speech-language pathologist who holds a valid
license 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 who holds a valid license under the
Speech-Language Pathologists and Audiologists Licensure Act.
(8) A dental hygienist who holds a valid license 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 who holds a
valid license 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 who holds a valid license under
the act of May 22, 1951 (P.L.317, No.69), known as The
Professional Nursing Law.
(11) An out-of-State health care provider.
"Health care services." Services for the diagnosis,
prevention, treatment, 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
by a health care facility or health care provider that is
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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).
"Interactive audio and video." Real-time two-way or
multiple-way communication between a health care provider and a
patient.
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"Licensure board." Each licensing board within the Bureau of
Professional and Occupational Affairs of the Department of State
with jurisdiction over a professional licensee identified as 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.
"Out-of-State health care provider." A health care provider
providing a telemedicine service that holds a valid license,
certificate or registration in another jurisdiction and is:
(1) discharging official duties in the armed forces of
the United States, the United States Public Health Services
or the United States Department of Veterans Affairs;
(2) providing telemedicine services to a patient through
a federally operated facility;
(3) providing telemedicine services in response to an
emergency medical condition, if the care for the patient is
referred to an appropriate health care provider in this
Commonwealth as promptly as possible under the circumstances;
(4) providing provider-to-provider consultation
services; or
(5) providing services which would otherwise be exempt
from the requirement of licensure, certification or
registration in this Commonwealth under the respective
licensure act.
"Participating network provider." Any of the following
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providers who are under contract with a health insurer:
(1) A physician who holds a valid license under the act
of December 20, 1985 (P.L.457, No.112), known as the Medical
Practice Act of 1985, or the act of October 5, 1978
(P.L.1109, No.261), known as the Osteopathic Medical Practice
Act.
(2) A clinical nurse specialist or certified registered
nurse practitioner who holds a valid license under the act of
May 22, 1951 (P.L.317, No.69), known as The Professional
Nursing Law.
(3) A physician assistant who holds a valid license
under the Medical Practice Act of 1985.
(4) A dentist who holds a valid license under the act of
May 1, 1933 (P.L.216, No.76), known as The Dental Law.
(5) An optometrist who holds a valid license under the
act of June 6, 1980 (P.L.197, No.57), known as the Optometric
Practice and Licensure Act.
(6) A psychologist who holds a valid license under the
act of March 23, 1972 (P.L.136, No.52), known as the
Professional Psychologists Practice Act.
(7) A social worker, clinical social worker or
professional counselor who holds a valid license 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.
(8) An occupational therapist who holds a valid license
under the act of June 15, 1982 (P.L.502, No.140), known as
the Occupational Therapy Practice Act.
(9) A physical therapist who holds a valid license under
the act of October 10, 1975 (P.L.383, No.110), known as the
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Physical Therapy Practice Act.
"Provider-to-provider consultation." The informal 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.
"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 telemedicine technologies to a patient by a
health care provider who is at a different location. The term
does not include a provider-to-provider consultation.
"Telemedicine technologies." As follows:
(1) Electronic information and telecommunications
technology, including, but not limited to, interactive audio
and video, remote patient monitoring or store-and-forward,
that meets the requirements of the Health Insurance
Portability and Accountability Act of 1996, the Health
Information Technology for Economic and Clinical Health Act
or other applicable Federal or State law.
(2) The term does not include the use of:
(i) Audio-only medium, voicemail, facsimile, e-mail,
instant messaging, text messaging or online
questionnaire, or any combination thereof.
(ii) A telephone call, except as provided under
section 5(a)(3).
Section 3. Regulation of telemedicine by professional licensure
boards.
(a) Requirements.--
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(1) A health care provider that holds a valid license,
certificate or registration from 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 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 for the appropriate use of
telemedicine technologies.
(2) Include patient privacy and data security standards
that are in compliance with the Health Insurance Portability
and Accountability Act of 1996 and the Health Information
Technology for Economic and Clinical Health Act.
(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 120 days of the
effective date of this section. Temporary regulations are not
subject to:
(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
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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 providing telemedicine services to an
individual located within this Commonwealth shall comply with
all applicable Federal and State laws and regulations, and shall
hold a valid license, certificate or registration by an
appropriate Commonwealth licensure board. Failure to hold a
valid license, certificate or registration shall subject the
health care provider to discipline by the respective licensure
board for unlicensed practice.
Section 5. Evaluation and treatment.
(a) Requirements.--Except as provided under subsection (c),
a health care provider who provides 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,
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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 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.
(3) Provide an appropriate examination or assessment
using telemedicine technologies. The health care provider may
utilize interactive audio without the requirement of
interactive video if it is used in conjunction with store-
and-forward technology and, 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.
(4) Establish a diagnosis and treatment plan or execute
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a treatment plan.
(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 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) 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.
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 who provides a
covered service via telemedicine consistent with the
insurer's medical policies. A health insurance policy may not
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exclude a health care service for coverage solely because the
service is provided through telemedicine.
(2) A health insurer shall reimburse a health care
provider that is a participating network provider 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.
(3) Payment for a covered service provided via
telemedicine by any network provider shall be established
between the health care provider and health insurer.
(b) Applicability.--This section shall apply as follows:
(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 interactive audio or video or written input from 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
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.
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(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.
Section 7. Medicaid program reimbursement.
(a) Medical assistance payment.--Medical assistance payments
shall be made on behalf of eligible individuals for
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) 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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