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A02674 Summary:

BILL NOA02674
 
SAME ASNo Same As
 
SPONSORWoerner
 
COSPNSRBronson, McMahon, Jones, Magnarelli, Stirpe, Gunther, Buttenschon, McDonald
 
MLTSPNSR
 
Amd 3217-h & 4306-g, Ins L; amd 4406-g, Pub Health L
 
Requires insurance coverage parity for primary care services delivered via telehealth, where both the insured individual and the health care provider are located in a clinical setting.
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A02674 Text:



 
                STATE OF NEW YORK
        ________________________________________________________________________
 
                                          2674
 
                               2021-2022 Regular Sessions
 
                   IN ASSEMBLY
 
                                    January 19, 2021
                                       ___________
 
        Introduced  by  M.  of  A. WOERNER, BRONSON, McMAHON, JONES, MAGNARELLI,
          STIRPE, GUNTHER, BUTTENSCHON -- read once and referred to the  Commit-
          tee on Insurance
 
        AN ACT to amend the insurance law and the public health law, in relation
          to  requiring insurance coverage parity for certain services delivered
          via telehealth

          The People of the State of New York, represented in Senate and  Assem-
        bly, do enact as follows:
 
     1    Section  1. Section 3217-h of the insurance law, as added by chapter 6
     2  of the laws of 2015, is amended to read as follows:
     3    § 3217-h. Telehealth delivery of services. (a) An  insurer  shall  not
     4  exclude from coverage a service that is otherwise covered under a policy
     5  that  provides  comprehensive coverage for hospital, medical or surgical
     6  care because the service is delivered via telehealth, as  that  term  is
     7  defined  in  subsection  (b) of this section; provided, however, that an
     8  insurer may exclude from coverage a service by a  health  care  provider
     9  where the provider is not otherwise covered under the policy. An insurer
    10  may  subject  the  coverage  of  a  service  delivered via telehealth to
    11  co-payments, coinsurance or deductibles provided that they are at  least
    12  as  favorable  to  the insured as those established for the same service
    13  when not delivered via telehealth. An insurer may subject  the  coverage
    14  of  a service delivered via telehealth to reasonable utilization manage-
    15  ment and quality assurance requirements that are consistent  with  those
    16  established  for  the same service when not delivered via telehealth. An
    17  insurer shall reimburse primary care services delivered via  telehealth,
    18  where  both  the  insured  individual  and  the health care provider are
    19  located in a clinical setting, on the same basis and at the same rate as
    20  would apply to such services if  the  services  had  been  delivered  in
    21  person.
    22    (b) For purposes of this section[,] the following terms shall have the
    23  following meanings:
 
         EXPLANATION--Matter in italics (underscored) is new; matter in brackets
                              [ ] is old law to be omitted.
                                                                   LBD01277-01-1

        A. 2674                             2
 
     1    (1)  "telehealth" means the use of electronic information and communi-
     2  cation technologies by a health care provider  to  deliver  health  care
     3  services  to an insured individual while such individual is located at a
     4  site that is different from the site where the health care  provider  is
     5  located; and
     6    (2) "clinical setting" means a site which is a facility licensed under
     7  article  twenty-eight  or  forty of the public health law, a facility as
     8  defined in subdivision six of section 1.03 of the mental hygiene law, or
     9  a private physician's office, nurse practitioner's office  or  midwifery
    10  located within the state of New York.
    11    § 2. Section 4306-g of the insurance law, as added by chapter 6 of the
    12  laws of 2015, is amended to read as follows:
    13    § 4306-g. Telehealth delivery of services. (a) A corporation shall not
    14  exclude  from  coverage  a  service  that  is  otherwise covered under a
    15  contract that provides comprehensive coverage for hospital,  medical  or
    16  surgical  care  because the service is delivered via telehealth, as that
    17  term is defined in subsection (b) of this  section;  provided,  however,
    18  that  a corporation may exclude from coverage a service by a health care
    19  provider where the provider is not otherwise covered under the contract.
    20  A corporation may subject the coverage of a service delivered via  tele-
    21  health to co-payments, coinsurance or deductibles provided that they are
    22  at  least  as favorable to the insured as those established for the same
    23  service when not delivered via telehealth. A corporation may subject the
    24  coverage of a service delivered via telehealth to reasonable utilization
    25  management and quality assurance requirements that are  consistent  with
    26  those  established  for  the  same  service when not delivered via tele-
    27  health.  A corporation shall reimburse primary care  services  delivered
    28  via  telehealth,  where  both the insured individual and the health care
    29  provider are located in a clinical setting, on the same basis and at the
    30  same rate as would apply to such  services  if  the  services  had  been
    31  delivered in person.
    32    (b) For purposes of this section[,] the following terms shall have the
    33  following meanings:
    34    (1)  "telehealth" means the use of electronic information and communi-
    35  cation technologies by a health care provider  to  deliver  health  care
    36  services  to an insured individual while such individual is located at a
    37  site that is different from the site where the health care  provider  is
    38  located; and
    39    (2) "clinical setting" means a site which is a facility licensed under
    40  article  twenty-eight  or  forty of the public health law, a facility as
    41  defined in subdivision six of section 1.03 of the mental hygiene law, or
    42  a private physician's office, nurse practitioner's office  or  midwifery
    43  located within the state of New York.
    44    § 3. Section 4406-g of the public health law, as added by chapter 6 of
    45  the laws of 2015, is amended to read as follows:
    46    §  4406-g.  Telehealth  delivery  of services. 1. A health maintenance
    47  organization shall not exclude from coverage a service that is otherwise
    48  covered under an enrollee contract of a health maintenance  organization
    49  because the service is delivered via telehealth, as that term is defined
    50  in  subdivision  two  of  this section; provided, however, that a health
    51  maintenance organization may exclude from coverage a service by a health
    52  care provider where the provider is  not  otherwise  covered  under  the
    53  enrollee  contract.  A  health  maintenance organization may subject the
    54  coverage of a service delivered via telehealth to  co-payments,  coinsu-
    55  rance or deductibles provided that they are at least as favorable to the
    56  enrollee  as  those  established for the same service when not delivered

        A. 2674                             3
 
     1  via telehealth. A health maintenance organization may subject the cover-
     2  age of a service delivered  via  telehealth  to  reasonable  utilization
     3  management  and  quality assurance requirements that are consistent with
     4  those  established  for  the  same  service when not delivered via tele-
     5  health.  A health maintenance organization shall reimburse primary  care
     6  services delivered via telehealth, where both the insured individual and
     7  the  health care provider are located in a clinical setting, on the same
     8  basis and at the same rate as  would  apply  to  such  services  if  the
     9  services had been delivered in person.
    10    2.  For purposes of this section[,] the following terms shall have the
    11  following meanings:
    12    (a) "telehealth" means the use of electronic information and  communi-
    13  cation  technologies  by  a  health care provider to deliver health care
    14  services to an enrollee while such enrollee is located at a site that is
    15  different from the site where the health care provider is located; and
    16    (b) "clinical setting" means a site which is a facility licensed under
    17  article twenty-eight or forty of this chapter, a facility as defined  in
    18  subdivision  six of section 1.03 of the mental hygiene law, or a private
    19  physician's office, nurse practitioner's  office  or  midwifery  located
    20  within the state of New York.
    21    §  4.  This  act shall take effect on the thirtieth day after it shall
    22  have become a law and shall apply to all policies and contracts  issued,
    23  renewed, modified, altered or amended on or after such date.
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