senate Bill S4355

2013-2014 Legislative Session

Consolidates provisions relating to telemedicine and telehealth into a single article of the public health law; repealer

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Archive: Last Bill Status - Passed Senate


  • Introduced
  • In Committee
  • On Floor Calendar
    • Passed Senate
    • Passed Assembly
  • Delivered to Governor
  • Signed/Vetoed by Governor

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Assembly Actions - Lowercase
Senate Actions - UPPERCASE
Feb 26, 2014 referred to health
delivered to assembly
passed senate
Feb 11, 2014 advanced to third reading
Feb 10, 2014 2nd report cal.
Feb 04, 2014 1st report cal.101
Jan 08, 2014 referred to health
returned to senate
died in assembly
Jun 11, 2013 referred to health
delivered to assembly
passed senate
Jun 10, 2013 advanced to third reading
Jun 05, 2013 2nd report cal.
Jun 04, 2013 1st report cal.1006
May 07, 2013 reported and committed to finance
Mar 21, 2013 referred to health

Votes

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Feb 4, 2014 - Health committee Vote

S4355
16
0
committee
16
Aye
0
Nay
0
Aye with Reservations
0
Absent
0
Excused
0
Abstained
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Jun 4, 2013 - Finance committee Vote

S4355
36
0
committee
36
Aye
0
Nay
1
Aye with Reservations
0
Absent
0
Excused
0
Abstained
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May 7, 2013 - Health committee Vote

S4355
13
0
committee
13
Aye
0
Nay
2
Aye with Reservations
0
Absent
1
Excused
0
Abstained
show Health committee vote details

Health Committee Vote: May 7, 2013

aye wr (2)
excused (1)

Co-Sponsors

S4355 - Bill Details

See Assembly Version of this Bill:
A9130
Current Committee:
Law Section:
Public Health Law
Laws Affected:
Rpld §§2111 & 2805-u, §3614 sub 3-c, sub 11 ¶(a) sub¶ (i), amd §2807-v, add Art 39-A §§3910 - 3913, Pub Health L

S4355 - Bill Texts

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Consolidates provisions relating to telemedicine and telehealth into a single article of the public health law.

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BILL NUMBER:S4355

TITLE OF BILL: An act to amend the public health law, in relation to
telemedicine and telehealth; and to repeal certain provisions of such
law relating thereto

PURPOSE: This legislation would consolidate provisions relating to
telemedicine and telehealth into a single article of the public health
law; repealer.

SUMMARY OF SPECIFIC PROVISIONS:

Section 1 would repeal section 2111 of the public health law.

Section 2 would repeal section 2805-u of the public health law,
telemedicine credentialing, which becomes section 3910 of the public
health law under section 6 of the bill.

Section three would amend the opening paragraph of paragraph (uu) of
subdivision 1 of section 2807-v of the public health law to direct
that funds be available for telemedicine and telehealth demonstration
programs authorized under section thirty-nine hundred thirteen.

Section 4 would repeal public health law section 3614 subdivision 3-c.
This provision is reenacted as section 3913 of the public health law
under section 6 of the bill.

Section 5 would repeal public health law section 3614 subdivision 11
paragraph (a) Subparagraph (i). This section is reenacted as section
3912 of the public health law under section 6 of the bill.

Section 7 states the enactment date.

JUSTIFICATION: This legislation would allow clear delineation of the
statutory permissions and requirements applicable to telehealth and
telemedicine by consolidating all public health law provisions related
to these services in one place. This is especially useful as these
innovative healthcare tools become more prevalent in our ever
advancing society. It does not make any substantive changes to the
law, but provides one cohesive act to encompass all telehealth and
telemedicine related provisions.

PRIOR LEGISLATIVE HISTORY: New bill

FISCAL IMPLICATIONS: None.

EFFECTIVE DATE: This act shall take effect on the first of April next
succeeding the date on which it shall have become law.

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                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                  4355

                       2013-2014 Regular Sessions

                            I N  S E N A T E

                             March 21, 2013
                               ___________

Introduced by Sen. YOUNG -- (at request of the Legislative Commission on
  Rural  Resources)  -- read twice and ordered printed, and when printed
  to be committed to the Committee on Health

AN ACT to amend the public health law, in relation to  telemedicine  and
  telehealth;  and  to  repeal  certain  provisions of such law relating
  thereto

  THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND  ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Section 2111 of the public health law is REPEALED.
  S  2. Section 2805-u of the public health law, as added by chapter 390
of the laws of 2012, is REPEALED.
  S 3. The opening paragraph of  paragraph  (uu)  of  subdivision  1  of
section 2807-v of the public health law, as amended by section 8 of part
C of chapter 59 of the laws of 2011, is amended to read as follows:
  Funds shall be reserved and accumulated from year to year and shall be
available,  including  income  from  invested  funds, for the purpose of
supporting disease management [and], telemedicine AND TELEHEALTH  demon-
stration   programs   authorized   pursuant   to   section  [twenty-one]
THIRTY-NINE hundred [eleven] TWELVE of this chapter  for  the  following
periods in the following amounts:
  S  4.  Subdivision  3-c  of  section  3614 of the public health law is
REPEALED.
  S 5. Subparagraph (i) of paragraph (a) of subdivision  11  of  section
3614 of the public health law is REPEALED.
  S  6. The public health law is amended by adding a new article 39-A to
read as follows:
                              ARTICLE 39-A
                       TELEMEDICINE AND TELEHEALTH
SECTION 3910. DEFINITIONS.
        3911. CREDENTIALING AND PRIVILEGING OF HEALTH  CARE  PRACTITION-
                ERS.

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD04641-01-3

S. 4355                             2

        3912. DISEASE MANAGEMENT DEMONSTRATION PROGRAMS.
        3913. HOME TELEHEALTH.
  S  3910.  DEFINITIONS. FOR THE PURPOSES OF THIS ARTICLE, THE FOLLOWING
TERMS SHALL HAVE THE FOLLOWING MEANINGS:
  1. "DISTANT SITE HOSPITAL" MEANS A HOSPITAL LICENSED PURSUANT TO  THIS
ARTICLE  OR  A HOSPITAL LICENSED BY ANOTHER STATE, THAT HAS ENTERED INTO
AN AGREEMENT WITH AN ORIGINATING HOSPITAL TO MAKE AVAILABLE ONE OR  MORE
HEALTH  CARE PRACTITIONERS THAT ARE MEMBERS OF ITS CLINICAL STAFF TO THE
ORIGINATING  HOSPITAL  FOR  THE  PURPOSES  OF   PROVIDING   TELEMEDICINE
SERVICES.  TO  QUALIFY  AS  A DISTANT SITE HOSPITAL FOR PURPOSES OF THIS
ARTICLE, A HOSPITAL LICENSED BY  ANOTHER  STATE  MUST  COMPLY  WITH  THE
FEDERAL REGULATIONS GOVERNING PARTICIPATION BY HOSPITALS IN MEDICARE.
  2. "HEALTH CARE PRACTITIONER" SHALL MEAN A PERSON LICENSED PURSUANT TO
ARTICLE  ONE  HUNDRED  THIRTY-ONE, ONE HUNDRED THIRTY-ONE-B, ONE HUNDRED
THIRTY-THREE, ONE HUNDRED THIRTY-NINE, ONE HUNDRED  FORTY,  ONE  HUNDRED
FORTY-ONE,  ONE HUNDRED FORTY-THREE, ONE HUNDRED FORTY-FOUR, ONE HUNDRED
FIFTY-THREE, ONE HUNDRED FIFTY-FOUR OR ONE  HUNDRED  FIFTY-NINE  OF  THE
EDUCATION LAW, OR AS OTHERWISE AUTHORIZED BY THE COMMISSIONER.
  3.  "ORIGINATING  HOSPITAL"  MEANS  THE HOSPITAL AT WHICH A PATIENT IS
LOCATED AT THE TIME TELEMEDICINE SERVICES ARE PROVIDED TO HIM OR HER.
  4. "TELEMEDICINE" MEANS THE DELIVERY OF CLINICAL HEALTH CARE  SERVICES
BY  MEANS  OF  REAL  TIME TWO-WAY ELECTRONIC AUDIO-VISUAL COMMUNICATIONS
WHICH FACILITATE THE  ASSESSMENT,  DIAGNOSIS,  CONSULTATION,  TREATMENT,
EDUCATION,  CARE  MANAGEMENT  AND  SELF MANAGEMENT OF A PATIENT'S HEALTH
CARE WHILE SUCH PATIENT IS AT THE ORIGINATING SITE AND THE  HEALTH  CARE
PROVIDER IS AT A DISTANT SITE.
  S  3911.  CREDENTIALING  AND PRIVILEGING OF HEALTH CARE PRACTITIONERS.
1. WHEN TELEMEDICINE SERVICES ARE PROVIDED TO AN ORIGINATING  HOSPITAL'S
PATIENTS  PURSUANT  TO  AN  AGREEMENT  WITH A DISTANT SITE HOSPITAL, THE
ORIGINATING HOSPITAL MAY, IN LIEU OF  SATISFYING  THE  REQUIREMENTS  SET
FORTH  IN  SECTION  TWENTY-EIGHT HUNDRED FIVE-K OF THIS ARTICLE, RELY ON
THE CREDENTIALING AND PRIVILEGING DECISIONS MADE  BY  THE  DISTANT  SITE
HOSPITAL IN GRANTING OR RENEWING PRIVILEGES TO A HEALTH CARE PRACTITION-
ER  WHO  IS A MEMBER OF THE CLINICAL STAFF OF THE DISTANT SITE HOSPITAL,
PROVIDED THAT:
  (A) THE DISTANT SITE HOSPITAL PARTICIPATES IN MEDICARE AND MEDICAID;
  (B) EACH HEALTH CARE PRACTITIONER PROVIDING TELEMEDICINE  IS  LICENSED
TO PRACTICE IN THIS STATE;
  (C)  THE DISTANT SITE HOSPITAL, IN ACCORDANCE WITH REQUIREMENTS OTHER-
WISE APPLICABLE TO THAT HOSPITAL, COLLECTS AND EVALUATES ALL CREDENTIAL-
ING INFORMATION CONCERNING EACH HEALTH CARE PRACTITIONER PROVIDING TELE-
MEDICINE SERVICES, PERFORMS ALL REQUIRED  VERIFICATION  ACTIVITIES,  AND
ACTS  ON  BEHALF OF THE ORIGINATING SITE HOSPITAL FOR SUCH CREDENTIALING
PURPOSES;
  (D) THE DISTANT SITE HOSPITAL REVIEWS PERIODICALLY, AT LEAST EVERY TWO
YEARS, AND AS OTHERWISE WARRANTED BASED ON OUTCOMES, COMPLAINTS OR OTHER
CIRCUMSTANCES, THE CREDENTIALS, PRIVILEGES, PHYSICAL AND MENTAL  CAPACI-
TY,  AND  COMPETENCE  IN  DELIVERING HEALTH CARE SERVICES OF EACH HEALTH
CARE  PRACTITIONER  PROVIDING  TELEMEDICINE  SERVICES,  CONSISTENT  WITH
REQUIREMENTS  OTHERWISE APPLICABLE TO THAT HOSPITAL; REPORTS THE RESULTS
OF SUCH REVIEW TO THE ORIGINATING HOSPITAL; AND NOTIFIES THE ORIGINATING
HOSPITAL IMMEDIATELY UPON ANY SUSPENSION, REVOCATION, OR  LIMITATION  OF
SUCH PRIVILEGES;
  (E)  WITH  RESPECT  TO  EACH DISTANT SITE HEALTH CARE PRACTITIONER WHO
HOLDS PRIVILEGES AT THE ORIGINATING HOSPITAL, THE  ORIGINATING  HOSPITAL
CONDUCTS  A  PERIODIC  INTERNAL REVIEW, AT LEAST EVERY TWO YEARS, OF THE

S. 4355                             3

DISTANT SITE PRACTITIONER'S PERFORMANCE OF THESE PRIVILEGES AND PROVIDES
THE DISTANT SITE HOSPITAL WITH SUCH PERFORMANCE INFORMATION FOR  USE  IN
THE  DISTANT HOSPITAL'S PERIODIC APPRAISAL OF THE DISTANT SITE PHYSICIAN
OR  HEALTH CARE PRACTITIONER. SUCH INFORMATION SHALL INCLUDE, AT A MINI-
MUM, ALL ADVERSE EVENTS  THAT  RESULT  FROM  THE  TELEMEDICINE  SERVICES
PROVIDED BY THE DISTANT SITE HEALTH CARE PRACTITIONER TO THE ORIGINATING
HOSPITAL'S   PATIENTS,  ALL  COMPLAINTS  THE  ORIGINATING  HOSPITAL  HAS
RECEIVED ABOUT  THE  DISTANT  SITE  PRACTITIONER,  AND  ANY  REVOCATION,
SUSPENSION  OR  LIMITATION OF THE DISTANT SITE PRACTITIONER'S PRIVILEGES
BY THE ORIGINATING HOSPITAL; AND
  (F) THE AGREEMENT ENTERED INTO BETWEEN THE ORIGINATING  SITE  HOSPITAL
AND DISTANT SITE HOSPITAL SHALL BE IN WRITING AND SHALL, AT A MINIMUM:
  (I)  PROVIDE  THE  CATEGORIES  OF  HEALTH  CARE PRACTITIONERS THAT ARE
ELIGIBLE CANDIDATES FOR APPOINTMENT TO THE ORIGINATING HOSPITAL'S  CLIN-
ICAL STAFF,
  (II) REQUIRE THE GOVERNING BODY OF THE DISTANT SITE HOSPITAL TO COMPLY
WITH  THE MEDICARE CONDITIONS OF PARTICIPATION GOVERNING THE APPOINTMENT
OF MEDICAL STAFF WITH REGARD TO THE HEALTH CARE PRACTITIONERS  PROVIDING
TELEMEDICINE SERVICES,
  (III)  ITEMIZE  THE  CREDENTIALING INFORMATION TO BE COLLECTED AND THE
REQUIRED VERIFICATION ACTIVITIES TO BE PERFORMED  BY  THE  DISTANT  SITE
HOSPITAL  AND RELIED UPON BY THE ORIGINATING HOSPITAL IN CONSIDERING THE
RECOMMENDATIONS OF THE DISTANT SITE HOSPITAL,
  (IV) REQUIRE EACH DISTANT  SITE  HEALTH  CARE  PRACTITIONER  PROVIDING
TELEMEDICINE SERVICES TO BE LICENSED TO PRACTICE IN THIS STATE AND PRIV-
ILEGED AT THE DISTANT SITE HOSPITAL,
  (V)  REQUIRE  THE  DISTANT SITE HOSPITAL TO PROVIDE TO THE ORIGINATING
HOSPITAL A CURRENT LIST OF EACH DISTANT SITE HEALTH CARE  PRACTITIONER'S
PRIVILEGES AT THE DISTANT SITE HOSPITAL, AND
  (VI)  REQUIRE  THE  DISTANT SITE HOSPITAL TO CONDUCT A PERIODIC REVIEW
CONSISTENT WITH REQUIREMENTS OTHERWISE APPLICABLE TO THAT  HOSPITAL,  AT
LEAST  EVERY  TWO  YEARS,  AND AS OTHERWISE WARRANTED BASED ON OUTCOMES,
COMPLAINTS OR OTHER CIRCUMSTANCES, THE CREDENTIALS, PRIVILEGES, PHYSICAL
AND MENTAL CAPACITY, AND COMPETENCE IN DELIVERING HEALTH  CARE  SERVICES
OF  EACH  HEALTH  CARE  PRACTITIONER PROVIDING TELEMEDICINE SERVICES; TO
PROVIDE THE ORIGINATING HOSPITAL WITH THE RESULTS OF SUCH REVIEW; AND TO
NOTIFY THE ORIGINATING HOSPITAL IMMEDIATELY UPON ANY SUSPENSION, REVOCA-
TION, OR LIMITATION OF SUCH PRIVILEGES.
  2. NOTHING IN THIS SECTION SHALL BE CONSTRUED AS ALLOWING AN ORIGINAT-
ING HOSPITAL TO DELEGATE ITS AUTHORITY OVER AND RESPONSIBILITY FOR DECI-
SIONS CONCERNING THE CREDENTIALING  AND  GRANTING  STAFF  MEMBERSHIP  OR
PROFESSIONAL PRIVILEGES TO HEALTH CARE PRACTITIONERS PROVIDING TELEMEDI-
CINE SERVICES.
  3.  NOTWITHSTANDING  ANY  CONTRARY  PROVISION  OF  LAW, AN ORIGINATING
HOSPITAL SHALL NOT BE REQUIRED TO PROVIDE A PHYSICAL EXAMINATION  OR  TO
MAINTAIN  RECORDED  MEDICAL HISTORY INCLUDING IMMUNIZATIONS FOR A HEALTH
CARE PROVIDER PROVIDING CONSULTATIONS SOLELY THROUGH TELEMEDICINE FROM A
DISTANT SITE HOSPITAL.
  S 3912. DISEASE MANAGEMENT DEMONSTRATION PROGRAMS. 1.  THE  DEPARTMENT
MAY  ESTABLISH  DISEASE  MANAGEMENT  DEMONSTRATION  PROGRAMS  THROUGH  A
REQUEST FOR PROPOSALS PROCESS TO ENHANCE THE QUALITY AND COST-EFFECTIVE-
NESS OF CARE RENDERED TO MEDICAID-ELIGIBLE PERSONS WITH  CHRONIC  HEALTH
PROBLEMS  WHOSE  CARE AND TREATMENT, BECAUSE OF ONE OR MORE HOSPITALIZA-
TIONS, MULTIPLE DISABLING CONDITIONS REQUIRING RESIDENTIAL TREATMENT  OR
OTHER  HEALTH  CARE REQUIREMENTS, RESULTS IN HIGH MEDICAID EXPENDITURES.
IN ORDER TO BE ELIGIBLE TO SPONSOR AND TO UNDERTAKE A DISEASE MANAGEMENT

S. 4355                             4

DEMONSTRATION PROGRAM, THE PROPOSED SPONSOR  MAY  BE  A  NOT-FOR-PROFIT,
FOR-PROFIT OR LOCAL GOVERNMENT ORGANIZATION THAT HAS DEMONSTRATED EXPER-
TISE  IN  THE MANAGEMENT OR COORDINATION OF CARE TO PERSONS WITH CHRONIC
DISEASES OR THAT HAS THE EXPERIENCE OF PROVIDING COST-EFFECTIVE COMMUNI-
TY-BASED  CARE  TO  SUCH  PATIENTS, OR IN THE CASE OF A LOCAL GOVERNMENT
ORGANIZATION, HAS EXPRESSED A  STRONG  WILLINGNESS  TO  SPONSOR  SUCH  A
PROGRAM.  THE  DEPARTMENT  MAY  ALSO  APPROVE  DISEASE MANAGEMENT DEMON-
STRATION PROGRAMS WHICH INCLUDE, BUT ARE NOT LIMITED TO,  THE  PROMOTION
OF  ADHERENCE  TO EVIDENCE-BASED GUIDELINES, IMPROVEMENT OF PROVIDER AND
PATIENT COMMUNICATION AND PROVIDE INFORMATION ON PROVIDER AND  BENEFICI-
ARY  UTILIZATION  OF  SERVICES. THE DEPARTMENT SHALL GRANT NO FEWER THAN
SIX DEMONSTRATION PROGRAMS, NO MORE  THAN  ONE-THIRD  OF  SUCH  PROGRAMS
SHALL  BE  SELECTED  TO  PROVIDE  THESE  SERVICES  IN  ANY SINGLE SOCIAL
SERVICES DISTRICT; PROVIDED FURTHER, WHERE THE  DEPARTMENT  GRANTS  LESS
THAN  SIX DEMONSTRATION PROGRAMS, NO MORE THAN ONE SUCH PROGRAM SHALL BE
SELECTED TO  PROVIDE  THESE  SERVICES  IN  ANY  SINGLE  SOCIAL  SERVICES
DISTRICT.  THE DEPARTMENT SHALL APPROVE DISEASE MANAGEMENT DEMONSTRATION
PROGRAMS WHICH ARE GEOGRAPHICALLY DIVERSE  AND  REPRESENTATIVE  OF  BOTH
URBAN  AND  RURAL  SOCIAL  SERVICES  DISTRICTS. THE PROGRAM SPONSOR MUST
ESTABLISH, TO THE SATISFACTION OF THE DEPARTMENT, ITS CAPACITY TO ENROLL
AND SERVE SUFFICIENT NUMBERS OF ENROLLEES TO DEMONSTRATE THE COST-EFFEC-
TIVENESS OF THE DEMONSTRATION PROGRAM.
  2. THE DEPARTMENT SHALL ESTABLISH THE CRITERIA  BY  WHICH  INDIVIDUALS
WILL  BE  IDENTIFIED  AS  ELIGIBLE  FOR  ENROLLMENT IN THE DEMONSTRATION
PROGRAMS.  PERSONS ELIGIBLE FOR ENROLLMENT  IN  THE  DISEASE  MANAGEMENT
DEMONSTRATION  PROGRAM  SHALL  BE  LIMITED  TO  INDIVIDUALS WHO: RECEIVE
MEDICAL ASSISTANCE PURSUANT TO TITLE  ELEVEN  OF  ARTICLE  FIVE  OF  THE
SOCIAL  SERVICES  LAW AND MAY BE ELIGIBLE FOR BENEFITS PURSUANT TO TITLE
18 OF THE SOCIAL SECURITY ACT (MEDICARE); ARE NOT ENROLLED IN A MEDICAID
MANAGED CARE PLAN, INCLUDING INDIVIDUALS WHO ARE  NOT  REQUIRED  OR  NOT
ELIGIBLE  TO  PARTICIPATE  IN MEDICAID MANAGED CARE PROGRAMS PURSUANT TO
SECTION THREE HUNDRED SIXTY-FOUR-J OF THE SOCIAL SERVICES LAW; ARE DIAG-
NOSED WITH CHRONIC HEALTH PROBLEMS AS MAY BE  SPECIFIED  BY  THE  ENTITY
UNDERTAKING THE DEMONSTRATION PROGRAM, INCLUDING, BUT NOT LIMITED TO ONE
OR  MORE OF THE FOLLOWING: CONGESTIVE HEART FAILURE, CHRONIC OBSTRUCTIVE
PULMONARY DISEASE, ASTHMA, DIABETES OR OTHER CHRONIC  HEALTH  CONDITIONS
AS MAY BE SPECIFIED BY THE DEPARTMENT; OR HAVE EXPERIENCED OR ARE LIKELY
TO  EXPERIENCE ONE OR MORE HOSPITALIZATIONS OR ARE OTHERWISE EXPECTED TO
INCUR EXCESSIVE COSTS AND HIGH UTILIZATION OF HEALTH CARE SERVICES.
  3. ENROLLMENT IN A DEMONSTRATION PROGRAM SHALL BE VOLUNTARY. A PARTIC-
IPATING INDIVIDUAL MAY DISCONTINUE HIS OR HER  ENROLLMENT  AT  ANY  TIME
WITHOUT  CAUSE. THE COMMISSIONER SHALL REVIEW AND APPROVE ALL ENROLLMENT
AND MARKETING MATERIALS FOR A DEMONSTRATION PROGRAM.
  4. THE DEMONSTRATION PROGRAM SHALL OFFER EVIDENCE-BASED  SERVICES  AND
INTERVENTIONS  DESIGNED TO ENSURE THAT THE ENROLLEES RECEIVE HIGH QUALI-
TY, PREVENTATIVE AND COST-EFFECTIVE CARE, AIMED AT REDUCING THE NECESSI-
TY FOR HOSPITALIZATION OR EMERGENCY ROOM CARE OR AT REDUCING LENGTHS  OF
STAY  WHEN  HOSPITALIZATION  IS NECESSARY. THE DEMONSTRATION PROGRAM MAY
INCLUDE SCREENING OF ELIGIBLE ENROLLEES,  DEVELOPING  AN  INDIVIDUALIZED
CARE  MANAGEMENT  PLAN  FOR  EACH  ENROLLEE  AND IMPLEMENTING THAT PLAN.
DISEASE MANAGEMENT DEMONSTRATION PROGRAMS THAT UTILIZE INFORMATION TECH-
NOLOGY SYSTEMS THAT ALLOW FOR CONTINUOUS APPLICATION  OF  EVIDENCE-BASED
GUIDELINES TO MEDICAL ASSISTANCE CLAIMS DATA AND OTHER AVAILABLE DATA TO
IDENTIFY  SPECIFIC  INSTANCES IN WHICH CLINICAL INTERVENTIONS ARE JUSTI-
FIED AND COMMUNICATE INDICATED INTERVENTIONS TO PHYSICIANS, HEALTH  CARE
PROVIDERS AND/OR PATIENTS, AND MONITOR PHYSICIAN AND HEALTH CARE PROVID-

S. 4355                             5

ER  RESPONSE  TO SUCH INTERVENTIONS, SHALL HAVE THE ENROLLEES, OR GROUPS
OF ENROLLEES, APPROVED BY THE DEPARTMENT FOR PARTICIPATION. THE SERVICES
PROVIDED BY THE DEMONSTRATION PROGRAM AS PART  OF  THE  CARE  MANAGEMENT
PLAN  MAY INCLUDE, BUT ARE NOT LIMITED TO, CASE MANAGEMENT, SOCIAL WORK,
INDIVIDUALIZED HEALTH COUNSELORS, MULTI-BEHAVIORAL GOALS  PLANS,  CLAIMS
DATA MANAGEMENT, HEALTH AND SELF-CARE EDUCATION, DRUG THERAPY MANAGEMENT
AND  OVERSIGHT, PERSONAL EMERGENCY RESPONSE SYSTEMS AND OTHER MONITORING
TECHNOLOGIES, TELEMEDICINE, TELEHEALTH AND SIMILAR SERVICES DESIGNED  TO
IMPROVE THE QUALITY AND COST-EFFECTIVENESS OF HEALTH CARE SERVICES.
  5.  THE  DEPARTMENT  SHALL  BE RESPONSIBLE FOR MONITORING THE QUALITY,
APPROPRIATENESS AND COST-EFFECTIVENESS OF A DEMONSTRATION  PROGRAM.  THE
DEPARTMENT  SHALL UTILIZE, TO THE EXTENT POSSIBLE, ALL POTENTIAL SOURCES
OF FUNDING FOR DEMONSTRATION PROGRAMS, INCLUDING, BUT  NOT  LIMITED  TO,
PRIVATE PAYMENTS AND DONATIONS. ALL SUCH FUNDS SHALL BE DEPOSITED BY THE
COMMISSIONER  AND CREDITED TO THE DISEASE MANAGEMENT ACCOUNT WHICH SHALL
BE ESTABLISHED BY THE COMPTROLLER IN  THE  SPECIAL  REVENUE-OTHER  FUND.
ADDITIONALLY,  TO  THE  EXTENT  OF  FUNDS APPROPRIATED THEREFOR, MEDICAL
ASSISTANCE FUNDS, INCLUDING ANY FUNDING OR SHARED SAVINGS AS MAY  BECOME
AVAILABLE THROUGH FEDERAL WAIVERS OR OTHERWISE UNDER TITLES 18 AND 19 OF
THE  FEDERAL  SOCIAL  SECURITY  ACT,  MAY  BE USED BY THE DEPARTMENT FOR
EXPENDITURES IN SUPPORT OF THE DISEASE MANAGEMENT PROGRAM.
  6. PAYMENTS SHALL BE MADE BY THE DEPARTMENT TO THE ENTITY  RESPONSIBLE
FOR  THE  OPERATION  OF  THE DEMONSTRATION PROGRAM ON A FIXED AMOUNT PER
MEMBER PER MONTH OF ENROLLMENT AND SHALL REIMBURSE THE  PROGRAM  SPONSOR
FOR  THE SERVICES RENDERED PURSUANT TO SUBDIVISION FOUR OF THIS SECTION.
THE AMOUNT PAID SHALL BE AN AMOUNT  REASONABLY  NECESSARY  TO  MEET  THE
COSTS  OF  PROVIDING  SUCH SERVICES, PROVIDED THAT THE TOTAL AMOUNT PAID
FOR MEDICAL ASSISTANCE TO  ENROLLEES  IN  ANY  SUCH  DISEASE  MANAGEMENT
DEMONSTRATION PROGRAM, INCLUDING ANY DEMONSTRATION PROGRAM EXPENDITURES,
SHALL  NOT EXCEED NINETY-FIVE PERCENT OF THE MEDICAL ASSISTANCE EXPENDI-
TURE RELATED TO SUCH ENROLLEE THAT WOULD  REASONABLY  HAVE  BEEN  ANTIC-
IPATED  IF  THE  ENROLLEE  HAD  NOT  BEEN ENROLLED IN SUCH DEMONSTRATION
PROGRAM. THE DEPARTMENT MAY MAKE PAYMENTS TO DEMONSTRATION PROGRAMS THAT
PROVIDE ADMINISTRATIVE SERVICES ONLY, PROVIDED  THAT  EXPENDITURES  MADE
FOR  ENROLLEES,  OR  A  GROUP  OF ENROLLEES, PARTICIPATING IN THE DEMON-
STRATION PROGRAM SHALL PROVIDE SUFFICIENT SAVINGS AS DETERMINED  BY  THE
DEPARTMENT, HAD THE ENROLLEES, OR GROUPS OF ENROLLEES, NOT BEEN ENROLLED
IN SUCH DEMONSTRATION. THE DEPARTMENT SHALL PROVIDE AN INTERIM REPORT TO
THE  GOVERNOR,  AND  THE LEGISLATURE ON OR BEFORE DECEMBER THIRTY-FIRST,
TWO THOUSAND SIX AND A FINAL REPORT ON OR BEFORE DECEMBER  THIRTY-FIRST,
TWO  THOUSAND  SEVEN  ON  THE  RESULTS  OF  DEMONSTRATION PROGRAMS. BOTH
REPORTS  SHALL  INCLUDE  FINDINGS  AS  TO  THE  DEMONSTRATION  PROGRAMS'
CONTRIBUTION  TO IMPROVING QUALITY OF CARE AND THEIR COST-EFFECTIVENESS.
IN THE FINAL REPORT, THE DEPARTMENT SHALL OFFER  RECOMMENDATIONS  AS  TO
WHETHER  DEMONSTRATION PROGRAMS SHOULD BE EXTENDED, MODIFIED, ELIMINATED
OR MADE PERMANENT.
  S 3913. HOME TELEHEALTH. 1.  DEMONSTRATION RATES OF  PAYMENT  OR  FEES
SHALL  BE ESTABLISHED FOR TELEHEALTH PROVIDED BY A CERTIFIED HOME HEALTH
AGENCY, A LONG TERM HOME HEALTH CARE PROGRAM OR AIDS HOME CARE  PROGRAM,
OR  FOR  TELEMEDICINE  BY  A  LICENSED  HOME  CARE SERVICES AGENCY UNDER
CONTRACT WITH SUCH AN AGENCY OR PROGRAM, IN ORDER TO ENSURE  THE  AVAIL-
ABILITY OF TECHNOLOGY-BASED PATIENT MONITORING, COMMUNICATION AND HEALTH
MANAGEMENT.    REIMBURSEMENT  FOR  TELEHEALTH  PROVIDED PURSUANT TO THIS
SECTION SHALL BE PROVIDED ONLY IN CONNECTION WITH FEDERAL FOOD AND  DRUG
ADMINISTRATION-APPROVED  AND  INTEROPERABLE DEVICES, AND INCORPORATED AS

S. 4355                             6

PART OF THE PATIENT'S PLAN OF CARE. THE COMMISSIONER SHALL SEEK  FEDERAL
FINANCIAL PARTICIPATION WITH REGARD TO THIS DEMONSTRATION INITIATIVE.
  2.  THE  PURPOSES OF SUCH SERVICES SHALL BE TO ASSIST IN THE EFFECTIVE
MONITORING AND MANAGEMENT OF PATIENTS WHOSE MEDICAL,  FUNCTIONAL  AND/OR
ENVIRONMENTAL  NEEDS  CAN  BE  APPROPRIATELY AND COST-EFFECTIVELY MET AT
HOME THROUGH THE APPLICATION OF TELEHEALTH  INTERVENTION.  REIMBURSEMENT
PROVIDED PURSUANT TO THIS SECTION SHALL BE FOR SERVICES TO PATIENTS WITH
CONDITIONS  OR  CLINICAL  CIRCUMSTANCES  ASSOCIATED  WITH  THE  NEED FOR
FREQUENT MONITORING, AND/OR THE NEED  FOR  FREQUENT  PHYSICIAN,  SKILLED
NURSING  OR  ACUTE  CARE SERVICES, AND WHERE THE PROVISION OF TELEHEALTH
CAN APPROPRIATELY REDUCE THE NEED FOR ON-SITE  OR  IN-OFFICE  VISITS  OR
ACUTE  OR  LONG TERM CARE FACILITY ADMISSIONS. SUCH CONDITIONS AND CLIN-
ICAL CIRCUMSTANCES SHALL INCLUDE, BUT  NOT  BE  LIMITED  TO,  CONGESTIVE
HEART  FAILURE,  DIABETES,  CHRONIC PULMONARY OBSTRUCTIVE DISEASE, WOUND
CARE, POLYPHARMACY, MENTAL OR BEHAVIORAL PROBLEMS LIMITING  SELF-MANAGE-
MENT,  AND TECHNOLOGY-DEPENDENT CARE SUCH AS CONTINUOUS OXYGEN, VENTILA-
TOR CARE, TOTAL PARENTERAL NUTRITION OR ENTERAL FEEDING.
  3. DEMONSTRATION RATES OR FEES ESTABLISHED  BY  THE  COMMISSIONER  AND
APPROVED  BY  THE  DIRECTOR  OF  THE  BUDGET,  FOR SUCH TELEHEALTH SHALL
REFLECT THE COSTS THEREOF ON A MONTHLY BASIS IN  ORDER  TO  ACCOUNT  FOR
DAILY  VARIATION IN THE INTENSITY AND COMPLEXITY OF PATIENTS' TELEHEALTH
NEEDS; PROVIDED THAT SUCH DEMONSTRATION RATES SHALL FURTHER REFLECT  THE
COST  OF THE DAILY OPERATION AND PROVISION OF SUCH SERVICES, WHICH COSTS
SHALL INCLUDE THE FOLLOWING FUNCTIONS UNDERTAKEN  BY  THE  PARTICIPATING
CERTIFIED  HOME  HEALTH AGENCY, LONG TERM HOME HEALTH CARE PROGRAM, AIDS
HOME CARE PROGRAM OR LICENSED HOME CARE SERVICES AGENCY:
  (A) MONITORING OF PATIENT VITAL SIGNS;
  (B) PATIENT EDUCATION;
  (C) MEDICATION MANAGEMENT;
  (D) EQUIPMENT MAINTENANCE;
  (E) REVIEW OF PATIENT TRENDS AND/OR OTHER CHANGES IN PATIENT CONDITION
NECESSITATING PROFESSIONAL INTERVENTION; AND
  (F) SUCH OTHER ACTIVITIES AS THE COMMISSIONER MAY DEEM  NECESSARY  AND
APPROPRIATE TO THIS SECTION.
  4. THE COMMISSIONER SHALL TAKE SUCH ADDITIONAL STEPS AS MAY BE REASON-
ABLY  NECESSARY  TO  IMPLEMENT  THE PROVISIONS OF THIS SECTION; PROVIDED
HOWEVER THAT THE  COMMISSIONER  SHALL  ESTABLISH  INITIAL  DEMONSTRATION
RATES OR FEES FOR TELEHEALTH AS PROVIDED FOR IN THIS SECTION BY NO LATER
THAN  OCTOBER FIRST, TWO THOUSAND SEVEN; AND PROVIDED, FURTHER, HOWEVER,
THAT THE COMMISSIONER SHALL  SEEK  THE  INPUT  OF  REPRESENTATIVES  FROM
PARTICIPATING  PROVIDERS AND OTHER INTERESTED PARTIES IN THE DEVELOPMENT
OF SUCH RATES OR FEES AND ANY APPLICABLE REQUIREMENTS ESTABLISHED PURSU-
ANT TO THIS SUBDIVISION.
  5. THE COMMISSIONER SHALL, WITHIN MONIES APPROPRIATED THEREFOR, ESTAB-
LISH A RURAL HOME TELEHEALTH DELIVERY  DEMONSTRATION  STUDY  PROGRAM  IN
COUNTIES  HAVING  A POPULATION OF NOT LESS THAN ONE HUNDRED THIRTY THOU-
SAND AND NOT MORE THAN ONE HUNDRED FORTY THOUSAND, ACCORDING TO THE  TWO
THOUSAND  TEN  DECENNIAL FEDERAL CENSUS. THE COMMISSIONER SHALL DIRECT A
HOME HEALTH ORGANIZATION  SERVING  IN  SUCH  COUNTY  TO  STUDY  PATIENTS
RECEIVING  TELEMEDICINE,  PURSUANT  TO THIS SECTION, WHO HAVE BEEN DIAG-
NOSED WITH CONGESTIVE HEART FAILURE, DIABETES AND/OR  CHRONIC  PULMONARY
OBSTRUCTIVE  DISEASE, AND WHOSE MEDICAL, FUNCTIONAL AND/OR ENVIRONMENTAL
NEEDS ARE APPROPRIATELY MET AT HOME THROUGH  THE  APPLICATION  OF  TELE-
HEALTH INTERVENTIONS. SUCH A STUDY SHALL DETERMINE THE COST OF PROVIDING
TELEHEALTH,  THE  QUALITY  OF  CARE  PROVIDED THROUGH TELEHEALTH AND THE
OUTCOMES OF PATIENTS RECEIVING SUCH TELEHEALTH. THE  COMMISSIONER  SHALL

S. 4355                             7

REIMBURSE  THE  HOME  HEALTH  ORGANIZATION FOR CONDUCTING THE STUDY WITH
AMOUNTS APPROPRIATED UNDER THIS SECTION. THE  HOME  HEALTH  ORGANIZATION
SHALL EVALUATE THE FINDINGS OF THE STUDY AND REPORT TO THE GOVERNOR, THE
TEMPORARY  PRESIDENT  OF  THE  SENATE,  THE SPEAKER OF THE ASSEMBLY, THE
COMMISSIONER, AND THE CHAIR  OF  THE  LEGISLATIVE  COMMISSION  ON  RURAL
RESOURCES ON ITS FINDINGS OF PROVIDING TELEHEALTH FOR EACH CONDITION, SO
AS  TO  PROVIDE THE COST BENCHMARKS WITH AND WITHOUT TELEHEALTH CARE, AS
WELL AS PROVIDING COST BENEFIT MEASUREMENTS  IN  TERMS  OF  THE  QUALITY
BENEFIT OUTCOMES FOR EACH OF THE CONDITIONS ADDRESSED VIA TELEHEALTH.
  6.  NOTWITHSTANDING  ANY  INCONSISTENT PROVISION OF LAW, RULE OR REGU-
LATION AND SUBJECT TO THE  AVAILABILITY  OF  FEDERAL  FINANCIAL  PARTIC-
IPATION,  THE  COMMISSIONER  IS  AUTHORIZED  AND DIRECTED TO IMPLEMENT A
PROGRAM WHEREBY HE OR SHE  SHALL  ADJUST  MEDICAL  ASSISTANCE  RATES  OF
PAYMENT  FOR  SERVICES  PROVIDED BY CERTIFIED HOME HEALTH AGENCIES, LONG
TERM HOME HEALTH CARE PROGRAMS, AIDS HOME CARE PROGRAMS AND PROVIDERS OF
PERSONAL CARE SERVICES AND/OR PROVIDERS OF PRIVATE DUTY NURSING SERVICES
UNDER THE SOCIAL SERVICES LAW IN ACCORDANCE WITH  THIS  SUBDIVISION  FOR
PURPOSES OF ENHANCING THE PROVISION, ACCESSIBILITY, QUALITY AND/OR EFFI-
CIENCY  OF  HOME  CARE  SERVICES. SUCH RATE ADJUSTMENTS SHALL BE FOR THE
PURPOSES  OF  ASSISTING  SUCH  PROVIDERS,  LOCATED  IN  SOCIAL  SERVICES
DISTRICTS  WHICH  DO  NOT  INCLUDE  A CITY WITH A POPULATION OF OVER ONE
MILLION PERSONS, IN MEETING THE COST OF INCREASED USE OF  TECHNOLOGY  IN
THE DELIVERY OF SERVICES, INCLUDING TELEHEALTH AND CLINICAL AND ADMINIS-
TRATIVE MANAGEMENT INFORMATION SYSTEM.
  S  7. This act shall take effect on the first of April next succeeding
the date on which it shall have become a law.

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