Assembly Bill A9667

                            
 
                     S T A T E   O F   N E W   Y O R K
 ________________________________________________________________________
 
                                   9667
 
                           I N  A S S E M B L Y
 
                             February 4, 2020
                                ___________
 
 Introduced  by M. of A. WOERNER -- 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:

   Section 1. Section 3217-h of the insurance law, as added by chapter  6
 of the laws of 2015, is amended to read as follows:
   §  3217-h.  Telehealth  delivery of services. (a) An insurer shall not
 exclude from coverage a service that is otherwise covered under a policy
 that provides comprehensive coverage for hospital, medical  or  surgical
 care  because  the  service is delivered via telehealth, as that term is
 defined in subsection (b) of this section; provided,  however,  that  an
 insurer  may  exclude  from coverage a service by a health care provider
 where the provider is not otherwise covered under the policy. An insurer
 may subject the coverage  of  a  service  delivered  via  telehealth  to
 co-payments,  coinsurance or deductibles provided that they are at least
 as favorable to the insured as those established for  the  same  service
 when  not  delivered via telehealth. An insurer may subject the coverage
 of a service delivered via telehealth to reasonable utilization  manage-
 ment  and  quality assurance requirements that are consistent with those
 established for the same service when not delivered via  telehealth.  AN
 INSURER  SHALL REIMBURSE PRIMARY CARE SERVICES DELIVERED VIA TELEHEALTH,
 WHERE BOTH THE INSURED INDIVIDUAL  AND  THE  HEALTH  CARE  PROVIDER  ARE
 LOCATED IN A CLINICAL SETTING, ON THE SAME BASIS AND AT THE SAME RATE AS
 WOULD  APPLY  TO  SUCH  SERVICES  IF  THE SERVICES HAD BEEN DELIVERED IN
 PERSON.
   (b) For purposes of this section[,] THE FOLLOWING TERMS SHALL HAVE THE
 FOLLOWING MEANINGS:
   (1) "telehealth" means the use of electronic information and  communi-
 cation  technologies  by  a  health care provider to deliver health care
 services to an insured individual while such individual is located at  a
 
  EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                       [ ] is old law to be omitted.
              

                                                            LBD14311-02-9

 A. 9667                             2
 
 site  that  is different from the site where the health care provider is
 located; AND
   (2) "CLINICAL SETTING" MEANS A SITE WHICH IS A FACILITY LICENSED UNDER
 ARTICLE  TWENTY-EIGHT  OR  FORTY OF THE PUBLIC HEALTH LAW, A FACILITY AS
 DEFINED IN SUBDIVISION SIX OF SECTION 1.03 OF THE MENTAL HYGIENE LAW, OR
 A PRIVATE PHYSICIAN'S OFFICE, NURSE PRACTITIONER'S OFFICE  OR  MIDWIFERY
 LOCATED WITHIN THE STATE OF NEW YORK.
   § 2. Section 4306-g of the insurance law, as added by chapter 6 of the
 laws of 2015, is amended to read as follows:
   § 4306-g. Telehealth delivery of services. (a) A corporation shall not
 exclude  from  coverage  a  service  that  is  otherwise covered under a
 contract that provides comprehensive coverage for hospital,  medical  or
 surgical  care  because the service is delivered via telehealth, as that
 term is defined in subsection (b) of this  section;  provided,  however,
 that  a corporation may exclude from coverage a service by a health care
 provider where the provider is not otherwise covered under the contract.
 A corporation may subject the coverage of a service delivered via  tele-
 health to co-payments, coinsurance or deductibles provided that they are
 at  least  as favorable to the insured as those established for the same
 service when not delivered via telehealth. A corporation may subject the
 coverage of a service delivered via telehealth to reasonable utilization
 management and quality assurance requirements that are  consistent  with
 those  established  for  the  same  service when not delivered via tele-
 health.  A CORPORATION SHALL REIMBURSE PRIMARY CARE  SERVICES  DELIVERED
 VIA  TELEHEALTH,  WHERE  BOTH THE INSURED INDIVIDUAL AND THE HEALTH CARE
 PROVIDER ARE LOCATED IN A CLINICAL SETTING, ON THE SAME BASIS AND AT THE
 SAME RATE AS WOULD APPLY TO SUCH  SERVICES  IF  THE  SERVICES  HAD  BEEN
 DELIVERED IN PERSON.
   (b) For purposes of this section[,] THE FOLLOWING TERMS SHALL HAVE THE
 FOLLOWING MEANINGS:
   (1)  "telehealth" means the use of electronic information and communi-
 cation technologies by a health care provider  to  deliver  health  care
 services  to an insured individual while such individual is located at a
 site that is different from the site where the health care  provider  is
 located; AND
   (2) "CLINICAL SETTING" MEANS A SITE WHICH IS A FACILITY LICENSED UNDER
 ARTICLE  TWENTY-EIGHT  OR  FORTY OF THE PUBLIC HEALTH LAW, A FACILITY AS
 DEFINED IN SUBDIVISION SIX OF SECTION 1.03 OF THE MENTAL HYGIENE LAW, OR
 A PRIVATE PHYSICIAN'S OFFICE, NURSE PRACTITIONER'S OFFICE  OR  MIDWIFERY
 LOCATED WITHIN THE STATE OF NEW YORK.
   § 3. Section 4406-g of the public health law, as added by chapter 6 of
 the laws of 2015, is amended to read as follows:
   §  4406-g.  Telehealth  delivery  of services. 1. A health maintenance
 organization shall not exclude from coverage a service that is otherwise
 covered under an enrollee contract of a health maintenance  organization
 because the service is delivered via telehealth, as that term is defined
 in  subdivision  two  of  this section; provided, however, that a health
 maintenance organization may exclude from coverage a service by a health
 care provider where the provider is  not  otherwise  covered  under  the
 enrollee  contract.  A  health  maintenance organization may subject the
 coverage of a service delivered via telehealth to  co-payments,  coinsu-
 rance or deductibles provided that they are at least as favorable to the
 enrollee  as  those  established for the same service when not delivered
 via telehealth. A health maintenance organization may subject the cover-
 age of a service delivered  via  telehealth  to  reasonable  utilization
 management  and  quality assurance requirements that are consistent with

 A. 9667                             3
 
 those established for the same service  when  not  delivered  via  tele-
 health.   A HEALTH MAINTENANCE ORGANIZATION SHALL REIMBURSE PRIMARY CARE
 SERVICES DELIVERED VIA TELEHEALTH, WHERE BOTH THE INSURED INDIVIDUAL AND
 THE  HEALTH CARE PROVIDER ARE LOCATED IN A CLINICAL SETTING, ON THE SAME
 BASIS AND AT THE SAME RATE AS  WOULD  APPLY  TO  SUCH  SERVICES  IF  THE
 SERVICES HAD BEEN DELIVERED IN PERSON.
   2.  For purposes of this section[,] THE FOLLOWING TERMS SHALL HAVE THE
 FOLLOWING MEANINGS:
   (A) "telehealth" means the use of electronic information and  communi-
 cation  technologies  by  a  health care provider to deliver health care
 services to an enrollee while such enrollee is located at a site that is
 different from the site where the health care provider is located; AND
   (B) "CLINICAL SETTING" MEANS A SITE WHICH IS A FACILITY LICENSED UNDER
 ARTICLE TWENTY-EIGHT OR FORTY OF THIS CHAPTER, A FACILITY AS DEFINED  IN
 SUBDIVISION  SIX OF SECTION 1.03 OF THE MENTAL HYGIENE LAW, OR A PRIVATE
 PHYSICIAN'S OFFICE, NURSE PRACTITIONER'S  OFFICE  OR  MIDWIFERY  LOCATED
 WITHIN THE STATE OF NEW YORK.
   §  4.  This  act shall take effect on the thirtieth day after it shall
 have become a law and shall apply to all policies and contracts  issued,
 renewed, modified, altered or amended on or after such date.