Summary of Current State Legislative Efforts Determining Telemedicine Policy (Followed by Telemedicine State Legislation Links)

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1 State Telemedicine Update for 2013 No 8 - February 2013 Summary of Current State Legislative Efforts Determining Telemedicine Policy (Followed by Telemedicine State Legislation Links) Telemedicine and Health Insurance Legislation to prohibit exclusion of telemedicine cost coverage solely because services were not provided face to face. Requires insurance coverage of health care services provided through telecommunications technology by legislative action. Proposals mandating provision of coverage for health care services that are provided through telemedicine if the health care service would be covered were it provided through in-person. Regulations indicating that all accident and health insurance policies and managed care plans must provide coverage for telemedicine services Acts providing that the required coverage for telemedicine services shall be subject to the same deductible, coinsurance, and copayment as if the telemedicine services were provided through face-to-face interactions between patients and their providers. Telemedicine services; health insurance plans must provide coverage to same extent as for inperson services. Removal of requirements that telemedicine services be delivered in a health care facility in order to qualify for health insurance coverage Telemedicine Definitions There is some variance in State definitions of telemedicine but most contain similar language to the items listed below: Telemedicine as it pertains to the delivery of health care services, means synchronous video conferencing, remote patient monitoring, asynchronous health images, or other health transmissions supported by mobile devices or other telecommunications technology used for the purpose of diagnosis, consultation, or treatment at a site other than the site where the provider is located. The ASNM Legislative Watchdog Bulletin is a special service of The American Society of Neurophysiological Monitoring meant for informational purposes only and does not imply any endorsement. For further information or questions about this service, please contact

2 Telemedicine means the use of interactive audio, video or other telecommunications technology by a health care provider to deliver health care services at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient in real time or through the use of store-and-forward technology. Telemedicine does not include: Audio-only telephone messages Facsimile transmission Telemedicine Licensing Some state legislators are considering telemedicine licensure. It is also the intent of some state s legislation activity to reduce the compliance requirements on hospitals when granting privileges or associations to telemedicine practitioners. For example; a hospital may rely on the credentialing and privileging decisions made for the health care professional by the distant-site hospital or distant-site telemedicine entity. Telemedicine Research and Implementation For the purpose of studying and developing certain strategies and recommendations for advancing telemedicine technologies and use. The study of any topic that a state s Task Force finds necessary to make recommendations regarding the use of telehealth. The funding and implementation of university medical centers to establish, maintain and operate a telemedicine communications system. ASNM encourages you to contact your state elected officials and tell them YOUR opinions on telemedicine legislation. Please use the link below to access ASNM s Federal and State Legislative Health Care resource to locate your state representatives. Click Here to read ASNM s Legislative Resource and Guide We also encourage you to carefully read the original state bills to help gauge potential outcomes of the intended language to your IONM practice, and to help determine necessary next steps to better serve your patients.

3 Current Trends In: Telemedicine State Legislation Arizona SB 1353 Health Insurance; Telemedicine All policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed on or after January 1, 2014 must provide coverage for health care services that are provided through telemedicine if the health care service would be covered were it provided through in person consultation between the subscriber and a health care provider. Connecticut SB 40 AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR TELEMEDICINE SERVICES R00- SB.htm Statement of Purpose: To require insurance coverage of health care services provided through telecommunications technology. Connecticut SB 858 AN ACT CONCERNING HEALTH INSURANCE COVERAGE FOR TELEMEDICINE SERVICES R00- SB.htm To require health insurance coverage of medical advice, diagnosis, care or treatment provided through telemedicine if such advice, diagnosis, care or treatment is covered when provided through in- person consultation. District of Columbia B20 50 TELEMEDICINE REIMBURSEMENT ACT OF A health insurer offering a health benefits plan in the District may not deny coverage for a healthcare service on the basis that the service is provided through telemedicine if the same service would be covered when delivered in person. Florida HB 499 Health Care Coverage Requires health insurers, corporations, & HMOs issuing certain health policies to provide coverage for telemedicine services; prohibits exclusion of telemedicine cost coverage solely because services were not provided face to face. Hawaii HB 162 and SB 489 Telemedicine

4 Apply to any practitioner of medicine and surgery from another state when in actual consultation, including in- person, mail, electronic, telephonic, fiber- optic, or other telemedicine consultation with a licensed physician or osteopathic physician of this State, if the physician or osteopathic physician from another state at the time of consultation is licensed to practice in the state in which the physician or osteopathic physician resides Illinois HB 107 DHFS- PUB AID- TELEMEDICINE Num=107&GAID=11&LegID=&SpecSess=&Session= Requires the Department of Healthcare and Family Services to reimburse the practice of telemedicine by medical services providers, including, but not limited to, physicians, advanced practice nurses, federally qualified health centers, or psychiatrists. Illinois SB 1422 INS CD- COVERAGE- TELEMEDICINE 422&GAID=12&LegID=72007&SpecSess=&Session= provide that accident and health insurance policies and managed care plans must provide coverage for telemedicine services. Provides that the required coverage for telemedicine services shall be subject to the same deductible, coinsurance, and copayment as if the telemedicine services were provided through face- to- face interactions between patients and their providers. Indiana SB 554 Telehealth services under Medicaid Telehealth and telemedicine services under Medicaid. Requires the office of Medicaid policy and planning to reimburse: (1) a home health agency for telehealth services; and (2) a federally- qualified health center and a rural health clinic for telemedicine services; under the Medicaid program Kansas HB 2200 Executive chief information technology officer; office of information technology services The university of Kansas medical center is hereby authorized to establish, maintain and operate a telemedicine communications system, subject to the approval by the secretary of administration executive chief information technology officer under K.S.A , and amendments thereto. The telemedicine communications system shall apply telecommunications technology to the practice of medicine through compressed, full- motion, high- resolution, two- way interactive video communication and information transfer over long distances within a medical setting. Maryland HB 931 & SB486 Maryland Medical Assistance Program Telemedicine

5 UNLESS OTHERWISE SPECIFICALLY PROHIBITED OR LIMITED BY FEDERAL OR STATE LAW, THE PROGRAM SHALL REIMBURSE A HEALTH CARE PROVIDER FOR A HEALTH CARE SERVICE DELIVERED BY TELEMEDICINE, AS DEFINED IN SECTION OF THE INSURANCE ARTICLE, IN THE SAME MANNER AS THE SAME HEALTH CARE SERVICE IS REIMBURSED WHEN DELIVERED IN PERSON. Maryland HB 934 &SBG 776 Task Force on the Use of Telehealth to Improve Maryland Health Care Study any topic that the Task Force finds necessary to make recommendations regarding the use of telehealth in the State. Maryland SB 494 Commission on Maryland Cybersecurity Innovation and Excellence FOR the purpose of requiring the Commission on Maryland Cyber security Innovation and Excellence to study and develop certain strategies and recommendations for advancing telemedicine technologies and use; Maryland SB 798 Hospitals - Credentialing and Privileging Process Telemedicine A PHYSICIAN WHO PROVIDES MEDICAL SERVICES TO PATIENTS AT THE HOSPITAL 20 ONLY THROUGH TELEMEDICINE FROM A DISTANT SITE HOSPITAL OR DISTANT SITE TELEMEDICINE ENTITY, A HOSPITAL MAY RELY ON THE CREDENTIALING AND PRIVILEGING DECISIONS MADE FOR THE PHYSICIAN BY THE DISTANT SITE HOSPITAL OR DISTANT SITE TELEMEDICINE ENTITY Missouri SB 262 Prohibits health carriers from denying coverage for a health care service on the basis that the service was provided through telemedicine if the same service would be covered when delivered in person bill/intro/sb262.pdf Under this act, health carriers issuing or renewing health benefit plans on or after January 1, 2014, shall not deny coverage for a health care service on the basis that the service was provided through telemedicine if the same service would be covered when delivered in person. Mississippi HB 904 & SB 2209 Telemedicine services; health insurance plans must provide coverage to the same extent as for in- person services. AN ACT TO REQUIRE HEALTH INSURANCE PLANS IN THIS STATE TO PROVIDE COVERAGE FOR TELEMEDICINE SERVICES TO THE SAME EXTENT THAT THE SERVICES WOULD BE COVERED IF THEY WERE PROVIDED THROUGH IN- PERSON CONSULTATION; TO DEFINE THE TERMS "HEALTH INSURANCE PLAN" AND "TELEMEDICINE"; TO AUTHORIZE HEALTH CARE PRACTITIONERS LICENSED IN THIS STATE TO PROVIDE TREATMENT RECOMMENDATIONS TO A PATIENT AFTER HAVING PERFORMED AN APPROPRIATE EXAMINATION OF THE PATIENT THROUGH TELEMEDICINE.

6 Montana HB 133 & LC 1257 Generally revise licensing board laws The department may issue four kinds of licenses under the board's seal, which include a physician's license, a specialized license, a temporary license, and a telemedicine license.. Montana SB 270 AN ACT REQUIRING INSURANCE COVERAGE FOR HEALTH CARE SERVICES PROVIDED VIA TELEMEDICINE Coverage for telemedicine services: Each group or individual policy, certificate of disability insurance, subscriber contract, membership contract, or health care services agreement that provides coverage for health care services must provide coverage for health care services provided by a health care provider or health care facility by means of telemedicine if the services are otherwise covered by the policy, certificate, contract, or agreement. New Jersey A 1809 Concerning the Nurse Multistate Licensure Compact and supplementing Title 45 of the Revised Statutes. The NMLC is intended to address the expanded mobility of nurses and the use of advanced communication technologies (telemedicine) by nurses, which requires greater coordination and cooperation among states in the areas of nurse licensure and regulation. New Mexico HB 1717 & SB 69 INSURANCE COVERAGE FOR TELEMEDICINE SERVICES COVERAGE FOR TELEMEDICINE SERVICES.- - An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall include coverage of telemedicine services. Telemedicine" means the use of interactive audio, video or other telecommunications technology by a health care provider to deliver health care services at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient in real time or through the use of store- and- forward technology. New York AB 3330 AN ACT to amend the public health law, in relation to promoting the development, provision and accessibility of telehealth/telemedicine services in New York Promotes the development, provision and accessibility of telehealth/telemedicine services in New York state; establishes a telehealth/telemedicine development and research grant fund.

7 South Carolina S 290 South Carolina Telemedicine Insurance Reimbursement Act TO REQUIRE COVERAGE OF TELEMEDICINE SERVICES BY INDIVIDUAL AND GROUP HEALTH MAINTENANCE ORGANIZATIONS Tennessee HB 923 & SB 484 AN ACT to amend Tennessee Code Annotated, Title 56; Title 63 and Title 71, relative to telemedicine. An entity subject to this section: (1) Shall provide coverage under a health insurance policy or contract for health care services appropriately delivered through telemedicine; and (2) May not exclude from coverage a health care service solely because it is provided through telemedicine and is not provided through an in- person consultation or contact between a health care provider and a patient. Virginia HB 346 Nurse practitioners; practice as part of patient care teams that includes a physician. bin/legp604.exe?121+ful+chap0213+pdf Nurse practitioners who are certified registered nurse anesthetists shall practice under the supervision of a licensed doctor of medicine, osteopathy, podiatry, or dentistry. Collaboration and consultation among nurse practitioners and patient care team physicians may be provided through telemedicine Virginia HB 171 Establishing a joint subcommittee to study reducing Medicaid costs by using telemedicine. bin/legp604.exe?121+ful+hj171+pdf In conducting its study, the joint subcommittee shall examine the current use of telemedicine in the Commonwealth and in other states; and research methods of reducing Medicaid costs using telemedicine. Vermont HB 272 & SB 88 AN ACT RELATING TO TELEMEDICINE SERVICES DELIVERED OUTSIDE A HEALTH CARE FACILITY pdf This bill proposes to remove a requirement that telemedicine services be delivered in a health care facility in order to qualify for health insurance coverage. All health insurance plans in this state shall provide coverage for telemedicine services delivered to a patient in a health care facility by telemedicine to the same extent that the services would be covered if they were provided through in- person consultation. Washington HB 1448 Regarding telemedicine

8 It is the intent of the legislature to recognize the application of telemedicine as a reimbursable service by which an individual receives medical services from a health care provider without face- to- face contact with the provider. It is also the intent of the legislature to reduce the compliance requirements on hospitals when granting privileges or associations to telemedicine physicians. Complied by Lawrence R. Wierzbowski, Au.D DABNM FASNM Chair ASNM Government Relations Committee The ASNM Legislative Watchdog Bulletin is a special service of The American Society of Neurological Monitoring meant for informational purposes only and does not imply any endorsement. For further information or questions about this service, please contact us at

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