Bill Text: NY A09667 | 2019-2020 | General Assembly | Introduced
Bill Title: 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.
Spectrum: Partisan Bill (Democrat 8-0)
Status: (Introduced - Dead) 2020-02-04 - referred to insurance [A09667 Detail]
Download: New_York-2019-A09667-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 9667 IN ASSEMBLY 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: 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: 24 (1) "telehealth" means the use of electronic information and communi- 25 cation technologies by a health care provider to deliver health care 26 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. LBD14311-02-9A. 9667 2 1 site that is different from the site where the health care provider is 2 located; and 3 (2) "clinical setting" means a site which is a facility licensed under 4 article twenty-eight or forty of the public health law, a facility as 5 defined in subdivision six of section 1.03 of the mental hygiene law, or 6 a private physician's office, nurse practitioner's office or midwifery 7 located within the state of New York. 8 § 2. Section 4306-g of the insurance law, as added by chapter 6 of the 9 laws of 2015, is amended to read as follows: 10 § 4306-g. Telehealth delivery of services. (a) A corporation shall not 11 exclude from coverage a service that is otherwise covered under a 12 contract that provides comprehensive coverage for hospital, medical or 13 surgical care because the service is delivered via telehealth, as that 14 term is defined in subsection (b) of this section; provided, however, 15 that a corporation may exclude from coverage a service by a health care 16 provider where the provider is not otherwise covered under the contract. 17 A corporation may subject the coverage of a service delivered via tele- 18 health to co-payments, coinsurance or deductibles provided that they are 19 at least as favorable to the insured as those established for the same 20 service when not delivered via telehealth. A corporation may subject the 21 coverage of a service delivered via telehealth to reasonable utilization 22 management and quality assurance requirements that are consistent with 23 those established for the same service when not delivered via tele- 24 health. A corporation shall reimburse primary care services delivered 25 via telehealth, where both the insured individual and the health care 26 provider are located in a clinical setting, on the same basis and at the 27 same rate as would apply to such services if the services had been 28 delivered in person. 29 (b) For purposes of this section[,] the following terms shall have the 30 following meanings: 31 (1) "telehealth" means the use of electronic information and communi- 32 cation technologies by a health care provider to deliver health care 33 services to an insured individual while such individual is located at a 34 site that is different from the site where the health care provider is 35 located; and 36 (2) "clinical setting" means a site which is a facility licensed under 37 article twenty-eight or forty of the public health law, a facility as 38 defined in subdivision six of section 1.03 of the mental hygiene law, or 39 a private physician's office, nurse practitioner's office or midwifery 40 located within the state of New York. 41 § 3. Section 4406-g of the public health law, as added by chapter 6 of 42 the laws of 2015, is amended to read as follows: 43 § 4406-g. Telehealth delivery of services. 1. A health maintenance 44 organization shall not exclude from coverage a service that is otherwise 45 covered under an enrollee contract of a health maintenance organization 46 because the service is delivered via telehealth, as that term is defined 47 in subdivision two of this section; provided, however, that a health 48 maintenance organization may exclude from coverage a service by a health 49 care provider where the provider is not otherwise covered under the 50 enrollee contract. A health maintenance organization may subject the 51 coverage of a service delivered via telehealth to co-payments, coinsu- 52 rance or deductibles provided that they are at least as favorable to the 53 enrollee as those established for the same service when not delivered 54 via telehealth. A health maintenance organization may subject the cover- 55 age of a service delivered via telehealth to reasonable utilization 56 management and quality assurance requirements that are consistent withA. 9667 3 1 those established for the same service when not delivered via tele- 2 health. A health maintenance organization shall reimburse primary care 3 services delivered via telehealth, where both the insured individual and 4 the health care provider are located in a clinical setting, on the same 5 basis and at the same rate as would apply to such services if the 6 services had been delivered in person. 7 2. For purposes of this section[,] the following terms shall have the 8 following meanings: 9 (a) "telehealth" means the use of electronic information and communi- 10 cation technologies by a health care provider to deliver health care 11 services to an enrollee while such enrollee is located at a site that is 12 different from the site where the health care provider is located; and 13 (b) "clinical setting" means a site which is a facility licensed under 14 article twenty-eight or forty of this chapter, a facility as defined in 15 subdivision six of section 1.03 of the mental hygiene law, or a private 16 physician's office, nurse practitioner's office or midwifery located 17 within the state of New York. 18 § 4. This act shall take effect on the thirtieth day after it shall 19 have become a law and shall apply to all policies and contracts issued, 20 renewed, modified, altered or amended on or after such date.
