Bill Text: FL S0898 | 2013 | Regular Session | Introduced
Bill Title: Health Care Coverage
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Failed) 2013-05-03 - Died in Banking and Insurance [S0898 Detail]
Download: Florida-2013-S0898-Introduced.html
Florida Senate - 2013 SB 898
By Senator Joyner
19-01298-13 2013898__
1 A bill to be entitled
2 An act relating to health care coverage; requiring
3 health insurers, corporations, and health maintenance
4 organizations issuing certain health policies to
5 provide coverage for telemedicine services; providing
6 definitions; prohibiting the exclusion of telemedicine
7 cost coverage solely because the services were not
8 provided face to face; specifying conditions under
9 which an insurer, corporation, or health maintenance
10 organization must reimburse a telemedicine provider
11 for certain fees and costs; authorizing provisions
12 requiring a deductible, copayment, or coinsurance
13 requirement for telemedicine services under certain
14 circumstances; prohibiting the imposition of certain
15 dollar and durational coverage limitations or
16 copayments, coinsurance, or deductibles on
17 telemedicine services unless imposed equally on all
18 terms and services; providing for applicability and
19 construction; requiring a utilization review under
20 certain circumstances; providing coverage under the
21 state plan or a waiver for health home services
22 provided to eligible individuals with chronic
23 conditions; requiring the Department of Health to
24 conduct an interagency study relating to telemedicine
25 services and coverage; requiring a report to the
26 Legislature; authorizing the department to adopt rules
27 in consultation with certain boards; providing an
28 effective date.
29
30 WHEREAS, today, more and more people take advantage of
31 telemedicine and e-health opportunities, including participating
32 in consultations with doctors and joining monitoring programs
33 for patients with chronic disease, and
34 WHEREAS, by connecting residents of the state with
35 geographically distant specialists, telemedicine can improve the
36 quality of care that residents may expect to receive and reduce
37 costs by providing services that might otherwise require long
38 distance travel or admission to a health care facility, NOW,
39 THEREFORE,
40
41 Be It Enacted by the Legislature of the State of Florida:
42
43 Section 1. Coverage for telemedicine services.—
44 (1) An insurer, corporation, or health maintenance
45 organization must provide coverage for the cost of health care
46 services provided through telemedicine services under the
47 following policies, contracts, and plans:
48 (a) An individual or group accident and sickness insurance
49 policy issued by an insurer to provide hospital, medical and
50 surgical, or major medical coverage on an expense-incurred
51 basis.
52 (b) An individual or group accident and sickness
53 subscription contract entered into by a corporation.
54 (c) A health care plan for health care services provided by
55 a health maintenance organization.
56 (2) As used in this section, the term:
57 (a) “Adverse decision” means a determination that the use
58 of telemedicine services rendered or proposed to be rendered is
59 not covered under the policy, contract, or plan.
60 (b) “Telemedicine services,” as it pertains to the delivery
61 of health care services, means synchronous video conferencing,
62 remote patient monitoring, asynchronous health images, or other
63 health transmissions supported by mobile devices (mHealth) or
64 other telecommunications technology used for the purpose of
65 diagnosis, consultation, or treatment at a site other than the
66 site where the provider is located. The term does not include an
67 audio-only telephone, e-mail messages, or facsimile
68 transmission.
69 (c) “Utilization review” means a review to determine the
70 appropriateness of telemedicine services, or whether coverage of
71 the delivery of telemedicine services rendered or proposed to be
72 rendered by a health care provider is required, if the
73 determination is made in the same manner as those determinations
74 are made for the treatment of any other illness, condition, or
75 disorder covered under the policy, contract, or plan.
76 (3) An insurer, corporation, or health maintenance
77 organization may not exclude a service from coverage solely
78 because the service is provided through telemedicine services
79 rather than face-to-face consultation or contact between a
80 health care provider and a patient.
81 (4) An insurer, corporation, or health maintenance
82 organization is not required to reimburse the telemedicine
83 provider or the consulting provider for technology fees or costs
84 related to the provision of telemedicine services; however, an
85 insurer, corporation, or health maintenance organization must
86 reimburse the telemedicine provider or the consulting provider
87 for the diagnosis, consultation, or treatment of the insured
88 delivered through telemedicine services on the same basis that
89 the insurer, corporation, or health maintenance organization is
90 responsible for coverage of the same services through face-to
91 face diagnosis, consultation, or treatment.
92 (5) An insurer, corporation, or health maintenance
93 organization may offer a health care plan containing a
94 deductible, copayment, or coinsurance requirement for a health
95 care service provided through telemedicine services if the
96 deductible, copayment, or coinsurance does not exceed the
97 deductible, copayment, or coinsurance that would be applicable
98 if the same services were provided through face-to-face
99 diagnosis, consultation, or treatment.
100 (6) An insurer, corporation, or health maintenance
101 organization may not impose any annual or lifetime dollar
102 maximum on coverage for telemedicine services other than an
103 annual or lifetime dollar maximum that applies in the aggregate
104 to all items and services covered under the policy, contract, or
105 plan and may not impose upon any person receiving benefits under
106 this section any copayment, coinsurance, or deductible amount,
107 or any policy year, calendar year, lifetime, or other durational
108 benefit limitation or maximum for benefits or services, that is
109 not equally imposed upon all terms and services covered under
110 the policy, contract, or plan.
111 (7) This section applies to:
112 (a) An insurance policy, contract, or plan that is
113 delivered, issued for delivery, reissued, or extended in this
114 state on or after July 1, 2013; a policy, contract, or plan for
115 which any term of the policy, contract, or plan is changed or
116 any premium adjustment is made on or after July 1, 2013; and,
117 effective July 1, 2014, any other policy, contract, or plan. For
118 purposes of this paragraph, a policy, contract, or plan is
119 deemed to be renewed no later than the next annual anniversary
120 date of the contract, policy, or plan.
121 (b) Medicaid plans, if the health care service would be
122 covered were it provided through in-person consultation between
123 the recipient and a health care provider, including statewide
124 coverage, services originating from a recipient’s home or any
125 other place where the recipient is located, and the provision of
126 any telemedicine services, including, but not limited to,
127 asynchronous health images or other health transmissions
128 supported by mobile devices provided by authorized health care
129 professions if such health care services would otherwise be
130 covered under the state Medicaid plan.
131 (8) This section does not apply to short-term travel,
132 accident-only, limited or specified disease, or individual
133 conversion policies or contracts; policies or contracts designed
134 for issuance to persons eligible for Medicare coverage under
135 Title XVIII of the federal Social Security Act; or any other
136 similar coverage under state or federal governmental plans.
137 (9) This section does not preclude an insurer, corporation,
138 or health maintenance organization providing coverage for
139 telemedicine services under an insurance policy, contract, or
140 plan from conducting a utilization review. After making an
141 adverse decision, an insurer, corporation, or health maintenance
142 organization must notify the covered individual and the
143 individual’s health care provider and must conduct a utilization
144 review after receiving a written request to conduct such a
145 review from a covered individual or the individual’s health care
146 provider.
147 Section 2. Under the state plan or a waiver of the state
148 plan, eligible individuals with chronic conditions as defined in
149 42 U.S.C. s. 1396w-4 are eligible for medical assistance that
150 provides health home services in compliance with 42 U.S.C. s.
151 1396w-4.
152 Section 3. Interagency telemedicine study by Department of
153 Health.—The Department of Health shall lead and conduct an
154 interagency study on options for inclusion in a comprehensive
155 state plan to implement telemedicine services and coverage that
156 includes multipayer coverage and reimbursement for stroke
157 diagnosis, high-risk pregnancies, premature births, and
158 emergency services. By July 1, 2014, the Department of Health
159 shall submit a final report of its findings and recommendations
160 concerning the study to the President of the Senate and the
161 Speaker of the House of Representatives.
162 Section 4. The Department of Health may adopt rules in
163 consultation with those boards that exercise regulatory or
164 rulemaking functions within the department relating to health
165 care practitioners as defined in s. 456.001(4), Florida
166 Statutes, to implement the requirements of this act relating to
167 the provision of telemedicine services and coverage by such
168 health care practitioners.
169 Section 5. This act shall take effect July 1, 2013.
