Bill Text: NY A02674 | 2021-2022 | 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 9-0)
Status: (Introduced - Dead) 2022-02-01 - enacting clause stricken [A02674 Detail]
Download: New_York-2021-A02674-Introduced.html
STATE OF NEW YORK ________________________________________________________________________ 2674 2021-2022 Regular Sessions IN ASSEMBLY January 19, 2021 ___________ Introduced by M. of A. WOERNER, BRONSON, McMAHON, JONES, MAGNARELLI, STIRPE, GUNTHER, BUTTENSCHON -- 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: EXPLANATION--Matter in italics (underscored) is new; matter in brackets [] is old law to be omitted. LBD01277-01-1A. 2674 2 1 (1) "telehealth" means the use of electronic information and communi- 2 cation technologies by a health care provider to deliver health care 3 services to an insured individual while such individual is located at a 4 site that is different from the site where the health care provider is 5 located; and 6 (2) "clinical setting" means a site which is a facility licensed under 7 article twenty-eight or forty of the public health law, a facility as 8 defined in subdivision six of section 1.03 of the mental hygiene law, or 9 a private physician's office, nurse practitioner's office or midwifery 10 located within the state of New York. 11 § 2. Section 4306-g of the insurance law, as added by chapter 6 of the 12 laws of 2015, is amended to read as follows: 13 § 4306-g. Telehealth delivery of services. (a) A corporation shall not 14 exclude from coverage a service that is otherwise covered under a 15 contract that provides comprehensive coverage for hospital, medical or 16 surgical care because the service is delivered via telehealth, as that 17 term is defined in subsection (b) of this section; provided, however, 18 that a corporation may exclude from coverage a service by a health care 19 provider where the provider is not otherwise covered under the contract. 20 A corporation may subject the coverage of a service delivered via tele- 21 health to co-payments, coinsurance or deductibles provided that they are 22 at least as favorable to the insured as those established for the same 23 service when not delivered via telehealth. A corporation may subject the 24 coverage of a service delivered via telehealth to reasonable utilization 25 management and quality assurance requirements that are consistent with 26 those established for the same service when not delivered via tele- 27 health. A corporation shall reimburse primary care services delivered 28 via telehealth, where both the insured individual and the health care 29 provider are located in a clinical setting, on the same basis and at the 30 same rate as would apply to such services if the services had been 31 delivered in person. 32 (b) For purposes of this section[,] the following terms shall have the 33 following meanings: 34 (1) "telehealth" means the use of electronic information and communi- 35 cation technologies by a health care provider to deliver health care 36 services to an insured individual while such individual is located at a 37 site that is different from the site where the health care provider is 38 located; and 39 (2) "clinical setting" means a site which is a facility licensed under 40 article twenty-eight or forty of the public health law, a facility as 41 defined in subdivision six of section 1.03 of the mental hygiene law, or 42 a private physician's office, nurse practitioner's office or midwifery 43 located within the state of New York. 44 § 3. Section 4406-g of the public health law, as added by chapter 6 of 45 the laws of 2015, is amended to read as follows: 46 § 4406-g. Telehealth delivery of services. 1. A health maintenance 47 organization shall not exclude from coverage a service that is otherwise 48 covered under an enrollee contract of a health maintenance organization 49 because the service is delivered via telehealth, as that term is defined 50 in subdivision two of this section; provided, however, that a health 51 maintenance organization may exclude from coverage a service by a health 52 care provider where the provider is not otherwise covered under the 53 enrollee contract. A health maintenance organization may subject the 54 coverage of a service delivered via telehealth to co-payments, coinsu- 55 rance or deductibles provided that they are at least as favorable to the 56 enrollee as those established for the same service when not deliveredA. 2674 3 1 via telehealth. A health maintenance organization may subject the cover- 2 age of a service delivered via telehealth to reasonable utilization 3 management and quality assurance requirements that are consistent with 4 those established for the same service when not delivered via tele- 5 health. A health maintenance organization shall reimburse primary care 6 services delivered via telehealth, where both the insured individual and 7 the health care provider are located in a clinical setting, on the same 8 basis and at the same rate as would apply to such services if the 9 services had been delivered in person. 10 2. For purposes of this section[,] the following terms shall have the 11 following meanings: 12 (a) "telehealth" means the use of electronic information and communi- 13 cation technologies by a health care provider to deliver health care 14 services to an enrollee while such enrollee is located at a site that is 15 different from the site where the health care provider is located; and 16 (b) "clinical setting" means a site which is a facility licensed under 17 article twenty-eight or forty of this chapter, a facility as defined in 18 subdivision six of section 1.03 of the mental hygiene law, or a private 19 physician's office, nurse practitioner's office or midwifery located 20 within the state of New York. 21 § 4. This act shall take effect on the thirtieth day after it shall 22 have become a law and shall apply to all policies and contracts issued, 23 renewed, modified, altered or amended on or after such date.
