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.
LBD01277-01-1
A. 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 delivered
A. 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.