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6 Cosponsor:
Steve Eliason
7
8 LONG TITLE
9 General Description:
10 This bill amends the Medical Assistance Act and the Public Employees' Benefit and
11 Insurance Program Act to provide coverage for certain telehealth services.
12 Highlighted Provisions:
13 This bill:
14 ▸ defines terms;
15 ▸ amends the Medical Assistance Act regarding reimbursement for telemedicine
16 services;
17 ▸ amends the Public Employees' Health Benefit and Insurance Program Act (PEHP)
18 regarding reimbursement for telemedicine services;
19 ▸ requires the Department of Health and PEHP to report to a legislative interim
20 committee and a task force regarding telehealth services;
21 ▸ requires a legislative study;
22 ▸ describes responsibilities of a provider offering telehealth services; and
23 ▸ amends the Electronic Prescribing Act to restrict certain prescriptions in conjuction
24 with telehealth services.
25 Money Appropriated in this Bill:
26 None
27 Other Special Clauses:
28 None
29 Utah Code Sections Affected:
30 AMENDS:
31 26-18-13, as enacted by Laws of Utah 2008, Chapter 41
32 58-82-201, as last amended by Laws of Utah 2012, Chapter 160
33 ENACTS:
34 26-18-13.5, Utah Code Annotated 1953
35 26-58-101, Utah Code Annotated 1953
36 26-58-102, Utah Code Annotated 1953
37 26-58-103, Utah Code Annotated 1953
38 26-58-104, Utah Code Annotated 1953
39 26-58-105, Utah Code Annotated 1953
40 49-20-414, Utah Code Annotated 1953
41
42 Be it enacted by the Legislature of the state of Utah:
43 Section 1. Section 26-18-13 is amended to read:
44 26-18-13. Telemedicine -- Reimbursement -- Rulemaking.
45 (1) (a) [
46 Chapter 58, Telehealth Act, communication by telemedicine is considered face-to-face contact
47 between a health care provider and a patient under the state's medical assistance program if:
48 (i) the communication by telemedicine meets the requirements of administrative rules
49 adopted in accordance with Subsection (3); and
50 (ii) the health care services are eligible for reimbursement under the state's medical
51 assistance program.
52 (b) This Subsection (1) applies to any managed care organization that contracts with
53 the state's medical assistance program.
54 (2) The reimbursement rate for telemedicine services approved under this section:
55 (a) shall be subject to reimbursement policies set by the state plan; and
56 (b) may be based on:
57 (i) a monthly reimbursement rate;
58 (ii) a daily reimbursement rate; or
59 (iii) an encounter rate.
60 (3) The department shall adopt administrative rules in accordance with Title 63G,
61 Chapter 3, Utah Administrative Rulemaking Act, which establish:
62 (a) the particular telemedicine services that are considered face to face encounters for
63 reimbursement purposes under the state's medical assistance program; and
64 (b) the reimbursement methodology for the telemedicine services designated under
65 Subsection (3)(a).
66 Section 2. Section 26-18-13.5 is enacted to read:
67 26-18-13.5. Mental health telemedicine services -- Reimbursement -- Reporting.
68 (1) As used in this section:
69 (a) "Behavioral health care" means treatment or prevention of mental illness, whether
70 in person or remotely, by means of observation, description, evaluation, interpretation,
71 intervention, or treatment to effect modification of human behavior by the application of
72 generally recognized clinical mental health counseling principles, methods, and procedures for
73 the purpose of preventing, treating, or eliminating mental or emotional illness or dysfunction,
74 accompanying symptoms, or maladaptive behavior.
75 (b) "Mental illness" means a mental or emotional condition defined in an approved
76 diagnostic and statistical manual for mental disorders generally recognized in the professions of
77 mental health therapy listed in Section 58-60-102.
78 (c) "Telemedicine services" means the same as that term is defined in Section
79 26-58-102.
80 (2) This section applies to:
81 (a) a managed care organization that contracts with the Medicaid program; and
82 (b) a provider who is reimbursed for health care services under the Medicaid program.
83 (3) The reimbursement rate for in-office behavioral health care visits provided through
84 telemedicine services may be determined by applying:
85 (a) the same reimbursement rate offered for a traditional face-to-face in-office
86 behavioral health care visit;
87 (b) the rate described in Subsection (3)(a) with an applicable Medicare relative value
88 adjustment for telemedicine; or
89 (c) a rate that is at or above the rate offered for behavioral health care visits that the
90 Medicaid program has established with a telemedicine-based provider.
91 (4) The department shall report to the Legislature's Public Utilities and Technology
92 Interim Committee and Health Reform Task Force, before December 1, 2017, on:
93 (a) the result of the reimbursement rate parity described in Subsection (3);
94 (b) existing and potential uses of telehealth and telemedicine services;
95 (c) issues of reimbursement to a provider offering telehealth and telemedicine services;
96 and
97 (d) potential rules or legislation related to providers offering and insurers reimbursing
98 for telehealth and telemedicine services.
99 Section 3. Section 26-58-101 is enacted to read:
100
101 26-58-101. Title.
102 This chapter is known as the "Telehealth Act."
103 Section 4. Section 26-58-102 is enacted to read:
104 26-58-102. Definitions.
105 As used in this chapter:
106 (1) "Asynchronous store and forward transfer" means the transmission of a patient's
107 health care information from an originating site to a provider at a distant site over a secure
108 connection that complies with state and federal security and privacy laws.
109 (2) "Distant site" means the physical location of a provider delivering telemedicine
110 services.
111 (3) "Originating site" means the physical location of a patient receiving telemedicine
112 services.
113 (4) "Patient" means an individual seeking telemedicine services.
114 (5) "Provider" means an individual licensed in the state, under Title 58, Occupations
115 and Professions, to provide health care.
116 (6) "Synchronous interaction" means real-time communication through interactive
117 technology that enables a provider at a distant site and a patient at an originating site to interact
118 simultaneously through two-way audio and video transmission.
119 (7) "Telehealth services" means the transmission of health-related services or
120 information through the use of electronic communication or information technology.
121 (8) "Telemedicine services" means telehealth services:
122 (a) including:
123 (i) clinical care;
124 (ii) health education;
125 (iii) health administration;
126 (iv) home health; or
127 (v) facilitation of self-managed care and caregiver support; and
128 (b) provided by a provider to a patient through the use of:
129 (i) asynchronous store and forward transfer; or
130 (ii) synchronous interaction.
131 Section 5. Section 26-58-103 is enacted to read:
132 26-58-103. Scope of telehealth practice.
133 (1) A provider offering telehealth services shall:
134 (a) at all times:
135 (i) act within the scope of the provider's license under Title 58, Occupations and
136 Professions, in accordance with the provisions of this chapter and all other applicable laws and
137 rules; and
138 (ii) be held to the same standards of practice as those applicable in traditional health
139 care settings;
140 (b) in accordance with Title 58, Chapter 82, Electronic Prescribing Act, before
141 providing treatment or ordering a prescription drug, obtain, from the patient or another
142 provider, and document the patient's relevant clinical history and current symptoms to establish
143 a diagnosis and identify underlying conditions and contraindications to a recommended
144 treatment;
145 (c) be available to a patient who receives telehealth services from the provider for
146 subsequent care related to the initial telemedicine services, in accordance with community
147 standards of practice;
148 (d) be familiar with available medical resources, including emergency resources near
149 the originating site, in order to make appropriate patient referrals when medically indicated;
150 and
151 (e) in accordance with any applicable state and federal laws, rules, and regulations,
152 generate, maintain, and make available to each patient receiving telehealth services the patient's
153 medical records.
154 (2) A provider may not offer telehealth services if:
155 (a) the provider is not in compliance with applicable laws, rules, and regulations
156 regarding the provider's licensed practice; or
157 (b) the provider's license under Title 58, Occupations and Professions, is not active and
158 in good standing.
159 Section 6. Section 26-58-104 is enacted to read:
160 26-58-104. Enforcement.
161 The Division of Occupational and Professional Licensing, created in Section 58-1-103,
162 is authorized to enforce the provisions of this chapter.
163 Section 7. Section 26-58-105 is enacted to read:
164 26-58-105. Study by Public Utilities and Technology Interim Committee and
165 Health Reform Task Force.
166 The Legislature's Public Utilities and Technology Interim Committee and Health
167 Reform Task Force shall receive the reports required in Sections 26-18-13.5 and 49-20-414,
168 and study:
169 (1) the result of the reimbursement rate parity described in Sections 26-18-13.5 and
170 49-20-414;
171 (2) practices and efforts of private health care facilities, health care providers,
172 self-funded employers, third-party payors, and health maintenance organizations to create
173 parity between reimbursement rates for telehealth services, as defined in Section 28-58-102,
174 and reimbursement rates offered in a traditional face-to-face setting;
175 (3) existing and potential uses of telehealth and telemedicine services;
176 (4) issues of reimbursement to a provider offering telehealth and telemedicine services;
177 and
178 (5) potential rules or legislation related to providers offering and insurers reimbursing
179 for telehealth and telemedicine services.
180 Section 8. Section 49-20-414 is enacted to read:
181 49-20-414. Mental health telemedicine services -- Reimbursement -- Reporting.
182 (1) As used in this section:
183 (a) "Behavioral health care" means the same as that term is defined in Section
184 26-18-13.5.
185 (b) "Mental illness" means the same as that term is defined in Section 26-18-13.5.
186 (c) "Telemedicine services" means the same as that term is defined in Section
187 26-58-102.
188 (2) This section applies to the risk pool established for the state under Subsection
189 49-20-201(1)(a).
190 (3) The reimbursement rate under the program for in-office behavioral health care
191 visits provided through telemedicine services may be determined by applying:
192 (a) the same reimbursement rate offered for a traditional face-to-face in-office
193 behavioral health care visit;
194 (b) the rate described in Subsection (3)(a) with an applicable Medicare relative value
195 adjustment for telemedicine; or
196 (c) a rate that is at or above the rate offered for behavioral health care visits that the
197 program has established with a telemedicine-based provider.
198 (4) The program shall report to the Legislature's Public Utilities and Technology
199 Interim Committee and Health Reform Task Force, before December 1, 2017, on:
200 (a) the result of the reimbursement rate parity described in Subsection (3);
201 (b) existing and potential uses of telehealth and telemedicine services;
202 (c) issues of reimbursement to a provider offering telehealth and telemedicine services;
203 and
204 (d) potential rules or legislation related to providers offering and insurers reimbursing
205 for telehealth and telemedicine services.
206 Section 9. Section 58-82-201 is amended to read:
207 58-82-201. Electronic prescriptions -- Restrictions -- Rulemaking authority.
208 (1) Subject to the provisions of this section, a practitioner shall:
209 (a) provide each existing patient of the practitioner with the option of participating in
210 electronic prescribing for prescriptions issued for the patient, if the practitioner prescribes a
211 drug or device for the patient on or after July 1, 2012; and
212 (b) offer the patient a choice regarding to which pharmacy the practitioner will issue
213 the electronic prescription.
214 (2) A practitioner may not issue a prescription through electronic prescribing for a
215 drug, device, or federal controlled substance that the practitioner is prohibited by federal law or
216 federal rule from issuing through electronic prescribing.
217 (3) A pharmacy shall:
218 (a) accept an electronic prescription that is transmitted in accordance with the
219 requirements of this section and division rules; and
220 (b) dispense a drug or device as directed in an electronic prescription described in
221 Subsection (3)(a).
222 (4) The division shall make rules to ensure that:
223 (a) except as provided in Subsection (6), practitioners and pharmacies comply with this
224 section;
225 (b) electronic prescribing is conducted in a secure manner, consistent with industry
226 standards; and
227 (c) each patient is fully informed of the patient's rights, restrictions, and obligations
228 pertaining to electronic prescribing.
229 (5) An entity that facilitates the electronic prescribing process under this section shall:
230 (a) transmit to the pharmacy the prescription for the drug prescribed by the prescribing
231 practitioner however, this Subsection (5)(a) does not prohibit the use of an electronic
232 intermediary if the electronic intermediary does not over-ride a patient's or prescriber's choice
233 of pharmacy;
234 (b) transmit only scientifically accurate, objective, and unbiased information to
235 prescribing practitioners; and
236 (c) allow a prescribing practitioner to electronically override a formulary or preferred
237 drug status when medically necessary.
238 (6) The division may, by rule, grant an exemption from the requirements of this section
239 to a pharmacy or a practitioner to the extent that the pharmacy or practitioner can establish, to
240 the satisfaction of the division, that compliance with the requirements of this section would
241 impose an extreme financial hardship on the pharmacy or practitioner.
242 (7) A practitioner treating a patient through telehealth services, as described in Title 26,
243 Chapter 58, Telehealth Act, may not issue a prescription through electronic prescribing for a
244 drug or treatment to cause an abortion, except in cases of rape, incest, or if the life of the
245 mother would be endangered without an abortion.
Legislative Review Note
Office of Legislative Research and General Counsel