Representative Ken Ivory proposes the following substitute bill:


1     
TELEMEDICINE REIMBURSEMENT AMENDMENTS

2     
2018 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Ken Ivory

5     
Senate Sponsor: ____________

6     

7     LONG TITLE
8     General Description:
9          This bill amends provisions regarding reimbursement for telemedicine services.
10     Highlighted Provisions:
11          This bill:
12          ▸     requires the Medicaid program and the Public Employees' Benefit and Insurance
13     Program to reimburse for certain telemedicine services at commercially reasonable
14     rates;
15          ▸     amends telemedicine reporting and study requirements; and
16          ▸     makes technical changes.
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     AMENDS:
23          26-18-13.5, as enacted by Laws of Utah 2017, Chapter 241
24          26-60-105, as enacted by Laws of Utah 2017, Chapter 241
25          49-20-414, as enacted by Laws of Utah 2017, Chapter 241
26     

27     Be it enacted by the Legislature of the state of Utah:
28          Section 1. Section 26-18-13.5 is amended to read:
29          26-18-13.5. Telemedicine services reimbursement.
30          (1) As used in this section[:], "telemedicine services" means the same as that term is
31     defined in Section 26-60-102.
32          [(a) "Mental health therapy" means the same as the term "practice of mental health
33     therapy" is defined in Section 58-60-102.]
34          [(b) "Mental illness" means a mental or emotional condition defined in an approved
35     diagnostic and statistical manual for mental disorders generally recognized in the professions of
36     mental health therapy listed in Section 58-60-102.]
37          [(c) "Telehealth services" means the same as that term is defined in Section
38     26-60-102.]
39          [(d) "Telemedicine services" means the same as that term is defined in Section
40     26-60-102.]
41          (2) This section applies to:
42          (a) a managed care organization that contracts with the Medicaid program; and
43          (b) a provider who is reimbursed for health care services under the Medicaid program.
44          (3) The Medicaid program shall reimburse for [personal mental health therapy office
45     visits provided through] telemedicine services [at a rate set by the Medicaid program] on the
46     same basis that the Medicaid program reimburses for other health care services.
47          (4) Before [December 1, 2017] November 1, 2018, the department shall report to the
48     Legislature's Public Utilities, Energy, and Technology Interim Committee and Health Reform
49     Task Force on:
50          (a) the result of the reimbursement requirement described in Subsection (3);
51          (b) existing and potential uses of telehealth and telemedicine services;
52          (c) issues of reimbursement to a provider offering telehealth and telemedicine services;
53          (d) potential rules or legislation related to:
54          (i) providers offering and insurers reimbursing for telehealth and telemedicine services;
55     and
56          (ii) increasing access to health care, increasing the efficiency of health care, and
57     decreasing the costs of health care; and
58          (e) the department's efforts to obtain a waiver from the federal requirement that
59     telemedicine communication be face-to-face communication.
60          Section 2. Section 26-60-105 is amended to read:
61          26-60-105. Study by Public Utilities, Energy, and Technology Interim Committee
62     and Health Reform Task Force.
63          The Legislature's Public Utilities, Energy, and Technology Interim Committee and
64     Health Reform Task Force shall receive the reports required in Sections 26-18-13.5 and
65     49-20-414 and, during the 2018 interim, study:
66          (1) the result of the reimbursement requirement described in Sections 26-18-13.5 and
67     49-20-414;
68          (2) practices and efforts of private health care facilities, health care providers,
69     self-funded employers, third-party payors, and health maintenance organizations to reimburse
70     for telehealth services;
71          (3) existing and potential uses of telehealth and telemedicine services;
72          (4) issues of reimbursement to a provider offering telehealth and telemedicine services;
73     and
74          (5) potential rules or legislation related to:
75          (a) providers offering and insurers reimbursing for telehealth and telemedicine
76     services; and
77          (b) increasing access to health care, increasing the efficiency of health care, and
78     decreasing the costs of health care.
79          Section 3. Section 49-20-414 is amended to read:
80          49-20-414. Telemedicine services reimbursement.
81          (1) As used in this section:
82          [(a) "Mental health therapy" means the same as the term "practice of mental health
83     therapy" is defined in Section 58-60-102.]
84          [(b) "Mental illness" means the same as that term is defined in Section 26-18-13.5.]
85          [(c)] (a) "Network provider" means a health care provider who has an agreement with
86     the program to provide health care services to a patient with an expectation of receiving
87     payment, other than coinsurance, copayments, or deductibles, directly from the managed care
88     organization.
89          [(d) "Telehealth services" means the same as that term is defined in Section
90     26-60-102.]
91          [(e)] (b) "Telemedicine services" means the same as that term is defined in Section
92     26-60-102.
93          (2) This section applies to the risk pool established for the state under Subsection
94     49-20-201(1)(a).
95          (3) The program shall, at the provider's request, reimburse a network provider for
96     [personal mental health therapy office visits provided through] medically appropriate
97     telemedicine services at a [rate set by the program] commercially reasonable rate.
98          (4) Before [December 1, 2017] November 1, 2018, the program shall report to the
99     Legislature's Public Utilities, Energy, and Technology Interim Committee and Health Reform
100     Task Force on:
101          (a) the result of the reimbursement requirement described in Subsection (3);
102          (b) existing and potential uses of telehealth and telemedicine services;
103          (c) issues of reimbursement to a provider offering telehealth and telemedicine services;
104     and
105          (d) potential rules or legislation related to:
106          (i) providers offering and insurers reimbursing for telehealth and telemedicine services;
107     [and]
108          (ii) increasing access to health care, increasing the efficiency of health care, and
109     decreasing the costs of health care[.]; and
110          (e) telemedicine services that the program declined to cover because the telemedicine
111     services that were requested were not medically appropriate.