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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
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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[
31 defined in Section 26-60-102.
32 [
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34 [
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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 [
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46 same basis that the Medicaid program reimburses for other health care services.
47 (4) Before [
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 [
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84 [
85 [
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 [
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91 [
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 [
97 telemedicine services at a [
98 (4) Before [
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 [
108 (ii) increasing access to health care, increasing the efficiency of health care, and
109 decreasing the costs of health care[
110 (e) telemedicine services that the program declined to cover because the telemedicine
111 services that were requested were not medically appropriate.