This document includes House Floor Amendments incorporated into the bill on Fri, Feb 28, 2020 at 3:09 PM by naomigarrow.
Representative Melissa G. Ballard proposes the following substitute bill:


1     
TELEHEALTH PARITY AMENDMENTS

2     
2020 GENERAL SESSION

3     
STATE OF UTAH

4     
Chief Sponsor: Melissa G. Ballard

5     
Senate Sponsor: Allen M. Christensen

6     

7     LONG TITLE
8     General Description:
9          This bill amends provisions related to insurance coverage for telehealth services and
10     telemedicine services.
11     Highlighted Provisions:
12          This bill:
13          ▸     amends the definition of telemedicine services;
14          ▸     clarifies the scope of telehealth practice; and
15          ▸     requires certain health benefit plans to provide coverage parity and commercially
16     reasonable reimbursement for telehealth services and telemedicine services.
17     Money Appropriated in this Bill:
18          None
19     Other Special Clauses:
20          None
21     Utah Code Sections Affected:
22     AMENDS:
23          26-60-102, as enacted by Laws of Utah 2017, Chapter 241
24          26-60-103, as enacted by Laws of Utah 2017, Chapter 241
25     ENACTS:
26          31A-22-649.5, Utah Code Annotated 1953
27     

28     Be it enacted by the Legislature of the state of Utah:
29          Section 1. Section 26-60-102 is amended to read:
30          26-60-102. Definitions.
31          As used in this chapter:
32          (1) "Asynchronous store and forward transfer" means the transmission of a patient's
33     health care information from an originating site to a provider at a distant site.
34          (2) "Distant site" means the physical location of a provider delivering telemedicine
35     services.
36          (3) "Originating site" means the physical location of a patient receiving telemedicine
37     services.
38          (4) "Patient" means an individual seeking telemedicine services.
39          (5) (a) "Patient-generated medical history" means medical data about a patient that the
40     patient creates, records, or gathers.
41          (b) "Patient-generated medical history" does not include a patient's medical record that
42     a healthcare professional creates and the patient personally delivers to a different healthcare
43     professional.
44          [(5)] (6) "Provider" means an individual who is:
45          (a) licensed under Title 26, Chapter 21, Health Care Facility Licensing and Inspection
46     Act;
47          (b) licensed under Title 58, Occupations and Professions, to provide health care; or
48          (c) licensed under Title 62A, Chapter 2, Licensure of Programs and Facilities.
49          [(6)] (7) "Synchronous interaction" means real-time communication through interactive
50     technology that enables a provider at a distant site and a patient at an originating site to interact
51     simultaneously through two-way audio and video transmission.
52          [(7)] (8) "Telehealth services" means the transmission of health-related services or
53     information through the use of electronic communication or information technology.
54          [(8)] (9) "Telemedicine services" means telehealth services:
55          (a) including:
56          (i) clinical care;
57          (ii) health education;
58          (iii) health administration;
59          (iv) home health; [or]
60          (v) facilitation of self-managed care and caregiver support; [and] or
61          (vi) remote patient monitoring occurring incidentally to general supervision; and
62          (b) provided by a provider to a patient through a method of communication that:
63          (i) (A) uses asynchronous store and forward transfer; or
64          (B) uses synchronous interaction; and
65          (ii) meets industry security and privacy standards, including compliance with:
66          (A) the federal Health Insurance Portability and Accountability Act of 1996, Pub. L.
67     No. 104-191, 110 Stat. 1936, as amended; and
68          (B) the federal Health Information Technology for Economic and Clinical Health Act,
69     Pub. L. No. 111-5, 123 Stat. 226, 467, as amended.
70          Section 2. Section 26-60-103 is amended to read:
71          26-60-103. Scope of telehealth practice.
72          (1) A provider offering telehealth services shall:
73          (a) at all times:
74          (i) act within the scope of the provider's license under Title 58, Occupations and
75     Professions, in accordance with the provisions of this chapter and all other applicable laws and
76     rules; and
77          (ii) be held to the same standards of practice as those applicable in traditional health
78     care settings;
79          (b) if the provider does not already have a provider-patient relationship with the
80     patient, establish a provider-patient relationship during the patient encounter in a manner
81     consistent with the standards of practice, determined by the Division of Professional Licensing
82     in rule made in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act,
83     including providing the provider's licensure and credentials to the patient;
84          [(b)] (c) in accordance with Title 58, Chapter 82, Electronic Prescribing Act, before
85     providing treatment or prescribing a prescription drug, establish a diagnosis and identify
86     underlying conditions and contraindications to a recommended treatment after:
87          (i) obtaining from the patient or another provider the patient's relevant clinical history;
88     and
89          (ii) documenting the patient's relevant clinical history and current symptoms;
90          [(c)] (d) be available to a patient who receives telehealth services from the provider for
91     subsequent care related to the initial telemedicine services, in accordance with community
92     standards of practice;
93          [(d)] (e) be familiar with available medical resources, including emergency resources
94     near the originating site, in order to make appropriate patient referrals when medically
95     indicated; [and]
96          [(e)] (f) in accordance with any applicable state and federal laws, rules, and
97     regulations, generate, maintain, and make available to each patient receiving telehealth services
98     the patient's medical records[.]; and
99          (g) if the patient has a Ĥ→ [primary] designated health ←Ĥ care provider who is not the
99a     telemedicine provider:
100          (i) consult with the patient regarding whether to provide the patient's Ĥ→ [primary]
100a     designated health ←Ĥ care
101     provider a medical record or other report containing an explanation of the treatment provided
102     to the patient and the telemedicine provider's evaluation, analysis, or diagnosis of the patient's
103     condition; Ĥ→ [and]
103a          (ii) collect from the patient the contact information of the patient's designated health
103b     care provider; and ←Ĥ
104          Ĥ→ [(ii)] (iii) ←Ĥ within two weeks after the day on which the telemedicine provider
104a     provides
105     services to the patient, and to the extent allowed under HIPAA as that term is defined in
106     Section 26-18-17, provide the medical record or report to the patient's Ĥ→ [primary] designated
106a     health ←Ĥ care provider,
107     unless the patient indicates that the patient does not want the telemedicine provider to send the
108     medical record or report to the patient's Ĥ→ [primary] designated health ←Ĥ care provider.
109          (2) Subsection (1)(g) does not apply to prescriptions for eyeglasses or contacts.
110          (3) Except as specifically provided in Title 58, Chapter 83, Online Prescribing,
111     Dispensing, and Facilitation Licensing Act, and unless a provider has established a
112     provider-patient relationship with a patient, a provider offering telemedicine services may not
113     diagnose a patient, provide treatment, or prescribe a prescription drug based solely on one of
114     the following:
115          (a) an online questionnaire;
116          (b) an email message; or
117          (c) a patient-generated medical history.
118          [(2)] (4) A provider may not offer telehealth services if:
119          (a) the provider is not in compliance with applicable laws, rules, and regulations
120     regarding the provider's licensed practice; or
121          (b) the provider's license under Title 58, Occupations and Professions, is not active and
122     in good standing.
123          Section 3. Section 31A-22-649.5 is enacted to read:
124          31A-22-649.5. Insurance parity for telemedicine services.
125          (1) As used in this section:
126          (a) "Telehealth services" means the same as that term is defined in Section 26-60-102.
127          (b) "Telemedicine services" means the same as that term is defined in Section
128     26-60-102.
129          (2) Notwithstanding the provisions of Section 31A-22-618.5, a health benefit plan
130     offered in the individual market, the small group market, or the large group market and entered
131     into or renewed on or after January 1, 2021, shall:
132          (a) provide coverage for telemedicine services that are covered by Medicare; and
133          (b) reimburse, at a commercially reasonable rate, a network provider that provides the
134     telemedicine services described in Subsection (2)(a).
135          (3) Notwithstanding Section 31A-45-303, a health benefit plan providing treatment
136     under Subsection (2) may not impose originating site restrictions, geographic restrictions, or
137     distance-based restrictions.