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:
19 Other Special Clauses:
21 Utah Code Sections Affected:
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
26 31A-22-649.5, Utah Code Annotated 1953
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
36 (3) "Originating site" means the physical location of a patient receiving telemedicine
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
45 (a) licensed under Title 26, Chapter 21, Health Care Facility Licensing and Inspection
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.
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.
53 information through the use of electronic communication or information technology.
55 (a) including:
56 (i) clinical care;
57 (ii) health education;
58 (iii) health administration;
59 (iv) home health; [
60 (v) facilitation of self-managed care and caregiver support; [
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;
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;
89 (ii) documenting the patient's relevant clinical history and current symptoms;
91 subsequent care related to the initial telemedicine services, in accordance with community
92 standards of practice;
94 near the originating site, in order to make appropriate patient referrals when medically
95 indicated; [
97 regulations, generate, maintain, and make available to each patient receiving telehealth services
98 the patient's medical records[
99 (g) if the patient has a Ĥ→ [
99a telemedicine provider:
100 (i) consult with the patient regarding whether to provide the patient's Ĥ→ [
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→ [
103a (ii) collect from the patient the contact information of the patient's designated health
103b care provider; and ←Ĥ
104 Ĥ→ [
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→ [
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→ [
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.
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
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.