Bill Text: NJ A4355 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires health benefits coverage for telemedicine services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2011-12-09 - Reviewed by the Pension and Health Benefits Commission Recommend not to enact [A4355 Detail]
Download: New_Jersey-2010-A4355-Introduced.html
Sponsored by:
Assemblywoman L. GRACE SPENCER
District 29 (Essex and Union)
SYNOPSIS
Requires health benefits coverage for telemedicine services.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning health benefits coverage for telemedicine services and supplementing various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Notwithstanding any other provision of law to the contrary, every hospital service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage pursuant to the provisions of this section.
a. The hospital service corporation shall provide coverage for telemedicine services that are determined medically necessary by a health care professional and are for health care services that the health care professional determines can be appropriately provided in the form of telemedicine services.
b. As used in this section:
"Health care professional" means a person licensed or otherwise authorized pursuant to Title 45 or Title 52 of the Revised Statutes to practice a health care profession that is regulated by the Director of the Division of Consumer Affairs in the Department of Law and Public Safety or by a professional and occupational licensing board within the division.
"Telemedicine services" means the use of interactive audio, video, or other telecommunications technology by a health care professional to deliver health care services within the scope of the health care professional's practice at a site other than the site where the patient is located. "Telemedicine services" shall include the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient, as well as for actual treatment of the patient, but shall not include an audio-only telephone conversation, electronic mail message, or facsimile transmission between a health care professional and a patient.
"To the same extent" means that the hospital service corporation cannot apply different copayments, deductibles, or health care services limits to telemedicine services than those applied to health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the contract.
c. The benefits provided pursuant to this section shall be provided to the same extent as for health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the contract.
d. The coverage required under this section may be subject to utilization review, including periodic review, by the hospital service corporation of the continued medical necessity of the telemedicine services; but coverage shall not be denied solely because the services being provided are telemedicine services.
e. Nothing in this section shall be construed to change the manner in which the hospital service corporation determines:
(1) whether a health care service meets the medical necessity standard as established by the hospital service corporation; or
(2) which providers shall be entitled to reimbursement or to be participating providers, as appropriate, for health care services under the contract.
f. The provisions of this section shall apply to all contracts in which the hospital service corporation has reserved the right to change the premium.
2. Notwithstanding any other provision of law to the contrary, every medical service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage pursuant to the provisions of this section.
a. The medical service corporation shall provide coverage for telemedicine services that are determined medically necessary by a health care professional and are for health care services that the health care professional determines can be appropriately provided in the form of telemedicine services.
b. As used in this section:
"Health care professional" means a person licensed or otherwise authorized pursuant to Title 45 or Title 52 of the Revised Statutes to practice a health care profession that is regulated by the Director of the Division of Consumer Affairs in the Department of Law and Public Safety or by a professional and occupational licensing board within the division.
"Telemedicine services" means the use of interactive audio, video, or other telecommunications technology by a health care professional to deliver health care services within the scope of the health care professional's practice at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient. "Telemedicine services" shall include the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient, as well as for actual treatment of the patient, but shall not include an audio-only telephone conversation, electronic mail message, or facsimile transmission between a health care professional and a patient.
"To the same extent" means that the medical service corporation cannot apply different copayments, deductibles, or health care services limits to telemedicine services than those applied to health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the contract.
c. The benefits provided pursuant to this section shall be provided to the same extent as for health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the contract.
d. The coverage required under this section may be subject to utilization review, including periodic review, by the medical service corporation of the continued medical necessity of the telemedicine services; but coverage shall not be denied solely because the services being provided are telemedicine services.
e. Nothing in this section shall be construed to change the manner in which the medical service corporation determines:
(1) whether a health care service meets the medical necessity standard as established by the medical service corporation; or
(2) which providers shall be entitled to reimbursement or to be participating providers, as appropriate, for health care services under the contract.
f. The provisions of this section shall apply to all contracts in which the medical service corporation has reserved the right to change the premium.
3. Notwithstanding any other provision of law to the contrary, every health service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage pursuant to the provisions of this section.
a. The health service corporation shall provide coverage for telemedicine services that are determined medically necessary by a health care professional and are for health care services that the health care professional determines can be appropriately provided in the form of telemedicine services.
b. As used in this section:
"Health care professional" means a person licensed or otherwise authorized pursuant to Title 45 or Title 52 of the Revised Statutes to practice a health care profession that is regulated by the Director of the Division of Consumer Affairs in the Department of Law and Public Safety or by a professional and occupational licensing board within the division.
"Telemedicine services" means the use of interactive audio, video, or other telecommunications technology by a health care professional to deliver health care services within the scope of the health care professional's practice at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient. "Telemedicine services" shall include the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient, as well as for actual treatment of the patient, but shall not include an audio-only telephone conversation, electronic mail message, or facsimile transmission between a health care professional and a patient.
"To the same extent" means that the health service corporation cannot apply different copayments, deductibles, or health care services limits to telemedicine services than those applied to health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the contract.
c. The benefits provided pursuant to this section shall be provided to the same extent as for health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the contract.
d. The coverage required under this section may be subject to utilization review, including periodic review, by the health service corporation of the continued medical necessity of the telemedicine services; but coverage shall not be denied solely because the services being provided are telemedicine services.
e. Nothing in this section shall be construed to change the manner in which the health service corporation determines:
(1) whether a health care service meets the medical necessity standard as established by the health service corporation; or
(2) which providers shall be entitled to reimbursement or to be participating providers, as appropriate, for health care services under the contract.
f. The provisions of this section shall apply to all contracts in which the health service corporation has reserved the right to change the premium.
4. Notwithstanding any other provision of law to the contrary, every individual health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to chapter 26 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage pursuant to the provisions of this section.
a. The insurer shall provide coverage for telemedicine services that are determined medically necessary by a health care professional and are for health care services that the health care professional determines can be appropriately provided in the form of telemedicine services.
b. As used in this section:
"Health care professional" means a person licensed or otherwise authorized pursuant to Title 45 or Title 52 of the Revised Statutes to practice a health care profession that is regulated by the Director of the Division of Consumer Affairs in the Department of Law and Public Safety or by a professional and occupational licensing board within the division.
"Telemedicine services" means the use of interactive audio, video, or other telecommunications technology by a health care professional to deliver health care services within the scope of the health care professional's practice at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient. "Telemedicine services" shall include the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient, as well as for actual treatment of the patient, but shall not include an audio-only telephone conversation, electronic mail message, or facsimile transmission between a health care professional and a patient.
"To the same extent" means that the insurer cannot apply different copayments, deductibles, or health care services limits to telemedicine services than those applied to health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the policy.
c. The benefits provided pursuant to this section shall be provided to the same extent as for health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the policy.
d. The coverage required under this section may be subject to utilization review, including periodic review, by the insurer of the continued medical necessity of the telemedicine services; but coverage shall not be denied solely because the services being provided are telemedicine services.
e. Nothing in this section shall be construed to change the manner in which the insurer determines:
(1) whether a health care service meets the medical necessity standard as established by the insurer; or
(2) which providers shall be entitled to reimbursement or to be participating providers, as appropriate, for health care services under the policy.
f. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
5. Notwithstanding any other provision of law to the contrary, every group health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to chapter 27 of Title 17B of the New Jersey Statutes, or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage pursuant to the provisions of this section.
a. The insurer shall provide coverage for telemedicine services that are determined medically necessary by a health care professional and are for health care services that the health care professional determines can be appropriately provided in the form of telemedicine services.
b. As used in this section:
"Health care professional" means a person licensed or otherwise authorized pursuant to Title 45 or Title 52 of the Revised Statutes to practice a health care profession that is regulated by the Director of the Division of Consumer Affairs in the Department of Law and Public Safety or by a professional and occupational licensing board within the division.
"Telemedicine services" means the use of interactive audio, video, or other telecommunications technology by a health care professional to deliver health care services within the scope of the health care professional's practice at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient. "Telemedicine services" shall include the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient, as well as for actual treatment of the patient, but shall not include an audio-only telephone conversation, electronic mail message, or facsimile transmission between a health care professional and a patient.
"To the same extent" means that the insurer cannot apply different copayments, deductibles, or health care services limits to telemedicine services than those applied to health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the policy.
c. The benefits provided pursuant to this section shall be provided to the same extent as for health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the policy.
d. The coverage required under this section may be subject to utilization review, including periodic review, by the insurer of the continued medical necessity of the telemedicine services; but coverage shall not be denied solely because the services being provided are telemedicine services.
e. Nothing in this section shall be construed to change the manner in which the insurer determines:
(1) whether a health care service meets the medical necessity standard as established by the insurer; or
(2) which providers shall be entitled to reimbursement or to be participating providers, as appropriate, for health care services under the policy.
f. The provisions of this section shall apply to all policies in which the insurer has reserved the right to change the premium.
6. Notwithstanding any other provision of law to the contrary, an individual health benefits plan that is delivered, issued, executed, renewed, or approved for issuance or renewal in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage pursuant to the provisions of this section.
a. The carrier shall provide coverage for telemedicine services that are determined medically necessary by a health care professional and are for health care services that the health care professional determines can be appropriately provided in the form of telemedicine services.
b. As used in this section:
"Health care professional" means a person licensed or otherwise authorized pursuant to Title 45 or Title 52 of the Revised Statutes to practice a health care profession that is regulated by the Director of the Division of Consumer Affairs in the Department of Law and Public Safety or by a professional and occupational licensing board within the division.
"Telemedicine services" means the use of interactive audio, video, or other telecommunications technology by a health care professional to deliver health care services within the scope of the health care professional's practice at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient. "Telemedicine services" shall include the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient, as well as for actual treatment of the patient, but shall not include an audio-only telephone conversation, electronic mail message, or facsimile transmission between a health care professional and a patient.
"To the same extent" means that the carrier cannot apply different copayments, deductibles, or health care services limits to telemedicine services than those applied to health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the health benefits plan.
c. The benefits provided pursuant to this section shall be provided to the same extent as for health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the health benefits plan.
d. The coverage required under this section may be subject to utilization review, including periodic review, by the carrier of the continued medical necessity of the telemedicine services; but coverage shall not be denied solely because the services being provided are telemedicine services.
e. Nothing in this section shall be construed to change the manner in which the carrier determines:
(1) whether a health care service meets the medical necessity standard as established by the carrier; or
(2) which providers shall be entitled to reimbursement or to be participating providers, as appropriate, for health care services under the health benefits plan.
f. The provisions of this section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
7. Notwithstanding any other provision of law to the contrary, a small employer health benefits plan that is delivered, issued, executed, renewed, or approved for issuance or renewal in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage pursuant to the provisions of this section.
a. The carrier shall provide coverage for telemedicine services that are determined medically necessary by a health care professional and are for health care services that the health care professional determines can be appropriately provided in the form of telemedicine services.
b. As used in this section:
"Health care professional" means a person licensed or otherwise authorized pursuant to Title 45 or Title 52 of the Revised Statutes to practice a health care profession that is regulated by the Director of the Division of Consumer Affairs in the Department of Law and Public Safety or by a professional and occupational licensing board within the division.
"Telemedicine services" means the use of interactive audio, video, or other telecommunications technology by a health care professional to deliver health care services within the scope of the health care professional's practice at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient. "Telemedicine services" shall include the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient, as well as for actual treatment of the patient, but shall not include an audio-only telephone conversation, electronic mail message, or facsimile transmission between a health care professional and a patient.
"To the same extent" means that the carrier cannot apply different copayments, deductibles, or health care services limits to telemedicine services than those applied to health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the health benefits plan.
c. The benefits provided pursuant to this section shall be provided to the same extent as for health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the health benefits plan.
d. The coverage required under this section may be subject to utilization review, including periodic review, by the carrier of the continued medical necessity of the telemedicine services; but coverage shall not be denied solely because the services being provided are telemedicine services.
e. Nothing in this section shall be construed to change the manner in which the carrier determines:
(1) whether a health care service meets the medical necessity standard as established by the carrier; or
(2) which providers shall be entitled to reimbursement or to be participating providers, as appropriate, for health care services under the health benefits plan.
f. The provisions of this section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
8. Notwithstanding any other provision of law to the contrary, a health maintenance organization enrollee agreement that provides health care services and is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage pursuant to the provisions of this section.
a. The health maintenance organization shall provide coverage for telemedicine services that are determined medically necessary by a health care professional and are for health care services that the health care professional determines can be appropriately provided in the form of telemedicine services.
b. As used in this section:
"Health care professional" means a person licensed or otherwise authorized pursuant to Title 45 or Title 52 of the Revised Statutes to practice a health care profession that is regulated by the Director of the Division of Consumer Affairs in the Department of Law and Public Safety or by a professional and occupational licensing board within the division.
"Telemedicine services" means the use of interactive audio, video, or other telecommunications technology by a health care professional to deliver health care services within the scope of the health care professional's practice at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient. "Telemedicine services" shall include the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient, as well as for actual treatment of the patient, but shall not include an audio-only telephone conversation, electronic mail message, or facsimile transmission between a health care professional and a patient.
"To the same extent" means that the health maintenance organization cannot apply different copayments, deductibles, or health care services limits to telemedicine services than those applied to health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the enrollee agreement.
c. The benefits provided pursuant to this section shall be provided to the same extent as for health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the enrollee agreement.
d. The coverage required under this section may be subject to utilization review, including periodic review, by the health maintenance organization of the continued medical necessity of the telemedicine services; but coverage shall not be denied solely because the services being provided are telemedicine services.
e. Nothing in this section shall be construed to change the manner in which the health maintenance organization determines:
(1) whether a health care service meets the medical necessity standard as established by the health maintenance organization; or
(2) which providers shall be entitled to reimbursement or to be participating providers, as appropriate, for health care services under the enrollee agreement.
f. The provisions of this section shall apply to those enrollee agreements in which the health maintenance organization has reserved the right to change the premium.
9. Notwithstanding any other provision of law to the contrary, the State Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act shall provide coverage pursuant to the provisions of this section.
a. The contract shall provide coverage for telemedicine services that are determined medically necessary by a health care professional and are for health care services that the health care professional determines can be appropriately provided in the form of telemedicine services.
b. As used in this section:
"Health care professional" means a person licensed or otherwise authorized pursuant to Title 45 or Title 52 of the Revised Statutes to practice a health care profession that is regulated by the Director of the Division of Consumer Affairs in the Department of Law and Public Safety or by a professional and occupational licensing board within the division.
"Telemedicine services" means the use of interactive audio, video, or other telecommunications technology by a health care professional to deliver health care services within the scope of the health care professional's practice at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient. "Telemedicine services" shall include the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient, as well as for actual treatment of the patient, but shall not include an audio-only telephone conversation, electronic mail message, or facsimile transmission between a health care professional and a patient.
"To the same extent" means that the contract cannot apply different copayments, deductibles, or health care services limits to telemedicine services than those applied to health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the contract.
c. The benefits provided pursuant to this section shall be provided to the same extent as for health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the contract.
d. The coverage required under this section may be subject to utilization review, including periodic review, by the commission or its agent of the continued medical necessity of the telemedicine services; but coverage shall not be denied solely because the services being provided are telemedicine services.
e. Nothing in this section shall be construed to change the manner in which the commission or its agent determines:
(1) whether a health care service meets the medical necessity standard as established by the commission or its agent; or
(2) which providers shall be entitled to reimbursement or to be participating providers, as appropriate, for health care services under the contract.
10. Notwithstanding any other provision of law to the contrary, the School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission on or after the effective date of this act shall provide coverage pursuant to the provisions of this section.
a. The contract shall provide coverage for telemedicine services that are determined medically necessary by a health care professional and are for health care services that the health care professional determines can be appropriately provided in the form of telemedicine services.
b. As used in this section:
"Health care professional" means a person licensed or otherwise authorized pursuant to Title 45 or Title 52 of the Revised Statutes to practice a health care profession that is regulated by the Director of the Division of Consumer Affairs in the Department of Law and Public Safety or by a professional and occupational licensing board within the division.
"Telemedicine services" means the use of interactive audio, video, or other telecommunications technology by a health care professional to deliver health care services within the scope of the health care professional's practice at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient. "Telemedicine services" shall include the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient, as well as for actual treatment of the patient, but shall not include an audio-only telephone conversation, electronic mail message, or facsimile transmission between a health care professional and a patient.
"To the same extent" means that the contract cannot apply different copayments, deductibles, or health care services limits to telemedicine services than those applied to health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the contract.
c. The benefits provided pursuant to this section shall be provided to the same extent as for health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the contract.
d. The coverage required under this section may be subject to utilization review, including periodic review, by the commission or its agent of the continued medical necessity of the telemedicine services; but coverage shall not be denied solely because the services being provided are telemedicine services.
e. Nothing in this section shall be construed to change the manner in which the commission or its agent determines:
(1) whether a health care service meets the medical necessity standard as established by the commission or its agent; or
(2) which providers shall be entitled to reimbursement or to be participating providers, as appropriate, for health care services under the contract.
11. The Commissioner of Human Services shall ensure that the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), and the NJ FamilyCare Program, established pursuant to section 3 of P.L.2005, c.156 (C.30:4J-10), provide benefits pursuant to the provisions of this section.
a. Each program shall provide benefits for telemedicine services that are determined medically necessary by a health care professional and are for health care services that the health care professional determines can be appropriately provided in the form of telemedicine services.
b. As used in this section:
"Health care professional" means a person licensed or otherwise authorized pursuant to Title 45 or Title 52 of the Revised Statutes to practice a health care profession that is regulated by the Director of the Division of Consumer Affairs in the Department of Law and Public Safety or by a professional and occupational licensing board within the division.
"Telemedicine services" means the use of interactive audio, video, or other telecommunications technology by a health care professional to deliver health care services within the scope of the health care professional's practice at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient. "Telemedicine services" shall include the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient, as well as for actual treatment of the patient, but shall not include an audio-only telephone conversation, electronic mail message, or facsimile transmission between a health care professional and a patient.
"To the same extent" means that each program cannot apply different copayments, deductibles, or health care services limits to telemedicine services than those applied to health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition.
c. The benefits provided pursuant to this section shall be provided to the same extent as for health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition.
d. The coverage required under this section may be subject to utilization review, including periodic review, by each program of the continued medical necessity of the telemedicine services; but coverage shall not be denied solely because the services being provided are telemedicine services.
e. Nothing in this section shall be construed to change the manner in which each program determines:
(1) whether a health care service meets the medical necessity standard as established by the program; or
(2) which providers shall be entitled to reimbursement or to be participating providers, as appropriate, for health care services under the program.
12. This act shall take effect on the 90th day after enactment and shall apply to policies or contracts issued or renewed on or after the effective date.
STATEMENT
This bill requires health insurers and State medical assistance programs to provide health benefits coverage for telemedicine services.
The bill provides specifically as follows:
· Its provisions apply to: health, hospital and medical service corporations; commercial individual and group health insurers; health maintenance organizations; health benefits plans issued pursuant to the New Jersey Individual Health Coverage and Small Employer Health Benefits Programs; the State Health Benefits Program; the School Employees' Health Benefits Program; Medicaid; and the NJ FamilyCare Program.
· The insurer or program is to provide coverage for telemedicine services that are determined medically necessary by a licensed health care professional and are for health care services that the health care professional determines can be appropriately provided in the form of telemedicine services.
· The bill defines "telemedicine services" to mean the use of interactive audio, video, or other telecommunications technology by a health care professional to deliver health care services within the scope of the health care professional's practice at a site other than the site where the patient is located. The definition of "telemedicine services" includes the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient, as well as for actual treatment of the patient, but does not include an audio-only telephone conversation, electronic mail message, or facsimile transmission between a health care professional and a patient.
· The benefits provided pursuant to the bill are to be provided to the same extent as for health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition under the health care plan (meaning that the insurer cannot apply different copayments, deductibles, or health care services limits to telemedicine services than those applied to health care services provided through face-to-face consultation or contact between a covered person and a health care professional for the same condition).
· The coverage required under this bill may be subject to utilization review, including periodic review, by the insurer or program of the continued medical necessity of the telemedicine services; but coverage is not to be denied solely because the services being provided are telemedicine services.
· Nothing in the bill is to be construed to change the manner in which the insurer or program determines:
-- whether a health care service meets the medical necessity standard as established by the insurer or program; or
-- which providers are entitled to reimbursement or to be participating providers, as appropriate, for health care services under the health care plan.
· The bill takes effect on the 90th day after enactment and applies to policies or contracts issued or renewed on or after the effective date.
