Bill Text: NJ S2338 | 2014-2015 | Regular Session | Introduced
Bill Title: Requires health insurance carriers, SHBP, and SEHBP to provide coverage for telemedicine.
Spectrum: Partisan Bill (Democrat 2-0)
Status: (Introduced - Dead) 2014-10-31 - Reviewed by the Pension and Health Benefits Commission Recommend to not enact [S2338 Detail]
Download: New_Jersey-2014-S2338-Introduced.html
Sponsored by:
Senator SHIRLEY K. TURNER
District 15 (Hunterdon and Mercer)
SYNOPSIS
Requires health insurance carriers, SHBP, and SEHBP to provide coverage for telemedicine.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning telemedicine and supplementing various parts of statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A carrier which offers a managed care plan in this State shall provide coverage for telemedicine services delivered to a covered person in a health care facility to the same extent that the services would be covered if they were provided through in-person consultation.
b. A carrier may:
(1) charge a deductible, co-payment, or coinsurance for a health care service provided through telemedicine so long as it does not exceed the deductible, co-payment, or coinsurance applicable to an in-person consultation;
(2) limit coverage to health care providers in the health benefits plan's network; and
(3) require originating site health care providers to document the reasons the services are being provided by telemedicine rather than in person.
c. Nothing in this section shall be construed to:
(1) prohibit a carrier from providing coverage for only those services that are medically necessary, subject to the terms and conditions of the covered person's health benefits plan; or
(2) require a carrier to reimburse the distant site health care provider if the distant site health care provider has insufficient information to render an opinion.
d. As used in this section:
"Health care facility" means the same as defined in section 2 of P.L.1971, c.136 (C.26:2H-2).
"Telemedicine" means the delivery of health care services such as diagnosis, consultation, or treatment through the use of live interactive audio and video over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub.L.104-191. Telemedicine shall not include the use of audio-only telephone, e-mail, or facsimile.
2. a. The State Health Benefits Commission shall ensure that every contract purchased by the commission that provides hospital and medical expense benefits shall provide coverage for telemedicine services delivered to a covered person in a health care facility to the same extent that the services would be covered if they were provided through in-person consultation.
b. The contract may:
(1) provide for a deductible, co-payment, or coinsurance for a health care service provided through telemedicine so long as it does not exceed the deductible, co-payment, or coinsurance applicable to an in-person consultation;
(2) limit coverage to services provided by health care providers in the health benefits plan's network; and
(3) require originating site health care providers to document the reasons the services are being provided by telemedicine rather than in person.
c. Nothing in this section shall be construed to:
(1) prohibit the contract from providing coverage for only those services that are medically necessary, subject to the terms and conditions of the covered person's health benefits plan; or
(2) require the contract to reimburse the distant site health care provider if the distant site health care provider has insufficient information to render an opinion.
d. As used in this section:
"Health care facility" means the same as defined in section 2 of P.L.1971, c.136 (C.26:2H-2).
"Telemedicine" means the delivery of health care services such as diagnosis, consultation, or treatment through the use of live interactive audio and video over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub.L.104-191. Telemedicine shall not include the use of audio-only telephone, e-mail, or facsimile.
3. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased by the commission that provides hospital and medical expense benefits shall provide coverage for telemedicine services delivered to a covered person in a health care facility to the same extent that the services would be covered if they were provided through in-person consultation.
b. The contract may:
(1) provide for a deductible, co-payment, or coinsurance for a health care service provided through telemedicine so long as it does not exceed the deductible, co-payment, or coinsurance applicable to an in-person consultation;
(2) limit coverage to services provided by health care providers in the health benefits plan's network; and
(3) require originating site health care providers to document the reasons the services are being provided by telemedicine rather than in person.
c. Nothing in this section shall be construed to:
(1) prohibit the contract from providing coverage for only those services that are medically necessary, subject to the terms and conditions of the covered person's health benefits plan; or
(2) require the contract to reimburse the distant site health care provider if the distant site health care provider has insufficient information to render an opinion.
d. As used in this section:
"Health care facility" means the same as defined in section 2 of P.L.1971, c.136 (C.26:2H-2).
"Telemedicine" means the delivery of health care services such as diagnosis, consultation, or treatment through the use of live interactive audio and video over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub.L.104-191. Telemedicine shall not include the use of audio-only telephone, e-mail, or facsimile.
4. This act shall take effect immediately and shall apply to contracts entered into on or after the effective date of this act.
STATEMENT
This bill requires health insurance carriers, the State Health Benefits Program, and the School Employees' Health Benefits Program to provide coverage for telemedicine delivered to a covered person in a health care facility to the same extent that the services would be covered if they were provided through in-person consultation.
Under the bill "telemedicine" means the delivery of health care services such as diagnosis, consultation, or treatment through the use of live interactive audio and video over a secure connection that complies with the requirements of the Health Insurance Portability and Accountability Act of 1996, Pub.L.104-191. Telemedicine does not include the use of audio-only telephone, e-mail, or facsimile.
The bill also specifies that a carrier, or the State programs, may charge a deductible, co-payment, or coinsurance for a health care service provided through telemedicine, limit coverage to health care providers in the health benefits plan's network, and require originating site health care providers to document the reasons the services are being provided by telemedicine rather than in person.
