Bill Text: NJ S3855 | 2024-2025 | Regular Session | Introduced
Bill Title: Revises reimbursement payments for providers using telemedicine and telehealth.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced) 2024-11-18 - Introduced in the Senate, Referred to Senate Commerce Committee [S3855 Detail]
Download: New_Jersey-2024-S3855-Introduced.html
Sponsored by:
Senator ROBERT W. SINGER
District 30 (Monmouth and Ocean)
Senator OWEN HENRY
District 12 (Burlington, Middlesex, Monmouth and Ocean)
SYNOPSIS
Revises reimbursement payments for providers using telemedicine and telehealth.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning telemedicine and telehealth and amending P.L.2017, c.117.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 8 of P.L.2017, c.117 (C.26:2S-29) is amended to read as follows:
8. a. A carrier that offers a health benefits plan in this State shall provide coverage and payment for health care services delivered to a covered person through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that [does not exceed] equals the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation in New Jersey, provided the services are otherwise covered under the plan when delivered through in-person contact and consultation in New Jersey. Reimbursement payments under this section may be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate. The requirements of this subsection shall not apply to a health care service provided by a telemedicine or telehealth organization that does not provide the health care service on an in-person basis in New Jersey.
b. A carrier may limit coverage to services that are delivered by health care providers in the health benefits plan's network, but may not charge any deductible, copayment, or coinsurance for a health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation. In no case shall a carrier:
(1) impose any restrictions on the location or setting of the distant site used by a health care provider to provide services using telemedicine and telehealth or on the location or setting of the originating site where the patient is located when receiving services using telemedicine and telehealth, except to ensure that the services provided using telemedicine and telehealth meet the same standard of care as would be provided if the services were provided in person;
(2) restrict the ability of a provider to use any electronic or technological platform to provide services using telemedicine or telehealth, including, but not limited to, interactive, real-time, two-way audio, which may be used in combination with asynchronous store-and-forward technology without video capabilities, including audio-only telephone conversations, to provide services using telemedicine or telehealth, provided that the platform used:
(a) allows the provider to meet the same standard of care as would be provided if the services were provided in person; and
(b) is compliant with the requirements of the federal health privacy rule set forth at 45 CFR Parts 160 and 164;
(3) deny coverage for or refuse to provide reimbursement for routine patient monitoring performed using telemedicine and telehealth, including remote monitoring of a patient's vital signs and routine check-ins with the patient to monitor the patient's status and condition, if coverage and reimbursement would be provided if those services are provided in person, and the provider is able to meet the same standard of care as would be provided if the services were provided in person; or
(4) limit coverage only to services delivered by select third-party telemedicine or telehealth organizations.
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) allow a carrier to require a covered person to use telemedicine or telehealth in lieu of receiving an in-person service from an in-network provider.
d. The Commissioner of Banking and Insurance shall adopt rules and regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to implement the provisions of this section.
e. As used in this section:
"Asynchronous store-and-forward" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Carrier" means the same as that term is defined by section 2 of P.L.1997, c.192 (C.26:2S-2).
"Covered person" means the same as that term is defined by section 2 of P.L.1997, c.192 (C.26:2S-2).
"Distant site" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Health benefits plan" means the same as that term is defined by section 2 of P.L.1997, c.192 (C.26:2S-2).
"Originating site" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Telehealth" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Telemedicine" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Telemedicine or telehealth organization" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
(cf: P.L.2021, c.310, s.1)
2. Section 7 of P.L.2017, c.117 (C.30:4D-6k) is amended to read as follows:
7. a. The State Medicaid and NJ FamilyCare programs shall provide coverage and payment for health care services delivered to a benefits recipient through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that [does not exceed] equals the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation in New Jersey, provided the services are otherwise covered when delivered through in-person contact and consultation in New Jersey. Reimbursement payments under this section may be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate. The requirements of this subsection shall not apply to a health care service provided by a telemedicine or telehealth organization that does not provide the health care service on an in-person basis in New Jersey.
b. The State Medicaid and NJ FamilyCare programs may limit coverage to services that are delivered by participating health care providers, but may not charge any deductible, copayment, or coinsurance for a health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation. In no case shall the State Medicaid and NJ FamilyCare programs:
(1) impose any restrictions on the location or setting of the distant site used by a health care provider to provide services using telemedicine and telehealth or on the location or setting of the originating site where the patient is located when receiving services using telemedicine and telehealth, except to ensure that the services provided using telemedicine and telehealth meet the same standard of care as would be provided if the services were provided in person;
(2) restrict the ability of a provider to use any electronic or technological platform to provide services using telemedicine or telehealth, including, but not limited to, interactive, real-time, two-way audio, which may be used in combination with asynchronous store-and-forward technology without video capabilities, including audio-only telephone conversations, to provide services using telemedicine or telehealth, provided that the platform used:
(a) allows the provider to meet the same standard of care as would be provided if the services were provided in person; and
(b) is compliant with the requirements of the federal health privacy rule set forth at 45 CFR Parts 160 and 164;
(3) deny coverage for or refuse to provide reimbursement for routine patient monitoring performed using telemedicine and telehealth, including remote monitoring of a patient's vital signs and routine check-ins with the patient to monitor the patient's status and condition, if coverage and reimbursement would be provided if those services are provided in person, and the provider is able to meet the same standard of care as would be provided if the services were provided in person; or
(4) limit coverage only to services delivered by select third-party telemedicine or telehealth organizations.
c. Nothing in this section shall be construed to:
(1) prohibit the State Medicaid or NJ FamilyCare programs from providing coverage for only those services that are medically necessary, subject to the terms and conditions of the recipient's benefits plan; or
(2) allow the State Medicaid or NJ FamilyCare programs to require a benefits recipient to use telemedicine or telehealth in lieu of obtaining an in-person service from a participating health care provider.
d. The Commissioner of Human Services, in consultation with the Commissioner of Children and Families, shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this section and to secure federal financial participation for State expenditures under the federal Medicaid program and Children's Health Insurance Program.
e. As used in this section:
"Asynchronous store-and-forward" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Benefits recipient" or "recipient" means a person who is eligible for, and who is receiving, hospital or medical benefits under the State Medicaid program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), or under the NJ FamilyCare program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.), as appropriate.
"Distant site" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Originating site" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Participating health care provider" means a licensed or certified health care provider who is registered to provide health care services to benefits recipients under the State Medicaid or NJ FamilyCare programs, as appropriate.
"Telehealth" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Telemedicine" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Telemedicine or telehealth organization" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
(cf: P.L.2021, c.310, s.2)
3. Section 9 of P.L.2017, c.117 (C.52:14-17.29w) is amended to read as follows:
9. a. The State Health Benefits Commission shall ensure that every contract purchased thereby, which provides hospital and medical expense benefits, additionally provides coverage and payment for health care services delivered to a covered person through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that [does not exceed] equals the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation in New Jersey, provided the services are otherwise covered under the contract when delivered through in-person contact and consultation in New Jersey. Reimbursement payments under this section may be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate. The requirements of this subsection shall not apply to a health care service provided by a telemedicine or telehealth organization that does not provide the health care service on an in-person basis in New Jersey.
b. A health benefits contract purchased by the State Health Benefits Commission may limit coverage to services that are delivered by health care providers in the health benefits plan's network, but may not charge any deductible, copayment, or coinsurance for a health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation. In no case shall a health benefits contract purchased by the State Health Benefits Commission:
(1) impose any restrictions on the location or setting of the distant site used by a health care provider to provide services using telemedicine and telehealth or on the location or setting of the originating site where the patient is located when receiving services using telemedicine and telehealth, except to ensure that the services provided using telemedicine and telehealth meet the same standard of care as would be provided if the services were provided in person;
(2) restrict the ability of a provider to use any electronic or technological platform to provide services using telemedicine or telehealth, including, but not limited to, interactive, real-time, two-way audio, which may be used in combination with asynchronous store-and-forward technology without video capabilities, including audio-only telephone conversations, to provide services using telemedicine or telehealth, provided that the platform used:
(a) allows the provider to meet the same standard of care as would be provided if the services were provided in person; and
(b) is compliant with the requirements of the federal health privacy rule set forth at 45 CFR Parts 160 and 164;
(3) deny coverage for or refuse to provide reimbursement for routine patient monitoring performed using telemedicine and telehealth, including remote monitoring of a patient's vital signs and routine check-ins with the patient to monitor the patient's status and condition, if coverage and reimbursement would be provided if those services are provided in person, and the provider is able to meet the same standard of care as would be provided if the services were provided in person; or
(4) limit coverage only to services delivered by select third-party telemedicine or telehealth organizations.
c. Nothing in this section shall be construed to:
(1) prohibit a health benefits 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) allow the State Health Benefits Commission, or a contract purchased thereby, to require a covered person to use telemedicine or telehealth in lieu of receiving an in-person service from an in-network provider.
d. The State Health Benefits Commission shall adopt rules and regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to implement the provisions of this section.
e. As used in this section:
"Asynchronous store-and-forward" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Distant site" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Originating site" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Telehealth" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Telemedicine" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Telemedicine or telehealth organization" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
(cf: P.L.2021, c.310, s.5)
4. Section 10 of P.L.2017, c.117 (C.52:14-17.46.6h) is amended to read as follows:
10. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased thereby, which provides hospital and medical expense benefits, additionally provides coverage and payment for health care services delivered to a covered person through telemedicine or telehealth, on the same basis as, and at a provider reimbursement rate that [does not exceed] equals the provider reimbursement rate that is applicable, when the services are delivered through in-person contact and consultation in New Jersey, provided the services are otherwise covered under the contract when delivered through in-person contact and consultation in New Jersey. Reimbursement payments under this section may be provided either to the individual practitioner who delivered the reimbursable services, or to the agency, facility, or organization that employs the individual practitioner who delivered the reimbursable services, as appropriate. The requirements of this subsection shall not apply to a health care service provided by a telemedicine or telehealth organization that does not provide the health care service on an in-person basis in New Jersey.
b. A health benefits contract purchased by the School Employees' Health Benefits Commission may limit coverage to services that are delivered by health care providers in the health benefits plan's network, but may not charge any deductible, copayment, or coinsurance for a health care service, delivered through telemedicine or telehealth, in an amount that exceeds the deductible, copayment, or coinsurance amount that is applicable to an in-person consultation. In no case shall a health benefits contract purchased by the School Employees' Health Benefits Commission:
(1) impose any restrictions on the location or setting of the distant site used by a health care provider to provide services using telemedicine and telehealth or on the location or setting of the originating site where the patient is located when receiving services using telemedicine and telehealth, except to ensure that the services provided using telemedicine and telehealth meet the same standard of care as would be provided if the services were provided in person;
(2) restrict the ability of a provider to use any electronic or technological platform to provide services using telemedicine or telehealth, including, but not limited to, interactive, real-time, two-way audio, which may be used in combination with asynchronous store-and-forward technology without video capabilities, including audio-only telephone conversations, to provide services using telemedicine or telehealth, provided that the platform used:
(a) allows the provider to meet the same standard of care as would be provided if the services were provided in person; and
(b) is compliant with the requirements of the federal health privacy rule set forth at 45 CFR Parts 160 and 164;
(3) deny coverage for or refuse to provide reimbursement for routine patient monitoring performed using telemedicine and telehealth, including remote monitoring of a patient's vital signs and routine check-ins with the patient to monitor the patient's status and condition, if coverage and reimbursement would be provided if those services are provided in person, and the provider is able to meet the same standard of care as would be provided if the services were provided in person; or
(4) limit coverage only to services delivered by select third-party telemedicine or telehealth organizations.
c. Nothing in this section shall be construed to:
(1) prohibit a health benefits 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) allow the School Employees' Health Benefits Commission, or a contract purchased thereby, to require a covered person to use telemedicine or telehealth in lieu of receiving an in-person service from an in-network provider.
d. The School Employees' Health Benefits Commission shall adopt rules and regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to implement the provisions of this section.
e. As used in this section:
"Asynchronous store-and-forward" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Distant site" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Originating site" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Telehealth" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Telemedicine" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
"Telemedicine or telehealth organization" means the same as that term is defined by section 1 of P.L.2017, c.117 (C.45:1-61).
(cf: P.L.2021, c.310, s.6)
5. This act shall take effect immediately and shall be applicable to requests for reimbursement made on or after the date of enactment.
STATEMENT
This bill revises reimbursement payments for providers using telemedicine and telehealth.
Under the bill, a health insurance carrier (including carriers of managed care plans, the State Health Benefits Commission, the School Employees' Health Benefits Commission, and health benefits plans under the Medicare program and NJ FamilyCare) will be required to provide coverage and payment for healthcare services delivered through telemedicine or telehealth at a provider reimbursement rate that equals the provider reimbursement rate that is applicable when services are delivered through in-person contact and consultation. Current law only requires that a carrier provide coverage and payment for services delivered through telemedicine and telehealth at a provider reimbursement rate that does not exceed the reimbursement rate that is applicable when the services are delivered through in-person contact or consultation. The requirements of this bill will not apply to a health care service provided by a telemedicine or telehealth organization that does not provide a health care service on an in-person basis in the State.
