Bill Text: OH HB609 | 2011-2012 | 129th General Assembly | Introduced

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Bill Title: To require the Medicaid program and to authorize health care insurers to provide coverage of telehealth services.

Spectrum: Partisan Bill (Republican 2-0)

Status: (Introduced - Dead) 2012-11-21 - To Health & Aging [HB609 Detail]

Download: Ohio-2011-HB609-Introduced.html

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As Introduced

129th General Assembly Regular Session 2011-2012

H. B. No. 609

Representatives Wachtmann, Gonzales 

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A BILL

To enact sections 1739.051, 1751.69, 3923.235, and

1

5111.0216 of the Revised Code to require the

2

Medicaid program and to authorize health care

3

insurers to provide coverage of telehealth

4

services.

5

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That sections 1739.051, 1751.69, 3923.235, and	6
5111.0216 of the Revised Code be enacted to read as follows:	7

Sec. 1739.051.  (A) As used in this section:

8

(1) "Asynchronous store and forward action" means the	9
transmission of a patient's medical information from an	10
originating site to a health care provider at a distant site for	11
review of the information by the provider at the distant site	12
without a synchronous interaction.	13

(2) "Distant site" means the location of a health care	14
provider when providing telehealth services to a patient.	15

(3) "Health care provider" means a person or government	16
entity licensed, certified, registered, or otherwise authorized to	17
provide health care services to patients as a health care	18
professional or a health care facility.	19

(4) "Originating site" means both of the following:

20

(a) The location of a patient when receiving telehealth	21
services from a health care provider;	22

(b) The location where an asynchronous store and forward	23
action originates.	24

(5) "Synchronous interaction" means a real-time interaction	25
between a patient receiving telehealth services at an originating	26
site and a health care provider delivering telehealth services	27
from a distant site.	28

(6) "Telehealth" means the use of interactive audio, video,	29
and other telecommunications technology by a health care provider	30
to deliver health care services between a distant site and an	31
originating site for diagnosis and treatment of a patient.	32

(7) "Telehealth service" means a health care service provided	33
through telehealth, including a service provided through a	34
synchronous interaction or asynchronous store and forward action.	35

(B) A multiple employer welfare arrangement operating a group	36
self-insurance program may include coverage of telehealth	37
services.	38

(C) If coverage of telehealth services is included in a group	39
self-insurance program operated by a multiple employer welfare	40
arrangement, all of the following apply:	41

(1) The coverage is applicable only to telehealth services	42
that are medically appropriate and medically necessary.	43

(2) Except as provided in divisions (D)(3) and (4) of this	44
section, the coverage of a telehealth service is to be the same in	45
amount, duration, and scope as the coverage that applies to a	46
service delivered in person to a patient.	47

(3) When the provision of a telehealth service includes	48
actions performed by both a health care provider and a health care	49
facility, the coverage of the service is limited to a single	50
reimbursement amount for that provider and facility.	51

(4) The coverage is not applicable to a telehealth service	52
unless, when the service is provided, the health care provider is	53
licensed, certified, registered, or otherwise authorized in this	54
state to provide the service.	55

(D) If a health care provider intends to seek reimbursement	56
for providing a telehealth service, the provider shall retain	57
relevant documentation of providing the service and any subsequent	58
telehealth service as part of the patient records maintained by	59
the provider.	60

(E) This section does not alter any coverage that may be	61
available for telemedicine services provided to a patient in this	62
state by a physician who is located outside this state and is	63
practicing under a telemedicine certificate issued by the state	64
medical board under section 4731.296 of the Revised Code.	65

Sec. 1751.69.  (A) As used in this section:

66

(1) "Asynchronous store and forward action" means the	67
transmission of a patient's medical information from an	68
originating site to a health care provider at a distant site for	69
review of the information by the provider at the distant site	70
without a synchronous interaction.	71

(2) "Distant site" means the location of a health care	72
provider when providing telehealth services to a patient.	73

(3) "Health care provider" means a person or government	74
entity licensed, certified, registered, or otherwise authorized to	75
provide health care services to patients as a health care	76
professional or a health care facility.	77

(4) "Originating site" means both of the following:

78

(a) The location of a patient when receiving telehealth	79
services from a health care provider;	80

(b) The location where an asynchronous store and forward	81
action originates.	82

(5) "Synchronous interaction" means a real-time interaction	83
between a patient receiving telehealth services at an originating	84
site and a health care provider delivering telehealth services	85
from a distant site.	86

(6) "Telehealth" means the use of interactive audio, video,	87
and other telecommunications technology by a health care provider	88
to deliver health care services between a distant site and an	89
originating site for diagnosis and treatment of a patient.	90

(7) "Telehealth service" means a health care service provided	91
through telehealth, including a service provided through a	92
synchronous interaction or asynchronous store and forward action.	93

(B) An individual or group health insuring corporation	94
policy, contract, or agreement delivered, issued for delivery, or	95
renewed in this state policy may include coverage of telehealth	96
services.	97

(C) If coverage of telehealth services is included in an	98
individual or group health insuring corporation policy, contract,	99
or agreement, all of the following apply:	100

(1) The coverage is applicable only to telehealth services	101
that are medically appropriate and medically necessary.	102

(2) Except as provided in divisions (D)(3) and (4) of this	103
section, the coverage of a telehealth service is to be the same in	104
amount, duration, and scope as the coverage that applies to a	105
service delivered in person to a patient.	106

(3) When the provision of a telehealth service includes	107
actions performed by both a health care provider and a health care	108
facility, the coverage of the service is limited to a single	109
reimbursement amount for that provider and facility.	110

(4) The coverage is not applicable to a telehealth service	111
unless, when the service is provided, the health care provider is	112
licensed, certified, registered, or otherwise authorized in this	113
state to provide the service.	114

(D) If a health care provider intends to seek reimbursement	115
for providing a telehealth service, the provider shall retain	116
relevant documentation of providing the service and any subsequent	117
telehealth service as part of the patient records maintained by	118
the provider.	119

(E) This section does not alter any coverage that may be	120
available for telemedicine services provided to a patient in this	121
state by a physician who is located outside this state and is	122
practicing under a telemedicine certificate issued by the state	123
medical board under section 4731.296 of the Revised Code.	124

Sec. 3923.235.  (A) As used in this section:

125

(1) "Asynchronous store and forward action" means the	126
transmission of a patient's medical information from an	127
originating site to a health care provider at a distant site for	128
review of the information by the provider at the distant site	129
without a synchronous interaction.	130

(2) "Distant site" means the location of a health care	131
provider when providing telehealth services to a patient.	132

(3) "Health care provider" means a person or government	133
entity licensed, certified, registered, or otherwise authorized to	134
provide health care services to patients as a health care	135
professional or a health care facility.	136

(4) "Originating site" means both of the following:

137

(a) The location of a patient when receiving telehealth	138
services from a health care provider;	139

(b) The location where an asynchronous store and forward	140
action originates.	141

(5) "Synchronous interaction" means a real-time interaction	142
between a patient receiving telehealth services at an originating	143
site and a health care provider delivering telehealth services	144
from a distant site.	145

(6) "Telehealth" means the use of interactive audio, video,	146
and other telecommunications technology by a health care provider	147
to deliver health care services between a distant site and an	148
originating site for diagnosis and treatment of a patient.	149

(7) "Telehealth service" means a health care service provided	150
through telehealth, including a service provided through a	151
synchronous interaction or asynchronous store and forward action.	152

(B) An individual or group policy of sickness and accident	153
insurance delivered, issued for delivery, or renewed in this state	154
may include coverage of telehealth services. A public employee	155
benefit plan established or modified in this state may include	156
coverage of telehealth services.	157

(C) If coverage of telehealth services is included in an	158
individual or group policy of sickness and accident insurance or a	159
public employee benefit plan, all of the following apply:	160

(1) The coverage is applicable only to telehealth services	161
that are medically appropriate and medically necessary.	162

(2) Except as provided in divisions (D)(3) and (4) of this	163
section, the coverage of a telehealth service is to be the same in	164
amount, duration, and scope as the coverage that applies to a	165
service delivered in person to a patient.	166

(3) When the provision of a telehealth service includes	167
actions performed by both a health care provider and a health care	168
facility, the coverage of the service is limited to a single	169
reimbursement amount for that provider and facility.	170

(4) The coverage is not applicable to a telehealth service	171
unless, when the service is provided, the health care provider is	172
licensed, certified, registered, or otherwise authorized in this	173
state to provide the service.	174

(D) If a health care provider intends to seek reimbursement	175
for providing a telehealth service, the provider shall retain	176
relevant documentation of providing the service and any subsequent	177
telehealth service as part of the patient records maintained by	178
the provider.	179

(E) This section does not alter any coverage that may be	180
available for telemedicine services provided to a patient in this	181
state by a physician who is located outside this state and is	182
practicing under a telemedicine certificate issued by the state	183
medical board under section 4731.296 of the Revised Code.	184

Sec. 5111.0216.  (A) As used in this section:

185

(1) "Asynchronous store and forward action" means the	186
transmission of a patient's medical information from an	187
originating site to a health care provider at a distant site for	188
review of the information by the provider at the distant site	189
without a synchronous interaction.	190

(2) "Distant site" means the location of a health care	191
provider when providing telehealth services to a patient.	192

(3) "Health care provider" means a person or government	193
entity licensed, certified, registered, or otherwise authorized to	194
provide health care services to patients as a health care	195
professional or a health care facility.	196

(4) "Originating site" means both of the following:

197

(a) The location of a patient when receiving telehealth	198
services from a health care provider;	199

(b) The location where an asynchronous store and forward	200
action originates.	201

(5) "Synchronous interaction" means a real-time interaction	202
between a patient receiving telehealth services at an originating	203
site and a health care provider delivering telehealth services	204
from a distant site.	205

(6) "Telehealth" means the use of interactive audio, video,	206
and other telecommunications technology by a health care provider	207
to deliver health care services between a distant site and an	208
originating site for diagnosis and treatment of a patient.	209

(7) "Telehealth service" means a health care service provided	210
through telehealth, including a service provided through a	211
synchronous interaction or asynchronous store and forward action.	212

(B) The medicaid program shall provide coverage of telehealth	213
services. The coverage shall be extended to all components of the	214
medicaid program, including services provided through the care	215
management system established under section 5111.16 of the Revised	216
Code.	217

(C) With respect to the medicaid program's coverage of	218
telehealth services, all of the following apply:	219

(1) The coverage is applicable only to telehealth services	220
that are medically appropriate and medically necessary.	221

(2) Except as provided in divisions (D)(3) and (4) of this	222
section, the coverage of a telehealth service is to be the same in	223
amount, duration, and scope as the coverage that applies to a	224
service delivered in person to a patient.	225

(3) When the provision of a telehealth service includes	226
actions performed by both a health care provider and a health care	227
facility, the coverage of the service is limited to a single	228
reimbursement amount for that provider and facility.	229

(4) The coverage is not applicable to a telehealth service	230
unless, when the service is provided, the health care provider is	231
licensed, certified, registered, or otherwise authorized in this	232
state to provide the service.	233

(5) The coverage is applicable only if the health care	234
provider holds a valid medicaid provider agreement.	235

(D) If a health care provider intends to seek reimbursement	236
for providing a telehealth service, the provider shall retain	237
relevant documentation of providing the service and any subsequent	238
telehealth service as part of the patient records maintained by	239
the provider.	240

(E) This section does not alter any coverage that may be	241
available for telemedicine services provided to a patient in this	242
state by a physician who is located outside this state and is	243
practicing under a telemedicine certificate issued by the state	244
medical board under section 4731.296 of the Revised Code.	245