PRIOR PRINTER'S NO. 824
PRINTER'S NO. 981
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
739
Session of
2023
INTRODUCED BY VOGEL, HAYWOOD, SANTARSIERO, LANGERHOLC, KANE,
STEFANO, BARTOLOTTA, SCHWANK, COSTA, PENNYCUICK, J. WARD,
LAUGHLIN, MARTIN, ROTHMAN, BAKER, YAW, AUMENT, ROBINSON,
COLLETT AND STREET, JUNE 2, 2023
SENATOR DiSANTO, BANKING AND INSURANCE, AS AMENDED,
JUNE 27, 2023
AN ACT
Relating to telemedicine; authorizing the regulation of
telemedicine by professional licensing boards; and providing
for insurance coverage of telemedicine.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Telemedicine
Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Agreement with the Department of Human Services." An
agreement between an MA or CHIP managed care plan and the
Department of Human Services to manage the purchase and
provision of services. The term includes a county or multicounty
agreement with the Department of Human Services for behavioral
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health services.
"Asynchronous interaction." An exchange of information
between a patient and a health care provider that does not occur
in real time, including the secure collection and transmission
of a patient's medical information, clinical data, clinical
images, laboratory results and self-reported medical history.
"Emergency medical services." As defined in 35 Pa.C.S. §
8103 (relating to definitions).
"Emergency service." As follows:
(1) A health care service, including behavioral health
services, provided to a patient after the sudden onset of a
medical condition that manifests itself by acute symptoms of
sufficient severity or severe pain such that a prudent
layperson who possesses an average knowledge of health and
medicine could reasonably expect the absence of immediate
medical attention to result in:
(i) placing the health of the patient in serious
jeopardy or, with respect to a pregnant woman, the health
of the woman or the unborn child in serious jeopardy;
(ii) serious impairment to bodily functions; or
(iii) serious dysfunction of any bodily organ or
part.
(2) The term includes emergency transportation, related
emergency service or emergency medical services provided by
an emergency medical services agency as defined in 35 Pa.C.S.
§ 8103.
"Enrollee." An individual who is entitled to receive health
care services under an agreement with the Department of Human
Services.
"Health care facility." An entity that is licensed to
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provide a health care service under Article X of the act of June
13, 1967 (P.L.31, No.21), known as the Human Services Code, or
the act of July 19, 1979 (P.L.130, No.48), known as the Health
Care Facilities Act. The term includes a federally qualified
health center and a rural health clinic as defined in 42 U.S.C.
§ 1395x(aa)(2) and (4) (relating to definitions).
"Health care provider." A health care facility, medical
equipment supplier or person that is licensed, certified or
otherwise regulated to provide health care services under the
laws of this Commonwealth or another state.
"Health care service." Any treatment, admission, procedure,
medical supplies and equipment or other services, including
behavioral health, prescribed or otherwise provided or proposed
to be provided by a health care provider to a patient for the
diagnosis, prevention, treatment, cure or relief of a health
condition, illness, injury or disease.
"Health Information Technology for Economic and Clinical
Health Act." The Health Information Technology for Economic and
Clinical Health Act (Public Law 111-5, 123 Stat. 226-279 and
467-496).
"Health insurance policy." A policy, subscriber contract,
certificate or plan issued by an insurer that provides medical
or health care coverage. The term includes a dental only and a
vision only policy. The term does not include:
(1) An accident only policy.
(2) A credit only policy.
(3) A long-term care or disability income policy.
(4) A specified disease policy.
(5) A Medicare supplement policy.
(6) A TRICARE policy, including a Civilian Health and
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Medical Program of the Uniformed Services (CHAMPUS)
supplement policy.
(7) A fixed indemnity policy.
(8) A hospital indemnity policy.
(9) A worker's compensation policy.
(10) An automobile medical payment policy under 75
Pa.C.S. (relating to vehicles).
(11) A homeowner's insurance policy.
(12) Any other similar policies providing for limited
benefits.
"Health Insurance Portability and Accountability Act of
1996." The Health Insurance Portability and Accountability Act
of 1996 (Public Law 104-191, 110 Stat. 1936).
"Insurer." An entity licensed by the Insurance Department
that offers, issues or renews a health insurance policy and
governed under any of the following:
(1) THE ACT OF MAY 17, 1921 (P.L.682, NO.284), KNOWN AS
THE INSURANCE COMPANY LAW OF 1921, INCLUDING SECTION 630 AND
ARTICLE XXIV.
(1) (2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(2) (3) 40 Pa.C.S. Ch. 61 (relating to hospital plan
corporations).
(3) (4) 40 Pa.C.S. Ch. 63 (relating to professional
health services plan corporations).
"Licensure board." Each licensing board within the Bureau of
Professional and Occupational Affairs of the Department of State
with jurisdiction over a health care provider.
"Medical Assistance or Children's Health Insurance Program
managed care plan" or "MA or CHIP managed care plan." A health
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care plan that uses a gatekeeper to manage the utilization of
health care services by medical assistance or children's health
insurance program enrollees and integrates the financing and
delivery of health care services.
"Participating network provider." A health care provider
that has entered a contractual or operating relationship with an
insurer or MA or CHIP managed care plan to participate in one or
more designated networks of the insurer or MA or CHIP managed
care plan to provide health care services under the terms of a
health insurance policy, or an agreement with the Department of
Human Services.
"Provider-to-provider consultation." An act of seeking
advice and recommendations concerning diagnostic studies,
therapeutic interventions or other health care services that may
benefit the patient of the health care provider from another
health care provider.
"Remote patient monitoring." The collection of physiological
data from a patient in one location, which is transmitted via an
electronic communication technology to a health care provider in
a different location for use in care and related support of the
patient.
"State." A state of the United States, the District of
Columbia, the Commonwealth of Puerto Rico and any territory or
possession of the United States.
"Synchronous interaction." A two-way or multiple-way
exchange of information between a patient and a health care
provider that occurs in real time via audio or video
conferencing.
"Telemedicine." The delivery of health care services to a
patient by a health care provider who is at a different
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location, through synchronous interactions, asynchronous
interactions or remote patient monitoring that meets the
requirements of the Health Insurance Portability and
Accountability Act of 1996, the Health Information Technology
for Economic and Clinical Health Act or other applicable Federal
law or law of this Commonwealth regarding the privacy and
security of electronic transmission of health information. The
term does not include a provider-to-provider consultation.
Section 3. Oversight of telemedicine by professional licensure
boards.
Each licensure board shall regulate health care providers
under the licensure's board jurisdiction to ensure that the use
of telemedicine is consistent with the health care provider's
scope of practice and that health care services provided by
telemedicine meet the same standard of care applicable to the
same health care service provided in an in-person setting. A
licensure board may not establish a separate standard of care
for telemedicine.
Section 4. Compliance.
A health care provider providing health care services through
telemedicine to a patient shall comply with Federal law, the
laws of this Commonwealth and applicable regulations. Failure to
comply with applicable laws and regulations shall subject the
health care provider to discipline by the applicable
Commonwealth authority.
Section 5. Evaluation and treatment.
(a) Requirements.--A health care provider who provides
health care services through telemedicine to a patient shall
comply with the following:
(1) For a telemedicine encounter in which the health
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care provider does not have an established provider-patient
relationship, disclose the health care provider's identity
and applicable state and type of license, certificate or
state-regulated credentials.
(2) Verify the state location and identity of the
patient receiving care by requesting that the patient provide
at least two patient identifiers, such as name and date of
birth.
(3) Obtain and document consent in accordance with the
act of December 16, 1999 (P.L.971, No.69), known as the
Electronic Transactions Act, from the patient or other person
acting in a health care decision-making capacity for the
patient after disclosure regarding the delivery models and
treatment methods or limitations of telemedicine, including
when it is advisable to seek in-person care. The patient or
other person acting in a health care decision-making
capacity, including the parent or legal guardian of a child
in accordance with the act of February 13, 1970 (P.L.19,
No.10), entitled "An act enabling certain minors to consent
to medical, dental and health services, declaring consent
unnecessary under certain circumstances," has the right to
choose the form of health care service delivery, which
includes the right to refuse telemedicine without
jeopardizing the patient's access to in-person health care
services.
(4) Perform a clinical evaluation that is appropriate
for the patient and the condition with which the patient
presents before providing treatment or issuing a prescription
using telemedicine.
(5) Establish a diagnosis and treatment plan consistent
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with the health care provider's scope of practice.
(6) Document in the patient's medical record the health
care services rendered using telemedicine according to the
same standard as required for in-person services.
(7) Create a visit summary and offer to the patient.
(8) Have an emergency action plan in place for medical
and behavioral health emergencies and referrals.
(b) Applicability.--
(1) Subsection (a)(1) and (2) do not apply to emergency
services.
(2) A health care provider licensed, certified or
otherwise regulated under the laws of this Commonwealth may
provide telemedicine to patients physically located in this
Commonwealth at the time of the health care service.
Telemedicine may be provided to patients physically located
outside this Commonwealth to the extent permissible by the
laws of the state where the patient is located.
(3) A health care provider licensed, certified or
otherwise regulated solely under the laws of another state
may provide telemedicine to patients located in this
Commonwealth only in the following circumstances:
(i) A patient for whom the health care provider has
an existing provider-patient relationship in the state in
which the provider is licensed, certified or otherwise
regulated, and the patient is temporarily located within
this Commonwealth. If the health care provider becomes
aware that the patient's location within this
Commonwealth is no longer temporary, the health care
provider shall transition care with the patient's consent
to a health care provider licensed, certified or
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otherwise regulated within this Commonwealth.
(ii) A patient located within this Commonwealth
prospectively seeking care or receiving follow-up care
from a health care provider licensed, certified or
otherwise regulated in another state for a health care
service that would be or has been provided outside this
Commonwealth.
(c) Standard of care.--A health care provider providing
health care services through telemedicine shall be subject to
the same standard of care that would apply to the health care
services in an in-person setting.
Section 6. Insurance coverage and reimbursement of
telemedicine.
(a) General rule.--
(1) A health insurance policy issued, delivered,
executed or renewed in this Commonwealth shall provide
coverage for medically necessary health care services
provided through telemedicine and delivered by a
participating network provider who provides a covered health
care service through telemedicine consistent with the
insurer's medical policies. A health insurance policy may not
exclude a health care service for FROM coverage solely
because the health care service is provided through
telemedicine.
(2) Subject to paragraph (1), an insurer shall reimburse
a participating network provider for COVERED health care
services delivered through telemedicine and pursuant to a
health insurance policy in accordance with the terms and
conditions of the contract as negotiated between the insurer
and the participating network provider. The A contract that
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includes reimbursement for COVERED health care services
delivered through telemedicine may not prohibit reimbursement
solely because a health care service is provided by
telemedicine. Reimbursement shall MAY not be conditioned upon
the use of an exclusive proprietary telemedicine technology
or vendor.
(b) Applicability.--
(1) Subsection (a) does not apply if the telemedicine-
enabling device, technology or service fails to comply with
applicable law and regulatory guidance.
(2) For a health insurance policy for which either rates
or forms are required to be filed with the Federal Government
or the Insurance Department, this section shall apply to a
policy for which a form or rate is first filed on or after
180 days after the effective date of this paragraph.
(3) For a health insurance policy for which neither
rates nor forms are required to be filed with the Federal
Government or the Insurance Department, this section shall
apply to a policy issued or renewed on or after 180 days
after the effective date of this paragraph.
(c) Construction.--This section may not be construed to:
(1) Prohibit an insurer from reimbursing other health
care providers for covered health care services provided
through telemedicine.
(2) Require an insurer to reimburse an out-of-network
health care provider for health care services provided
through telemedicine.
(3) Require an insurer to reimburse a participating
network provider if the provision of the health care service
through telemedicine would be inconsistent with the standard
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of care.
Section 7. Medical assistance and children's health insurance
program coverage.
(a) MA or CHIP managed care plan payment.--
(1) MA or CHIP managed care plan payments shall be made
on behalf of enrollees for medically necessary health care
services provided through telemedicine, as specified under
sections 2, 4 and 5, if all of the following apply:
(i) The health care service would be covered through
an in-person encounter.
(ii) The provision of the health care service
through telemedicine is consistent with Federal law and
the laws of this Commonwealth, applicable regulations and
clinical guidance.
(iii) Federal approval, if necessary for the
provision of the health care service through
telemedicine, has been received by the Department of
Human Services.
(2) The MA or CHIP managed care plan shall reimburse a
participating network provider for covered health care
services delivered through telemedicine in accordance with
the terms and conditions of the contract as negotiated
between the MA or CHIP managed care plan, the participating
network provider and the agreement with the Department of
Human Services.
(b) Applicability.--Subsection (a) does not apply if the
telemedicine-enabling device, technology or service fails to
comply with applicable law and regulatory guidance.
(c) Construction.--This section may not be construed to:
(1) Prohibit a MA or CHIP managed care plan from making
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payments on behalf of enrollees to other health care
providers for covered health care services provided through
telemedicine.
(2) Require a MA or CHIP managed care plan to reimburse
a participating network provider if the provision of the
health care service through telemedicine would be
inconsistent with the standard of care.
Section 8. Effective date.
This act shall take effect as follows:
(1) Sections 6 and 7 shall take effect in 90 days.
(2) The remainder of this act shall take effect
immediately.
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