HOUSE AMENDED
PRIOR PRINTER'S NOS. 824, 981, 1590
PRINTER'S NO. 1670
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, STREET, ARGALL AND BROWN, JUNE 2, 2023
AS REPORTED FROM COMMITTEE ON INSURANCE, HOUSE OF
REPRESENTATIVES, AS AMENDED, JUNE 3, 2024
AN ACT
Amending Title 40 (Insurance) of the Pennsylvania Consolidated
Statutes, in regulation of insurers and related persons
generally, providing for telemedicine.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Title 40 of the Pennsylvania Consolidated
Statutes is amended by adding a chapter to read:
CHAPTER 47
TELEMEDICINE
Sec.
4701. Scope of chapter.
4702. Definitions.
4703. Insurance coverage and reimbursement of telemedicine.
4704. Medical assistance and children's health insurance
program coverage.
4705. Standard of care.
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ยง 4701. Scope of chapter.
This chapter relates to telemedicine.
ยง 4702. Definitions.
The following words and phrases when used in this chapter
shall have the meanings given to them in this section unless the
context clearly indicates otherwise:
"Agreement with the Department of Human Services." As
follows:
(1) An agreement between an MA or CHIP managed care plan
and the Department of Human Services to manage the purchase
and provision of services.
(2) The term includes a county or multicounty agreement
with the Department of Human Services for behavioral 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.
"CHILDREN'S HEALTH INSURANCE PROGRAM" OR "CHIP." THE
CHILDREN'S HEALTH INSURANCE PROGRAM UNDER ARTICLE XXIII-A OF THE
ACT OF MAY 17, 1921 (P.L.682, NO.284), KNOWN AS THE INSURANCE
COMPANY LAW OF 1921.
"Enrollee." An individual who is entitled to receive health
care services under an agreement with the Department of Human
Services.
"Health care facility." As follows:
(1) An entity that is licensed to 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
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19, 1979 (P.L.130, No.48), known as the Health Care
Facilities Act.
(2) The term includes a federally qualified health
center and a rural health clinic as defined in 42 U.S.C. ยง
1395x(aa)(2) and (4) (relating to definitions).
(2) A FEDERALLY QUALIFIED HEALTH CENTER AS DEFINED IN 42
U.S.C. ยง 1395X(AA)(4) (RELATING TO DEFINITIONS).
(3) A RURAL HEALTH CLINIC AS DEFINED IN 42 U.S.C. ยง
1395XX(AA)(2).
"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." As follows:
(1) A policy, subscriber contract, certificate or plan
issued by an insurer that provides medical or health care
coverage.
(2) The term includes a dental only and a vision only
policy.
(3) The term does not include:
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(i) An accident only policy.
(ii) A credit only policy.
(iii) A long-term care or disability income policy.
(iv) A specified disease policy.
(v) A Medicare supplement policy.
(vi) A TRICARE policy, including a Civilian Health
and Medical Program of the Uniformed Services (CHAMPUS)
supplement policy.
(vii) A fixed indemnity policy.
(viii) A hospital indemnity policy.
(ix) A worker's compensation policy.
(x) An automobile medical payment policy under 75
Pa.C.S. (relating to vehicles).
(xi) A homeowner's insurance policy.
(xii) 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 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 of that act.
(2) The act of December 29, 1972 (P.L.1701, No.364),
known as the Health Maintenance Organization Act.
(3) Chapter 61 (relating to hospital plan corporations).
(4) Chapter 63 (relating to professional health services
plan corporations).
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"MEDICAL ASSISTANCE" OR "MA." THE MEDICAL ASSISTANCE PROGRAM
ESTABLISHED UNDER ARTICLE IV OF THE HUMAN SERVICES CODE.
"Medical Assistance or Children's Health Insurance Program
managed care plan" or "MA or CHIP managed care plan." A health
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.
"MEDICAL POLICY." AS DEFINED IN SECTION 2102 OF THE
INSURANCE COMPANY LAW OF 1921.
"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 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.
"Remote patient monitoring." The collection AND MONITORING
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
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patient by a health care provider who is at a different
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.
ยง 4703. Insurance coverage and reimbursement of telemedicine.
(a) General rule.--
(1) A health insurance policy issued, delivered,
executed OFFERED, ISSUED 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 from coverage solely because
the health care service is provided through telemedicine.
(2) Subject to paragraph (1), an insurer shall PAY OR
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. A contract that
includes PAYMENT OR reimbursement for covered health care
services delivered through telemedicine may not prohibit
PAYMENT OR reimbursement solely because a health care service
is provided by telemedicine. Reimbursement PAYMENT OR
REIMBURSEMENT may not be conditioned upon the use of an
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exclusive OR 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. THE HEALTH INSURANCE
PORTABILITY AND ACCOUNTABILITY ACT OF 1996, THE HEALTH
INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT
OR OTHER APPLICABLE STATUTE, REGULATION OR GUIDANCE.
(2) For a health insurance policy for which either rates
or forms are required to be filed with the Federal Government
or the 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 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 PAYING OR reimbursing other
health care providers for covered health care services
provided through telemedicine.
(2) Require an insurer to PAY OR reimburse an out-of-
network health care provider for health care services
provided through telemedicine.
(3) Require an insurer to PAY OR reimburse a
participating network provider if the provision of the health
care service through telemedicine would be inconsistent with
the standard of care.
ยง 4704. Medical assistance and children's health insurance
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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, 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
REGULATIONS, 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.
(2) THE MA OR CHIP MANAGED CARE PLAN SHALL PAY A
PARTICIPATING NETWORK PROVIDER FOR COVERED HEALTH CARE
SERVICES DELIVERED THROUGH TELEMEDICINE IN ACCORDANCE WITH
THE TERMS AND CONDITIONS OF BOTH:
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(I) THE CONTRACT NEGOTIATED BETWEEN THE MA OR CHIP
MANAGED CARE PLAN AND THE PARTICIPATING NETWORK PROVIDER;
AND
(II) THE AGREEMENT WITH THE DEPARTMENT OF HUMAN
SERVICES.
(B) APPLICABILITY.--
(1) SUBSECTION (A) DOES NOT APPLY IF THE TELEMEDICINE-
ENABLING DEVICE, TECHNOLOGY OR SERVICE FAILS TO COMPLY WITH
THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF
1996, THE HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND
CLINICAL HEALTH ACT OR OTHER APPLICABLE STATUTE, REGULATION
OR GUIDANCE FROM THE FEDERAL GOVERNMENT OR THE DEPARTMENT OF
HUMAN SERVICES.
(2) THIS SECTION SHALL APPLY TO MA AND CHIP MANAGED CARE
PLANS BEGINNING ON OR AFTER JANUARY 1, 2026.
(c) Construction.--This section may not be construed to:
(1) Prohibit a MA or CHIP managed care plan from making
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 PAY FOR A
HEALTH CARE SERVICE IF THE DELIVERY of the health care
service through telemedicine would be inconsistent with the
standard of care.
ยง 4705. 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 2. This act shall take effect in 90 days.
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