Florida Senate - 2011 COMMITTEE AMENDMENT
Bill No. SB 1882
Barcode 283978
LEGISLATIVE ACTION
Senate . House
.
.
.
.
.
—————————————————————————————————————————————————————————————————
—————————————————————————————————————————————————————————————————
The Committee on Banking and Insurance (Hays) recommended the
following:
1 Senate Amendment (with title amendment)
2
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Coverage for telemedicine services.—Each insurer
6 proposing to issue individual or group accident and sickness
7 insurance policies providing hospital, medical and surgical, or
8 major medical coverage on an expense-incurred basis, and each
9 health maintenance organization providing a health care plan for
10 health care services, may provide coverage for the cost of such
11 health care services provided by an in-network health care
12 provider through telemedicine services, as provided in this
13 section.
14 (1) As used in this section, the term:
15 (a) “Adverse decision” means a determination that the use
16 of telemedicine services rendered or proposed to be rendered by
17 an in-network provider is not covered under the policy,
18 contract, or plan.
19 (b) “In-network provider” means a licensed health care
20 provider who has contracted with an insurer or a health
21 maintenance organization to provide services to the insurer’s
22 policyholders or the subscribers of the health maintenance
23 organization.
24 (c) “Telemedicine services,” as it pertains to the delivery
25 of health care services by an in-network provider, means
26 interactive audio, video, or other electronic media used for the
27 purpose of diagnosis, consultation, or treatment, including home
28 health video conferencing and remote patient monitoring. The
29 term does not include an audio-only telephone, electronic mail
30 message, or facsimile transmission, or radiology services
31 performed by a health care practitioner not licensed in this
32 state.
33 (d) “Utilization review” means a review to determine the
34 appropriateness of telemedicine services or whether coverage of
35 the delivery of telemedicine services rendered or proposed to be
36 rendered by an in-network health care provider is required, if
37 the determination is made in the same manner as those
38 determinations that are made for the treatment of any other
39 illness, condition, or disorder covered under the policy,
40 contract, or plan.
41 (2) An insurer or health maintenance organization may not
42 exclude a service from coverage solely because the service is
43 provided through telemedicine services rather than face-to-face
44 consultation or contact between an in-network health care
45 provider and a patient.
46 (3) An insurer or health maintenance organization is not
47 required to reimburse the telemedicine provider or the
48 consulting provider for technological fees or costs for the
49 provision of telemedicine services; however, an insurer or
50 health maintenance organization must reimburse the telemedicine
51 provider or the consulting provider for the diagnosis,
52 consultation, or treatment of the insured delivered through
53 telemedicine services according to the terms of the contract
54 between the in-network provider and the insurer or health
55 maintenance organization.
56 (4) An insurer or health maintenance organization may offer
57 a health care plan containing a deductible, copayment, or
58 coinsurance requirement for a health care service provided
59 through telemedicine services.
60 (5) An insurer or health maintenance organization may not
61 impose any annual or lifetime dollar maximum on coverage for
62 telemedicine services other than an annual or lifetime dollar
63 maximum that applies in the aggregate to all items and services
64 covered under the policy, contract, or plan, and may not impose
65 upon any person receiving benefits under this section any
66 copayment, coinsurance, or deductible amount, or any policy
67 year, calendar year, lifetime, or other durational benefit
68 limitation or maximum for benefits or services, which is not
69 equally imposed upon all terms and services covered under the
70 policy, contract, or plan.
71 (6) This section applies to insurance policies, contracts,
72 and plans delivered, issued for delivery, reissued, renewed, or
73 extended in this state on and after October 1, 2011.
74 (7) This section does not apply to short-term travel,
75 accident-only, limited benefit or specified disease, disability
76 income, or long-term care policies designed for issuance to
77 persons who are eligible for Medicare coverage under Title XVIII
78 of the Social Security Act or any other similar coverage under
79 state or federal governmental plans.
80 (8) This section does not preclude any insurer or health
81 maintenance organization providing coverage for telemedicine
82 services under an insurance policy, contract, or plan from
83 undertaking a utilization review. After making an adverse
84 decision, an insurer or health maintenance organization shall
85 notify the covered individual and the individual’s health care
86 provider.
87 Section 2. This act shall take effect July 1, 2011.
88
89 ================= T I T L E A M E N D M E N T ================
90 And the title is amended as follows:
91 Delete everything before the enacting clause
92 and insert:
93 A bill to be entitled
94 An act relating to telemedicine coverage; authorizing
95 health insurers and health maintenance organizations
96 issuing certain health policies to provide coverage
97 for telemedicine services; providing definitions;
98 prohibiting the exclusion of telemedicine cost
99 coverage solely because the services were not provided
100 face to face; specifying conditions under which an
101 insurer or health maintenance organization must
102 reimburse a telemedicine provider for certain fees and
103 costs; authorizing an insurer or health maintenance
104 organization to offer a health care plan containing a
105 deductible, copayment, or coinsurance requirement for
106 a health care service provided through telemedicine
107 services; prohibiting the imposition of certain dollar
108 and durational coverage limitations or copayments,
109 coinsurance, or deductibles on telemedicine services
110 unless imposed equally on all terms and services;
111 providing for application of the act; providing for
112 certain exclusions; providing that an insurer or
113 health maintenance organization that provides coverage
114 for telemedicine services under an insurance policy,
115 contract, or plan is not precluded from undertaking a
116 utilization review; providing effective dates.