Florida Senate - 2011 SB 1882
By Senator Garcia
40-01494A-11 20111882__
1 A bill to be entitled
2 An act relating to telemedicine coverage; requiring
3 health insurers, corporations, and health maintenance
4 organizations issuing certain health policies to
5 provide coverage for telemedicine services; providing
6 definitions; prohibiting the exclusion of telemedicine
7 cost coverage solely because the services were not
8 provided face to face; specifying conditions under
9 which an insurer, corporation, or health maintenance
10 organization must reimburse a telemedicine provider
11 for certain fees and costs; authorizing provisions
12 requiring a deductible, copayment, or coinsurance
13 requirement for telemedicine services under certain
14 circumstances; prohibiting the imposition of certain
15 dollar and durational coverage limitations or
16 copayments, coinsurance, or deductibles on
17 telemedicine services unless imposed equally on all
18 terms and services; providing application; providing
19 construction; requiring a utilization review under
20 certain circumstances; providing coverage under the
21 state plan or a waiver for health home services
22 provided to eligible individuals with chronic
23 conditions; providing effective dates.
24
25 Be It Enacted by the Legislature of the State of Florida:
26
27 Section 1. Coverage for telemedicine services.—Each insurer
28 proposing to issue individual or group accident and sickness
29 insurance policies providing hospital, medical and surgical, or
30 major medical coverage on an expense-incurred basis; each
31 corporation providing individual or group accident and sickness
32 subscription contracts; and each health maintenance organization
33 providing a health care plan for health care services must
34 provide coverage for the cost of such health care services
35 provided through telemedicine services, as provided in this
36 section.
37 (1) As used in this section, the term:
38 (a) “Adverse decision” means a determination that the use
39 of telemedicine services rendered or proposed to be rendered is
40 not covered under the policy, contract, or plan.
41 (b) “Telemedicine services,” as it pertains to the delivery
42 of health care services, means interactive audio, video, or
43 other electronic media used for the purpose of diagnosis,
44 consultation, or treatment, including home health video
45 conferencing and remote patient monitoring. “Telemedicine
46 services” does not include an audio-only telephone, electronic
47 mail message, or facsimile transmission.
48 (c) “Utilization review” means a review to determine the
49 appropriateness of telemedicine services or whether coverage of
50 the delivery of telemedicine services rendered or proposed to be
51 rendered by a health care provider is required, provided the
52 determination is made in the same manner as those determinations
53 are made for the treatment of any other illness, condition, or
54 disorder covered under the policy, contract, or plan.
55 (2) An insurer, corporation, or health maintenance
56 organization may not exclude a service from coverage solely
57 because the service is provided through telemedicine services
58 rather than face-to-face consultation or contact between a
59 health care provider and a patient.
60 (3) An insurer, corporation, or health maintenance
61 organization is not required to reimburse the telemedicine
62 provider or the consulting provider for technological fees or
63 costs for the provision of telemedicine services; however, an
64 insurer, corporation, or health maintenance organization must
65 reimburse the telemedicine provider or the consulting provider
66 for the diagnosis, consultation, or treatment of the insured
67 delivered through telemedicine services on the same basis that
68 the insurer, corporation, or health maintenance organization is
69 responsible for coverage for the provision of the same services
70 through face-to-face diagnosis, consultation, or treatment.
71 (4) An insurer, corporation, or health maintenance
72 organization may offer a health care plan containing a
73 deductible, copayment, or coinsurance requirement for a health
74 care service provided through telemedicine services if the
75 deductible, copayment, or coinsurance does not exceed the
76 deductible, copayment, or coinsurance applicable if the same
77 services were provided through face-to-face diagnosis,
78 consultation, or treatment.
79 (5) An insurer, corporation, or health maintenance
80 organization may not impose any annual or lifetime dollar
81 maximum on coverage for telemedicine services other than an
82 annual or lifetime dollar maximum that applies in the aggregate
83 to all items and services covered under the policy, contract, or
84 plan and may not impose upon any person receiving benefits under
85 this section any copayment, coinsurance, or deductible amount,
86 or any policy year, calendar year, lifetime, or other durational
87 benefit limitation or maximum for benefits or services, that is
88 not equally imposed upon all terms and services covered under
89 the policy, contract, or plan.
90 (6) This section applies to:
91 (a) Insurance policies, contracts, and plans delivered,
92 issued for delivery, reissued, or extended in this state on and
93 after July 1, 2011, or at any time after July 1, 2011, when any
94 term of the policy, contract, or plan is changed or any premium
95 adjustment is made, but in no event later than July 1, 2012. For
96 purposes of this paragraph, all policies, contracts, and plans
97 are deemed to be renewed no later than the next yearly
98 anniversary date of the contract, policy, or plan.
99 (b) Medicaid plans if the health care service would be
100 covered were it provided through in-person consultation between
101 the recipient and a health care provider.
102 (7) This section does not apply to short-term travel,
103 accident-only, limited or specified disease, or individual
104 conversion policies or contracts or to policies or contracts
105 designed for issuance to persons eligible for Medicare coverage
106 under Title XVIII of the Social Security Act or any other
107 similar coverage under state or federal governmental plans.
108 (8) This section may not be construed to preclude any
109 insurer, corporation, or health maintenance organization
110 providing coverage for telemedicine services under an insurance
111 policy, contract, or plan from undertaking a utilization review.
112 After making an adverse decision, an insurer, corporation, or
113 health maintenance organization must notify the covered
114 individual and the individual’s health care provider and must
115 undertake a utilization review after receiving a written request
116 to undertake such review from a covered individual or the
117 individual’s health care provider.
118 Section 2. Effective January 1, 2012, under the state plan
119 or a waiver of the state plan, eligible individuals with chronic
120 conditions as defined in 42 U.S.C. s. 1396w-4 are eligible for
121 medical assistance that provides health home services in
122 compliance with 42 U.S.C. s. 1396w-4.
123 Section 3. Except as otherwise expressly provided in this
124 act, this act shall take effect July 1, 2011.