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.