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H. B. No. 123 As IntroducedAs Introduced
130th General Assembly | Regular Session | 2013-2014 |
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Representatives Gonzales, Wachtmann
Cosponsors:
Representatives Adams, J., Brenner, Henne, McClain, Williams, Young
A BILL
To enact sections 1739.051, 1751.69, 3923.235, and
5111.0216 of the Revised Code regarding Medicaid
and health insurance coverage of telehealth
services.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:
Section 1. That sections 1739.051, 1751.69, 3923.235, and
5111.0216 of the Revised Code be enacted to read as follows:
Sec. 1739.051. (A) As used in this section, "telehealth
service" means a health care service delivered to a patient
through the use of interactive audio, video, or other
telecommunications or electronic technology from a site other than
the site where the patient is located.
(B) A multiple employer welfare arrangement operating a group
self-insurance program may include coverage of telehealth
services.
(C) If coverage of telehealth services is included in a group
self-insurance program operated by a multiple employer welfare
arrangement, all of the following apply:
(1) The coverage applies only to telehealth services that
involve a health care provider's immediate or direct interaction
with a patient and only if the services are medically appropriate
and medically necessary.
(2) The coverage extends to telehealth services provided by
either a health care professional or health care facility, but the
coverage applies only if, at the time the telehealth services are
provided, the professional or facility is licensed, certified, or
registered in this state as a health care professional or health
care facility, as applicable.
(3) The coverage applies only to telehealth services provided
through systems that are secure, as evidenced by adherence to
standards established in federal regulations adopted pursuant to
the "Health Insurance Portability and Accountability Act of 1996,"
Pub. L. No. 104-191, as amended, with respect to ensuring the
confidentiality, integrity, and security of electronic protected
health information, including the standards established in 45
C.F.R. Part 160 and Subparts A and C of 45 C.F.R. Part 164.
(D) If a health care provider intends to seek reimbursement
for providing telehealth services covered pursuant to this
section, all of the following apply:
(1) Before providing telehealth services to a patient, the
health care provider, except as provided in division (D)(2) of
this section, shall do both of the following:
(a) Verbally inform the patient or the patient's authorized
representative that telehealth services may be used in providing
health care services to the patient.
(b) Obtain verbal consent to the use of telehealth services
from the patient or the patient's authorized representative.
(2) The health care provider is not required to provide the
information or obtain the consent described in division (D)(1) of
this section in any circumstance, such as an emergency, in which a
patient or the patient's authorized representative is unable to
provide consent before it is necessary to provide the services.
(3) The health care provider shall retain relevant
documentation of providing the telehealth services as part of the
patient records maintained by the provider, including
documentation of the consent obtained in accordance with division
(D)(1) of this section.
Sec. 1751.69. (A) As used in this section, "telehealth
service" means a health care service delivered to a patient
through the use of interactive audio, video, or other
telecommunications or electronic technology from a site other than
the site where the patient is located.
(B) An individual or group health insuring corporation
policy, contract, or agreement delivered, issued for delivery, or
renewed in this state policy may include coverage of telehealth
services.
(C) If coverage of telehealth services is included in an
individual or group health insuring corporation policy, contract,
or agreement, all of the following apply:
(1) The coverage applies only to telehealth services that
involve a health care provider's immediate or direct interaction
with a patient and only if the services are medically appropriate
and medically necessary.
(2) The coverage extends to telehealth services provided by
either a health care professional or health care facility, but the
coverage applies only if, at the time the telehealth services are
provided, the professional or facility is licensed, certified, or
registered in this state as a health care professional or health
care facility, as applicable.
(3) The coverage applies only to telehealth services provided
through systems that are secure, as evidenced by adherence to
standards established in federal regulations adopted pursuant to
the "Health Insurance Portability and Accountability Act of 1996,"
Pub. L. No. 104-191, as amended, with respect to ensuring the
confidentiality, integrity, and security of electronic protected
health information, including the standards established in 45
C.F.R. Part 160 and Subparts A and C of 45 C.F.R. Part 164.
(D) If a health care provider intends to seek reimbursement
for providing telehealth services covered pursuant to this
section, all of the following apply:
(1) Before providing telehealth services to a patient, the
health care provider, except as provided in division (D)(2) of
this section, shall do both of the following:
(a) Verbally inform the patient or the patient's authorized
representative that telehealth services may be used in providing
health care services to the patient.
(b) Obtain verbal consent to the use of telehealth services
from the patient or the patient's authorized representative.
(2) The health care provider is not required to provide the
information or obtain the consent described in division (D)(1) of
this section in any circumstance, such as an emergency, in which a
patient or the patient's authorized representative is unable to
provide consent before it is necessary to provide the services.
(3) The health care provider shall retain relevant
documentation of providing the telehealth services as part of the
patient records maintained by the provider, including
documentation of the consent obtained in accordance with division
(D)(1) of this section.
Sec. 3923.235. (A) As used in this section, "telehealth
service" means a health care service delivered to a patient
through the use of interactive audio, video, or other
telecommunications or electronic technology from a site other than
the site where the patient is located.
(B) An individual or group policy of sickness and accident
insurance delivered, issued for delivery, or renewed in this state
may include coverage of telehealth services. A public employee
benefit plan established or modified in this state may include
coverage of telehealth services.
(C) If coverage of telehealth services is included in an
individual or group policy of sickness and accident insurance or a
public employee benefit plan, all of the following apply:
(1) The coverage applies only to telehealth services that
involve a health care provider's immediate or direct interaction
with a patient and only if the services are medically appropriate
and medically necessary.
(2) The coverage extends to telehealth services provided by
either a health care professional or health care facility, but the
coverage applies only if, at the time the telehealth services are
provided, the professional or facility is licensed, certified, or
registered in this state as a health care professional or health
care facility, as applicable.
(3) The coverage applies only to telehealth services provided
through systems that are secure, as evidenced by adherence to
standards established in federal regulations adopted pursuant to
the "Health Insurance Portability and Accountability Act of 1996,"
Pub. L. No. 104-191, as amended, with respect to ensuring the
confidentiality, integrity, and security of electronic protected
health information, including the standards established in 45
C.F.R. Part 160 and Subparts A and C of 45 C.F.R. Part 164.
(D) If a health care provider intends to seek reimbursement
for providing telehealth services covered pursuant to this
section, all of the following apply:
(1) Before providing telehealth services to a patient, the
health care provider, except as provided in division (D)(2) of
this section, shall do both of the following:
(a) Verbally inform the patient or the patient's authorized
representative that telehealth services may be used in providing
health care services to the patient.
(b) Obtain verbal consent to the use of telehealth services
from the patient or the patient's authorized representative.
(2) The health care provider is not required to provide the
information or obtain the consent described in division (D)(1) of
this section in any circumstance, such as an emergency, in which a
patient or the patient's authorized representative is unable to
provide consent before it is necessary to provide the services.
(3) The health care provider shall retain relevant
documentation of providing the telehealth services as part of the
patient records maintained by the provider, including
documentation of the consent obtained in accordance with division
(D)(1) of this section.
Sec. 5111.0216. (A) As used in this section, "telehealth
service" means a health care service delivered to a patient
through the use of interactive audio, video, or other
telecommunications or electronic technology from a site other than
the site where the patient is located.
(B) The office of medical assistance shall establish
standards for medicaid reimbursement for health care services the
office determines are appropriate to be covered by the medicaid
program when provided as telehealth services. The standards shall
be established in rules adopted under section 5111.02 of the
Revised Code.
(C) With respect to any medicaid coverage of telehealth
services, all of the following apply:
(1) The coverage applies only to telehealth services that
involve a health care provider's immediate or direct interaction
with a patient and only if the services are medically appropriate
and medically necessary.
(2) The coverage extends to telehealth services provided by
either a health care professional or health care facility, but the
coverage applies only if, at the time the telehealth services are
provided, both of the following are the case:
(a) The professional or facility is licensed, certified, or
registered in this state as a health care professional or health
care facility, as applicable.
(b) The professional or facility holds a valid medicaid
provider agreement.
(3) The coverage applies only if either of the following is
the case:
(a) The coverage is at least as cost effective as the
program's coverage of health care services when provided by a
health care provider at the same site where the patient is
located.
(b) The coverage is provided as necessary to support the
medicaid program's administrative responsibilities under the
"Social Security Act," section 1902, 42 U.S.C. 1396a(a)(30)(A),
with respect to enlisting a sufficient number of providers under
the program.
(4) The coverage applies only to telehealth services provided
through systems that are secure, as determined by the office of
medical assistance.
(D) If a health care provider intends to seek reimbursement
for providing telehealth services, the provider shall retain
relevant documentation of providing the services as part of the
patient records maintained by the provider.
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