130th Ohio General Assembly
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H. B. No. 123  As Introduced
As Introduced

130th General Assembly
Regular Session
2013-2014
H. B. No. 123


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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