Rep. Norm Thurston — Voting Record

Bill

Number

H.B. 154 (2017GS)

Sponsor

Rep. Ivory, K.

Final action

Governor Signed 3/22/2017

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• defines terms;
• amends the Medical Assistance Act regarding reimbursement for telemedicine services;
• amends the Insurance Code to require insurer transparency regarding telehealth reimbursement;
• amends the Public Employees' Benefit and Insurance Program Act (PEHP) regarding reimbursement for telemedicine services;
• requires the Department of Health and PEHP to report to a legislative interim committee and a task force regarding telehealth services;
• requires a legislative study; Ŝ→ and ←Ŝ
• describes responsibilities of a provider offering telehealth services Ŝ→ [ ; and ] ←Ŝ Ŝ→ . 24a ←Ŝ Ŝ→ [
• amends the Electronic Prescribing Act to restrict certain prescriptions in conjunction with telehealth services. ] ←Ŝ

Every vote on this bill

Bill text

This document includes Senate Committee Amendments incorporated into the bill on Mon, Feb 13, 2017 at 5:19 PM by lpoole.
This document includes Senate Committee Amendments incorporated into the bill on Wed, Feb 15, 2017 at 9:31 AM by lpoole.
This document includes Senate 2nd Reading Floor Amendments incorporated into the bill on Wed, Feb 22, 2017 at 3:01 PM by lucydaynes.
TELEHEALTH AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Ken Ivory
Senate Sponsor: 
 Allen M. Christensen
LONG TITLE
General Description:
This bill amends the Medical Assistance Act, the Public Employees' Benefit and
Insurance Program Act, and the Insurance Code to provide coverage, and coverage
transparency, for certain telehealth services.
Highlighted Provisions:
This bill:
▸ defines terms;
▸ amends the Medical Assistance Act regarding reimbursement for telemedicine
services;
▸ amends the Insurance Code to require insurer transparency regarding telehealth
reimbursement;
▸ amends the Public Employees' Benefit and Insurance Program Act (PEHP)
regarding reimbursement for telemedicine services;
▸ requires the Department of Health and PEHP to report to a legislative interim
committee and a task force regarding telehealth services;
▸ requires a legislative study; 
Ŝ→ 
and
 ←Ŝ
▸ describes responsibilities of a provider offering telehealth services 
Ŝ→ [
; and
] ←Ŝ
Ŝ→ 
.
24a 
 ←Ŝ
Ŝ→ [
 ▸ amends the Electronic Prescribing Act to restrict certain prescriptions in
conjunction with telehealth services.
] ←Ŝ
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
AMENDS:
26-18-13
, as enacted by Laws of Utah 2008, Chapter 41
31A-22-613.5
, as last amended by Laws of Utah 2015, Chapters 257 and 283
Ŝ→ [
58-82-201
, as last amended by Laws of Utah 2012, Chapter 160
] ←Ŝ
ENACTS:
26-18-13.5
, Utah Code Annotated 1953
26-59-101
, Utah Code Annotated 1953
26-59-102
, Utah Code Annotated 1953
26-59-103
, Utah Code Annotated 1953
26-59-104
, Utah Code Annotated 1953
26-59-105
, Utah Code Annotated 1953
49-20-414
, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
26-18-13
 is amended to read:
26-18-13.
Telemedicine -- Reimbursement -- Rulemaking.
(1) (a) [
On or after July 1, 2008,
] 
As used in this section,
 communication by
telemedicine is considered [
face to face
] 
face-to-face
 contact between a health care provider
and a patient under the state's medical assistance program if:
(i) the communication by telemedicine meets the requirements of administrative rules
adopted in accordance with Subsection (3); and
(ii) the health care services are eligible for reimbursement under the state's medical
assistance program.
(b) This Subsection (1) applies to any managed care organization that contracts with
the state's medical assistance program.
(2) The reimbursement rate for telemedicine services approved under this section:
(a) shall be subject to reimbursement policies set by the state plan; and
(b) may be based on:
(i) a monthly reimbursement rate;
(ii) a daily reimbursement rate; or
(iii) an encounter rate.
(3) The department shall adopt administrative rules in accordance with Title 63G,
Chapter 3, Utah Administrative Rulemaking Act, which establish:
(a) the particular telemedicine services that are considered [
face to face
] 
face-to-face
encounters for reimbursement purposes under the state's medical assistance program; and
(b) the reimbursement methodology for the telemedicine services designated under
Subsection (3)(a).
Section 2. Section 
26-18-13.5
 is enacted to read:
 26-18-13.5.
Mental health telemedicine services -- Reimbursement -- Reporting.
(1) As used in this section:
(a) "Mental health therapy" means the same as the term "practice of mental health
therapy" is defined in Section 
58-60-102
.
(b) "Mental illness" means a mental or emotional condition defined in an approved
diagnostic and statistical manual for mental disorders generally recognized in the professions of
mental health therapy listed in Section 
58-60-102
.
(c) "Telehealth services" means the same as that term is defined in Section 
26-59-102
.
(d) "Telemedicine services" means the same as that term is defined in Section
26-59-102
.
(2) This section applies to:
(a) a managed care organization that contracts with the Medicaid program; and
(b) a provider who is reimbursed for health care services under the Medicaid program.
(3) The Medicaid program shall reimburse for personal mental health therapy office
visits provided through telemedicine services at a rate set by the Medicaid program.
(4) Before December 1, 2017, the department shall report to the Legislature's Public
Utilities, Energy, and Technology Interim Committee and Health Reform Task Force on:
(a) the result of the reimbursement requirement described in Subsection (3);
(b) existing and potential uses of telehealth and telemedicine services;
(c) issues of reimbursement to a provider offering telehealth and telemedicine services;
(d) potential rules or legislation related to:
(i) providers offering and insurers reimbursing for telehealth and telemedicine services;
and
(ii) increasing access to health care, increasing the efficiency of health care, and
decreasing the costs of health care; and
(e) the department's efforts to obtain a waiver from the federal requirement that
telemedicine communication be face-to-face communication.
Section 3. Section 
26-59-101
 is enacted to read:
CHAPTER 59. TELEHEALTH ACT
 26-59-101.
Title.
This chapter is known as the "Telehealth Act."
Section 4. Section 
26-59-102
 is enacted to read:
 26-59-102.
Definitions.
As used in this chapter:
(1) "Asynchronous store and forward transfer" means the transmission of a patient's
health care information from an originating site to a provider at a distant site
Ŝ→ [
over a secure
connection that complies with state and federal security and privacy laws
] ←Ŝ
.
(2) "Distant site" means the physical location of a provider delivering telemedicine
services.
(3) "Originating site" means the physical location of a patient receiving telemedicine
services.
(4) "Patient" means an individual seeking telemedicine services.
(5) "Provider" means an individual who is:
(a) licensed under Title 26, Chapter 21, Health Care Facility Licensing and Inspection
Act;
(b) licensed under Title 58, Occupations and Professions, to provide health care; or
(c) licensed under Title 62A, Chapter 2, Licensure of Programs and Facilities.
(6) "Synchronous interaction" means real-time communication through interactive
technology that enables a provider at a distant site and a patient at an originating site to interact
simultaneously through two-way audio and video transmission.
(7) "Telehealth services" means the transmission of health-related services or
information through the use of electronic communication or information technology.
(8) "Telemedicine services" means telehealth services:
(a) including:
(i) clinical care;
(ii) health education;
(iii) health administration;
(iv) home health; or
(v) facilitation of self-managed care and caregiver support; and
(b) provided by a provider to a patient through a method of communication that:
(i) (A) uses asynchronous store and forward transfer; or
(B) uses synchronous interaction; and
(ii) meets industry security and privacy standards, including compliance with:
(A) the federal Health Insurance Portability and Accountability Act of 1996, Pub. L.
No. 104-191, 110 Stat. 1936, as amended; and
(B) the federal Health Information Technology for Economic and Clinical Health Act,
Pub. L. No. 111-5, 123 Stat. 226, 467, as amended.
Section 5. Section 
26-59-103
 is enacted to read:
 26-59-103.
Scope of telehealth practice.
(1) A provider offering telehealth services shall:
(a) at all times:
(i) act within the scope of the provider's license under Title 58, Occupations and
Professions, in accordance with the provisions of this chapter and all other applicable laws and
rules; and
(ii) be held to the same standards of practice as those applicable in traditional health
care settings;
(b) in accordance with Title 58, Chapter 82, Electronic Prescribing Act, before
providing treatment or prescribing a prescription drug, establish a diagnosis and identify
underlying conditions and contraindications to a recommended treatment after:
(i) obtaining from the patient or another provider the patient's relevant clinical history;
and
(ii) documenting the patient's relevant clinical history and current symptoms;
(c) be available to a patient who receives telehealth services from the provider for
subsequent care related to the initial telemedicine services, in accordance with community
standards of practice;
(d) be familiar with available medical resources, including emergency resources near
the originating site, in order to make appropriate patient referrals when medically indicated;
and
(e) in accordance with any applicable state and federal laws, rules, and regulations,
generate, maintain, and make available to each patient receiving telehealth services the patient's
medical records.
(2) A provider may not offer telehealth services if:
(a) the provider is not in compliance with applicable laws, rules, and regulations
regarding the provider's licensed practice; or
(b) the provider's license under Title 58, Occupations and Professions, is not active and
in good standing.
Section 6. Section 
26-59-104
 is enacted to read:
 26-59-104.
Enforcement.
(1) The Division of Occupational and Professional Licensing created in Section
58-1-103
 is authorized to enforce the provisions of Section 
26-59-103
 as it relates to providers
licensed under Title 58, Occupations and Professions.
(2) The department is authorized to enforce the provisions of Section 
26-59-103
 as it
relates to providers licensed under this title.
(3) The Department of Human Services created in Section 
62A-1-102
 is authorized to
enforce the provisions of Section 
26-59-103
 as it relates to providers licensed under Title 62A,
Chapter 2, Licensure of Programs and Facilities.
Section 7. Section 
26-59-105
 is enacted to read:
 26-59-105.
Study by Public Utilities, Energy, and Technology Interim Committee
and Health Reform Task Force.
The Legislature's Public Utilities, Energy, and Technology Interim Committee and
Health Reform Task Force shall receive the reports required in Sections 
26-18-13.5
 and
49-20-414
 and study:
(1) the result of the reimbursement requirement described in Sections 
26-18-13.5
 and
49-20-414
;
(2) practices and efforts of private health care facilities, health care providers,
self-funded employers, third-party payors, and health maintenance organizations to reimburse
for telehealth services;
(3) existing and potential uses of telehealth and telemedicine services;
(4) issues of reimbursement to a provider offering telehealth and telemedicine services;
and
(5) potential rules or legislation related to:
(a) providers offering and insurers reimbursing for telehealth and telemedicine
services; and
(b) increasing access to health care, increasing the efficiency of health care, and
decreasing the costs of health care.
Section 8. Section 
31A-22-613.5
 is amended to read:
31A-22-613.5.
Price and value comparisons of health insurance.
(1) (a) This section applies to all health benefit plans.
(b) Subsection (2) applies to:
(i) all health benefit plans; and
(ii) coverage offered to state employees under Subsection 
49-20-202
(1)(a).
(2) (a) The commissioner shall promote informed consumer behavior and responsible
health benefit plans by requiring an insurer issuing a health benefit plan to:
(i) provide to all enrollees, prior to enrollment in the health benefit plan
,
 written
disclosure of:
(A) restrictions or limitations on prescription drugs and biologics including:
(I) the use of a formulary;
(II) co-payments and deductibles for prescription drugs; and
(III) requirements for generic substitution;
(B) coverage limits under the plan;
(C) any limitation or exclusion of coverage including:
(I) a limitation or exclusion for a secondary medical condition related to a limitation or
exclusion from coverage; and
(II) easily understood examples of a limitation or exclusion of coverage for a secondary
medical condition; [
and
]
(D) whether the insurer permits an exchange of the adoption indemnity benefit in
Section 
31A-22-610.1
 for infertility treatments, in accordance with Subsection
31A-22-610.1
(1)(c)(ii) and the terms associated with the exchange of benefits; and
(E) whether the insurer provides coverage for telehealth services in accordance with
Section 
26-18-13.5
 and terms associated with that coverage; and
(ii) provide the commissioner with:
(A) the information described in Subsections 
31A-22-635
(5) through (7) in the
standardized electronic format required by Subsection 
63N-11-107
(1); and
(B) information regarding insurer transparency in accordance with Subsection (4).
(b) An insurer shall provide the disclosure required by Subsection (2)(a)(i) in writing to
the commissioner:
(i) upon commencement of operations in the state; and
(ii) anytime the insurer amends any of the following described in Subsection (2)(a)(i):
(A) treatment policies;
(B) practice standards;
(C) restrictions;
(D) coverage limits of the insurer's health benefit plan or health insurance policy; or
(E) limitations or exclusions of coverage including a limitation or exclusion for a
secondary medical condition related to a limitation or exclusion of the insurer's health
insurance plan.
(c) An insurer shall provide the enrollee with notice of an increase in costs for
prescription drug coverage due to a change in benefit design under Subsection (2)(a)(i)(A):
(i) either:
(A) in writing; or
(B) on the insurer's website; and
(ii) at least 30 days prior to the date of the implementation of the increase in cost, or as
soon as reasonably possible.
(d) If under Subsection (2)(a)(i)(A) a formulary is used, the insurer shall make
available to prospective enrollees and maintain evidence of the fact of the disclosure of:
(i) the drugs included;
(ii) the patented drugs not included;
(iii) any conditions that exist as a precedent to coverage; and
(iv) any exclusion from coverage for secondary medical conditions that may result
from the use of an excluded drug.
(e) (i) The commissioner shall develop examples of limitations or exclusions of a
secondary medical condition that an insurer may use under Subsection (2)(a)(i)(C).
(ii) Examples of a limitation or exclusion of coverage provided under Subsection
(2)(a)(i)(C) or otherwise are for illustrative purposes only, and the failure of a particular fact
situation to fall within the description of an example does not, by itself, support a finding of
coverage.
(3) The commissioner:
(a) shall forward the information submitted by an insurer under Subsection (2)(a)(ii) to
the Health Insurance Exchange created under Section 
63N-11-104
; and
(b) may request information from an insurer to verify the information submitted by the
insurer under this section.
(4) The commissioner shall:
(a) convene a group of insurers, a member representing the Public Employees' Benefit
and Insurance Program, consumers, and an organization that provides multipayer and
multiprovider quality assurance and data collection, to develop information for consumers to
compare health insurers and health benefit plans on the Health Insurance Exchange, which
shall include consideration of:
(i) the number and cost of an insurer's denied health claims;
(ii) the cost of denied claims that is transferred to providers;
(iii) the average out-of-pocket expenses incurred by participants in each health benefit
plan that is offered by an insurer in the Health Insurance Exchange;
(iv) the relative efficiency and quality of claims administration and other administrative
processes for each insurer offering plans in the Health Insurance Exchange; and
(v) consumer assessment of each insurer or health benefit plan;
(b) adopt an administrative rule that establishes:
(i) definition of terms;
(ii) the methodology for determining and comparing the insurer transparency
information;
(iii) the data, and format of the data, that an insurer shall submit to the commissioner in
order to facilitate the consumer comparison on the Health Insurance Exchange in accordance
with Section 
63N-11-107
; and
(iv) the dates on which the insurer shall submit the data to the commissioner in order
for the commissioner to transmit the data to the Health Insurance Exchange in accordance with
Section 
63N-11-107
; and
(c) implement the rules adopted under Subsection (4)(b) in a manner that protects the
business confidentiality of the insurer.
Section 9. Section 
49-20-414
 is enacted to read:
 49-20-414.
Mental health telemedicine services -- Reimbursement -- Reporting.
(1) As used in this section:
(a) "Mental health therapy" means the same as the term "practice of mental health
therapy" is defined in Section 
58-60-102
.
(b) "Mental illness" means the same as that term is defined in Section 
26-18-13.5
.
(c) "Network provider" means a health care provider who has an agreement with the
program to provide health care services to a patient with an expectation of receiving payment,
other than coinsurance, copayments, or deductibles, directly from the managed care
organization.
(d) "Telehealth services" means the same as that term is defined in Section 
26-59-102
.
(e) "Telemedicine services" means the same as that term is defined in Section
26-59-102
.
(2) This section applies to the risk pool established for the state under Subsection
49-20-201
(1)(a).
(3) The program shall reimburse a network provider for personal mental health therapy
office visits provided through telemedicine services at a rate set by the program.
(4) Before December 1, 2017, the program shall report to the Legislature's Public
Utilities, Energy, and Technology Interim Committee and Health Reform Task Force on:
(a) the result of the reimbursement requirement described in Subsection (3);
(b) existing and potential uses of telehealth and telemedicine services;
(c) issues of reimbursement to a provider offering telehealth and telemedicine services;
and
(d) potential rules or legislation related to:
(i) providers offering and insurers reimbursing for telehealth and telemedicine services;
and
(ii) increasing access to health care, increasing the efficiency of health care, and
decreasing the costs of health care.
Ŝ→ [
Section 10. 
Section 
58-82-201
 is amended to read:
58-82-201. Electronic prescriptions -- Restrictions -- Rulemaking authority.
(1) Subject to the provisions of this section, a practitioner shall:
(a) provide each existing patient of the practitioner with the option of participating in
electronic prescribing for prescriptions issued for the patient, if the practitioner prescribes a
drug or device for the patient on or after July 1, 2012; and
(b) offer the patient a choice regarding to which pharmacy the practitioner will issue
the electronic prescription.
(2) A practitioner may not issue a prescription through electronic prescribing for a
drug, device, or federal controlled substance that the practitioner is prohibited by federal law or
federal rule from issuing through electronic prescribing.
(3) A pharmacy shall:
(a) accept an electronic prescription that is transmitted in accordance with the
requirements of this section and division rules; and
(b) dispense a drug or device as directed in an electronic prescription described in
Subsection (3)(a).
(4) The division shall make rules to ensure that:
(a) except as provided in Subsection (6), practitioners and pharmacies comply with this
section;
(b) electronic prescribing is conducted in a secure manner, consistent with industry
standards; and
(c) each patient is fully informed of the patient's rights, restrictions, and obligations
pertaining to electronic prescribing.
(5) An entity that facilitates the electronic prescribing process under this section shall:
(a) transmit to the pharmacy the prescription for the drug prescribed by the prescribing
practitioner however, this Subsection (5)(a) does not prohibit the use of an electronic
intermediary if the electronic intermediary does not over-ride a patient's or prescriber's choice
of pharmacy;
(b) transmit only scientifically accurate, objective, and unbiased information to
prescribing practitioners; and
(c) allow a prescribing practitioner to electronically override a formulary or preferred
drug status when medically necessary.
(6) The division may, by rule, grant an exemption from the requirements of this section
to a pharmacy or a practitioner to the extent that the pharmacy or practitioner can establish, to
the satisfaction of the division, that compliance with the requirements of this section would
impose an extreme financial hardship on the pharmacy or practitioner.
Ŝ→ [
(7) A practitioner treating a patient through telehealth services, as described in Title 26,
Chapter 59, Telehealth Act, may not issue a prescription through electronic prescribing for a
drug or treatment to cause an abortion
] ←Ŝ 
Ŝ→ [
, except in cases of rape, incest, or if the life of the
mother would be endangered without an abortion
] ←Ŝ Ŝ→ [
.
] ←Ŝ
] ←Ŝ
Legislative Review Note
Office of Legislative Research and General Counsel