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ARIZONA HOUSE OF REPRESENTATIVESFifty-fifth Legislature First Regular Session |
House: HHS DPA 8-0-0-1 |
HB 2454: telehealth; health care providers; requirements
Sponsor: Representative Cobb, LD 5
Caucus & Cow
Overview
Requires, by January 1, 2021, all contracts issued by specified health insurers to provide coverage for health care services that are provided through telehealth. Adds the definition for telehealth and establishes the Telehealth Advisory Committee on Telehealth Best Practices (Committee).
History
A hospital, medical, dental and optometric service corporation (corporation) are corporations organized for the purpose of establishing, maintaining and operating nonprofit hospital, medical, dental and optometric service plans. The Corporation contracts with general, specialized or restricted practice optometrists to provide subscribers with hospital, medical, dental and optometric services (A.R.S. § 20-822).
A health care services organization (organization) is a person who administers one or more health care plans. An organization includes a provider sponsored health care services organization (A.R.S. § 20-1051).
Statute outlines the scope and format of a policy with a disability insurer, group disability insurer or a blanket disability insurer (disability insurers) (A.R.S. §§ 20-1342 and 20-1401).
Under current law, telemedicine is defined as the practice of health care delivery, diagnosis, consultation and treatment and the transfer of medical data through interactive audio, video or data communications that occur in the physical presence of the patient, including audio or video communications sent to a health care provider for diagnostic or treatment consultation (A.R.S § 36-3601).
Provisions
Health Insurers
1. Requires, by January 1, 2021, all contracts, evidences of coverage and policies issued by corporations, organizations and disability insurers to provide coverage for health care services that are provided through telehealth if the health care service would be covered were it through an in-person encounter. (Sec. 1-4)
2. Specifies that the following requirements apply to coverage of telehealth services:
a) A health insurer may not limit or deny coverage of health care services provided through telehealth, including ancillary services, except for procedures or service for which the weight of evidence, based on peer-reviewed clinical publications or research, recommends not be provided through telehealth;
b) A health insurer must reimburse health care providers (providers) at the same level of payment for equivalent services whether provided through telehealth or in-person care;
c) A health insurer can establish reasonable requirements and parameters for telehealth services, including documentation and recordkeeping, but these requirements must not be more restrictive or less favorable to providers or subscribers than are required for in-person health care services;
d) Telehealth services can be provided and must be covered regardless of where the subscriber is located or the type of site; and
e) Except in an emergency, the contract can limit the coverage to providers that are members of the health insurer's provider network. (Sec. 1-4)
3. States that services provided through telehealth or resulting from a telehealth encounter are subject to the following:
a) Arizona's laws governing prescribing, dispensing and administering prescription pharmaceuticals;
b) Arizona licensure requirements; and
c) Any practice guidelines established by the Committee, or if necessary due to lack of clear guidance, the practice guidelines of a national association of medical professionals. (Sec. 1-4)
4. Modifies the definition of telehealth to:
a) Include the use of an audio-only telephone encounter between a subscriber and a provider if an audio-visual telehealth encounter is not reasonably available due to the subscriber's preference, the functional status, lack of technology or telecommunications infrastructure limits; and
b) Exclude the use of a fax machine, instant messages that do not comply with the Health Insurance Portability and Accountability Act of 1996 (HIPPA), voicemail or email. (Sec. 1-4)
Workers' Compensation
5. Requires a request for a medical examination for an employee to fix a time and place with regard to whether the medical examination could be conducted through telehealth. (Sec. 5)
6. Allows a medical examination to be conducted via telehealth with the consent of both the employee and the requesting party. (Sec. 5)
Medical Professionals
7. Specifies that a licensed physician may conduct a physical or mental health status examination through telehealth with clinical evaluation that is appropriate for the patient and the condition for which the patient presents. (Sec. 6,7)
8. Stipulates that it is unprofessional conduct for a licensed pharmacist to knowingly dispense a drug on a prescription order from a diagnosis by mail or the internet unless the order was written pursuant to a physical or mental status examination conducted through telehealth. (Sec. 8)
Definitions
9. Modifies the definition of a provider by adding:
a) Nursing care institution administrators and assisted living facilities managers, midwives and hearing aid dispensers, audiologists and speech language pathologists; and
b) A licensed health care institution. (Sec. 14)
10. Repeals the definition of telemedicine. (Sec. 14)
11. Defines health care provider regulatory board or agency. (Sec. 14)
12. Defines telehealth as:
a) The interactive use of audio, video or other electronic media for the practice of health care, assessment, diagnosis, consultation or treatment and the transfer of medical data;
b) Including the use of an audio-only telephone encounter between the patient or client and provider if an audio-visual telehealth encounter is not reasonably available due to the patient's preference, functional status, lack of technology or telecommunication infrastructure limits; and
c) Not including the use of a fax machine, instant messages that are not compliant with HIPPA, voicemail or email. (Sec. 14)
Requirements for Providers
13. Requires a provider to make a good faith effort to use best practices in determining whether a health care service should be provided through telehealth instead of in person. (Sec. 18)
14. Instructs a provider to use clinical judgement based on best practices considering whether the nature of the services necessitates physical interventions and close observation and the circumstances of the patient, as outlined. (Sec. 18)
15. Requires a provider to make a good faith effort to use best practices in determining the communication medium of telehealth and, whenever reasonably practicable, the telehealth communication medium that allows the provider to most effectively assess, diagnose and treat the patient. (Sec. 18)
16. Allows a provider to use their clinical judgement to determine whether other technology is advisable and available in each circumstance if a patient does not have available access to technology or telecommunications infrastructure to support real-time audio or audio-visual telehealth. (Sec. 18)
17. Allows a provider who is not licensed in Arizona to provide telehealth services to an Arizona resident if the provider complies with the all of the following:
a) Holds a current, valid and unrestricted license to practice in another state and is not subject to any past or pending disciplinary proceeding;
b) Acts in full compliance with all applicable laws and rules, including scope of practice and telehealth requirements;
c) Complies with all existing requirements regarding maintaining liability insurance;
d) Consents to Arizona's jurisdiction for any litigation arising from providing telehealth; and
e) Follows Arizona's community of care standards. (Sec. 18)
18. Stipulates that a provider who fails to comply with the applicable laws and rules of Arizona is subject to investigation and disciplinary action by the applicable regulatory board or agency, which may include revoking the provider's practice privileges and referring the matter to the appropriate licensing authority. (Sec. 18)
19.
Stipulates that the
venue for any action arising from a violation of the above-mentioned provisions
is the patient's county of residence in Arizona.
(Sec. 18)
Committee
20. Establishes the Committee consisting of specified health care professionals who are appointed by the Governor. (Sec. 18)
21. Requires the Committee to:
a) Review national and other standards for telehealth best practices and relevant peer-reviewed literature;
b) Conduct public meetings at which testimony may be taken regarding the efficacy of various communication mediums and the types of services and populations for which telehealth is appropriate;
c) By September 1, 2021, submit a report to the Governor and Legislature with recommendations, including best practice guidelines for telehealth use by providers; and
d) Update the Committee's best practice guidelines when applicable. (Sec. 18)
22. Terminates the Committee on July 1, 2029. (Sec. 18)
Miscellaneous
23. Stipulates that a health care provider regulatory board or agency may not enforce any statute, rule or policy that would require a licensed provider who is authorized to write prescriptions to require an in-person examination of the patient before issuing a prescription. (Sec. 15)
24. Specifies that a physical or mental health status examination may be conducted during a real-time telehealth encounter. (Sec. 15)
25. Removes the term telemedicine and replaces it with telehealth throughout various sections of statute. (1-4, 6-10, 12, 15-17, 19, 20)
26. Changes the heading of Title 36, Chapter 36 from telemedicine to telehealth. (Sec. 13)
27. Makes technical and conforming changes. (Sec. 1-20)
28. Contains a retroactivity clause of January 1, 2021. (Sec. 21)
29. Contains an emergency clause. (Sec. 22)
Amendments
Committee on Health and Human Services
1. Specifies that all contracts in this state issued by specified health insurers must provide coverage for health care services that are provided through telehealth.
2. Stipulates that specified health insurers must reimburse providers at the same level of payment for equivalent services as identified by the diagnostic and procedure codes provided through telehealth or in person unless the telehealth encounter is provided through a platform sponsored or provided by the corporation.
3. Requires providers to have access at the time of the visit to relevant medical records and inform the subscriber before the visit if there is a charge for the telehealth encounter.
4. Modifies the definition of telehealth by:
a) Including the use of an audio-only telephone encounter between a subscriber and a provider who has an existing relationship if the telehealth encounter is initiated at the request of the subscriber or authorized by the subscriber before the telehealth encounter; and
b) Removing HIPPA compliant instant messages.
5. Adds members to the Committee.
6. Removes the retroactivity clause.
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HB 2454
Initials EB Page 0 Caucus & COW
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