OLR Bill Analysis

sHB 5445

AN ACT CONCERNING MEDICAID COVERAGE OF TELEMONITORING SERVICES.

SUMMARY:

This bill requires the Department of Social Service (DSS), to the extent permitted under federal law, to provide Medicaid coverage for a Medicaid beneficiary with specified conditions for certain home telemonitoring services performed by a home health care agency.

The bill requires DSS to establish coverage criteria for home telemonitoring based on “evidence-based best practices,” which it defines as the integration of the best available research with clinical expertise in the context of the patient's characteristics and preferences.

DSS must ensure that clinical information a home health care agency gathers while providing home telemonitoring services is shared with the patient's treating physician. The transmission, storage, and dissemination of data and records related to telemonitoring services must comply with federal and state laws and regulations on the privacy, security, confidentiality, and safeguarding of individually identifiable information. The bill allows DSS to impose other reasonable requirements on the use of home telemonitoring services.

The bill (1) requires DSS to adopt implementing regulations and (2) allows DSS to seek a waiver from federal Medicaid requirements or an amendment to the Medicaid state plan if needed to implement its provisions.

EFFECTIVE DATE: July 1, 2014

ELIGIBLE BENEFICIARIES

Under the bill, a Medicaid beneficiary is eligible for the telemonitoring services if she or he has:

1. serious or chronic medical conditions that may result in frequent or recurrent hospitalizations and emergency room admissions,

2. a documented history of poor adherence to ordered medication regimes,

3. a documented history of falls in the six-month period prior to evaluation of the need for telemonitoring,

4. limited or no informal support systems,

5. a documented history of challenges with access to care, or

6. a history of living alone or being home alone for extended periods of time.

ELIGIBLE SERVICES

Under the bill, eligible “home telemonitoring services” are health services included in an integrated plan of care written by a treating physician that requires:

1. scheduled remote data monitoring related to a patient's health,

2. a licensed home health care agency to interpret this data,

3. the agency to disseminate the data to a treating physician, and

4. follow-up by a health care professional in the home or referrals for care as determined medically necessary by a treating physician.

Scheduled remote data monitoring may include monitoring a patient's blood pressure, heart rate, weight, and oxygen level.

COMMITTEE ACTION

Human Services Committee

Joint Favorable Substitute

Yea

17

Nay

0

(03/20/2014)