PA 15-88—sSB 467

Public Health Committee

Insurance and Real Estate Committee

AN ACT CONCERNING THE FACILITATION OF TELEHEALTH

SUMMARY: This act establishes requirements for health care providers who provide medical services through the use of “telehealth” as defined below. Among other things, a telehealth provider must obtain a patient's informed consent, at the first telehealth interaction, to provide telehealth services.

The act also requires certain health insurance policies to cover medical services provided through telehealth to the extent that they cover the services through in-person visits between an insured person and a health care provider.

EFFECTIVE DATE: October 1, 2015, except for the insurance coverage provisions, which are effective January 1, 2016.

TELEHEALTH PROVIDER REQUIREMENTS

Definitions

The act defines a “telehealth provider” as any of the following who provides health care services through the use of telehealth within his or her scope of practice and in accordance with the profession's standard of care: a licensed physician, advanced practice registered nurse, physician assistant, occupational or physical therapist, naturopath, chiropractor, optometrist, podiatrist, psychologist, marital and family therapist, clinical or master social worker, alcohol and drug counselor, professional counselor, or certified dietitian-nutritionist.

It defines “telehealth” as delivering health care services through information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient's physical and mental health. It includes:

1. interaction between a patient at an originating site and the telehealth provider at a distant site and

2. synchronous (real-time) interactions, asynchronous store and forward transfers (transmitting medical information from the patient to the telehealth provider for review at a later time), or remote patient monitoring.

Telehealth does not include using fax, audio-only telephone, texting, or e-mail.

Requirements

Under the act, a telehealth provider can provide telehealth services to a patient only when the provider:

1. is communicating through real time, interactive, two-way communication technology or store and forward technologies;

2. has access to, or knowledge of, the patient's medical history, as provided by the patient, and the patient's health record, including the patient's primary care provider's name and address, if any;

3. gives the patient his or her provider license number and contact information; and

4. conforms to the standard of care for his or her profession and expected for in-person care as appropriate for the patient's age and presenting condition. But when the standard of care requires the use of diagnostic testing and a physical examination, the provider may perform the testing or examination though appropriate peripheral devices (i. e. , instruments he or she uses to examine a patient).

The act requires a telehealth provider, at his or her first telehealth interaction with a patient, to (1) inform the patient about the treatment methods and limitations of treating a person through telehealth and (2) obtain the patient's consent to provide telehealth services. The provider must document the notice and consent in the patient's health record.

Prohibitions

The act prohibits a telehealth provider from (1) prescribing schedule I, II, or III controlled substances through the use of telehealth or (2) charging a facility fee for telehealth services.

By law, a “facility fee” is any fee a hospital or health system charges or bills for outpatient hospital services provided in a hospital-based facility that is (1) intended to compensate the hospital or health system for its operational expenses and (2) separate and distinct from a professional fee, which is a fee charged or billed by a provider for professional medical services provided in a hospital-based facility.

Records and HIPAA Compliance

The act requires a telehealth provider, at each telehealth interaction with a patient, to obtain the patient's consent to provide records of the interaction to his or her primary care provider. If the patient consents, the records must be provided in a timely manner and in accordance with the standard access to health records law. Providers must maintain and disclose records of telehealth interactions and provide telehealth services in compliance with the federal Health Insurance Portability and Accountability Act (HIPAA).

Allowable Transactions

The act allows a licensed or certified health care provider to (1) provide on-call coverage for another provider, (2) consult with another provider about a patient's care, or (3) issue orders for hospital patients.

INSURANCE COVERAGE REQUIREMENTS

Coverage Required

The act requires certain health insurance policies to cover medical advice, diagnosis, care, or treatment provided through telehealth to the extent that they cover those services through in-person visits between an insured person and a health care provider. It subjects telehealth coverage to the same terms and conditions that apply to other benefits under the policy.

Under the act, insurers and related entities (e. g. , HMOs) may conduct utilization review for telehealth services in the same manner it is conducted for in-person services, including using the same clinical review criteria.

Prohibitions

The act prohibits health insurance policies from:

1. excluding coverage solely because a service is provided through telehealth, provided telehealth is appropriate for the service or

2. having to reimburse a treating or consulting health care provider for any technical fees or costs associated with providing telehealth services.

Applicability

The act applies to individual and group health insurance policies delivered, issued, renewed, amended, or continued in Connecticut that cover (1) basic hospital expenses; (2) basic medical-surgical expenses; (3) major medical expenses; or (4) hospital or medical services, including coverage provided to subscribers of a health care center (i. e. , HMO). Under the federal Employee Retirement Income Security Act (ERISA), state insurance benefit mandates do not apply to self-insured benefit plans.

OLR Tracking: ND: DC: PF: cmg