OLR Bill Analysis
AN ACT CONCERNING MEDICAID COVERAGE OF TELEMONITORING SERVICES.
This bill requires the Department of Social Services (DSS), to the extent federal law allows, to provide Medicaid coverage for home telemonitoring services performed by a home health care agency for a Medicaid beneficiary in certain circumstances or with certain heath conditions.
The bill (1) allows DSS to seek a waiver from federal Medicaid requirements or a Medicaid state plan amendment if needed to provide such coverage and (2) requires DSS to adopt regulations, in accordance with the Uniform Administrative Procedures Act, to implement the bill.
EFFECTIVE DATE: July 1, 2016
HOME TELEMONITORING SERVICE
The bill defines “home telemonitoring service” as a health service included in an integrated care plan written by a treating physician. The plan must require:
1. scheduled remote monitoring of a patient's health data, including blood pressure, heart rate, weight, and oxygen level;
2. a licensed home health care agency to interpret the transmitted data and send the data to a treating physician; and
3. health care professional to follow-up in the home or the treating physician to refer the patient for care as determined medically necessary.
The bill defines a “home health care agency” as a public or private organization, or such an organization's subdivision, that provides professional nursing services and certain other services 24 hours per day in the patient's home or a substantially equivalent environment. The agency must (1) provide professional nursing services and at least one additional service directly and all other services directly or through contract and (2) be available to enroll new patients seven days a week, 24 hours per day.
Under the bill, home telemonitoring services may be used for a Medicaid beneficiary with:
1. serious or chronic medical conditions that may result in frequent or recurrent hospitalizations and emergency room admissions;
2. a documented history of (a) poor adherence to ordered medication regimes, (b) falls in the six-month period before evaluation for the services, or (c) challenges with access to care;
3. limited or absent informal support systems; and
4. a history or living alone or being home alone for extended periods.
The bill requires DSS to establish coverage criteria for home telemonitoring services based on evidence-based best practices (i.e., the integration of the best available research with clinical expertise in the context of patient characteristics and preferences).
Data Sharing and Protection
Under the bill, DSS must ensure that the information the home health care agency gathers while providing home telemonitoring services is shared with the patient's physician. The bill allows the department to impose other reasonable requirements on the use of such services.
Additionally, the bill requires the transmission, storage, and dissemination of data and home telemonitoring records to comply with federal and state laws and regulations on privacy, security, confidentiality, and safeguarding of individually identifiable information. (The bill does not specify which entity is responsible for storing the data.)
SB 115, favorably reported by the Human Services Committee, allows DSS to provide coverage for telemonitoring services to Medicaid recipients in the Money Follows the Person federal demonstration program.