SB 6399 — Concerning telemedicine payment parity.

S-4647.1SUBSTITUTES-3573.1SENATE SENATE BILL 6399State of Washington65th Legislature2018 Regular SessionBy Senate Health & Long Term Care (originally sponsored by Senators Becker, Cleveland, Rivers, Brown, Bailey, Fain, Kuderer, and Van De Wege)READWegeRead FIRSTfirst TIMEtime 02/02/18.AN01/15/18. ACT Relating to telemedicine payment parity;

andReferred creatingto newCommittee sections.BEon ITHealth ENACTED& BYLong THETerm LEGISLATURECare.AN OFACT THERelating STATEto OF WASHINGTON:NEW SECTION.  Sec. 1.  The legislature understands that telemedicine ispayment anparity; evolving field, and that there are variances between federal and state programs in how services are paid.

amending RCW 48.43.735, 41.05.700, and 74.09.325;

adding a new section to chapter 43.41 RCW;

adding a new section to chapter 43.70 RCW;

adding a new section to chapter 48.43 RCW;

adding a new section to chapter 74.09 RCW;

adding a new section to chapter 41.05 RCW;

creating new sections;

and providing an expiration date.BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:NEW SECTION.  Sec. 1.  The legislature understands that telemedicine is an evolving field, and that there are variances between federal and state programs in how services are paid.

Telemedicine provides increasingly cohesive care in the areas of telestroke, diabetes, mental health, stroke,dermatology, chronic pain, and opioidmore. dependence treatment.

The legislature intends to provide servicesservices, including preventive, follow-up, and lifesaving treatments by utilizing telemedicine, and to improve outcomes for patients.patients.NEW SECTION.  Sec. 2.  A new section is added to chapter 43.41 RCW to read as follows:(1) The office shall establish a telemedicine payment parity pilot program to provide parity in reimbursement for certain health care services.

The legislatureduration intendsof tothe utilizepilot recommendationsprogram fromwill thebe telemedicinefive collaborativeyears, beginning January 1, 2019, and ending December 31, 2023.(2) For health plans issued or renewed on or after January 1, 2019, health carriers subject to establishthe arequirements telemedicinein paymentRCW parity48.43.735, pilothealth programplans offered to evaluateemployees and their covered dependents subject to the benefitsrequirements of telemedicine.NEWRCW SECTION.  Sec. 2.  (1)(a)41.05.700, Theand collaborativemanaged shallhealth reviewcare systems subject to the conceptrequirements of telemedicineRCW payment74.09.325 parityshall andreimburse developa recommendationsprovider onfor reimbursingthe forfollowing health care services provided to a covered person through telemedicine and store and forward technologytechnology, at the same rate as if the health care service werewas provided in person by the provider, forand treatmentconsistent of:(i)with Diabetesthe mellitus;(ii)requirements Stroke;(iii)in MentalRCW health48.43.735(1), conditions;(iv)41.05.700(1), Opioidand dependence;74.09.325(1):(a) Diabetes;(b) Telestroke;(c) Telepsychology;

and(v)and(d) ChronicTreatment pain.(b)for opioid use disorder.(3) The collaborativeonly shallservices includeusing intelemedicine itsand recommendations,store aand reviewforward technology that may be considered for the purposes of variousthis reimbursementpilot methodologies,program andare shallservices considerprovided whetherthrough andconventional tocontracting whatby extentcarriers.(4) facilityThe feesreimbursement shouldrequirements befor reimbursedservices listed in this section expire December 31, 2023.(5) In the provisionevent a twenty percent or greater savings has been achieved for the four conditions listed in subsection (2)(a) through (d) of this section, all services provided utilizing telemedicine services.(c)and Thestore collaborativeand forward technology shall includebe paid, beginning January 1, 2024, at the same rate as services delivered in itsperson.Sec. 3.  RCW recommendations,48.43.735 parametersand for2017 ac three219 s 1 are each amended to five-yearread telemedicineas paymentfollows:(1) parityFor pilothealth program,plans utilizingissued aor recommendedrenewed paymenton parityor andafter facilityJanuary fee1, reimbursement2017, methodologya health carrier shall reimburse a provider for reimbursinga serviceshealth utilizedcare service provided to treata covered person through telemedicine or store and forward technology if:(a) The plan provides coverage of the fivehealth conditionscare listedservice when provided in subsectionperson (1)(a)by the provider;(b) The health care service is medically necessary;(c) The health care service is a service recognized as an essential health benefit under section 1302(b) of thisthe section.federal patient protection and affordable care act in effect on January 1, 2015;

and(d) The pilothealth programcare parametersservice mustis outlinedetermined proceduresto forbe thesafely collaborative,and ineffectively conjunctionprovided withthrough thetelemedicine officeor ofstore financialand management,forward totechnology analyzeaccording claimsto datagenerally inaccepted the all-payer health care claimspractices databaseand tostandards, determineand ifthe anytechnology savingsused orto increasedprovide telemedicinethe orhealth storecare andservice forwardmeets utilization are realized through the pilotstandards program.(d)required Theby collaborativestate shalland alsofederal includelaws ingoverning itsthe recommendations,privacy theand designsecurity of aprotected traininghealth programinformation.(2) toFor teach health careplans professionalsissued aboutor telemedicinerenewed andon properor billingafter methodologies.(2)January By1, December2019, 1,a 2018,health andcarrier inshall compliancecomply with RCW 43.01.036, the collaborativerequirements mustof report its recommendations, including the parameters for a telemedicine payment parity pilot program,program tocreated thein healthsection care2 committees of thethis legislature.(3)act.(3)(a) ForIf purposesthe ofservice thisis section,provided "thethrough collaborative"store meansand theforward collaborativetechnology forthere themust advancementbe ofan telemedicineassociated createdoffice byvisit sectionbetween 2,the chaptercovered 68,person Lawsand ofthe 2016.---referring ENDhealth ---care provider.

Nothing in this section prohibits the use of telemedicine for the associated office visit.(b) For purposes of this section, reimbursement of store and forward technology is available only for those covered services specified in the negotiated agreement between the health carrier and the health care provider.(((3))) (4) An originating site for a telemedicine health care service subject to subsection (1) of this section includes a:(a) Hospital;(b) Rural health clinic;(c) Federally qualified health center;(d) Physician's or other health care provider's office;(e) Community mental health center;(f) Skilled nursing facility;(g) Home or any location determined by the individual receiving the service;

or(h) Renal dialysis center, except an independent renal dialysis center.(((4) Except for subsection (3)(g) of this section, any originating site under subsection (3) of this section may charge a facility fee for infrastructure and preparation of the patient.

Reimbursement must be subject to a negotiated agreement between the originating site and the health carrier.

A distant site or any other site not identified in subsection (3) of this section may not charge a facility fee.))(5) No hospital facility fees may be charged when providing services utilizing telemedicine and store and forward technology for services provided for the four conditions listed in section 2(2) (a) through (d) of this act.

The originating site provider shall be reimbursed at the contracted rate in the same way as the provider would be reimbursed for an in-person visit.(6) A health carrier may not distinguish between originating sites that are rural and urban in providing the coverage required in subsection (1) of this section.(((6))) (7) A health carrier may subject coverage of a telemedicine or store and forward technology health service under subsection (1) of this section to all terms and conditions of the plan in which the covered person is enrolled including, but not limited to, utilization review, prior authorization, deductible, copayment, or coinsurance requirements that are applicable to coverage of a comparable health care service provided in person.(((7))) (8) This section does not require a health carrier to reimburse:(a) An originating site for professional fees;(b) A provider for a health care service that is not a covered benefit under the plan;

((or))(c) An originating site or health care provider when the site or provider is not a contracted provider under the plan;

or(d) A provider who has not completed the required training as established in section 7 of this act.(((8))) (9) For purposes of this section:(a) "Distant site" means the site at which a physician or other licensed provider, delivering a professional service, is physically located at the time the service is provided through telemedicine;(b) "Health care service" has the same meaning as in RCW 48.43.005;(c) "Hospital" means a facility licensed under chapter 70.41, 71.12, or 72.23 RCW;(d) "Originating site" means the physical location of a patient receiving health care services through telemedicine;(e) "Provider" has the same meaning as in RCW 48.43.005;(f) "Store and forward technology" means use of an asynchronous transmission of a covered person's medical information from an originating site to the health care provider at a distant site which results in medical diagnosis and management of the covered person, and does not include the use of audio-only telephone, facsimile, or email;

and(g) "Telemedicine" means the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.

For purposes of this section only, "telemedicine" does not include the use of audio-only telephone, facsimile, or email.Sec. 4.  RCW 41.05.700 and 2017 c 219 s 2 are each amended to read as follows:(1) A health plan offered to employees and their covered dependents under this chapter issued or renewed on or after January 1, 2017, shall reimburse a provider for a health care service provided to a covered person through telemedicine or store and forward technology if:(a) The plan provides coverage of the health care service when provided in person by the provider;(b) The health care service is medically necessary;(c) The health care service is a service recognized as an essential health benefit under section 1302(b) of the federal patient protection and affordable care act in effect on January 1, 2015;

and(d) The health care service is determined to be safely and effectively provided through telemedicine or store and forward technology according to generally accepted health care practices and standards, and the technology used to provide the health care service meets the standards required by state and federal laws governing the privacy and security of protected health information.(2) For health plans issued or renewed on or after January 1, 2019, a health plan offered to employees and their covered dependents under this chapter shall comply with the requirements of the telemedicine payment parity pilot program created in section 2 of this act.(3)(a) If the service is provided through store and forward technology there must be an associated office visit between the covered person and the referring health care provider.

Nothing in this section prohibits the use of telemedicine for the associated office visit.(b) For purposes of this section, reimbursement of store and forward technology is available only for those covered services specified in the negotiated agreement between the health plan and health care provider.(((3))) (4) An originating site for a telemedicine health care service subject to subsection (1) of this section includes a:(a) Hospital;(b) Rural health clinic;(c) Federally qualified health center;(d) Physician's or other health care provider's office;(e) Community mental health center;(f) Skilled nursing facility;(g) Home or any location determined by the individual receiving the service;

or(h) Renal dialysis center, except an independent renal dialysis center.(((4) Except for subsection (3)(g) of this section, any originating site under subsection (3) of this section may charge a facility fee for infrastructure and preparation of the patient.

Reimbursement must be subject to a negotiated agreement between the originating site and the health plan.

A distant site or any other site not identified in subsection (3) of this section may not charge a facility fee.))(5) No hospital facility fees may be charged when providing services utilizing telemedicine and store and forward technology for services provided for the four conditions listed in section 2(2) (a) through (d) of this act.

The originating site provider shall be reimbursed at the contracted rate in the same way as the provider would be reimbursed for an in-person visit.(6) The plan may not distinguish between originating sites that are rural and urban in providing the coverage required in subsection (1) of this section.(((6))) (7) The plan may subject coverage of a telemedicine or store and forward technology health service under subsection (1) of this section to all terms and conditions of the plan including, but not limited to, utilization review, prior authorization, deductible, copayment, or coinsurance requirements that are applicable to coverage of a comparable health care service provided in person.(((7))) (8) This section does not require the plan to reimburse:(a) An originating site for professional fees;(b) A provider for a health care service that is not a covered benefit under the plan;

((or))(c) An originating site or health care provider when the site or provider is not a contracted provider under the plan;

or(d) A provider who has not completed the required training as established in section 7 of this act.(((8))) (9) For purposes of this section:(a) "Distant site" means the site at which a physician or other licensed provider, delivering a professional service, is physically located at the time the service is provided through telemedicine;(b) "Health care service" has the same meaning as in RCW 48.43.005;(c) "Hospital" means a facility licensed under chapter 70.41, 71.12, or 72.23 RCW;(d) "Originating site" means the physical location of a patient receiving health care services through telemedicine;(e) "Provider" has the same meaning as in RCW 48.43.005;(f) "Store and forward technology" means use of an asynchronous transmission of a covered person's medical information from an originating site to the health care provider at a distant site which results in medical diagnosis and management of the covered person, and does not include the use of audio-only telephone, facsimile, or email;

and(g) "Telemedicine" means the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.

For purposes of this section only, "telemedicine" does not include the use of audio-only telephone, facsimile, or email.Sec. 5.  RCW 74.09.325 and 2017 c 219 s 3 are each amended to read as follows:(1) Upon initiation or renewal of a contract with the Washington state health care authority to administer a medicaid managed care plan, a managed health care system shall reimburse a provider for a health care service provided to a covered person through telemedicine or store and forward technology if:(a) The medicaid managed care plan in which the covered person is enrolled provides coverage of the health care service when provided in person by the provider;(b) The health care service is medically necessary;(c) The health care service is a service recognized as an essential health benefit under section 1302(b) of the federal patient protection and affordable care act in effect on January 1, 2015;

and(d) The health care service is determined to be safely and effectively provided through telemedicine or store and forward technology according to generally accepted health care practices and standards, and the technology used to provide the health care service meets the standards required by state and federal laws governing the privacy and security of protected health information.(2) For medicaid managed care plans issued or renewed on or after January 1, 2019, a managed health care system shall comply with the requirements of the telemedicine payment parity pilot program created in section 2 of this act.(3)(a) If the service is provided through store and forward technology there must be an associated visit between the covered person and the referring health care provider.

Nothing in this section prohibits the use of telemedicine for the associated office visit.(b) For purposes of this section, reimbursement of store and forward technology is available only for those services specified in the negotiated agreement between the managed health care system and health care provider.(((3))) (4) An originating site for a telemedicine health care service subject to subsection (1) of this section includes a:(a) Hospital;(b) Rural health clinic;(c) Federally qualified health center;(d) Physician's or other health care provider's office;(e) Community mental health center;(f) Skilled nursing facility;(g) Home or any location determined by the individual receiving the service;

or(h) Renal dialysis center, except an independent renal dialysis center.(((4) Except for subsection (3)(g) of this section, any originating site under subsection (3) of this section may charge a facility fee for infrastructure and preparation of the patient.

Reimbursement must be subject to a negotiated agreement between the originating site and the managed health care system.

A distant site or any other site not identified in subsection (3) of this section may not charge a facility fee.))(5) No hospital facility fees may be charged when providing services utilizing telemedicine and store and forward technology for services provided for the four conditions listed in section 2(2) (a) through (d) of this act.

The originating site provider shall be reimbursed at the contracted rate in the same way as the provider would be reimbursed for an in-person visit.(6) A managed health care system may not distinguish between originating sites that are rural and urban in providing the coverage required in subsection (1) of this section.(((6))) (7) A managed health care system may subject coverage of a telemedicine or store and forward technology health service under subsection (1) of this section to all terms and conditions of the plan in which the covered person is enrolled including, but not limited to, utilization review, prior authorization, deductible, copayment, or coinsurance requirements that are applicable to coverage of a comparable health care service provided in person.(((7))) (8) This section does not require a managed health care system to reimburse:(a) An originating site for professional fees;(b) A provider for a health care service that is not a covered benefit under the plan;