House committee substitute to the 2nd edition makes the following changes.
Eliminates subsections (b) through (i) of proposed GS 58-50-305, which set forth several requirements and limitations of health benefit plans concerning telehealth coverage. Now prohibits a health benefit plan from excluding from coverage a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telehealth service solely because the service or procedure is not provided through an in-person consultation (was, referred to services generally and more broadly prohibited exclusion from coverage on grounds that the services are not being provided through in-person consultation or in-person delivery of services). Adds that a health benefit plan can require a deductible, a copayment, or coinsurance for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telehealth service, but prohibits the amount from exceeding the same required for the covered health care service or procedure provided through an in-person consultation (previously required telehealth coverage and reimbursement to be equivalent to the coverage and reimbursement for the same service provided in person).
Summary date: May 6 2019 - View summary
Summary date: May 2 2019 - View summary
House committee substitute to the 1st edition makes the following changes. Deletes Part III of the act which provided funds for a telehealth infrastructure and equipment grants pilot program. Makes conforming changes.
Summary date: Apr 11 2019 - View summary
Requires the Department of Health and Human Services (DHHS) to ensure that Medicaid and NC Health Choice coverage of telemedicine and telepsychiatry services are consistent with this act and requires amending Clinical Coverage Policy No: 1H as necessary. Requires using the term "telehealth" instead of "telemedicine" in all clinical coverage policies. Defines telehealth for the purposes of Medicaid and NC Health Choice coverage, as the delivery of health care-related services by a Medicaid or NC Health Choice provider licensed in the State to a Medicaid or NC Health Choice recipient through one of the three specified types of communications and technologies. Specifies that telehealth does not include the delivery of services solely through electronic mail, text chat, or audio-communication unless either additional medical history and clinical information is communicated electronically between the provider and patient or the services delivered are behavioral health services. Specifies four actions that DHHS must take regarding Medicaid and NC Health Choice coverage of telehealth services, including promoting access to health care for Medicaid and NC Health Choice recipients through telehealth services. Prohibits DHHS from requiring seven specified items as a condition of coverage of telehealth services, including that a provider be part of a telehealth network in order to bill for Medicaid or NC Health Choice services, and that the Provider be physically present with the patient or client unless the provider determines it is medically necessary to perform the services in person. Requires DHHS to ensure that (1) Medicaid and NC Health Choice coverage and reimbursement for telehealth services are equivalent to the reimbursement and coverage for the same services if provided in person and (2) that any deductible, copayment, or coinsurance requirement is equivalent to the same service if it was provided to the patient in person. Requires DHHS to submit to the Centers for Medicare and Medicaid Services any waivers or amendments to the NC Medicaid State Plan necessary to implement the above provisions. Requires DHHS by September 1, 2020, to report on changes, expected costs, savings, and outcomes of telehealth services to the specified NCGA committee and division.
Enacts new GS 58-50-305 to require every health benefit plan offered by an insurer in this State to reimburse for covered services provided to an insured through telehealth (as defined in the statute). Requires coverage and reimbursement to be equivalent to the coverage and reimbursement for the same service provided in person. Prohibits an insurer from requiring a provider to be physically present with a patient or a client, unless the health care provider determines that it is necessary to perform the health care services in person; also prohibits requiring prior authorization, medical review, or administrative clearance for telehealth that would not be required if the service were provided in person. Prohibits a health benefit plan from excluding from coverage services provided via telehealth solely because the service is not provided in person. Sets out requirements for secure communications connections when telehealth delivery is used. Prohibits requiring a provider to be part of a telehealth network in order to participate in any health benefit plan. Makes a conforming change to GS 135-48.51 to make new GS 58-50-305 applicable to the State Health Plan.
All of the above provisions are effective October 1, 2019.
Appropriates $1 million in nonrecurring funds for the 2019-21 biennium from the General Fund to DHHS for a telehealth infrastructure and equipment grants project in the two counties with the poorest health outcomes. Requires funds to be distributed by October 1, 2020. Requires DHHS to report by November 1, 2020, to the specified NCGA committee on the expenditure of the funds.