HOUSE BILL 171

51st legislature - STATE OF NEW MEXICO - first session, 2013

INTRODUCED BY

Stephen Easley

AN ACT

RELATING TO HEALTH CARE COVERAGE; ENACTING SECTIONS OF THE HEALTH CARE PURCHASING ACT, THE NEW MEXICO INSURANCE CODE, THE HEALTH MAINTENANCE ORGANIZATION LAW AND THE NONPROFIT HEALTH CARE PLAN LAW TO REQUIRE COVERAGE FOR TELEMEDICINE SERVICES; PROVIDING FOR UTILIZATION REVIEW AND APPEAL RIGHTS FOR DENIALS OF TELEMEDICINE COVERAGE.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF NEW MEXICO:

     SECTION 1. A new section of the Health Care Purchasing Act is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR TELEMEDICINE SERVICES.--

          A. Group health coverage, including any form of self-insurance, offered, issued or renewed under the Health Care Purchasing Act shall include coverage of telemedicine services.

          B. A determination by a group health plan that health care services delivered through the use of interactive audio, video or other telecommunications technology are not covered under the plan shall be subject to utilization review and administrative review of adverse utilization review decisions.

          C. The provisions of this section shall not apply in the event that federal law requires the state to make payments on behalf of enrollees to cover the costs of implementing this section.

          D. Nothing in this section shall require a health care provider to be physically present with a patient at the originating site unless the consulting telemedicine provider deems it necessary.

          E. As used in this section:

                (1) "consulting telemedicine provider" means a health care provider that delivers telemedicine services from a location remote from an originating site;

                (2) "health care provider" means a person that is licensed, certified or otherwise authorized by law to deliver health care within the regular course of business and that is working within the person's scope of practice;

                (3) "in real time" means occurring simultaneously, instantaneously or within seconds of an event so that there is little or no noticeable delay between two or more events;

                (4) "originating site" means a place at which a patient is physically located and receiving health care services via telemedicine;

                (5) "store-and-forward technology" means electronic information, imaging and communication, including interactive audio, video and data communications, that is transferred or recorded or otherwise stored for asynchronous use; and

                (6) "telemedicine" means the use of interactive audio, video or other telecommunications technology by a health care provider to deliver health care services at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient in real time or through the use of store-and-forward technology."

     SECTION 2. A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR TELEMEDICINE SERVICES.--

          A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall include coverage of telemedicine services.

          B. A determination by an insurer that health care services delivered through the use of interactive audio, video or other telecommunications technology are not covered under the plan shall be subject to utilization review and appeal pursuant to Chapter 59A, Article 4 NMSA 1978.

          C. The provisions of this section shall not apply in the event that federal law requires the state to make payments on behalf of enrollees to cover the costs of implementing this section.

          D. Nothing in this section shall require a health care provider to be physically present with a patient at the originating site unless the consulting telemedicine provider deems it necessary.

          E. As used in this section:

                (1) "consulting telemedicine provider" means a health care provider that delivers telemedicine services from a location remote from an originating site;

                (2) "health care provider" means a person that is licensed, certified or otherwise authorized by law to deliver health care within the regular course of business and that is working within the person's scope of practice;

                (3) "in real time" means occurring simultaneously, instantaneously or within seconds of an event so that there is little or no noticeable delay between two or more events;

                (4) "originating site" means a place at which a patient is physically located and receiving health care services via telemedicine;

                (5) "store-and-forward technology" means electronic information, imaging and communication, including interactive audio, video and data communication, that is transferred or recorded or otherwise stored for asynchronous use; and

                (6) "telemedicine" means the use of interactive audio, video or other telecommunications technology by a health care provider to deliver health care services at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient in real time or through the use of store-and-forward technology."

     SECTION 3. A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR TELEMEDICINE SERVICES.--

          A. A blanket or group health insurance policy or contract that is delivered, issued for delivery or renewed in this state shall include coverage of telemedicine services.

          B. A determination by an insurer that health care services delivered through the use of interactive audio, video or other telecommunications technology are not covered under the plan shall be subject to utilization review and appeal pursuant to Chapter 59A, Article 4 NMSA 1978.

          C. The provisions of this section shall not apply in the event that federal law requires the state to make payments on behalf of enrollees to cover the costs of implementing this section.

          D. Nothing in this section shall require a health care provider to be physically present with a patient at the originating site unless the consulting telemedicine provider deems it necessary.

          E. As used in this section:

                (1) "consulting telemedicine provider" means a health care provider that delivers telemedicine services from a location remote from an originating site;

                (2) "health care provider" means a person that is licensed, certified or otherwise authorized by law to deliver health care within the regular course of business and that is working within the person's scope of practice;

                (3) "in real time" means occurring simultaneously, instantaneously or within seconds of an event so that there is little or no noticeable delay between two or more events;

                (4) "originating site" means a place at which a patient is physically located and receiving health care services via telemedicine;

                (5) "store-and-forward technology" means electronic information, imaging and communication, including interactive audio, video and data communication, that is transferred or recorded or otherwise stored for asynchronous use; and

                (6) "telemedicine" means the use of interactive audio, video or other telecommunications technology by a health care provider to deliver health care services at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient in real time or through the use of store-and-forward technology."

     SECTION 4. A new section of the Health Maintenance Organization Law is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR TELEMEDICINE SERVICES.--

          A. An individual or group health maintenance organization contract that is delivered, issued for delivery or renewed in this state shall include coverage of telemedicine services.

          B. A determination by a health maintenance organization that health care services delivered through the use of interactive audio, video or other telecommunications technology are not covered under the plan shall be subject to utilization review and appeal pursuant to Chapter 59A, Article 4 NMSA 1978.

          C. The provisions of this section shall not apply in the event that federal law requires the state to make payments on behalf of enrollees to cover the costs of implementing this section.

          D. Nothing in this section shall require a health care provider to be physically present with a patient at the originating site unless the consulting telemedicine provider deems it necessary.

          E. As used in this section:

                (1) "consulting telemedicine provider" means a health care provider that delivers telemedicine services from a location remote from an originating site;

                (2) "in real time" means occurring simultaneously, instantaneously or within seconds of an event so that there is little or no noticeable delay between two or more events;

                (3) "originating site" means a place at which a patient is physically located and receiving health care services via telemedicine;

                (4) "store-and-forward technology" means electronic information, imaging and communication, including interactive audio, video and data communication, that is transferred or recorded or otherwise stored for asynchronous use; and

                (5) "telemedicine" means the use of interactive audio, video or other telecommunications technology by a health care provider to deliver health care services within that provider's scope of practice at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient in real time or through the use of store-and-forward technology."

     SECTION 5. A new section of Chapter 59A, Article 47 NMSA 1978 is enacted to read:

     "[NEW MATERIAL] COVERAGE FOR TELEMEDICINE SERVICES.--

          A. An individual or group health insurance policy, health care plan or certificate of health insurance delivered or issued for delivery in this state shall include coverage of telemedicine services.

          B. A determination by a nonprofit health plan that health care services delivered through the use of interactive audio, video or other telecommunications technology are not covered under the plan shall be subject to utilization review and appeal pursuant to Chapter 59A, Article 4 NMSA 1978.

          C. The provisions of this section shall not apply in the event that federal law requires the state to make payments on behalf of enrollees to cover the costs of implementing this section.

          D. Nothing in this section shall require a health care provider to be physically present with a patient at the originating site unless the consulting telemedicine provider deems it necessary.

          E. As used in this section:

                (1) "consulting telemedicine provider" means a health care provider that delivers telemedicine services from a location remote from an originating site;

                (2) "health care provider" means a person that is licensed, certified or otherwise authorized by law to deliver health care within the regular course of business and that is working within the person's scope of practice;

                (3) "in real time" means occurring simultaneously, instantaneously or within seconds of an event so that there is little or no noticeable delay between two or more events;

                (4) "originating site" means a place at which a patient is physically located and receiving health care services via telemedicine;

                (5) "store-and-forward technology" means electronic information, imaging and communication, including interactive audio, video and data communication, that is transferred or recorded or otherwise stored for asynchronous use; and

                (6) "telemedicine" means the use of interactive audio, video or other telecommunications technology by a health care provider to deliver health care services at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient in real time or through the use of store-and-forward technology."

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