File No. 355

House of Representatives, April 11, 2012

The Committee on Human Services reported through REP. TERCYAK of the 26th Dist., Chairperson of the Committee on the part of the House, that the substitute bill ought to pass.

AN ACT CONCERNING COVERAGE OF TELEMEDICINE SERVICES UNDER MEDICAID.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective January 1, 2013) (a) (1) As used in this section, "telemedicine" means the use of interactive audio, interactive video or interactive data communication in the delivery of medical advice, diagnosis, care or treatment, and includes the types of services described in subsection (d) of section 20-9 of the general statutes and 42 CFR 410.78(a)(3). "Telemedicine" does not include the use of facsimile or audio-only telephone.

(2) "Medically appropriate" means care that is (A) provided in a timely manner and meets professionally recognized standards of acceptable medical care; (B) delivered in the appropriate medical setting; and (C) the least costly of multiple, equally-effective alternative treatments or diagnostic modalities.

(b) The Commissioner of Social Services may establish a demonstration project to offer telemedicine as a Medicaid-covered service at federally-qualified community health centers.

(c) To the extent permitted by federal law, and where deemed medically appropriate, in-person contact between a health care provider and a patient shall not be required for health care services delivered by telemedicine that otherwise would be eligible for reimbursement under the state Medicaid plan.

(d) The Commissioner of Social Services, in consultation with the Commissioner of Public Health, shall adopt regulations, in accordance with the provisions of chapter 54 of the general statutes, establishing rates for cost reimbursement for telemedicine services provided to Medicaid recipients. The commissioners shall consider, to the extent applicable, reductions in travel costs by health care providers and patients to deliver or to access health care services and such other factors as the Commissioner of Social Services deems relevant.

(e) The Commissioner of Social Services may apply, if necessary, to the federal government for an amendment to the state Medicaid plan to cover telemedicine services.

(f) The transmission, storage and dissemination of data and records related to telemedicine services shall be in accordance with federal and state law and regulations concerning the privacy, security, confidentiality and safeguarding of individually identifiable information.

(g) Not later than January 1, 2014, the commissioner shall submit a report, in accordance with section 11-4a of the general statutes, on the demonstration project to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and human services. The report shall concern the services offered and the cost-effectiveness of the program.

The following Fiscal Impact Statement and Bill Analysis are prepared for the benefit of the members of the General Assembly, solely for purposes of information, summarization and explanation and do not represent the intent of the General Assembly or either chamber thereof for any purpose. In general, fiscal impacts are based upon a variety of informational sources, including the analyst's professional knowledge. Whenever applicable, agency data is consulted as part of the analysis, however final products do not necessarily reflect an assessment from any specific department.

OFA Fiscal Note

State Impact:

Note: GF=General Fund

Municipal Impact: None

Explanation

The bill permits the Department of Social Services (DSS) to establish a demonstration project to offer telemedicine services as a Medicaid-covered service at federally-qualified health centers. The bill may result in a cost to the DSS if a demonstration project is implemented. The cost of the project is indeterminate and would be dependent on yet to be established rates and program utilization. This service is not and has not been a Medicaid-covered service; therefore data on cost is not currently available.

The Out Years

The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.

OLR Bill Analysis

sHB 5483

AN ACT CONCERNING COVERAGE OF TELEMEDICINE SERVICES UNDER MEDICAID.

SUMMARY:

To the extent permitted by federal law, and where deemed medically appropriate, this bill permits Medicaid-covered health care services to be provided by telemedicine in place of in-person contact between a patient and health care provider. Under the bill, “telemedicine” means the use of interactive audio, video, or data communication in the delivery of medical advice, diagnosis, care, or treatment.

It includes the provision, through electronic communications or interstate commerce, of diagnostic or treatment services, including primary diagnosis of pathology specimens, slides or images, to any person located in this state as well as similar “telehealth” services approved by federal Medicare regulations.

Facsimile and audio-only telephone transmissions are excluded from the definition of telemedicine.

EFFECTIVE DATE: January 1, 2013

MEDICALLY APPROPRIATE

Under the bill, “medically appropriate” means care that is (1) provided in a timely manner and meets professionally recognized standards of acceptable medical care, (2) delivered in the appropriate medical setting, and (3) the least costly of multiple, equally-effective alternative treatments or diagnostic modalities.

FEDERAL APPROVAL

If necessary, the bill requires the DSS commissioner to apply to the federal Centers for Medicare and Medicaid Services (CMS) for a state plan amendment for Medicaid coverage and reimbursement for telemedicine services. By law, he must submit notice of the proposed amendment to the Human Services and Appropriations committees before submitting the application to CMS.

RATE-SETTING

The bill also requires the Department of Social Services (DSS) commissioner, in consultation with the Department of Public Health commissioner, to adopt Medicaid reimbursement rate regulations in conformity with the requirements of the Uniform Administrative Procedure Act. The commissioners must consider, to the extent applicable, reductions in travel costs by health care providers and patients to deliver or access health care services. The DSS commissioner may consider other factors he deems relevant.

PRIVACY PROTECTIONS

The bill subjects telemedicine transmission, storage, and dissemination of data and records to federal and state law and regulations governing the privacy, security, confidentiality, and safeguarding of individually identifiable information.

COMMITTEE ACTION

Human Services Committee

Joint Favorable Substitute