House of Representatives
File No. 559
February Session, 2012
(Reprint of File No. 355)
As Amended by House Amendment
Approved by the Legislative Commissioner
April 20, 2012
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) "Clinically 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. Under the demonstration project, 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 program, to the extent permitted by federal law and where deemed clinically appropriate.
(c) The Commissioner of Social Services may establish rates for cost reimbursement for telemedicine services provided to Medicaid recipients under the demonstration project. The commissioner 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.
(d) The Commissioner of Social Services may apply, if necessary, to the federal government for an amendment to the state Medicaid plan to establish the demonstration project.
(e) The transmission, storage and dissemination of data and records related to telemedicine services provided under the demonstration project shall be in accordance with federal and state law and regulations concerning the privacy, security, confidentiality and safeguarding of individually identifiable information.
(f) The commissioner shall submit a report, in accordance with section 11-4a of the general statutes, on any demonstration project established pursuant to this section 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
FY 13 $
FY 14 $
Social Services, Dept.
GF - Cost
Note: GF=General Fund
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.
House “A” made the following changes which do not result in a fiscal impact: 1) various technical and conforming changes 2) removed the requirement that the Department of Social Services establish rates and regulations in consultation with the Department of Public Health, and 3) removed the reporting deadline and instead requires a report should a demonstration project be implemented.
The annualized ongoing fiscal impact identified above would continue into the future subject to inflation.
OLR Bill Analysis
To the extent permitted by federal law, and where deemed clinically appropriate, this bill authorizes the Department of Social Services (DSS) to establish a demonstration project at federally-qualified community health centers. The project would provide Medicaid-covered health care services 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, other than facsimile and audio-only telephone transmissions, in the delivery of medical advice, diagnosis, care, treatment, or similar services.
The bill also:
1. authorizes the DSS commissioner to follow existing procedures to ensure the project's services are covered by Medicaid and to set reimbursement rates for telemedicine procedures,
2. subjects personally identifying telemedicine data and records to state and federal confidentiality laws, and
3. requires the commissioner to report to legislative committees on telemedicine services offered and their cost-effectiveness.
*House Amendment “A”:
1. substitutes the term “clinically appropriate” for “medically appropriate,” but leaves the definition unchanged;
2. allows, rather than requires, the DSS commissioner to establish Medicaid reimbursement rates for telemedicine, eliminating requirements that he (a) set rates by regulation and (b) consult with the Public Health commissioner; and
3. eliminates the deadline for DSS to file a report with legislative committees.
EFFECTIVE DATE: January 1, 2013
The project targets individuals who have difficulty gaining access to, or paying for, primary care.
Under the bill, “clinically 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.
If necessary, the bill authorizes the DSS commissioner to file a state plan amendment with federal Medicaid officials to ensure that the demonstration project's telemedicine services will be covered. By law, he must notify the Human Services and Appropriations committees before submitting it to the federal officials.
The bill also allows the DSS commissioner to establish reimbursement rates for telemedicine service providers. He must consider, to the extent applicable, reductions in how far patients' and health care providers' travel to receive or provide treatment, and may take into account other factors he deems relevant.
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.
The bill requires the commissioner to submit a report to the Appropriations and Human Services committees concerning the services offered and the program's cost effectiveness. It does not set a deadline for doing so.
Federally Qualified Community Health Centers
Federally qualified community health centers are non-profit or public health care organizations that provide comprehensive primary care and supportive services to medically underserved populations. These include low-income people, the uninsured, those who speak little or no English, and the homeless. Fees are adjusted based on ability to pay.
Human Services Committee
Joint Favorable Substitute