KS
Kansas House Bill HB2337

Kansas 2023-2024 Regular Session

Kansas House Bill HB2337 Compare Versions

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11 Session of 2023
22 HOUSE BILL No. 2337
33 By Committee on Health and Human Services
44 2-7
55 AN ACT concerning health and healthcare; relating to telemedicine;
66 defining in-state and interstate practitioners under the Kansas
77 telemedicine act; requiring certain insurance coverage of in-state
88 telemedicine services; providing for certain standards of care;
99 establishing the Kansas telehealth advisory committee; amending
1010 K.S.A. 40-2,210, 40-2,211, 40-2,212 and 40-2,213 and repealing the
1111 existing sections.
1212 Be it enacted by the Legislature of the State of Kansas:
1313 New Section 1. (a) There is hereby established the Kansas telehealth
1414 advisory committee.
1515 (b) The committee shall advise and make recommendations regarding
1616 telemedicine quality care practices. Such recommendations and any
1717 resource materials developed by the committee shall recommend
1818 evidence-based practices for the use and future of telemedicine in Kansas.
1919 On or before the first day of each regular session of the legislature, the
2020 committee shall provide information to the Kansas legislature on
2121 telemedicine usage data in Kansas.
2222 (c) The committee shall consist of the following 22 voting members
2323 and three non-voting members:
2424 (1) Two members of the senate appointed by the president of the
2525 senate, including one member from the senate standing committee on
2626 public health and welfare, or any successor committee, and one member
2727 from the senate standing committee on financial institutions and insurance,
2828 or any successor committee;
2929 (2) two members of the house of representatives appointed by the
3030 speaker of the house of representatives, including one member from the
3131 house of representatives standing committee on health and human
3232 services, or any successor committee, and one member from the house of
3333 representatives standing committee on insurance and pensions, or any
3434 successor committee;
3535 (3) one member of the senate appointed by the minority leader of the
3636 senate;
3737 (4) one member of the house of representatives appointed by the
3838 minority leader of the house of representatives;
3939 (5) two members who are physicians, including one member
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7676 appointed by the Kansas academy of family physicians and one member
7777 appointed by the Kansas medical society. The two members appointed
7878 under this paragraph shall include one member from an urban area and one
7979 member from a rural area;
8080 (6) one member who is a physician appointed by the Kansas chapter
8181 of the American academy of pediatrics;
8282 (7) two members who are hospital administrators appointed by the
8383 Kansas hospital association. The two members appointed under this
8484 paragraph shall include one member from an urban area and one member
8585 from a rural area;
8686 (8) two members who are behavioral health professionals, including
8787 one member appointed by the association of community mental health
8888 centers of Kansas and one member appointed by the Kansas association of
8989 addiction support professionals. The two members appointed under this
9090 paragraph shall include one member from an urban area and one member
9191 from a rural area;
9292 (9) one member who is a healthcare professional whose primary area
9393 of focus is nursing appointed by the Kansas state nurses association;
9494 (10) one member who is a healthcare professional whose primary
9595 area of focus is treating individuals with developmental disabilities
9696 appointed by interhab;
9797 (11) one member appointed by leadingage Kansas;
9898 (12) one member who is a business community representative
9999 appointed by the Kansas chamber of commerce;
100100 (13) one member who is a community representative appointed by
101101 Kansas farm bureau;
102102 (14) one member who is an insurance industry representative
103103 appointed by blue cross blue shield of Kansas;
104104 (15) one member who is a physician representing an interstate
105105 telemedicine practitioner appointed by aetna;
106106 (16) one member appointed by the heartland telehealth resource
107107 center;
108108 (17) one member appointed by the Kansas bankers association;
109109 (18) one non-voting member appointed by the state medicaid
110110 director;
111111 (19) one non-voting member appointed by the insurance
112112 commissioner; and
113113 (20) one non-voting member appointed by the state board of healing
114114 arts.
115115 (d) Initial members of the committee shall be appointed within 90
116116 days after the effective date of this section. Any member appointed to fill a
117117 vacancy in the membership of the committee shall be appointed in the
118118 manner provided for the original appointment of the member who vacated.
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162162 (e) The president of the senate shall select one member of the
163163 committee who is a member of the senate, and the speaker of the house of
164164 representatives shall select one member of the committee who is a member
165165 of the house of representatives, both to serve as co-chairpersons of the
166166 committee.
167167 (f) The committee shall meet not fewer than four times per year upon
168168 the call of either co-chairperson. The co-chairpersons shall call the first
169169 meeting of the committee on or before October 1, 2023. A majority of the
170170 voting members of the committee constitutes a quorum. Any action by the
171171 committee shall be by motion adopted by a majority of the voting
172172 members present when there is a quorum.
173173 (g) Staff of the office of revisor of statutes, the legislative research
174174 department and the division of legislative administrative services shall
175175 provide assistance to the committee as may be requested by the co-
176176 chairpersons.
177177 (h) Subject to approval by the legislative coordinating council,
178178 legislative members of the committee attending meetings of the committee
179179 shall be paid amounts for expenses, mileage and subsistence as provided in
180180 K.S.A. 75-3223(e), and amendments thereto.
181181 (i) This section shall be a part of and supplemental to the Kansas
182182 telemedicine act.
183183 Sec. 2. K.S.A. 40-2,210 is hereby amended to read as follows: 40-
184184 2,210. (a) K.S.A. 40-2,210 through 40-2,216, and amendments thereto,
185185 and section 1, and amendments thereto, shall be known and may be cited
186186 as the Kansas telemedicine act.
187187 (b) This section shall take effect on and after January 1, 2019.
188188 Sec. 3. K.S.A. 40-2,211 is hereby amended to read as follows: 40-
189189 2,211. (a) For purposes of the Kansas telemedicine act:
190190 (1)(a) "Distant site" means a site at which, including an unlicensed or
191191 private location, where a healthcare provider is located while providing
192192 healthcare services by means of telemedicine.
193193 (2)(b) "Healthcare provider" means a physician, licensed physician
194194 assistant, licensed advanced practice registered nurse or person licensed,
195195 registered, certified or otherwise authorized to practice by the behavioral
196196 sciences regulatory board.
197197 (3)(c) "In-state practitioner" means any healthcare provider who has
198198 a physical location of practice in the state of Kansas as authorized by the
199199 applicable Kansas licensing and regulatory agency.
200200 (d) "Interstate telehealth practitioner" means a healthcare provider
201201 who does not have a physical location of practice in the state of Kansas
202202 and provides only telemedicine services to patients in the state of Kansas
203203 pursuant to a telemedicine waiver issued by the state board of healing
204204 arts.
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248248 (e)  "Originating site" means a site at which a patient is located at
249249 the time healthcare services are provided by means of telemedicine.
250250 (4)(f) "Physician" means a person licensed to practice medicine and
251251 surgery by the state board of healing arts.
252252 (5)(g) "Telemedicine," including "telehealth," means the delivery of
253253 healthcare services or consultations while the patient is at an originating
254254 site and the healthcare provider is at a distant site. Telemedicine shall be
255255 provided by means of real-time two-way interactive audio, visual, or
256256 audio-visual communications, including the application of secure video
257257 conferencing, remote patient monitoring or store-and-forward technology
258258 to provide or support healthcare delivery, that facilitate the assessment,
259259 diagnosis, consultation, treatment, education and care management of a
260260 patient's healthcare. "Telemedicine" does not include communication
261261 between:
262262 (A)(1) Healthcare providers that consist solely of a telephone voice-
263263 only conversation, an email or facsimile transmission; or
264264 (B)(2) a physician healthcare provider and a patient that consists
265265 solely of an email, voicemail, instant message or facsimile transmission.
266266 (b) This section shall take effect on and after January 1, 2019.
267267 Sec. 4. K.S.A. 40-2,212 is hereby amended to read as follows: 40-
268268 2,212. (a) The same requirements for patient privacy and confidentiality
269269 under the health insurance portability and accountability act of 1996 and
270270 42 C.F.R. § 2.13, as applicable, that apply to healthcare services delivered
271271 via in-person contact shall also apply to healthcare services delivered via
272272 telemedicine. Nothing in this section shall supersede the provisions of any
273273 state law relating to the confidentiality, privacy, security or privileged
274274 status of protected health information.
275275 (b) Telemedicine may be used to establish a valid provider-patient
276276 relationship.
277277 (c) Telemedicine may be used by an in-state practitioner to refer a
278278 patient to a specialty service healthcare provider to the extent that such
279279 services are consistent with the standard of care for an in-state
280280 practitioner.
281281 (d) The same standards of practice and conduct that apply to
282282 healthcare services delivered via in-person contact with a patient shall also
283283 apply to healthcare services delivered via telemedicine.
284284 (d)(e) (1) A person healthcare provider authorized by law to provide
285285 and who provides telemedicine services to a patient shall provide the
286286 patient with guidance on appropriate follow-up care.
287287 (2) (A) Except when otherwise prohibited by any other provision of
288288 law, when the patient consents to treatment via telemedicine and the
289289 patient has a primary care physician or other treating physician, the person
290290 in-state practitioner or interstate telemedicine practitioner providing
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334334 telemedicine services shall send within three business days a report to such
335335 primary care physician or other treating physician of the treatment and
336336 services rendered to the patient in the telemedicine encounter.
337337 (B) A person licensed, registered, certified or otherwise authorized to
338338 practice by the behavioral sciences regulatory board shall not be required
339339 to comply with the provisions of subparagraph (A).
340340 (e) This section shall take effect on and after January 1, 2019.
341341 (f) An in-state practitioner may use audio-only communication with a
342342 patient who has an existing relationship with an in-state practitioner if:
343343 (1) An audio-visual telemedicine encounter is not reasonably
344344 available due to the patient's functional status or lack of technological
345345 access or telecommunications infrastructure limits, as determined by the
346346 in-state practitioner; and
347347 (2) the telemedicine encounter is initiated at the request of the patient
348348 or authorized by the patient before the telemedicine encounter.
349349 (g) (1) If the actions described in subparagraphs (A) through (E)
350350 would be required for the provision of the same healthcare services
351351 delivered in a manner other than telemedicine, a healthcare provider who
352352 uses telemedicine shall:
353353 (A) Establish a healthcare provider-patient relationship prior to
354354 providing care and treatment to a patient;
355355 (B) obtain the patient's name and contact information and, to the
356356 extent reasonably possible, confirmation of the identity of the patient and
357357 a verbal statement or other data from the patient identifying the patient's
358358 location;
359359 (C) disclose the provider's name and licensure, certification or
360360 registration;
361361 (D) create and maintain a medical record for the patient consistent
362362 with the standard of care for maintaining medical records for patients
363363 treated in an in-person setting; and
364364 (E) if a prescription order is issued for the patient and subject to the
365365 consent of the patient, notify the patient's primary care physician, if any, of
366366 any prescription orders issued for the patient.
367367 (2) The requirements of paragraph (1) shall not apply if the
368368 healthcare provider:
369369 (A) Is using an electronic health record system that the patient's
370370 primary care physician is authorized to access; and
371371 (B) has established an ongoing provider-patient relationship with the
372372 patient by providing care and treatment to the patient at least two
373373 consecutive times via telemedicine services.
374374 (3) Any medical records required to be created and maintained under
375375 this subsection shall be created and maintained under the same standards
376376 of appropriate practice as such standards apply for medical records for
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420420 patients in an in-person setting.
421421 (h) A healthcare provider may refuse at any time to provide
422422 healthcare services using telemedicine if, in the healthcare provider's sole
423423 discretion, the provider believes:
424424 (1) A patient's health quality may be negatively impacted by
425425 providing services or items via telemedicine; or
426426 (2) the healthcare provider would be unable to provide the same
427427 clinical standards of care as provided in an in-person setting.
428428 (i) Nothing in the Kansas telemedicine act shall be construed to
429429 require any individual to use telemedicine or any healthcare provider to
430430 provide services via telemedicine.
431431 Sec. 5. K.S.A. 40-2,213 is hereby amended to read as follows: 40-
432432 2,213. (a) The provisions of this section shall apply to any individual or
433433 group health insurance policy, medical service plan, contract, hospital
434434 service corporation contract, hospital and medical service corporation
435435 contract, fraternal benefit society or health maintenance organization that
436436 provides coverage for accident and health services and that is delivered,
437437 issued for delivery, amended or renewed on or after January 1, 2019 July
438438 1, 2023. The provisions of this section shall also apply to the Kansas
439439 medical assistance program.
440440 (b) No individual or group health insurance policy, medical service
441441 plan, contract, hospital service corporation contract, hospital and medical
442442 service corporation contract, fraternal benefit society, health maintenance
443443 organization or the Kansas medical assistance program shall:
444444 (1) Exclude an otherwise covered healthcare service from coverage
445445 solely because such service is provided through telemedicine, rather than
446446 in-person contact, or based upon the lack of a commercial office for the
447447 practice of medicine, when such service is delivered by a healthcare
448448 provider; or
449449 (2) require the use of any specific information technology application
450450 by any in-state practitioner.
451451 (c) The insured's covered individual's medical record shall serve to
452452 satisfy all documentation for the reimbursement of all telemedicine
453453 healthcare services, and no additional documentation outside of the
454454 medical record shall be required.
455455 (d) Payment or reimbursement of covered healthcare services
456456 delivered through telemedicine may by an in-state practitioner shall be
457457 established by an insurance company, nonprofit health service corporation,
458458 nonprofit medical and hospital service corporation or health maintenance
459459 organization in the same manner as payment or reimbursement for covered
460460 services that are delivered via in-person contact are is established.
461461 (e) An individual or group health insurance policy, medical service
462462 plan, contract, hospital service corporation contract, hospital and medical
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506506 service corporation contract, fraternal benefit society or health
507507 maintenance organization that provides coverage for accident and health
508508 services and the Kansas medical assistance program shall provide
509509 payment and reimbursement for telemedicine services provided by an in-
510510 state practitioner under the same criteria that the policy provides for
511511 payment and reimbursement for the same or similar healthcare services
512512 delivered in person by an in-state practitioner.
513513 (f) Coverage and payment for telemedicine services provided by an
514514 in-state practitioner shall not be subject to any dollar limit, deductible or
515515 coinsurance requirement that is less favorable to a covered individual than
516516 the dollar limit, deductible or coinsurance requirement that applies to the
517517 same healthcare services delivered to a covered individual in person by an
518518 in-state practitioner.
519519 (g) Any coverage limit or annual or lifetime aggregate dollar limit
520520 that applies to telemedicine services provided by an in-state practitioner
521521 shall be the same such limit that applies to all items and services provided
522522 by an in-state practitioner covered under the policy.
523523 (h) An interstate telehealth practitioner shall not be affected by in-
524524 state practitioner reimbursement rates established under Kansas law. The
525525 provisions of subsections (d) through (g) shall not apply to items or
526526 services provided by an interstate telemedicine practitioner.
527527 (i) Nothing in this section shall be construed to:
528528 (1) Prohibit an individual or group health insurance policy, medical
529529 service plan, contract, hospital service corporation contract, hospital and
530530 medical service corporation contract, fraternal benefit society or health
531531 maintenance organization that provides coverage for telemedicine or the
532532 Kansas medical assistance program from providing coverage for only
533533 those services that are medically necessary, subject to the terms and
534534 conditions of the covered individual's health benefits plan;
535535 (2) mandate coverage for a healthcare service delivered via
536536 telemedicine if such healthcare service is not already a covered healthcare
537537 service, when delivered by a healthcare provider subject to the terms and
538538 conditions of the covered individual's health benefits plan; or
539539 (3) allow an individual or group health insurance policy, medical
540540 service plan, contract, hospital service corporation contract, hospital and
541541 medical service corporation contract, fraternal benefit society or health
542542 maintenance organization that provides coverage for telemedicine or the
543543 Kansas medical assistance program to require a covered individual to use
544544 telemedicine or in lieu of receiving an in-person healthcare service or
545545 consultation from an in-network provider.
546546 (f)(j) The provisions of K.S.A. 40-2248 and 40-2249a, and
547547 amendments thereto, shall not apply to this section.
548548 (g) This section shall take effect on and after January 1, 2019.
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592592 Sec. 6. K.S.A. 40-2,210, 40-2,211, 40-2,212 and 40-2,213 are hereby
593593 repealed.
594594 Sec. 7. This act shall take effect and be in force from and after its
595595 publication in the Kansas register.
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