HLS 14RS-3374 ENGROSSED
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Regular Session, 2014
HOUSE BILL NO. 1280 (Substitute for House Bill No. 903 by Representative Simon)
BY REPRESENTATIVE SIMON
HEALTH SERVICES: Provides for the Louisiana Telehealth Access Act
AN ACT1
To amend and reenact R.S. 22:1821(F) and R.S. 37:1262(B)(2) and to enact R.S.2
37:1271(B)(3) through (5) and Part LXXV of Chapter 5 of Title 40 of the Louisiana3
Revised Statutes of 1950, to be comprised of R.S. 40:1300.381 through 1300.385,4
relative to telehealth services; to provide for definitions; to provide for the delivery5
of healthcare services through telemedicine; to require state agencies and licensing6
boards and commissions to promulgate rules governing healthcare services provided7
by telehealth; to provide for insurance coverage for telehealth services; and to8
provide for related matters.9
Be it enacted by the Legislature of Louisiana:10
Section 1. R.S. 22:1821(F) is hereby amended and reenacted to read as follows: 11
§1821. Payment of claims; health and accident policies; prospective review;12
penalties; self-insurers; telemedicine reimbursement by insurers13
* * *14
F.(1) Notwithstanding any provision of any policy or contract of insurance15
or health benefits issued, whenever such policy provides for payment, benefit, or16
reimbursement for any health care service, including but not limited to diagnostic17
testing, treatment, referral, or consultation, and such health care service is performed18
via transmitted electronic imaging or telemedicine, such a payment, benefit, or19
reimbursement under such policy or contract shall not be denied to a licensed20 HLS 14RS-3374 ENGROSSED
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physician conducting or participating in the transmission at the originating health1
care facility or terminus who is physically present with the individual who is the2
subject of such electronic imaging transmission and is contemporaneously3
communicating and interacting with a licensed physician at the receiving terminus4
of the transmission. The payment, benefit, or reimbursement to such a licensed5
physician at the originating facility or terminus shall not be less than seventy-five6
percent of the reasonable and customary amount of payment, benefit, or7
reimbursement which that licensed physician receives for an intermediate office8
visit.9
Any health insurance issuer that covers healthcare services provided via10
telemedicine, as defined in R.S. 37:1262(4), or healthcare services provided via11
telehealth, as defined in R.S. 40:1300.383, shall provide such coverage in accordance12
with the provisions of the insurance plan or contract. For any issuer that covers13
telemedicine, the plan or contract shall include coverage of both healthcare providers14
in cases when the telemedicine encounter requires a healthcare provider to be present15
at both the originating site and the distant site.16
(2)(a) Any health care service proposed to be performed or performed via17
transmitted electronic imaging or telemedicine under this Subsection shall be subject18
to the applicable utilization review criteria and requirements of the insurer.19
Terminology in a health and accident insurance policy or contract that either20
discriminates against or prohibits such a method of transmitted electronic imaging21
or the use of telemedicine or the delivery of healthcare services via telehealth shall22
be void as against public policy of providing the highest quality health care to the23
citizens of the state.24
(b) The provisions of this Paragraph shall not apply to language in a health25
or accident insurance policy or contract that excludes the use of telemedicine or the26
delivery of healthcare services via telehealth from coverage under the policy or27
contract.28 HLS 14RS-3374 ENGROSSED
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(3) The provisions of this Subsection shall not apply to limited benefit health1
insurance policies or contracts authorized to be issued in the state.2
Section 2. R.S. 37:1271(B)(2) is hereby amended and reenacted and R.S.3
37:1271(B)(3) through (5) are hereby enacted to read as follows:4
§1271. License to practice medicine or telemedicine required5
* * *6
B.7
* * *8
(2) Any person authorized by the board to practice Except as provided in9
R.S. 37:1276.1, all of the following shall apply to any physician practicing10
telemedicine as defined in this Part: shall ensure that a licensed health care11
professional who can adequately and accurately assist with any of the requirements12
listed in R.S. 37:1276.1(B)(2) is in the examination room with the patient at the time13
such patient is receiving telemedicine services. The board shall promulgate rules in14
accordance with the Administrative Procedure Act to establish what type of health15
care professional is necessary and appropriate under the circumstances.16
(a) The physician practicing telemedicine shall use the same standard of care17
as if the healthcare services were provided in person.18
(b) The physician practicing telemedicine shall not be required to conduct19
an in-person patient history or physical examination of the patient before engaging20
in a telemedicine encounter if the physician satisfies all of the following conditions:21
(i) Holds an unrestricted license to practice medicine in Louisiana.22
(ii) Has access to the patient's medical records upon consent of the patient.23
(iii) Maintains a physical practice location within the state of Louisiana or24
executes an affirmation with the board that the physician has an arrangement with25
another physician who maintains a physical practice location in Louisiana to provide26
for referrals and follow up care which may be necessary.27
(3) Except as authorized by rule promulgated by the board, no physician28
practicing telemedicine pursuant to this Subsection shall prescribe any controlled29 HLS 14RS-3374 ENGROSSED
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dangerous substance prior to conducting an appropriate in-person patient history or1
physical examination of the patient as determined by the board.2
(4) A patient receiving telemedicine services may be in any location at the3
time that the telemedicine services are rendered. A physician practicing4
telemedicine may be in any location when providing telemedicine services to a5
patient.6
(5) A physician practicing telemedicine shall document the telemedicine7
services rendered in the patient's medical records according to the same standard as8
that required for nontelemedicine services. Medical records including but not9
limited to video, audio, electronic, or other records generated as a result of providing10
telemedicine services shall be considered as confidential and shall be subject to all11
applicable state and federal laws and regulations relative to the privacy of health12
information.13
Section 3. Part LXXV of Chapter 5 of Title 40 of the Louisiana Revised Statutes of14
1950, comprised of R.S. 40:1300.381 through 1300.385, is hereby enacted to read as15
follows:16
PART LXXV. LOUISIANA TELEHEALTH ACCESS ACT17
§1300.381. Short title18
This Part shall be known and may be cited as the "Louisiana Telehealth19
Access Act".20
§1300.382. Legislative findings21
The legislature hereby finds and declares the following:22
(1) As an innovative form of health care, telehealth is extremely valuable23
because it enhances access to care, particularly in rural locations and other medically24
underserved areas; makes delivery of care more cost-effective; and distributes25
limited provider resources more efficiently.26
(2) Many patients with limited access to traditional health care can be27
diagnosed and treated sooner through telehealth than they would be otherwise,28 HLS 14RS-3374 ENGROSSED
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resulting in improved outcomes and less costly treatments due to early detection and1
prevention.2
(3) Telehealth services could potentially address a great unmet need for3
health care by persons who have limited access to both traditional healthcare settings4
and to telemedicine as currently defined in Louisiana law.5
(4) If this state is to achieve much needed improvement in health outcomes,6
a prudent and responsible policy for doing so would be to balance patient safety and7
access to care through expanding access to telehealth services for the people of8
Louisiana.9
§1300.383. Definitions10
(1) "Asynchronous store and forward transfer" means the transmission of a11
patient's medical information from an originating site to the provider at the distant12
site without the patient being present.13
(2) "Distant site" means the site at which the healthcare provider delivering14
the service is located at the time the service is provided via a telecommunications15
system.16
(3) "Healthcare provider" means a person, partnership, limited liability17
partnership, limited liability company, corporation, facility, or institution licensed18
or certified by this state to provide health care or professional services as a physician,19
physician assistant, hospital, nursing home, dentist, registered nurse, advanced20
practice registered nurse, licensed practical nurse, certified nurse assistant, offshore21
health service provider, ambulance service, licensed midwife, pharmacist,22
optometrist, podiatrist, chiropractor, physical therapist, occupational therapist,23
psychologist, social worker, licensed professional counselor, licensed perfusionist,24
licensed respiratory therapist, licensed radiologic technologist, or licensed clinical25
laboratory scientist.26
(4) "Originating site" means the location of the patient at the time the service27
is furnished via a telecommunications system or when the asynchronous store and28
forward transfer occurs.29 HLS 14RS-3374 ENGROSSED
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(5) "Synchronous interaction" means communication through interactive1
technology that enables a healthcare provider and a patient at two locations separated2
by distance to interact via two-way video and audio transmissions simultaneously.3
(6) "Telehealth" means a mode of delivering healthcare services that utilizes4
information and communication technologies to enable the diagnosis, consultation,5
treatment, education, care management, and self-management of patients at a6
distance from healthcare providers. Telehealth allows services to be accessed when7
providers are in a distant site and patients are in the originating site. Telehealth8
facilitates patient self-management and caregiver support for patients and includes9
synchronous interactions and asynchronous store and forward transfers.10
§1300.384. Telehealth; rulemaking required11
A. Each state agency or professional or occupational licensing board or12
commission that regulates the practice of a healthcare provider, as defined in this13
Part, shall promulgate, in accordance with the Administrative Procedure Act, any14
rules necessary to provide for, promote, and regulate the use of telehealth in the15
delivery of healthcare services within the scope of practice regulated by the licensing16
entity.17
B. The rules shall, at a minimum, provide for all of the following:18
(1) Application of all laws regarding the confidentiality of healthcare19
information and the patient's rights to the patient's medical information to telehealth20
interactions.21
(2) Application of the same standard of care by a healthcare provider as if22
the healthcare services were provided in person.23
(3)(a) Licensing or registration of out-of-state healthcare providers who seek24
to furnish healthcare services via telehealth to persons at originating sites in25
Louisiana. The rules shall ensure that any such healthcare provider possesses, at a26
minimum, an unrestricted and unencumbered license in good standing to perform the27
healthcare service in the state in which the healthcare provider is located, and that28 HLS 14RS-3374 ENGROSSED
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the license is comparable to its corresponding license in Louisiana as determined by1
the respective Louisiana licensing agency, board, or commission.2
(b) Each state agency and professional or occupational licensing board or3
commission is authorized to provide by rule for a reasonable fee for the license or4
registration provided for in this Subsection.5
(4) Exemption from the telehealth license or registration required by this6
Subsection for the consultation of a healthcare professional licensed by this state7
with an out-of-state peer professional.8
C. Nothing in this Part shall be construed to authorize a state agency or9
professional or occupational licensing board or commission to expand, diminish, or10
alter the scope of practice of any healthcare provider.11
§1300.385. Coverage for telehealth; health insurance; medical assistance program12
A. Any health insurance issuer that covers healthcare services provided via13
telemedicine, as defined in R.S. 37:1262(4), or healthcare services provided via14
telehealth, as defined in R.S. 40:1300.383, shall provide such coverage in accordance15
with the provisions of the insurance plan or contract. For any issuer that covers16
telemedicine, the plan or contract shall include coverage of both healthcare providers17
in cases when the telemedicine encounter requires a healthcare provider to be present18
at both the originating site and the distant site.19
B. Any medical assistance program administered by the Department of20
Health and Hospitals that covers healthcare services provided via telemedicine, as21
defined in R.S. 37:1262(4), or healthcare services provided via telehealth, as defined22
in R.S. 40:1300.383, shall provide such coverage in accordance with the provisions23
of that program.24
C. The provisions of this Subsection shall not apply to limited benefit health25
insurance policies or contracts authorized to be issued in the state.26 HLS 14RS-3374 ENGROSSED
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DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Simon HB No. 1280
Abstract: Provides for greater access to telehealth services by requiring licensing boards
and commissions to promulgate rules to provide for, promote, and regulate the use
of telehealth in the delivery of healthcare services within the scope of practice
regulated by the licensing entity.
Present law requires any person authorized by the La. State Board of Medical Examiners
(LSBME) to practice telemedicine to ensure that a licensed healthcare professional who can
adequately and accurately assist is in the examination room with the patient at the time such
patient is receiving telemedicine services.
Proposed law repeals present law and requires any physician practicing telemedicine as
defined in present law, except for those physicians practicing pursuant to a telemedicine
license, to use the same standard of care as if the healthcare services were provided in
person.
Proposed law further provides that a telemedicine provider, except for those physicians
practicing pursuant to a telemedicine license, shall not be required to conduct an in-person
patient history or physical examination of the patient before engaging in a telemedicine
encounter if all of the following conditions are met:
(1)The physician practicing telemedicine holds an unrestricted license to practice
medicine in La.
(2)The physician practicing telemedicine has access to the patient's medical records
upon consent of the patient.
(3)The physician practicing telemedicine maintains a physical practice location within
the state of La. or executes an affirmation with the LSBME that the physician has an
arrangement with another physician who maintains a physical practice location in
Louisiana to provide for referrals and follow up care which may be necessary.
Proposed law prohibits, unless authorized by the LSBME, a physician practicing
telemedicine pursuant to proposed law from prescribing any controlled dangerous substance
prior to conducting an appropriate in-person patient history or physical examination of the
patient as determined by the LSBME.
Proposed law provides that a patient receiving telemedicine services may be in any location
at the time that the telemedicine services are rendered and a telemedicine provider may be
in any location when providing telemedicine services to a patient.
Proposed law requires a telemedicine provider to document the telemedicine services
rendered in the patient's medical records according to the same standard as that required for
nontelemedicine services. Medical records, including video, audio, electronic, or other
records generated as a result of providing telemedicine services shall be considered as
confidential and shall be subject to all applicable state and federal laws and regulations
relative to the privacy of health information. HLS 14RS-3374 ENGROSSED
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are additions.
Proposed law defines "telehealth" as a mode of delivering healthcare services that utilizes
information and communication technologies to enable the diagnosis, consultation,
treatment, education, care management, and self-management of patients at a distance from
healthcare providers and which allows services to be accessed when providers are in a
distant site and patients are in the originating site. Telehealth facilitates patient
self-management and caregiver support for patients and includes synchronous interactions
and asynchronous store and forward transfers.
Proposed law requires each state agency or professional or occupational licensing board or
commission that regulates the practice of a healthcare provider to promulgate any rules
necessary to provide for, promote, and regulate the use of telehealth in the delivery of
healthcare services within the scope of practice regulated by the licensing entity.
Proposed law further requires that the rules shall, at a minimum, provide for all of the
following:
(1)Application of all laws regarding the confidentiality of healthcare
information and the patient's rights to the patient's medical information to
telehealth interactions.
(2)Application of the same standard of care by a healthcare provider as if the
healthcare services were provided in person.
(3)(a)Licensing or registration of out-of-state healthcare providers who seek to
furnish healthcare services via telehealth to persons at originating sites in La.
The rules shall ensure that any such healthcare provider possesses, at a
minimum, an unrestricted and unencumbered license in good standing to
perform the healthcare service in the state in which the healthcare provider
is located, and that the license is comparable to its corresponding license in
La. as determined by the respective La. licensing agency, board, or
commission.
(b)Each state agency and professional or occupational licensing board or
commission is authorized to provide by rule for a reasonable fee for the
license or registration.
(4)Exemption from the telehealth license or registration requirement for the
consultation of a healthcare professional licensed by this state with an out-of-
state peer professional.
Nothing in proposed law shall be construed to authorize a state agency or licensing board
or commission to expand, diminish, or alter the scope of practice of any healthcare provider.
Present law requires that, if any contract or policy that provides for payment, benefit, or
reimbursement for any healthcare service, including but not limited to diagnostic testing,
treatment, referral, or consultation and the healthcare service is performed via transmitted
electronic imaging or telemedicine, the payment, benefit, or reimbursement under the policy
or contract shall not be denied to a licensed physician conducting or participating in the
transmission at the originating healthcare facility or terminus who is physically present with
the individual who is the subject of such electronic imaging transmission and is
contemporaneously communicating and interacting with a licensed physician at the receiving
terminus of the transmission. Present law requires the payment, benefit, or reimbursement
to be at least 75% percent of the reasonable and customary amount of payment, benefit, or
reimbursement which that licensed physician receives for an intermediate office visit.
Proposed law repeals present law and requires any health insurance issuer that covers
healthcare services provided via telemedicine or healthcare services provided via telehealth
to provide such coverage in accordance with the provisions of the insurance plan or contract. HLS 14RS-3374 ENGROSSED
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are additions.
Proposed law further requires coverage of both healthcare providers in cases when the
telemedicine encounter requires a healthcare provider to be present at both the originating
site and the distant site.
Present law provides that any healthcare service proposed to be performed or performed via
transmitted electronic imaging or telemedicine shall be subject to the applicable utilization
review criteria and requirements of the insurer.
Proposed law repeals present law.
Present law deems terminology in a health and accident insurance policy or contract that
either discriminates against or prohibits such a method of transmitted electronic imaging or
telemedicine as void and against public policy of providing the highest quality health care
to the citizens of the state.
Proposed law deems terminology in a health and accident insurance policy or contract that
either discriminates against or prohibits the use of telemedicine or the delivery of healthcare
services via telehealth as void and against public policy of providing the highest quality
health care to the citizens of the state.
Proposed law does not apply to language in a health or accident insurance policy or contract
that excludes the use of telemedicine or the delivery of healthcare services via telehealth
from coverage under the policy or contract.
Present law and proposed law do not apply to limited benefit health insurance policies or
contracts authorized to be issued in the state.
Proposed law requires any medical assistance program administered by the Dept. of Health
and Hospitals that covers healthcare services provided via telemedicine or healthcare
services provided via telehealth to provide such coverage in accordance with the provisions
of that program.
(Amends R.S. 22:1821(F) and R.S. 37:1271(B)(2); Adds R.S. 37:1271(B)(3)-(5) and R.S.
40:1300.381-1300.385)