HLS 14RS-1077 ORIGINAL
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Regular Session, 2014
HOUSE BILL NO. 903
BY REPRESENTATIVE SIMON
HEALTH SERVICES: Provides for the Louisiana Telehealth Access Act
AN ACT1
To amend and reenact R.S. 37:1262(4), 1271(B)(2), and 1276.1(2)(a) and to enact R.S.2
36:259(Y), R.S. 37:1271(B)(3) through (5), and Part LXXV of Chapter 5 of Title 403
of the Louisiana Revised Statutes of 1950, to be comprised of R.S. 40:1300.3814
through 1300.3829, relative telehealth services; to define telehealth services; to5
provide for telemedicine; to require insurance coverage for telehealth services; to6
require the medical assistance program to cover telehealth services; to create the7
Louisiana Commission on Telehealth Access within the Department of Health and8
Hospitals; and to provide for related matters.9
Be it enacted by the Legislature of Louisiana:10
Section 1. R.S. 36:259(Y) is hereby enacted to read as follows:11
§259. Transfer of agencies and functions to Department of Health and Hospitals12
* * *13
Y. The Louisiana Commission on Telehealth Access (R.S. 40:1300.389) is14
placed within the Department of Health and Hospitals and shall exercise and perform15
its powers, duties, functions, and responsibilities as provided by law.16
* * *17
Section 2. R.S. 37:1262(4), 1271(B)(2), and 1276.1(2)(a) are hereby amended and18
reenacted and R.S. 37:1271(B)(3) through (5) are hereby enacted to read as follows:19 HLS 14RS-1077 ORIGINAL
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§1262. Definition1
As used in this Part the following words and phrases shall have the meanings2
ascribed to them:3
* * *4
(4) "Telemedicine" means the practice of health care delivery, diagnosis,5
consultation, treatment, medicine and transfer of medical data using interactive6
telecommunication technology that enables a health care practitioner physician and7
a patient at two locations separated by distance to interact via two-way video and8
audio transmissions simultaneously or through the use of asynchronous store-and-9
forward technology. Neither a telephone conversation nor an electronic mail10
message between a health care practitioner physician and patient, or a true11
consultation an informal consultation or second opinion as may be defined by rules12
promulgated by the board pursuant to the Administrative Procedure Act, constitutes13
telemedicine for the purposes of this Part.14
* * *15
§1271. License to practice medicine or telemedicine required16
* * *17
B.18
* * *19
(2) Any person authorized by the board to practice telemedicine as defined20
in this Part shall ensure that a licensed health care professional who can adequately21
and accurately assist with any of the requirements listed in R.S. 37:1276.1(B)(2) is22
in the examination room with the patient at the time such patient is receiving23
telemedicine services. The board shall promulgate rules in accordance with the24
Administrative Procedure Act to establish what type of health care professional is25
necessary and appropriate under the circumstances use the same standard of care as26
if the healthcare services were provided in person. The telemedicine provider is not27
required to conduct a patient history or physical examination of the patient before28
engaging in a telemedicine encounter if the telemedicine provider conducts a patient29 HLS 14RS-1077 ORIGINAL
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evaluation sufficient to meet the community standard of care for the service1
provided. The patient evaluation may be performed using telemedicine.2
(3) A patient receiving telemedicine services may be in any location at the3
time that the telemedicine services are rendered. A telemedicine provider may be4
in any location when providing telemedicine services to a patient.5
(4) A telemedicine provider shall document the telemedicine services6
rendered in the patient's medical records according to the same standard as that7
required for nontelemedicine services. Medical records including but not limited to8
video, audio, electronic, or other records generated as a result of providing9
telemedicine services are considered as confidential.10
(5) Nothing in this Section shall be construed to prevent a physician from11
practicing telehealth pursuant to R.S. 40:1300.381 et seq.12
* * *13
§1276.1. Telemedicine license14
* * *15
B. The board shall establish by rule in accordance with the Administrative16
Procedure Act the requirements for licensure under this Section provided the rules17
include the following:18
* * *19
(2) The physician, when examining a patient by telemedicine, shall establish20
a bona fide physician-patient relationship by:21
(a)(i) Conducting an appropriate examination of the patient as determined22
by the board.23
(ii) An examination conducted pursuant to this Paragraph shall not require24
that the physician or other healthcare professional be present with the patient but25
may include but not be limited to review of any relevant history, examination by26
electronic means using a secure video line, laboratory or diagnostic studies, review27
of diagnoses, or other information deemed pertinent by the physician.28
* * *29 HLS 14RS-1077 ORIGINAL
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Section 3. Part LXXV of Chapter 5 of Title 40 of the Louisiana Revised Statutes of1
1950, comprised of R.S. 40:1300.381 through 1300.3829, is hereby enacted to read as2
follows:3
PART LXXV. LOUISIANA TELEHEALTH ACCESS ACT4
§1300.381. Short title5
This Part shall be known and may be cited as the "Louisiana Telehealth6
Access Act".7
§1300.382. Legislative findings8
The legislature hereby find and declares the following:9
(1) As an innovative form of health care, telehealth is extremely valuable10
because it enhances access to care, particularly in rural locations and other medically11
underserved areas; makes delivery of care more cost-effective; and distributes12
limited provider resources more efficiently.13
(2) Many patients with limited access to traditional health care can be14
diagnosed and treated sooner through telemedicine than they would be otherwise,15
resulting in improved outcomes and less costly treatments due to early detection and16
prevention.17
(3) Telehealth services could potentially address a great unmet need for18
health care by persons who have limited access to both traditional health care19
settings and to telemedicine as currently defined in Louisiana law.20
(4) If our state is to achieve much needed improvement in health outcomes,21
a prudent and responsible policy for doing so would be to balance patient safety and22
access to care through expanding access by Louisianians to telehealth services.23
§1300.383. Definitions24
(1) "Asynchronous store and forward transfer" means the transmission of a25
patient’s medical information from an originating site to the provider at the distant26
site without the patient being present.27 HLS 14RS-1077 ORIGINAL
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(2) "Distant site" means the site at which the healthcare provider delivering1
the service is located at the time the service is provided via a telecommunications2
system.3
(3) "Healthcare provider" means a person, partnership, limited liability4
partnership, limited liability company, corporation, facility, or institution licensed5
or certified by this state to provide health care or professional services as a physician,6
hospital, nursing home, community blood center, tissue bank, dentist, registered or7
licensed practical nurse or certified nurse assistant, offshore health service provider,8
ambulance service, certified registered nurse anesthetist, nurse midwife, licensed9
midwife, nurse practitioner, clinical nurse specialist, pharmacist, optometrist,10
podiatrist, chiropractor, physical therapist, occupational therapist, psychologist,11
social worker, licensed professional counselor, licensed perfusionist, licensed12
respiratory therapist, licensed radiologic technologist, licensed clinical laboratory13
scientist, or any nonprofit facility considered tax-exempt under Section 501(c)(3),14
Internal Revenue Code, pursuant to 26 U.S.C. 501(c)(3), for the diagnosis and15
treatment of cancer or cancer-related diseases, whether or not such a facility is16
required to be licensed by this state, or any professional corporation a healthcare17
provider is authorized to form under the provisions of Title 12 of the Louisiana18
Revised Statutes of 1950, or any partnership, limited liability partnership, limited19
liability company, management company, or corporation whose business is20
conducted principally by healthcare providers, or an officer, employee, partner,21
member, shareholder, or agent thereof acting in the course and scope of his22
employment.23
(4) "Originating site" means the location of the patient at the time the service24
is furnished via a telecommunications where the asynchronous store and forward25
transfer occurs.26
(5) "Telehealth" means a mode of delivering healthcare services, including27
but not limited to telemedicine, and public health that utilizes information and28
communication technologies to enable the diagnosis, consultation, treatment,29 HLS 14RS-1077 ORIGINAL
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education, care management and self-management of patients at a distance from1
healthcare providers. Telehealth allows services to be accessed when providers are2
in a distant site and patients are in the originating site. Telehealth facilitates patient3
self-management and caregiver support for patients and includes synchronous4
interactions and asynchronous store and forward transfers.5
(6) "Telemedicine" means the practice of medicine as defined in R.S.6
37:1262.7
§1300.384. Scope of practice not affected8
Nothing in this Part shall be construed to expand, diminish, or alter the scope9
of practice of any healthcare provider.10
§1300.385. Confidentiality11
All laws regarding the confidentiality of healthcare information and the12
patient’s rights to the patient's medical information shall apply to telehealth13
interactions.14
§1300.386. Coverage required for telehealth15
A. No healthcare service plan shall require that in-person contact occur16
between a healthcare provider and a patient before payment is made for the covered17
services provided, and every healthcare service plan shall adopt payment policies18
consistent with this Section to compensate healthcare providers who provide covered19
healthcare services through telehealth.20
B. Payment for telehealth interactions shall include reasonable compensation21
to the originating site for the transmission cost incurred during the delivery of22
healthcare services.23
C. Healthcare service plans shall pay for covered healthcare services when24
provided by information and communication technologies including but not limited25
to telephone or Internet technologies and for asynchronous store and forward26
services.27
D. Payment for covered services provided by telehealth shall be the lower28
of the usual and customary rate charged for that service or the contract amount the29 HLS 14RS-1077 ORIGINAL
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healthcare service plan pays for the same service when provided in an in-person1
encounter with the patient.2
E. The healthcare service plan shall not limit the type of setting where3
services are provided for the patient or the provider and shall pay providers at both4
the distant site and the originating site.5
F. The requirements of this Section shall also be operative for healthcare6
service plan contracts with the medical assistance program administered by the7
Department of Health and Hospitals pursuant to the authority provided in R.S.8
36:254.9
§1300.387. Coverage required for telehealth; medical assistance program10
A. In-person contact between a healthcare provider and a patient shall not11
be required under the medical assistance program, administered by the Department12
of Health and Hospitals pursuant to the authority provided in R.S. 36:254, for any13
service otherwise covered by the program when the service is provided by telehealth,14
including but not limited to services provided via telephone or Internet technologies15
and services provided by asynchronous store and forward transfer.16
B. The Department of Health and Hospitals shall not require any provider17
to document a barrier to an in-person visit for coverage of services provided via18
telehealth.19
C. Payment for covered services provided by telehealth shall be the lower20
of the usual and customary rate charged for that service or the fee schedule amount21
the program pays for the same service when provided in an in-person encounter with22
the patient.23
D. The department shall not limit the type of setting where services are24
provided for the patient or the provider when paying the providers at both the distant25
site and the originating site.26
E. Payment for telehealth interactions shall include reasonable compensation27
to the originating site for the transmission cost incurred during the delivery of28
healthcare services.29 HLS 14RS-1077 ORIGINAL
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F. The department may promulgate, in accordance with the Administrative1
Procedure Act, any rules or regulations necessary for the administration of this2
Section.3
§1300.388. Telemedicine4
The practice of telemedicine by a physician shall be subject to the5
requirements of R.S. 37:1261 et seq.6
§1300.389. Louisiana Commission on Telehealth Access7
A. There is hereby established within the Department of Health and8
Hospitals the Louisiana Commission on Telehealth Access, composed of thirteen9
members as follows:10
(1) The secretary of the Department of Health and Hospitals or his designee.11
(2) The executive director of the Louisiana State Board of Medical12
Examiners or his designee.13
(3) A representative of the Louisiana State University Health Sciences14
Center at New Orleans.15
(4) A representative of the Louisiana State University Health Sciences16
Center at Shreveport.17
(5) A representative of the Tulane University School of Medicine.18
(6) A representative of the Louisiana State Medical Society.19
(7) A representative of the Louisiana Primary Care Association.20
(8) A representative of the Louisiana Health Care Quality Forum.21
(9) A representative of the HomeCare Association of Louisiana.22
(10) A representative of the Louisiana Hospital Association.23
(11) A representative of the Louisiana Association of Health Plans.24
(12) A representative of the Louisiana Cable and Telecommunications25
Association.26
(13) A representative of the TexLa Telehealth Resource Center.27 HLS 14RS-1077 ORIGINAL
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B. The secretary of the Department of Health and Hospitals shall take such1
actions as are necessary to ensure that the initial convening of the commission occurs2
no later than October 1, 2014.3
C. A chairman of the commission shall be elected annually by the4
commission members and shall serve as chairman without salary.5
D. Commission members shall serve without compensation, except per diem6
or expense reimbursement to which they may be individually entitled by their7
respective employer organizations.8
E. The commission shall hold at least two regular meetings each year at a9
place designated by the chairman.10
F. The functions of the commission shall be to:11
(1) Serve as an advisory body to the legislature and the Department of Health12
and Hospitals on policies and practices that expand access to telehealth services in13
a manner that ensures quality of care and patient safety.14
(2) Serve as a coordinating forum on telehealth related matters between and15
among state agencies, local government, and other nongovernmental groups.16
(3) On a regular basis, research and review state regulations, guidelines,17
policies, and procedures that pertain in any way to telehealth and make18
recommendations to the governor, the legislature, and the secretary of the19
Department of Health and Hospitals as deemed necessary and appropriate by the20
chairman.21
G. On or before January 1, 2015, and semiannually thereafter, the22
commission shall prepare and submit to the governor and the legislature a report on23
the status of telehealth access in Louisiana.24
H. The commission may request administrative and technical support from25
the Department of Health and Hospitals, office of the secretary, and the office of26
public health to carry out the functions and responsibilities provided in this Section.27
I. The commission shall terminate on September 1, 2018.28 HLS 14RS-1077 ORIGINAL
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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. 903
Abstract: Provides for greater access to telehealth services by providing for standards of
care, confidentiality, and insurance coverage; expands the definition of telemedicine;
creates the La. Commission on Telehealth Access.
Present law defines "telemedicine" as the practice of healthcare delivery, diagnosis,
consultation, treatment, and transfer of medical data using interactive telecommunication
technology that enables a healthcare practitioner a patient at two locations separated by
distance to interact via two-way video and audio transmissions simultaneously. Neither a
telephone conversation nor an electronic mail message between a healthcare practitioner
physician and patient, or a true consultation as may be defined by rules promulgated by the
Louisiana State Board Medical Examiners (LSBME).
Proposed law defines "telemedicine" as the practice of medicine and transfer of medical data
using interactive telecommunication technology that enables a physician and a patient at
two locations separated by distance to interact via two-way video and audio transmissions
simultaneously or through the use of asynchronous store-and-forward technology. Neither
a telephone conversation nor an electronic mail message between a physician and patient,
or an informal consultation or second opinion as may be defined by rules promulgated by
the LSBME.
Present law requires any person authorized by 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 person authorized by LSMBE to use the
same standard of care as if the healthcare services were provided in person. Proposed law
further provides that the telemedicine provider is not required to conduct a patient history
or physical examination of the patient before engaging in a telemedicine encounter if the
telemedicine provider conducts a patient evaluation sufficient to meet the community
standard of care for the service provided. The patient evaluation may be performed using
telemedicine.
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 are considered as
confidential.
Present law requires LSBME to establish by rule the requirements for licensure and requires
the rules to require the physician, when examining a patient by telemedicine, to establish a
bona fide physician-patient relationship by conducting an appropriate examination of the
patient as determined by the board.
Proposed law retains present law and further provides that the examination shall not require
that the physician or other healthcare professional be present with the patient but may HLS 14RS-1077 ORIGINAL
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include but not be limited to review of any relevant history, examination by electronic means
using a secure video line, laboratory or diagnostic studies, review of diagnoses, or other
information deemed pertinent by the physician.
Proposed law defines "telehealth" as a mode of delivering healthcare services, including but
not limited to telemedicine, and public health 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. Telehealth 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.
Nothing in proposed law shall be construed to expand, diminish, or alter the scope of
practice of any healthcare provider.
Proposed law requires all laws regarding the confidentiality of healthcare information and
the patient’s right to the patient's medical information to apply to telehealth interactions.
Proposed law prohibits a healthcare service plan from requiring that in-person contact occur
between a healthcare provider and a patient before payment is made for the covered services
provided, and requires every healthcare service plan to adopt payment policies to
compensate healthcare providers who provide covered healthcare services through
telehealth.
Proposed law requires payment for telehealth interactions to include reasonable
compensation to the originating site for the transmission cost incurred during the delivery
of healthcare services.
Proposed law requires healthcare service plans to pay for covered healthcare services when
provided by information and communication technologies including but not limited to
telephone or Internet technologies and for asynchronous store and forward services.
Proposed law requires payment for covered services provided by telehealth to be the lower
of the usual and customary rate charged for that service or the contract amount the healthcare
service plan pays for the same service when provided in an in-person encounter with the
patient.
Proposed law prohibits a healthcare service plan from limiting the type of setting where
services are provided for the patient or the provider and requires the healthcare service plan
to pay providers at both the distant site and the originating site.
Proposed law shall also be operative for healthcare service plan contracts with the medical
assistance program administered by the Dept. of Health and Hospitals (DHH).
Proposed law establishes the La. Commission on Telehealth Access, composed of 13
members as follows:
(1)The secretary of the Dept. of Health and Hospitals or his designee.
(2)The executive director of the La. State Board of Medical Examiners or his designee.
(3)A representative of the LSU Health Sciences Center at New Orleans.
(4)A representative of the LSU Health Sciences Center at Shreveport.
(5)A representative of the Tulane University School of Medicine.
(6)A representative of the La. State Medical Society. HLS 14RS-1077 ORIGINAL
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(7)A representative of the La. Primary Care Association.
(8)A representative of the La. Health Care Quality Forum.
(9)A representative of the HomeCare Association of La.
(10)A representative of the La. Hospital Association.
(11)A representative of the La. Association of Health Plans.
(12)A representative of the La. Cable and Telecommunications Association.
(13)A representative of the TexLa Telehealth Resource Center.
Proposed law provides for the officers, compensation, and meetings of the commission.
Proposed law provides that the functions of the commission are the following:
(1)Serve as an advisory body to the legislature and DHH on policies and practices that
expand access to telehealth services in a manner that ensures quality of care and
patient safety.
(2)Serve as a coordinating forum on telehealth related matters between and among state
agencies, local government, and other nongovernmental groups.
(3)On a regular basis, research and review state regulations, guidelines, policies, and
procedures that pertain in any way to telehealth and make recommendations to the
governor, the legislature, and the secretary of DHH as deemed necessary and
appropriate by the chairman.
Proposed law requires the commission to prepare and submit to the governor and the
legislature, on a semiannual basis, a report on the status of telehealth access in La.
Proposed law provides that the commission shall terminate on Sept. 1, 2018.
(Amends R.S. 37:1262(4), 1271(B)(2), and 1276.1(2)(a); Adds R.S. 36:259(Y), R.S.
37:1271(B)(3)-(5), and R.S. 40:1300.381-1300.389)