EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW. [Brackets] indicate matter deleted from existing law. Underlining indicates amendments to bill. Strike out indicates matter stricken from the bill by amendment or deleted from the law by amendment. *sb0534* SENATE BILL 534 J1, J5 3lr2155 By: Senators Gile, Beidle, Ellis, Griffith, Hershey, Klausmeier, and Mautz Introduced and read first time: February 3, 2023 Assigned to: Finance Committee Report: Favorable with amendments Senate action: Adopted Read second time: February 26, 2023 CHAPTER ______ AN ACT concerning 1 Preserve Telehealth Access Act of 2023 2 FOR the purpose of extending to a certain date the inclusion of certain audio–only 3 telephone conversations under the definition of “telehealth” for the purpose of certain 4 provisions of law relating to reimbursement and coverage of telehealth by the 5 Maryland Medical Assistance Program and certain insurers, nonprofit health service 6 plans, and health maintenance organizations; extending to a certain date a 7 requirement on the Program and certain insurers, nonprofit health service plans, 8 and health maintenance organizations to provide reimbursement for certain health 9 care services provided through telehealth on a certain basis and at a certain rate; 10 requiring the Maryland Health Care Commission to study and make 11 recommendations regarding the delivery of health care services through telehealth, 12 including payment parity for the delivery of health care services through audiovisual 13 and audio–only telehealth technologies; and generally relating to the coverage and 14 reimbursement of health care services delivered through telehealth. 15 BY repealing and reenacting, with amendments, 16 Article – Health – General 17 Section 15–141.2(a)(7) and (g) 18 Annotated Code of Maryland 19 (2019 Replacement Volume and 2022 Supplement) 20 BY repealing and reenacting, with amendments, 21 Article – Insurance 22 Section 15–139(a) and (d) 23 2 SENATE BILL 534 Annotated Code of Maryland 1 (2017 Replacement Volume and 2022 Supplement) 2 BY repealing and reenacting, without amendments, 3 Article – Insurance 4 Section 15–139(b) and (c) 5 Annotated Code of Maryland 6 (2017 Replacement Volume and 2022 Supplement) 7 SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 8 That the Laws of Maryland read as follows: 9 Article – Health – General 10 15–141.2. 11 (a) (7) (i) “Telehealth” means the delivery of medically necessary somatic, 12 dental, or behavioral health services to a patient at an originating site by a distant site 13 provider through the use of technology–assisted communication. 14 (ii) “Telehealth” includes: 15 1. Synchronous and asynchronous interactions; 16 2. From July 1, 2021, to June 30, [2023] 2025, both 17 inclusive, an audio–only telephone conversation between a health care provider and a 18 patient that results in the delivery of a billable, covered health care service; and 19 3. Remote patient monitoring services. 20 (iii) “Telehealth” does not include the provision of health care 21 services solely through: 22 1. Except as provided in subparagraph (ii)2 of this 23 paragraph, an audio–only telephone conversation; 24 2. An e–mail message; or 25 3. A facsimile transmission. 26 (g) (1) Subject to paragraph (3) of this subsection, the Program shall 27 reimburse a health care provider for the diagnosis, consultation, and treatment of a 28 Program recipient for a health care service covered by the Program that can be 29 appropriately provided through telehealth. 30 (2) This subsection does not require the Program to reimburse a health 31 care provider for a health care service delivered in person or through telehealth that is: 32 SENATE BILL 534 3 (i) Not a covered health care service under the Program; or 1 (ii) Delivered by an out–of–network provider unless the health care 2 service is a self–referred service authorized under the Program. 3 (3) (i) From July 1, 2021, to June 30, [2023] 2025, both inclusive, when 4 appropriately provided through telehealth, the Program shall provide reimbursement in 5 accordance with paragraph (1) of this subsection on the same basis and the same rate as if 6 the health care service were delivered by the health care provider in person. 7 (ii) The reimbursement required under subparagraph (i) of this 8 paragraph does not include: 9 1. Clinic facility fees unless the health care service is 10 provided by a health care provider not authorized to bill a professional fee separately for 11 the health care service; or 12 2. Any room and board fees. 13 Article – Insurance 14 15–139. 15 (a) (1) In this section, “telehealth” means, as it relates to the delivery of health 16 care services, the use of interactive audio, video, or other telecommunications or electronic 17 technology by a licensed health care provider to deliver a health care service within the 18 scope of practice of the health care provider at a location other than the location of the 19 patient. 20 (2) “Telehealth” includes from July 1, 2021, to June 30, [2023] 2025, both 21 inclusive, an audio–only telephone conversation between a health care provider and a 22 patient that results in the delivery of a billable, covered health care service. 23 (3) “Telehealth” does not include: 24 (i) except as provided in paragraph (2) of this subsection, an 25 audio–only telephone conversation between a health care provider and a patient; 26 (ii) an electronic mail message between a health care provider and a 27 patient; or 28 (iii) a facsimile transmission between a health care provider and a 29 patient. 30 (b) This section applies to: 31 4 SENATE BILL 534 (1) insurers and nonprofit health service plans that provide hospital, 1 medical, or surgical benefits to individuals or groups on an expense–incurred basis under 2 health insurance policies or contracts that are issued or delivered in the State; and 3 (2) health maintenance organizations that provide hospital, medical, or 4 surgical benefits to individuals or groups under contracts that are issued or delivered in 5 the State. 6 (c) (1) An entity subject to this section: 7 (i) shall provide coverage under a health insurance policy or 8 contract for health care services appropriately delivered through telehealth regardless of 9 the location of the patient at the time the telehealth services are provided; 10 (ii) may not exclude from coverage a health care service solely 11 because it is provided through telehealth and is not provided through an in–person 12 consultation or contact between a health care provider and a patient; and 13 (iii) may not exclude from coverage or deny coverage for a behavioral 14 health care service that is a covered benefit under a health insurance policy or contract 15 when provided in person solely because the behavioral health care service may also be 16 provided through a covered telehealth benefit. 17 (2) The health care services appropriately delivered through telehealth 18 shall include counseling and treatment for substance use disorders and mental health 19 conditions. 20 (d) (1) Subject to paragraph (2) of this subsection, an entity subject to this 21 section: 22 (i) shall reimburse a health care provider for the diagnosis, 23 consultation, and treatment of an insured patient for a health care service covered under a 24 health insurance policy or contract that can be appropriately provided through telehealth; 25 (ii) is not required to: 26 1. reimburse a health care provider for a health care service 27 delivered in person or through telehealth that is not a covered benefit under the health 28 insurance policy or contract; or 29 2. reimburse a health care provider who is not a covered 30 provider under the health insurance policy or contract; and 31 (iii) 1. may impose a deductible, copayment, or coinsurance 32 amount on benefits for health care services that are delivered either through an in–person 33 consultation or through telehealth; 34 SENATE BILL 534 5 2. may impose an annual dollar maximum as permitted by 1 federal law; and 2 3. may not impose a lifetime dollar maximum. 3 (2) (i) From July 1, 2021, to June 30, [2023] 2025, both inclusive, when 4 a health care service is appropriately provided through telehealth, an entity subject to this 5 section shall provide reimbursement in accordance with paragraph (1)(i) of this subsection 6 on the same basis and at the same rate as if the health care service were delivered by the 7 health care provider in person. 8 (ii) The reimbursement required under subparagraph (i) of this 9 paragraph does not include: 10 1. clinic facility fees unless the health care service is 11 provided by a health care provider not authorized to bill a professional fee separately for 12 the health care service; or 13 2. any room and board fees. 14 (iii) This paragraph may not be construed to supersede the authority 15 of the Health Services Cost Review Commission to set the appropriate rates for hospitals, 16 including setting the hospital facility fee for hospital–provided telehealth. 17 SECTION 2. AND BE IT FURTHER ENACTED, That: 18 (a) The Maryland Health Care Commission shall study and make 19 recommendations regarding the delivery of health care services through telehealth, 20 including payment parity for the delivery of health care services through audiovisual and 21 audio–only telehealth technologies. 22 (b) In conducting the study required under subsection (a) of this section, the 23 Maryland Health Care Commission shall: 24 (1) determine whether it is more or less costly for health care providers to 25 deliver health care services through telehealth; 26 (2) determine whether the delivery of health care services through 27 telehealth requires more or less clinical effort on the part of the health care provider; 28 (3) to help inform the debate on payment parity, identify the aspects of 29 telehealth that are subject to overuse or underuse or yield greater or lower value; 30 (4) assess the adequacy of reimbursement for behavioral health services 31 delivered in–person and by telehealth; and 32 6 SENATE BILL 534 (5) address any other issues related to telehealth as determined necessary 1 by the Commission. 2 (c) On or before December 1, 2024, the Maryland Health Care Commission shall 3 submit a report on its findings and recommendations to the General Assembly, in 4 accordance with § 2–1257 of the State Government Article. 5 SECTION 2. 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 6 June 1, 2023. 7 Approved: ________________________________________________________________________________ Governor. ________________________________________________________________________________ President of the Senate. ________________________________________________________________________________ Speaker of the House of Delegates.