STATE OF NEW YORK ________________________________________________________________________ 365 2023-2024 Regular Sessions IN ASSEMBLY January 6, 2023 ___________ Introduced by M. of A. L. ROSENTHAL -- read once and referred to the Committee on Insurance AN ACT to amend the insurance law, the public health law and the social services law, in relation to requiring coverage for delivery through store and forward technology The People of the State of New York, represented in Senate and Assem- bly, do enact as follows: 1 Section 1. Legislative findings and declaration. The Legislature here- 2 by finds that there is a serious health concern in insurance policies 3 denying coverage for contraceptive care. The Legislature also finds that 4 throughout the COVID-19 pandemic, telemedicine has been essential for 5 patients across the state to receive care safely. 6 This Act enacts various provisions requiring that insurance policies 7 cover services provided through telemedicine, including requirements 8 that insurers provide coverage for contraceptive care, that will allow 9 patients across the state to receive care and limit the risk of 10 infection of COVID-19 throughout the pandemic. 11 § 2. Subsection (a) of section 3217-h of the insurance law, as amended 12 by section 3 of part V of chapter 57 of the laws of 2022, is amended to 13 read as follows: 14 (a) (1) An insurer shall not exclude from coverage a service that is 15 otherwise covered under a policy that provides comprehensive coverage 16 for hospital, medical or surgical care, or prescription drugs because 17 the service is delivered via telehealth or through store and forward 18 technology, as [that term is] such terms are defined in subsection (b) 19 of this section[; provided, however, that an insurer may exclude from 20 coverage a service by a health care provider where the provider is not 21 otherwise covered under the policy] and in section twenty-nine hundred 22 ninety-nine-cc of the public health law. An insurer may subject the 23 coverage of a service delivered via telehealth to co-payments, coinsu- 24 rance or deductibles provided that they are at least as favorable to the EXPLANATION--Matter in italics (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD01398-02-3
A. 365 2 1 insured as those established for the same service when not delivered via 2 telehealth. An insurer may subject the coverage of a service delivered 3 via telehealth to reasonable utilization management and quality assur- 4 ance requirements that are consistent with those established for the 5 same service when not delivered via telehealth. 6 (2) An insurer that provides comprehensive coverage for hospital, 7 medical or surgical care shall reimburse covered services delivered by 8 means of telehealth on the same basis, at the same rate, and to the same 9 extent that such services are reimbursed when delivered in person; 10 provided that reimbursement of covered services delivered via telehealth 11 shall not require reimbursement of costs not actually incurred in the 12 provision of the telehealth services, including charges related to the 13 use of a clinic or other facility when neither the originating site nor 14 distant site occur within the clinic or other facility. 15 (3) An insurer that provides comprehensive coverage for hospital, 16 medical, or surgical care with a network of health care providers shall 17 ensure that such network is adequate to meet the telehealth needs of 18 insured individuals for services covered under the policy when medically 19 appropriate. 20 § 2-a. Subsection (a) of section 3217-h of the insurance law, as added 21 by chapter 6 of the laws of 2015, is amended to read as follows: 22 (a) An insurer shall not exclude from coverage a service that is 23 otherwise covered under a policy that provides comprehensive coverage 24 for hospital, medical or surgical care, or prescription drugs because 25 the service is delivered via telehealth or through store and forward 26 technology, as [that term is] such terms are defined in subsection (b) 27 of this section [; provided, however, that an insurer may exclude from 28 coverage a service by a health care provider where the provider is not 29 otherwise covered under the policy] and in section twenty-nine hundred 30 ninety-nine-cc of the public health law. An insurer may subject the 31 coverage of a service delivered via telehealth to co-payments, coinsu- 32 rance or deductibles provided that they are at least as favorable to the 33 insured as those established for the same service when not delivered via 34 telehealth. An insurer may subject the coverage of a service delivered 35 via telehealth to reasonable utilization management and quality assur- 36 ance requirements that are consistent with those established for the 37 same service when not delivered via telehealth. 38 § 3. Subsection (i) of section 3216 of the insurance law is amended by 39 adding a new paragraph 39 to read as follows: 40 (39) Every policy which provides coverage for prescription drugs shall 41 include coverage for the cost of contraceptive care delivered through 42 store and forward technology as authorized by section twenty-nine 43 hundred ninety-nine-cc of the public health law. 44 § 4. Subsection (l) of section 3221 of the insurance law is amended by 45 adding a new paragraph 22 to read as follows: 46 (22) Every policy which provides coverage for prescription drugs shall 47 include coverage for the cost of contraceptive care delivered through 48 store and forward technology in accordance with section twenty-nine 49 hundred ninety-nine-cc of the public health law. 50 § 5. Section 4303 of the insurance law is amended by adding a new 51 subsection (uu) to read as follows: 52 (uu) Every contract issued by a hospital service corporation or a 53 health service corporation which provides coverage for prescription 54 drugs shall include coverage for the cost of contraceptive care deliv- 55 ered through store and forward technology as that term is defined in 56 section twenty-nine hundred ninety-nine-cc of the public health law.
A. 365 3 1 § 6. Subsection (a) of section 4306-g of the insurance law, as amended 2 by section 4 of part V of chapter 57 of the laws of 2022, is amended to 3 read as follows: 4 (a) (1) A corporation shall not exclude from coverage a service that 5 is otherwise covered under a contract that provides comprehensive cover- 6 age for hospital, medical or surgical care, or prescription drugs 7 because the service is delivered via telehealth[,] or through store and 8 forward technology as [that term is] such terms are defined in 9 subsection (b) of this section[; provided, however, that a corporation 10 may exclude from coverage a service by a health care provider where the 11 provider is not otherwise covered under the contract] and in section 12 twenty-nine hundred ninety-nine-cc of the public health law. A corpo- 13 ration may subject the coverage of a service delivered via telehealth to 14 co-payments, coinsurance or deductibles provided that they are at least 15 as favorable to the insured as those established for the same service 16 when not delivered via telehealth. A corporation may subject the cover- 17 age of a service delivered via telehealth to reasonable utilization 18 management and quality assurance requirements that are consistent with 19 those established for the same service when not delivered via tele- 20 health. 21 (2) A corporation that provides comprehensive coverage for hospital, 22 medical or surgical care shall reimburse covered services delivered by 23 means of telehealth on the same basis, at the same rate, and to the same 24 extent that such services are reimbursed when delivered in person; 25 provided that reimbursement of covered services delivered via telehealth 26 shall not require reimbursement of costs not actually incurred in the 27 provision of the telehealth services, including charges related to the 28 use of a clinic or other facility when neither the originating site nor 29 the distant site occur within the clinic or other facility. The super- 30 intendent may promulgate regulations to implement the provisions of this 31 section. 32 (3) A corporation that provides comprehensive coverage for hospital, 33 medical, or surgical care with a network of health care providers shall 34 ensure that such network is adequate to meet the telehealth needs of 35 insured individuals for services covered under the policy when medically 36 appropriate. 37 § 6-a. Subsection (a) of section 4306-g of the insurance law, as added 38 by chapter 6 of the laws of 2015, is amended to read as follows: 39 (a) A corporation shall not exclude from coverage a service that is 40 otherwise covered under a contract that provides comprehensive coverage 41 for hospital, medical or surgical care, or prescription drugs because 42 the service is delivered via telehealth[,] or through store and forward 43 technology as [that term is] such terms are defined in subsection (b) of 44 this section [; provided, however, that a corporation may exclude from 45 coverage a service by a health care provider where the provider is not 46 otherwise covered under the contract] and in section twenty-nine hundred 47 ninety-nine-cc of the public health law. A corporation may subject the 48 coverage of a service delivered via telehealth to co-payments, coinsu- 49 rance or deductibles provided that they are at least as favorable to the 50 insured as those established for the same service when not delivered via 51 telehealth. A corporation may subject the coverage of a service deliv- 52 ered via telehealth to reasonable utilization management and quality 53 assurance requirements that are consistent with those established for 54 the same service when not delivered via telehealth. 55 § 7. Subdivision 6 of section 2999-cc of the public health law, as 56 added by chapter 6 of the laws of 2015, is amended to read as follows:
A. 365 4 1 6. "Store and forward technology" means the asynchronous, electronic 2 transmission of a patient's health information [in the form of patient- 3 specific digital images and/or pre-recorded videos from a provider at] 4 from an originating site to a telehealth provider at a distant site. 5 § 8. Subdivision 2 of section 365-a of the social services law is 6 amended by adding a new paragraph (kk) to read as follows: 7 (kk) care and services provided by a telehealth provider pursuant to 8 section twenty-nine hundred ninety-nine-cc of the public health law. 9 § 9. This act shall take effect immediately; provided that the amend- 10 ments to subsection (a) of section 3217-h of the insurance law made by 11 section two of this act shall be subject to the expiration and reversion 12 of such subdivision pursuant to section 7 of part V of chapter 57 of the 13 laws of 2022, as amended, when upon such date the provisions of section 14 two-a of this act shall take effect; provided, further, the amendments 15 to subsection (a) of section 4306-g of the insurance law made by section 16 six of this act shall be subject to the expiration and reversion of such 17 subsection pursuant to section 7 of part V of chapter 57 of the laws of 18 2022, as amended, when upon such date the provisions of section six-a of 19 this act shall take effect.