H.B. 534
LEGISLATIVE GENERAL COUNSEL
6 Approved for Filing: D.M. Cheung 6
6 02-21-23 11:01 AM 6
H.B. 534
1 TELEMEDICINE AMENDMENTS
2 2023 GENERAL SESSION
3 STATE OF UTAH
4 Chief Sponsor: Melissa G. Ballard
5 Senate Sponsor: ____________
6
7LONG TITLE
8General Description:
9 This bill amends provisions relating to reimbursement for telemedicine services.
10Highlighted Provisions:
11 This bill:
12 <requires a health insurer to reimburse for telemedicine services at 90% or more of
13the rate that is paid for the equivalent in-person service if the network provider also
14provides the health care service in-person in the state.
15Money Appropriated in this Bill:
16 None
17Other Special Clauses:
18 None
19Utah Code Sections Affected:
20AMENDS:
21 31A-22-649.5, as last amended by Laws of Utah 2021, Chapters 19, 404 and last
22amended by Coordination Clause, Laws of Utah 2021, Chapter 404
23
24Be it enacted by the Legislature of the state of Utah:
25 Section 1. Section 31A-22-649.5 is amended to read:
26 31A-22-649.5. Insurance parity for telemedicine services -- Method of technology
27used.
*HB0534* H.B. 534 02-21-23 11:01 AM
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28 (1) As used in this section:
29 (a) "Mental health condition" means a mental disorder or a substance-related disorder
30that falls under a diagnostic category listed in the Diagnostic and Statistical Manual, as
31periodically revised.
32 (b) "Telemedicine services" means the same as that term is defined in Section
3326-60-102.
34 (2) Notwithstanding the provisions of Section 31A-22-618.5, a health benefit plan
35offered in the individual market, the small group market, or the large group market shall:
36 (a) provide coverage for:
37 (i) telemedicine services that are covered by Medicare; and
38 (ii) treatment of a mental health condition through telemedicine services if:
39 (A) the health benefit plan provides coverage for the treatment of the mental health
40condition through in-person services; and
41 (B) the health benefit plan determines treatment of the mental health condition through
42telemedicine services meets the appropriate standard of care; [and]
43 (b) reimburse a network provider that provides the telemedicine services described in
44Subsection (2)(a) at a negotiated commercially reasonable rate[.]; and
45 (c) for a health benefit plan entered into or renewed on or after January 1, 2024, if a
46network provider also provides health care services at an in-person location in the state,
47reimburse the telemedicine services described in Subsection (2)(a) that are delivered by the
48network provider at a rate that is at least 90% of the rate that is paid to the network provider for
49the same health care service that is delivered in-person.
50 (3) (a) Notwithstanding Section 31A-45-303, a health benefit plan providing coverage
51under Subsection (2)(a) may not impose originating site restrictions, geographic restrictions, or
52distance-based restrictions.
53 (b) A network provider that provides the telemedicine services described in Subsection
54(2)(a) may utilize any synchronous audiovisual technology for the telemedicine services that is
55compliant with the federal Health Insurance Portability and Accountability Act of 1996.