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    Document Summary
    - Report Published -

    Report Document No. 23

    Document Title
    Report of the Special Advisory Commission on Mandated Health Insurance Benefits - Mandated Coverage For Telehealth Services: House Bill 2191and Senate Bill 1458

    Special Advisory Commission on Mandated Health Insurance Benefits

    Enabling Authority

    Executive Summary
    House Bill 2191 and Senate Bill 1458 were referred to the Special Advisory Commission on Mandated Health Insurance Benefits (Advisory Commission) for review by the House Committee on Commerce and Labor during the 2009 Session of the General Assembly of Virginia. House Bill 2191 was introduced by Delegate Clarence C. Phillips. Senator William C. Wampler introduced Senate Bill 1458, and it was referred to the Advisory Commission with identical language as House Bill 2191.

    House Bill 2191 and Senate Bill 1458 would add 38.2-3418.15 to the mandated benefits article and would amend 38.2-4319 to make it applicable to health maintenance organizations (HMOs). These bills would require insurers proposing to issue individual or group accident and sickness policies providing hospital, medical and surgical, or major medical coverage on an expense-incurred basis; corporations providing individual or group subscription contracts; and HMOs providing health care plans to provide coverage for the treatment of telehealth services.

    The bills define “Telehealth services” as the use of interactive audio, video, or other telecommunications technology by a health care provider to deliver health care services within the scope of the provider's practice at a site other than the site where the patient is located, including the use of electronic media for consultation relating to the health care diagnosis or treatment of the patient, transfer of medical data, and medical education. "Telehealth services" do not include an audio-only telephone conversation, electronic mail message, or facsimile transmission between a health care provider and a patient.

    An insurer, corporation, or HMO cannot exclude a service for coverage solely because the service is provided through telehealth and is not provided through face-to-face consultation or contact between a health care provider and a patient for services appropriately provided through telehealth services.

    No insurer, corporation, or HMO can impose any annual or lifetime dollar maximum on coverage for telehealth services other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy, or impose upon any person receiving benefits pursuant to this section any co-payment, coinsurance, or deductible amounts, or any policy year, calendar year, lifetime, or other durational benefit limitation or maximum for benefits or services, that is not equally imposed upon all terms and services covered under the policy, contract, or plan.

    The requirements of the bill apply to all insurance policies, contracts, and plans delivered, issued for delivery, reissued, or extended in the Commonwealth on and after January 1, 2010, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made.

    The bill does not apply to short-term travel, accident-only, limited or specified disease, or individual conversion policies or contracts, or to policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under state or federal governmental plans.

    The Advisory Commission held a public hearing on June 29, 2009 in Richmond to receive public comments on House Bill 2191 and Senate Bill 1458. In addition to patron Delegate Clarence E. Phillips, nine individuals representing the Office of Telemedicine at the University of Virginia Health System (UVA), the Virginia Stroke Systems Task Force (VSSTF), the American Telemedicine Association (ATA), the Virginia Telemedicine Network (VTN), the Virginia Community Healthcare Association, the Northern Neck Middle Peninsula Telehealth Consortium and Southwest Virginia Health Authority spoke in support of the bills. Representing the Virginia Commonwealth University (VCU) Office of Telemedicine was a professor of Surgery, who serves as an Editor-in-Chief of the Journal of Telemedicine and E-Health (and fellow), and who is also a member of the American College of Chest Physicians. Also, a local physician in private practice for more than thirty years spoke in favor of the bill.

    Written comments supporting the bill were received from the American Telemedicine Association (ATA), the Virginia Telemedicine Network VTN), and the Virginia Community Healthcare Association and the Virginia Rural Health Association. The Medical Society of Virginia wrote a letter of support, as well as the Virginia Stroke System of Care Task Force (VSSTF). Congressman Rick Boucher, 9th District (Virginia), conveyed his support for telemedicine services in a letter dated October 29, 2009. The Joint Commission on Health Care (JCHC) also submitted a letter of support of a mandate for coverage of telemedicine services. Two letters were submitted from private citizens in support of the proposed legislation. Written comments opposing the bill were received from the Virginia Association of Health Plans (VAHP) and the National Federation of Independent Business (NFIB). Representatives from the VAHP and the NFIB also spoke in opposition to the bills.

    The Advisory Commission voted unanimously (10 – 0) on November 17, 2009 to defer House Bill 2191 and Senate Bill 1458 until 2010. Delegate Philips presented amended language that would emphasize telemedicine services and asked the Advisory Commission to defer the bill and review the revised language in 2010. Specifically, the substitute language would narrow the scope of the proposed mandate. A telemedicine service may apply to more specialized applications that usually involve a medical team or other medical professionals. Telehealth services consist of a broad range of various applications and practices.

    The Advisory Commission deliberated the significance of the impact of telemedicine on certain populations; some would benefit from access to medical specialists and treatments; some would benefit from a decrease in distance traveled necessary to visit a medical professional; and some individuals would benefit from less loss of time from work as a result of one's inability to access medical care in an appropriate time frame. The Advisory Commission believed it is essential that interested parties have the opportunity to review and discuss the substitute language, and agreed to defer House Bill 2191 and Senate Bill 1458 until 2010.