April 8,, 2022
Final Telehealth language below!
Also see the entire Health and Mental Hygiene budget bill just released.
Note: Human Services COLA and Opioid Settlement Fund approps not in the bill attached – they will be in the Aid to Localities bill (not yet released).
PART V
4 Section 1. Paragraphs (x) and (y) of subdivision 2 of section 2999-cc
5 of the public health law, as amended by section 3 of part F of chapter
6 57 of the laws of 2021, are amended to read as follows:
7 (x) certified peer recovery advocate services providers certified by
8 the commissioner of addiction services and supports pursuant to section
9 19.18-b of the mental hygiene law, peer providers credentialed by the
10 commissioner of addiction services and supports and peers certified or
11 credentialed by the office of mental health; [and]
12 (y) a mental health practitioner licensed pursuant to article one
13 hundred sixty-three of the education law; and
14 (z) any other provider as determined by the commissioner pursuant to
15 regulation or, in consultation with the commissioner, by the commission-
16 er of the office of mental health, the commissioner of the office of
17 addiction services and supports, or the commissioner of the office for
18 people with developmental disabilities pursuant to regulation.
19 § 2. Subdivision 1 of section 2999-dd of the public health law, as
20 amended by chapter 124 of the laws of 2020, is amended to read as
21 follows:
22 1. Health care services delivered by means of telehealth shall be
23 entitled to reimbursement under section three hundred sixty-seven-u of
24 the social services law on the same basis, at the same rate, and to the
25 same extent the equivalent services, as may be defined in regulations
26 promulgated by the commissioner, are reimbursed when delivered in
27 person; provided, however, that health care services delivered by means
28 of telehealth shall not require reimbursement to a telehealth provider
29 for certain costs, including but not limited to facility fees or costs
30 reimbursed through ambulatory patient groups or other clinic reimburse-
31 ment methodologies set forth in section twenty-eight hundred seven of
32 this chapter, if such costs were not incurred in the provision of tele-
33 health services due to neither the originating site nor the distant site
34 occurring within a facility or other clinic setting; and further
35 provided, however, reimbursement for additional modalities, provider
36 categories and originating sites specified in accordance with section
37 twenty-nine hundred ninety-nine-ee of this article, and audio-only tele-
38 phone communication defined in regulations promulgated pursuant to
39 subdivision four of section twenty-nine hundred ninety-nine-cc of this
40 article, shall be contingent upon federal financial participation.
41 Notwithstanding the provisions of this subdivision, for services
42 licensed, certified or otherwise authorized pursuant to article sixteen,
43 article thirty-one or article thirty-two of the mental hygiene law, such
44 services provided by telehealth, as deemed appropriate by the relevant
45 commissioner, shall be reimbursed at the applicable in person rates or
46 fees established by law, or otherwise established or certified by the
47 office for people with developmental disabilities, office of mental
48 health, or the office of addiction services and supports pursuant to
49 article forty-three of the mental hygiene law.
50 § 3. Subsection (a) of section 3217-h of the insurance law, as added
51 by chapter 6 of the laws of 2015, is amended to read as follows:
S. 8007--C 27 A. 9007--C
1 (a) (1) An insurer shall not exclude from coverage a service that is
2 otherwise covered under a policy that provides comprehensive coverage
3 for hospital, medical or surgical care because the service is delivered
4 via telehealth, as that term is defined in subsection (b) of this
5 section; provided, however, that an insurer may exclude from coverage a
6 service by a health care provider where the provider is not otherwise
7 covered under the policy. An insurer may subject the coverage of a
8 service delivered via telehealth to co-payments, coinsurance or deduct-
9 ibles provided that they are at least as favorable to the insured as
10 those established for the same service when not delivered via tele-
11 health. An insurer may subject the coverage of a service delivered via
12 telehealth to reasonable utilization management and quality assurance
13 requirements that are consistent with those established for the same
14 service when not delivered via telehealth.
15 (2) An insurer that provides comprehensive coverage for hospital,
16 medical or surgical care shall reimburse covered services delivered by
17 means of telehealth on the same basis, at the same rate, and to the same
18 extent that such services are reimbursed when delivered in person;
19 provided that reimbursement of covered services delivered via telehealth
20 shall not require reimbursement of costs not actually incurred in the
21 provision of the telehealth services, including charges related to the
22 use of a clinic or other facility when neither the originating site nor
23 distant site occur within the clinic or other facility.
24 (3) An insurer that provides comprehensive coverage for hospital,
25 medical, or surgical care with a network of health care providers shall
26 ensure that such network is adequate to meet the telehealth needs of
27 insured individuals for services covered under the policy when medically
28 appropriate.
29 § 4. Subsection (a) of section 4306-g of the insurance law, as added
30 by chapter 6 of the laws of 2015, is amended to read as follows:
31 (a) (1) A corporation shall not exclude from coverage a service that
32 is otherwise covered under a contract that provides comprehensive cover-
33 age for hospital, medical or surgical care because the service is deliv-
34 ered via telehealth, as that term is defined in subsection (b) of this
35 section; provided, however, that a corporation may exclude from coverage
36 a service by a health care provider where the provider is not otherwise
37 covered under the contract. A corporation may subject the coverage of a
38 service delivered via telehealth to co-payments, coinsurance or deduct-
39 ibles provided that they are at least as favorable to the insured as
40 those established for the same service when not delivered via tele-
41 health. A corporation may subject the coverage of a service delivered
42 via telehealth to reasonable utilization management and quality assur-
43 ance requirements that are consistent with those established for the
44 same service when not delivered via telehealth.
45 (2) A corporation that provides comprehensive coverage for hospital,
46 medical or surgical care shall reimburse covered services delivered by
47 means of telehealth on the same basis, at the same rate, and to the same
48 extent that such services are reimbursed when delivered in person;
49 provided that reimbursement of covered services delivered via tele-
50 health shall not require reimbursement of costs not actually incurred
51 in the provision of the telehealth services, including charges related
52 to the use of a clinic or other facility when neither the originating
53 site nor the distant site occur within the clinic or other facility. The
54 superintendent may promulgate regulations to implement the provisions
55 of this section.
S. 8007--C 28 A. 9007--C
1 (3) A corporation that provides comprehensive coverage for hospital,
2 medical, or surgical care with a network of health care providers shall
3 ensure that such network is adequate to meet the telehealth needs of
4 insured individuals for services covered under the policy when medically
5 appropriate.
6 § 5. Section 4406-g of the public health law is amended by adding two
7 new subdivisions 3 and 4 to read as follows:
8 3. A health maintenance organization that provides comprehensive
9 coverage for hospital, medical or surgical care shall reimburse covered
10 services delivered via telehealth on the same basis, at the same rate,
11 and to the extent that such services are reimbursed when delivered in
12 person; provided that reimbursement of covered services delivered by
13 means of telehealth shall not require reimbursement of costs not actu-
14 ally incurred in the provision of the telehealth services, including
15 charges related to the use of a clinic or other facility when neither
16 the originating site nor the distant site occur within the clinic or
17 other facility. The commissioner, in consultation with the superinten-
18 dent, may promulgate regulations to implement the provisions of this
19 section.
20 4. A health maintenance organization that provides comprehensive
21 coverage for hospital, medical, or surgical care with a network of
22 health care providers shall ensure that such network is adequate to meet
23 the telehealth needs of insured individuals for services covered under
24 the policy when medically appropriate.
25 § 6. The superintendent of financial services, in collaboration with
26 the commissioner of health, shall report on the impact of reimbursement
27 for telehealth services that, pursuant to the insurance law and public
28 health law, will be reimbursed by an accident and health insurer and a
29 corporation subject to article 43 of the insurance law, including a
30 health maintenance organization, on the same basis, at the same rate,
31 and to the same extent the equivalent services are reimbursed when
32 delivered in person. The report shall, at a minimum, and to the extent
33 possible, contain information regarding the use of telehealth services
34 broken down by: social service district or county; age and gender of
35 patients; procedure codes, diagnosis codes, and associated descriptions
36 or modifiers; claims paid amount totals; claims information such as
37 categories of services, specialty or type codes; and trends in the types
38 of telehealth services used such as primary care, behavioral and mental
39 health care, and the number of telehealth visits by provider type. The
40 report shall include such utilization information dating from the effec-
41 tive date of this act and ending on the one-year anniversary of such
42 effective date, and shall be submitted to the governor, the temporary
43 president of the senate, and the speaker of the assembly by December 31,
44 2023.
45 § 7. This act shall take effect immediately and shall be deemed to
46 have been in full force and effect on and after April 1, 2022; provided,
47 however, this act shall expire and be deemed repealed on and after April
48 1, 2024.