Bill Summary – FastDemocracy

CERTIFICATION OF ENROLLMENT
                               SENATE BILL 5821
                        Chapter 215, Laws of 2024
                                68th Legislature
                              2024 Regular Session
AUDIO-ONLY TELEMEDICINE—DEFINITION OF ESTABLISHED RELATIONSHIP WITH
                             PROVIDER
                       EFFECTIVE DATE: June 6, 2024
 Passed by the Senate February 6, 2024                CERTIFICATE
   Yeas 49 Nays 0
                                         I, Sarah Bannister, Secretary of
                                         the   Senate   of  the   State   of
               DENNY HECK                Washington, do hereby certify that
 President of the Senate                 the attached is SENATE BILL 5821 as
                                         passed by the Senate and the House
                                         of Representatives on the dates
                                         hereon set forth.
 Passed by the House February 28, 2024
   Yeas 79 Nays 16
                                                   SARAH BANNISTER
             LAURIE JINKINS                                           Secretary
 Speaker of the House of
 Representatives
 Approved March 19, 2024 3:16 PM                         FILED
                                                     March 21, 2024
                                                  Secretary of State
               JAY INSLEE                         State of Washington
 Governor of the State of Washington
                               SENATE BILL 5821
                   Passed Legislature - 2024 Regular Session
     State of Washington       68th Legislature          2024 Regular Session
     By Senators Muzzall, Randall, Kuderer, and Rivers
     Prefiled 12/08/23. Read first time 01/08/24.    Referred to Committee
     on Health & Long Term Care.
      AN ACT Relating to establishing a uniform standard for creating
  an established relationship for the purposes of coverage of audio-
  only telemedicine services by expanding the time in which a health
  care provider has seen the patient and removing the expiration of
  provisions allowing for the use of real-time interactive appointments
  using both audio and video technology; amending RCW 41.05.700 and
  48.43.735; and reenacting and amending RCW 74.09.325.
 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:
     Sec. 1. RCW 41.05.700 and 2023 c 8 s 1 are each amended to read
 as follows:
     (1)(a) A health plan offered to employees, school employees, and
 their covered dependents under this chapter issued or renewed on or
 after January 1, 2017, shall reimburse a provider for a health care
 service provided to a covered person through telemedicine or store
 and forward technology if:
     (i) The plan provides coverage of the health care service when
 provided in person by the provider;
     (ii) The health care service is medically necessary;
     (iii) The health care service is a service recognized as an
 essential health benefit under section 1302(b) of the federal patient
 protection and affordable care act in effect on January 1, 2015;
                                     p. 1                          SB 5821.SL
     (iv) The health care service is determined to be safely and
 effectively provided through telemedicine or store and forward
 technology according to generally accepted health care practices and
 standards, and the technology used to provide the health care service
 meets the standards required by state and federal laws governing the
 privacy and security of protected health information; and
     (v) Beginning January 1, 2023, for audio-only telemedicine, the
 covered person has an established relationship with the provider.
     (b)(i) Except as provided in (b)(ii) of this subsection, a health
 plan offered to employees, school employees, and their covered
 dependents under this chapter issued or renewed on or after January
 1, 2021, shall reimburse a provider for a health care service
 provided to a covered person through telemedicine the same amount of
 compensation the carrier would pay the provider if the health care
 service was provided in person by the provider.
     (ii) Hospitals, hospital systems, telemedicine companies, and
 provider groups consisting of eleven or more providers may elect to
 negotiate an amount of compensation for telemedicine services that
 differs from the amount of compensation for in-person services.
     (iii) For purposes of this subsection (1)(b), the number of
 providers in a provider group refers to all providers within the
 group, regardless of a provider's location.
     (2) For purposes of this section, reimbursement of store and
 forward technology is available only for those covered services
 specified in the negotiated agreement between the health plan and
 health care provider.
     (3) An originating site for a telemedicine health care service
 subject to subsection (1) of this section includes a:
     (a) Hospital;
     (b) Rural health clinic;
     (c) Federally qualified health center;
     (d) Physician's or other health care provider's office;
     (e) Licensed or certified behavioral health agency;
     (f) Skilled nursing facility;
     (g) Home or any location determined by the individual receiving
 the service; or
     (h) Renal dialysis center, except an independent renal dialysis
 center.
     (4) Except for subsection (3)(g) of this section, any originating
 site under subsection (3) of this section may charge a facility fee
                                     p. 2                       SB 5821.SL
 for infrastructure and preparation of the patient. Reimbursement for
 a facility fee must be subject to a negotiated agreement between the
 originating site and the health plan. A distant site, a hospital that
 is an originating site for audio-only telemedicine, or any other site
 not identified in subsection (3) of this section may not charge a
 facility fee.
     (5) The plan may not distinguish between originating sites that
 are rural and urban in providing the coverage required in subsection
 (1) of this section.
     (6) The plan may subject coverage of a telemedicine or store and
 forward technology health service under subsection (1) of this
 section to all terms and conditions of the plan including, but not
 limited to, utilization review, prior authorization, deductible,
 copayment, or coinsurance requirements that are applicable to
 coverage of a comparable health care service provided in person.
      (7) This section does not require the plan to reimburse:
      (a) An originating site for professional fees;
      (b) A provider for a health care service that is not a covered
 benefit under the plan; or
     (c) An originating site or health care provider when the site or
 provider is not a contracted provider under the plan.
      (8)(a) If a provider intends to bill a patient or the patient's
 health plan for an audio-only telemedicine service, the provider must
 obtain patient consent for the billing in advance of the service
 being delivered.
      (b) If the health care authority has cause to believe that a
 provider has engaged in a pattern of unresolved violations of this
 subsection (8), the health care authority may submit information to
 the appropriate disciplining authority, as defined in RCW 18.130.020,
 for action. Prior to submitting information to the appropriate
 disciplining authority, the health care authority may provide the
 provider with an opportunity to cure the alleged violations or
 explain why the actions in question did not violate this subsection
 (8).
      (c) If the provider has engaged in a pattern of unresolved
 violations of this subsection (8), the appropriate disciplining
 authority may levy a fine or cost recovery upon the provider in an
 amount not to exceed the applicable statutory amount per violation
 and take other action as permitted under the authority of the
 disciplining authority. Upon completion of its review of any
                                     p. 3                       SB 5821.SL
 potential violation submitted by the health care authority or
 initiated directly by an enrollee, the disciplining authority shall
 notify the health care authority of the results of the review,
 including whether the violation was substantiated and any enforcement
 action taken as a result of a finding of a substantiated violation.
     (9) For purposes of this section:
     (a)(i) "Audio-only telemedicine" means the delivery of health
 care services through the use of audio-only technology, permitting
 real-time communication between the patient at the originating site
 and the provider, for the purpose of diagnosis, consultation, or
 treatment.
     (ii) For purposes of this section only, "audio-only telemedicine"
 does not include:
     (A) The use of facsimile or email; or
     (B) The delivery of health care services that are customarily
 delivered by audio-only technology and customarily not billed as
 separate services by the provider, such as the sharing of laboratory
 results;
     (b) "Disciplining authority" has the same meaning as in RCW
 18.130.020;
     (c) "Distant site" means the site at which a physician or other
 licensed provider, delivering a professional service, is physically
 located at the time the service is provided through telemedicine;
     (d) "Established relationship" means the provider providing
 audio-only telemedicine has access to sufficient health records to
 ensure safe, effective, and appropriate care services and:
     (i) ((For health care services included in the essential health
 benefits category of mental health and substance use disorder
 services, including behavioral health treatment:
     (A))) The covered person has had, within the past three years, at
 least one in-person appointment, or at least one real-time
 interactive appointment using both audio and video technology, with
 the provider providing audio-only telemedicine or with a provider
 employed at the same medical group, at the same clinic, or by the
 same integrated delivery system operated by a carrier licensed under
 chapter 48.44 or 48.46 RCW as the provider providing audio-only
 telemedicine; or
     (((B))) (ii) The covered person was referred to the provider
 providing audio-only telemedicine by another provider who has had,
 within the past three years, at least one in-person appointment, or
                                     p. 4                       SB 5821.SL
 at least one real-time interactive appointment using both audio and
 video technology, with the covered person and has provided relevant
 medical   information    to   the   provider   providing   audio-only
 telemedicine;
     (((ii) For any other health care service:
     (A) The covered person has had, within the past two years, at
 least one in-person appointment, or, until July 1, 2024, at least one
 real-time interactive appointment using both audio and video
 technology, with the provider providing audio-only telemedicine or
 with a provider employed at the same medical group, at the same
 clinic, or by the same integrated delivery system operated by a
 carrier licensed under chapter 48.44 or 48.46 RCW as the provider
 providing audio-only telemedicine; or
     (B) The covered person was referred to the provider providing
 audio-only telemedicine by another provider who has had, within the
 past two years, at least one in-person appointment, or, until July 1,
 2024, at least one real-time interactive appointment using both audio
 and video technology, with the covered person and has provided
 relevant medical information to the provider providing audio-only
 telemedicine;))
     (e) "Health care service" has the same meaning as in RCW
 48.43.005;
     (f) "Hospital" means a facility licensed under chapter 70.41,
 71.12, or 72.23 RCW;
     (g) "Originating site" means the physical location of a patient
 receiving health care services through telemedicine;
     (h) "Provider" has the same meaning as in RCW 48.43.005;
     (i) "Store and forward technology" means use of an asynchronous
 transmission of a covered person's medical information from an
 originating site to the health care provider at a distant site which
 results in medical diagnosis and management of the covered person,
 and does not include the use of audio-only telephone, facsimile, or
 email; and
     (j) "Telemedicine" means the delivery of health care services
 through the use of interactive audio and video technology, permitting
 real-time communication between the patient at the originating site
 and the provider, for the purpose of diagnosis, consultation, or
 treatment. For purposes of this section only, "telemedicine" includes
 audio-only telemedicine, but does not include facsimile or email.
                                     p. 5                       SB 5821.SL
     Sec. 2. RCW 48.43.735 and 2023 c 8 s 2 are each amended to read
 as follows:
     (1)(a) For health plans issued or renewed on or after January 1,
 2017, a health carrier shall reimburse a provider for a health care
 service provided to a covered person through telemedicine or store
 and forward technology if:
     (i) The plan provides coverage of the health care service when
 provided in person by the provider;
     (ii) The health care service is medically necessary;
     (iii) The health care service is a service recognized as an
 essential health benefit under section 1302(b) of the federal patient
 protection and affordable care act in effect on January 1, 2015;
     (iv) The health care service is determined to be safely and
 effectively provided through telemedicine or store and forward
 technology according to generally accepted health care practices and
 standards, and the technology used to provide the health care service
 meets the standards required by state and federal laws governing the
 privacy and security of protected health information; and
     (v) Beginning January 1, 2023, for audio-only telemedicine, the
 covered person has an established relationship with the provider.
     (b)(i) Except as provided in (b)(ii) of this subsection, for
 health plans issued or renewed on or after January 1, 2021, a health
 carrier shall reimburse a provider for a health care service provided
 to a covered person through telemedicine the same amount of
 compensation the carrier would pay the provider if the health care
 service was provided in person by the provider.
     (ii) Hospitals, hospital systems, telemedicine companies, and
 provider groups consisting of eleven or more providers may elect to
 negotiate an amount of compensation for telemedicine services that
 differs from the amount of compensation for in-person services.
     (iii) For purposes of this subsection (1)(b), the number of
 providers in a provider group refers to all providers within the
 group, regardless of a provider's location.
     (2) For purposes of this section, reimbursement of store and
 forward technology is available only for those covered services
 specified in the negotiated agreement between the health carrier and
 the health care provider.
     (3) An originating site for a telemedicine health care service
 subject to subsection (1) of this section includes a:
     (a) Hospital;
                                     p. 6                       SB 5821.SL
     (b) Rural health clinic;
     (c) Federally qualified health center;
     (d) Physician's or other health care provider's office;
     (e) Licensed or certified behavioral health agency;
     (f) Skilled nursing facility;
     (g) Home or any location determined by the individual receiving
 the service; or
     (h) Renal dialysis center, except an independent renal dialysis
 center.
     (4) Except for subsection (3)(g) of this section, any originating
 site under subsection (3) of this section may charge a facility fee
 for infrastructure and preparation of the patient. Reimbursement for
 a facility fee must be subject to a negotiated agreement between the
 originating site and the health carrier. A distant site, a hospital
 that is an originating site for audio-only telemedicine, or any other
 site not identified in subsection (3) of this section may not charge
 a facility fee.
     (5) A health carrier may not distinguish between originating
 sites that are rural and urban in providing the coverage required in
 subsection (1) of this section.
     (6) A health carrier may subject coverage of a telemedicine or
 store and forward technology health service under subsection (1) of
 this section to all terms and conditions of the plan in which the
 covered person is enrolled including, but not limited to, utilization
 review, prior authorization, deductible, copayment, or coinsurance
 requirements that are applicable to coverage of a comparable health
 care service provided in person.
     (7) This section does not require a health carrier to reimburse:
     (a) An originating site for professional fees;
     (b) A provider for a health care service that is not a covered
 benefit under the plan; or
     (c) An originating site or health ca