MISSISSIPPI LEGISLATURE
2018 Regular Session
To: Public Health and Human Services
By: Representative Mims
AN ACT TO AMEND SECTION 83-9-351, MISSISSIPPI CODE OF 1972, TO PROVIDE THAT HEALTH INSURANCE COMPANIES AND EMPLOYEE BENEFIT PLANS MAY LIMIT TELEMEDICINE COVERAGE TO HEALTH CARE PROVIDERS IN NETWORK WITH THE PLAN INSTEAD OF IN A TELEMEDICINE NETWORK APPROVED BY THE PLAN; TO AMEND SECTION 83-9-353, MISSISSIPPI CODE OF 1972, TO REVISE THE DEFINITION OF "STORE-AND-FORWARD TELEMEDICINE SERVICES" FOR THE PURPOSES OF COVERAGE AND REIMBURSEMENT FOR THOSE SERVICES; TO REVISE THE CRITERIA FOR QUALIFYING PATIENTS FOR REMOTE PATIENT MONITORING SERVICES; TO DELETE THE REQUIREMENT THAT A REMOTE PATIENT MONITORING PRIOR AUTHORIZATION REQUEST BE SUBMITTED TO REQUEST TELEMONITORING SERVICES; TO REVISE THE PROVISION THAT PROHIBITS PLACING GEOGRAPHICAL RESTRICTIONS ON THE DELIVERY OF TELEMDICINE SERVICES TO DELETE REFERENCE TO SERVICES IN THE HOME SETTING; TO PROVIDE THAT HEALTH INSURANCE COMPANIES AND EMPLOYEE BENEFIT PLANS MAY LIMIT TELEMEDICINE COVERAGE TO HEALTH CARE PROVIDERS IN NETWORK WITH THE PLAN INSTEAD OF IN A TELEMEDICINE NETWORK APPROVED BY THE PLAN; TO PROHIBIT A HEALTH INSURANCE OR EMPLOYEE BENEFIT PLAN FROM CONDITIONING PAYMENT FOR SERVICES TO A HEALTH CARE PROVIDER OR FACILITY BASED UPON THE ACTIONS OR OMISSIONS OF ANOTHER HEALTH CARE PROVIDER OR FACILITY; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. Section 83-9-351, Mississippi Code of 1972, is amended as follows:
83-9-351. (1) As used in this section:
(a) "Employee benefit plan" means any plan, fund or program established or maintained by an employer or by an employee organization, or both, to the extent that such plan, fund or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, medical, surgical, hospital care or other benefits.
(b) "Health insurance plan" means any health insurance policy or health benefit plan offered by a health insurer, and includes the State and School Employees Health Insurance Plan and any other public health care assistance program offered or administered by the state or any political subdivision or instrumentality of the state. The term does not include policies or plans providing coverage for specified disease or other limited benefit coverage.
(c) "Health insurer" means any health insurance company, nonprofit hospital and medical service corporation, health maintenance organization, preferred provider organization, managed care organization, pharmacy benefit manager, and, to the extent permitted under federal law, any administrator of an insured, self-insured or publicly funded health care benefit plan offered by public and private entities, and other parties that are by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service.
(d) "Telemedicine" means the delivery of health care services such as diagnosis, consultation, or treatment through the use of interactive audio, video, or other electronic media. Telemedicine must be "real-time" consultation, and it does not include the use of audio-only telephone, e-mail, or facsimile.
(2) All health insurance and employee benefit plans in this state must provide coverage for telemedicine services to the same extent that the services would be covered if they were provided through in-person consultation.
(3) A health insurance or employee benefit plan may charge a deductible, co-payment, or coinsurance for a health care service provided through telemedicine so long as it does not exceed the deductible, co-payment, or coinsurance applicable to an in-person consultation.
(4) A health insurance or
employee benefit plan may limit coverage to health care providers in * * * network * * * with the plan.
(5) Nothing in this section shall be construed to prohibit a health insurance or employee benefit plan from providing coverage for only those services that are medically necessary, subject to the terms and conditions of the covered person's policy.
(6) In a claim for the services provided, the appropriate procedure code for the covered services shall be included with the appropriate modifier indicating interactive communication was used.
(7) The originating site is eligible to receive a facility fee, but facility fees are not payable to the distant site.
SECTION 2. Section 83-9-353, Mississippi Code of 1972, is amended as follows:
83-9-353. (1) As used in this section:
(a) "Employee benefit plan" means any plan, fund or program established or maintained by an employer or by an employee organization, or both, to the extent that such plan, fund or program was established or is maintained for the purpose of providing for its participants or their beneficiaries, through the purchase of insurance or otherwise, medical, surgical, hospital care or other benefits.
(b) "Health insurance plan" means any health insurance policy or health benefit plan offered by a health insurer, and includes the State and School Employees Health Insurance Plan and any other public health care assistance program offered or administered by the state or any political subdivision or instrumentality of the state. The term does not include policies or plans providing coverage for specified disease or other limited benefit coverage.
(c) "Health insurer" means any health insurance company, nonprofit hospital and medical service corporation, health maintenance organization, preferred provider organization, managed care organization, pharmacy benefit manager, and, to the extent permitted under federal law, any administrator of an insured, self-insured or publicly funded health care benefit plan offered by public and private entities, and other parties that are by statute, contract, or agreement, legally responsible for payment of a claim for a health care item or service.
(d) "Store-and-forward
telemedicine services" means the use of asynchronous computer-based
communication between a patient and a consulting provider or a referring health
care provider and a medical specialist at a distant site for the purpose of
diagnostic and therapeutic assistance in the care of patients * * *.
Store-and-forward telemedicine services involve the transferring of medical
data from one (1) site to another through the use of a camera or similar device
that records (stores) an image that is sent (forwarded) via telecommunication
to another site for consultation.
(e) "Remote patient monitoring services" means the delivery of home health services using telecommunications technology to enhance the delivery of home health care, including:
(i) Monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry and other condition-specific data, such as blood glucose;
(ii) Medication adherence monitoring; and
(iii) Interactive video conferencing with or without digital image upload as needed.
(f) "Mediation adherence management services" means the monitoring of a patient's conformance with the clinician's medication plan with respect to timing, dosing and frequency of medication-taking through electronic transmission of data in a home telemonitoring program.
(2) Store-and-forward telemedicine services allow a health care provider trained and licensed in his or her given specialty to review forwarded images and patient history in order to provide diagnostic and therapeutic assistance in the care of the patient without the patient being present in real time. Treatment recommendations made via electronic means shall be held to the same standards of appropriate practice as those in traditional provider-patient setting.
(3) Any patient receiving medical care by store-and-forward telemedicine services shall be notified of the right to receive interactive communication with the distant specialist health care provider and shall receive an interactive communication with the distant specialist upon request. If requested, communication with the distant specialist may occur at the time of the consultation or within thirty (30) days of the patient's notification of the request of the consultation. Telemedicine networks unable to offer the interactive consultation shall not be reimbursed for store-and-forward telemedicine services.
(4) Remote patient monitoring services aim to allow more people to remain at home or in other residential settings and to improve the quality and cost of their care, including prevention of more costly care. Remote patient monitoring services via telehealth aim to coordinate primary, acute, behavioral and long-term social service needs for high-need, high-cost patients. Specific patient criteria must be met in order for reimbursement to occur.
(5) Qualifying patients for remote patient monitoring services must meet all the following criteria:
(a) Be diagnosed * * * with one or
more chronic conditions, as defined by the Centers for Medicare and Medicaid
Services (CMS), which include, but are not limited to, sickle cell, mental
health, asthma, diabetes, and heart disease; and
(b) * * *
The patient's health care provider recommends disease management
services via remote patient monitoring.
* * *
( * * *6) The entity that will provide the
remote monitoring must be a Mississippi-based entity and have protocols in
place to address all of the following:
(a) Authentication and authorization of users;
(b) A mechanism for monitoring, tracking and responding to changes in a client's clinical condition;
(c) A standard of acceptable and unacceptable parameters for client's clinical parameters, which can be adjusted based on the client's condition;
(d) How monitoring staff will respond to abnormal parameters for client's vital signs, symptoms and/or lab results;
(e) The monitoring, tracking and responding to changes in client's clinical condition;
(f) The process for notifying the prescribing physician for significant changes in the client's clinical signs and symptoms;
(g) The prevention of unauthorized access to the system or information;
(h) System security, including the integrity of information that is collected, program integrity and system integrity;
(i) Information storage, maintenance and transmission;
(j) Synchronization and verification of patient profile data; and
(k) Notification of the client's discharge from remote patient monitoring services or the de-installation of the remote patient monitoring unit.
( * * *7) The telemonitoring equipment must:
(a) Be capable of monitoring any data parameters in the plan of care; and
(b) Be a FDA Class II hospital-grade medical device.
( * * *8) Monitoring of the client's data
shall not be duplicated by another provider.
( * * *9) To receive payment for the
delivery of remote patient monitoring services via telehealth, the service must
involve:
(a) An assessment, problem identification, and evaluation that includes:
(i) Assessment and monitoring of clinical data including, but not limited to, appropriate vital signs, pain levels and other biometric measures specified in the plan of care, and also includes assessment of response to previous changes in the plan of care; and
(ii) Detection of condition changes based on the telemedicine encounter that may indicate the need for a change in the plan of care.
(b) Implementation of a management plan through one or more of the following:
(i) Teaching regarding medication management as appropriate based on the telemedicine findings for that encounter;
(ii) Teaching regarding other interventions as appropriate to both the patient and the caregiver;
(iii) Management and evaluation of the plan of care including changes in visit frequency or addition of other skilled services;
(iv) Coordination of care with the ordering health care provider regarding telemedicine findings;
(v) Coordination and referral to other medical providers as needed; and
(vi) Referral for an in-person visit or the emergency room as needed.
( * * *10) The telemedicine equipment and
network used for remote patient monitoring services should meet the following
requirements:
(a) Comply with applicable standards of the United States Food and Drug Administration;
(b) Telehealth equipment be maintained in good repair and free from safety hazards;
(c) Telehealth equipment be new or sanitized before installation in the patient's home setting;
(d) Accommodate non-English language options; and
(e) Have 24/7 technical and clinical support services available for the patient user.
( * * *11) All health insurance and employee
benefit plans in this state must provide coverage and reimbursement for the
asynchronous telemedicine services of store-and-forward telemedicine services
and remote patient monitoring services based on the criteria set out in this
section. Store-and-forward telemedicine services shall be reimbursed to the
same extent that the services would be covered if they were provided through in-person
consultation.
( * * *12) Remote patient monitoring
services shall include reimbursement for a daily monitoring rate at a minimum
of Ten Dollars ($10.00) per day each month and Sixteen Dollars ($16.00) per day
when medication adherence management services are included, not to exceed
thirty-one (31) days per month. These reimbursement rates are only eligible to
Mississippi-based telehealth programs affiliated with a Mississippi health care
facility.
( * * *13) A one-time telehealth
installation/training fee for remote patient monitoring services will also be
reimbursed at a minimum rate of Fifty Dollars ($50.00) per patient, with a
maximum of two (2) installation/training fees/calendar year. These
reimbursement rates are only eligible to Mississippi-based telehealth programs
affiliated with a Mississippi health care facility.
( * * *14) No geographic restrictions shall
be placed on the delivery of telemedicine services * * * other than requiring the
patient reside within the State of Mississippi.
( * * *15) Health care providers seeking
reimbursement for store-and-forward telemedicine services must be licensed
Mississippi providers that are affiliated with an established Mississippi
health care facility in order to qualify for reimbursement of telemedicine
services in the state. If a service is not available in Mississippi, then a
health insurance or employee benefit plan may decide to allow a non-Mississippi-based
provider who is licensed to practice in Mississippi reimbursement for those
services.
( * * *16) A health insurance or employee
benefit plan may charge a deductible, co-payment, or coinsurance for a health
care service provided through store-and-forward telemedicine services or remote
patient monitoring services so long as it does not exceed the deductible, co-payment,
or coinsurance applicable to an in-person consultation.
( * * *17) A health insurance or employee
benefit plan may limit coverage to health care providers in * * * network * * * with the plan.
( * * *18) Nothing in this section shall be
construed to prohibit a health insurance or employee benefit plan from
providing coverage for only those services that are medically necessary,
subject to the terms and conditions of the covered person's policy.
( * * *19) In a claim for the services
provided, the appropriate procedure code for the covered service shall be
included with the appropriate modifier indicating telemedicine services were
used. A "GQ" modifier is required for asynchronous telemedicine
services such as store-and-forward and remote patient monitoring.
( * * *20) The originating site is eligible
to receive a facility fee, but facility fees are not payable to the distant
site.
(21) A health insurance or employee benefit plan may not condition payment for services to a health care provider or facility based upon the actions or omissions of another health care provider or facility.
SECTION 3. This act shall take effect and be in force from and after July 1, 2018.