First Regular Session H.B. 2454
PROPOSED
SENATE AMENDMENTS TO H.B. 2454
(Reference to House engrossed bill)
Page 1, strike lines 2 through 27
Renumber to conform
Line 39, after "1." insert "Except as otherwise provided in this subsection,"
Page 2, line 1, after "on" insert "practice guidelines,"; after "research" strike remainder of line insert "or recommendations by the telehealth advisory committee on telehealth best practices established by section 36-3607, determines not to be appropriate to be"
Line 3, after "2." insert "Except as otherwise provided in this paragraph,"
Line 4, strike "diagnostic"
Line 5, strike "and procedure codes" insert "healthcare common procedure coding system"; after "telehealth" insert "using an audio-visual format"
Line 6, strike ", unless the" insert ". A corporation shall reimburse health care providers at the same level of payment for equivalent in-person behavioral health and substance use disorder services as identified by the healthcare common procedure coding system if provided through telehealth using an audio-only format. This paragraph does not apply to a"; strike "is"
Line 9, after "corporation" insert "as a condition of network participation"; after the period strike remainder of line
Line 10, strike "level of payment," insert:
"3. Before January 1, 2022, a corporation shall cover services provided through an audio-only telehealth encounter if that service is covered by medicare or the Arizona health care cost containment system when provided through an audio-only telehealth encounter. Beginning January 1, 2022, a corporation shall cover services provided through an audio-only telehealth encounter if the telehealth advisory committee on telehealth best practices established by section 36-3607 recommends that the services may appropriately be provided through an audio-only telehealth encounter.
4. A health care provider shall bill for a telehealth encounter using the healthcare common procedure coding system and shall identify whether the telehealth encounter was provided in an audio-only or audio-video format. To submit a claim for an audio-only service,"
Renumber to conform
Page 2, line 12, after the period insert:
"5."
Renumber to conform
Line 23, after "4." insert "Covered"; strike "and shall be covered"
Between lines 27 and 28, insert:
"B. Subsection A of this section does not:
1. Limit the ability of corporations to provide incentives to subscribers that are designed to improve health outcomes, increase adherence to a course of treatment or reduce risk.
2. Prevent corporations from offering network contracts to health care providers who employ value-based purchasing or bundled payment methodologies if otherwise allowed by law or prevent health care providers from voluntarily agreeing to enter into such contracts with a corporation.
C. This section does not relieve a corporation from an obligation to provide adequate access to in-person health care services. Network adequacy standards required by federal or state law may not be met by a corporation through the use of contracted health care providers who provide only telehealth services and do not provide in-person health care services in this state or within fifty miles of the border of this state."
Reletter to conform
Line 33, after the period insert "If the corporation waives a deductible or copayment or coinsurance requirement that impacts a health care provider's contracted reimbursement rate, the corporation shall reimburse the health care provider for the cost of the deductible or copayment or coinsurance requirement to ensure that the health care provider receives the contracted reimbursement rate if the service is covered and the claim meets other requirements of the network participation agreement."
Page 3, line 11, strike "the subscriber's preference,"
Line 37, after "1." insert "Except as otherwise provided in this subsection,"
Line 44, after "on" insert "practice guidelines,"; strike the second comma
Line 45, strike "recommends not" insert "or recommendations by the telehealth advisory committee on telehealth best practices established by section 36-3607, determines not to be appropriate to"
Page 4, line 1, after "2." insert "Except as otherwise provided in this paragraph,"
Line 3, strike "diagnostic and procedure code" insert "healthcare common procedure coding system"
Line 4, after the first "telehealth" insert "using an audio-visual format"; strike ", unless the" insert ". A health care services organization shall reimburse health care providers at the same level of payment for equivalent in-person behavioral health and substance use disorder services as identified by the healthcare common procedure coding system if provided through telehealth using an audio-only format. This paragraph does not apply to a"; strike "is"
Line 8, after "organization" insert "as a condition of network participation"; strike "to"
Line 9, strike "qualify for the same level of payment," insert:
"3. Before January 1, 2022, a health care services organization shall cover services provided through an audio-only telehealth encounter if that service is covered by medicare or the Arizona health care cost containment system when provided through an audio-only telehealth encounter. Beginning January 1, 2022, a health care services organization shall cover services provided through an audio-only telehealth encounter if the telehealth advisory committee on telehealth best practices established by section 36-3607 recommends that the services may appropriately be provided through an audio-only telehealth encounter.
4. A health care provider shall bill for a telehealth encounter using the healthcare common procedure coding system and shall identify whether the telehealth encounter was provided in an audio-only or audio-video format. To submit a claim for an audio-only service,"
Renumber to conform
Page 4, line 11, after the period insert:
"5."
Renumber to conform
Line 23, after "4." insert "Covered"; strike "and shall be covered"
Between lines 28 and 29, insert:
"B. Subsection A of this section does not:
1. Limit the ability of health care services organizations to provide incentives to enrollees that are designed to improve health outcomes, increase adherence to a course of treatment or reduce risk.
2. Prevent health care services organizations from offering network contracts to health care providers who employ value-based purchasing or bundled payment methodologies if otherwise allowed by law or prevent health care providers from voluntarily agreeing to enter into such contracts with a health care services organization.
C. This section does not relieve a health care services organization from an obligation to provide adequate access to in-person health care services. Network adequacy standards required by federal or state law may not be met by a health care services organization through the use of contracted health care providers who provide only telehealth services and do not provide in-person health care services in this state or within fifty miles of the border of this state."
Reletter to conform
Line 34, after the period insert "If the health care services organization waives a deductible or copayment or coinsurance requirement that impacts a health care provider's contracted reimbursement rate, the health care services organization shall reimburse the health care provider for the cost of the deductible or copayment or coinsurance requirement to ensure that the health care provider receives the contracted reimbursement rate if the service is covered and the claim meets other requirements of the network participation agreement."
Page 5, line 13, strike "the enrollee's preference,"
Line 37, after "1." insert "Except as otherwise provided in this subsection,"
Line 43, after "evidence" insert a comma; after "on" insert "practice guidelines,"; strike the comma
Line 44, strike "recommends not" insert "or recommendations by the telehealth advisory committee on telehealth best practices established by section 36-3607, determines not to be appropriate to"
Page 6, line 1, after "2." insert "Except as otherwise provided in this paragraph,"
Line 3, strike "diagnostic and procedure codes" insert "healthcare common procedure coding system"; after "telehealth" insert "using an audio-visual format"
Line 4, strike ", unless the" insert ". A disability insurer shall reimburse health care providers at the same level of payment for equivalent in-person behavioral health and substance use disorder services as identified by the healthcare common procedure coding system if provided through telehealth using an audio-only format. This paragraph does not apply to a"; strike "is"
Line 8, after "insurer" insert "as a condition of network participation"; strike "to qualify for the same level of payment," insert:
"3. Before January 1, 2022, a disability insurer shall cover services provided through an audio-only telehealth encounter if that service is reimbursed by medicare or the Arizona health care cost containment system when provided through an audio-only telehealth encounter. Beginning January 1, 2022, a disability insurer shall cover services provided through an audio-only telehealth encounter if the telehealth advisory committee on telehealth best practices established by section 36-3607 recommends that the services may appropriately be provided through an audio-only telehealth encounter.
4. A health care provider shall bill for a telehealth encounter using the healthcare common procedure coding system and shall identify whether the telehealth encounter was provided in an audio-only or audio-video format. To submit a claim for an audio-only service,"
Renumber to conform
Page 6, line 10, after the period insert:
"5."
Renumber to conform
Line 22, after "4." insert "Covered"; strike "and shall be covered"
Between lines 26 and 27, insert:
"B. Subsection A of this section does not:
1. Limit the ability of disability insurers to provide incentives to insureds that are designed to improve health outcomes, increase adherence to a course of treatment or reduce risk.
2. Prevent disability insurers from offering network contracts to health care providers that employ value-based purchasing or bundled payment methodologies if otherwise allowed by law or prevent health care providers from voluntarily agreeing to enter into such contracts with a disability insurer.
C. This section does not relieve a disability insurer from an obligation to provide adequate access to in-person health care services. Network adequacy standards required by federal or state law may not be met by a disability insurer through the use of contracted health care providers who provide only telehealth services and do not provide in-person health care services in this state or within fifty miles of the border of this state."
Reletter to conform
Line 32, after the period insert "If the disability insurer waives a deductible or copayment or coinsurance requirement that impacts a health care provider's contracted reimbursement rate, the disability insurer shall reimburse the health care provider for the cost of the deductible or copayment or coinsurance requirement to ensure that the health care provider receives the contracted reimbursement rate if the service is covered and the claim meets other requirements of the network participation agreement."
Page 7, line 11, strike "the insured's preference,"
Line 36, after "1." insert "except as otherwise provided in this subsection,"
Line 42, after "on" insert "practice guidelines,"
Line 43, strike ", recommends not" insert "or recommendations by the telehealth advisory committee on telehealth best practices established by section 36-3607, determines not to be appropriate to"
Page 8, line 1, after "2." insert "Except as otherwise provided in this paragraph,"
Line 3, strike "diagnostic and procedure codes" insert "healthcare common procedure coding system"
Line 4, after the first "telehealth" insert "using an audio-visual format"; strike ", unless the" insert ". A group or blanket disability insurer shall reimburse health care providers at the same level of payment for equivalent in-person behavioral health and substance use disorder services as identified by the healthcare common procedure coding system if provided through telehealth using an audio-only format. This paragraph does not apply to a"; strike "is"
Line 8, after "insurer" insert "as a condition of network participation"; strike "to"
Line 9, strike "qualify for the same level of payment," insert:
"3. Before January 1, 2022, a group or blanket disability insurer shall cover services provided through an audio-only telehealth encounter if that service is reimbursed by medicare or the Arizona health care cost containment system when provided through an audio-only telehealth encounter. Beginning January 1, 2022, a group or blanket disability insurer shall cover services provided through an audio-only telehealth encounter if the telehealth advisory committee on telehealth best practices established by section 36-3607 recommends that the services may appropriately be provided through an audio-only telehealth encounter.
4. A health care provider shall bill for a telehealth encounter using the healthcare common procedure coding system and shall identify whether the telehealth encounter was provided in an audio-only or audio-video format. To submit a claim for an audio-only service,"
Renumber to conform
Page 8, line 11, after the period insert:
"5."
Renumber to conform
Line 23, after "4." insert "Covered"; strike "and shall be covered"
Between lines 27 and 28, insert:
"B. Subsection A of this section does not:
1. Limit the ability of group or blanket disability insurers to provide incentives to insureds that are designed to improve health outcomes, increase adherence to a course of treatment or reduce risk.
2. Prevent group or blanket disability insurers from offering network contracts to health care providers who employ value-based purchasing or bundled payment methodologies if otherwise allowed by law or prevent health care providers from voluntarily agreeing to enter into such contracts with a group or blanket disability insurer.
C. This section does not relieve a group or blanket disability insurer from an obligation to provide adequate access to in-person health care services. Network adequacy standards required by federal or state law may not be met by a group or blanket disability insurer through the use of contracted health care providers who provide only telehealth services and do not provide in-person health care services in this state or within fifty miles of the border of this state."
Reletter to conform
Line 33, after the period insert "If the group or blanket disability insurer waives a deductible or copayment or coinsurance requirement that impacts a health care provider's contracted reimbursement rate, the group or blanket disability insurer shall reimburse the health care provider for the cost of the deductible or copayment or coinsurance requirement to ensure that the health care provider receives the contracted reimbursement rate if the service is covered and the claim meets other requirements of the network participation agreement."
Page 9, line 11, strike "the insured's preference,"
Line 16, strike "Includes"
Line 39, strike ", and whether"
Strike line 40
Line 41, strike "in section 36-3601"; after "telehealth" insert "as defined in section 36-3601"
Page 18, line 8, after "with" insert "a"
Page 41, line 19, after "includes" insert ":
(i)"
Line 21, strike "(c) Includes" insert "(ii)"
Line 38, strike "the patient's"
Line 39, strike "preference,"
Page 42, line 5, strike "F" insert "G"
Line 20, after "E." insert "except as provided in subsection F of this section and for schedule II drugs,"
Line 23, after "prescriptions" insert "or dispense or administer prescription drugs and devices"; strike "require" insert "provide"
Line 26, after the period insert "Schedule II drugs may be prescribed only after an in-person or audio-visual examination and only to the extent allowed by federal and state law.
F. Services provided through telehealth are subject to this state's laws and rules governing the health care provider's scope of practice and the practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607."
Reletter to conform
Page 43, line 13, strike "and" insert a comma; after "36-3607" insert "and 36-3608"
Page 43, line 16, strike "A." insert "Consistent with the best practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607,"
Line 17, after "determining" insert "both of the following:
1."
Line 19, after "judgment" insert "in"
Strike line 23
Line 24, strike "determining" insert:
"2."
Line 28, strike "may"
Line 30, after the period strike remainder of line
Strike lines 31 and 32
Line 44, after "all" insert "United States"
Line 45, after the period insert "verification of licensure in another state shall be made through information obtained from the applicable regulatory board's website."
Page 44, between lines 6 and 7, insert:
"2. Before prescribing a controlled substance to a patient in this state, registers with the controlled substances prescription monitoring program established pursuant to chapter 28 of this title."
Renumber to conform
Line 16, after the first "The" insert "health care provider"
Line 20, strike "and" insert ", laws and rules governing prescribing, dispensing and administering prescription drugs and devices,"; after "requirements" insert "and the best practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607"
Line 30, strike "update" insert "updates"
Line 31, strike "submit" insert "submits"
Line 36, after "not" insert ":
1."; after "state" insert ", except as part of a multistate provider group that includes at least one health care provider who is licensed in this state through the applicable health care provider regulatory board or agency."; strike "or" insert "2."
Page 44, line 41, after the second "and" insert "both nondisciplinary and"
Line 43, after the period insert "For the purposes of"
Line 44, after "state" strike remainder of line
Strike line 45
Page 45, strike lines 1 and 2, insert ", all statutory authority regarding investigating, rehabilitating and educating health care providers may be used. If a health care provider fails to comply with the applicable laws and rules of this state, the applicable health care provider regulatory board or agency in this state may revoke or prohibit the health care provider's privileges in this state, report the action to the national practitioner database and refer the matter to the licensing authority in the state or states where the health care provider possesses a professional license. In any matter or proceeding arising from such a referral, the applicable health care provider regulatory board or agency in this state may share any related disciplinary and investigative information in its possession with another state licensing board."
Line 3, after "any" insert "civil or criminal"
Line 25, strike "report" insert "reports"
Page 46, strike line 1
Renumber to conform
Line 15, after "insurers" insert "who are licensed health care providers"
Between lines 17 and 18, insert:
"18. One representative of a vertically integrated telemedicine technology manufacturer of hardware and compatible software.
19. One behavioral analyst who is licensed pursuant to title 32, chapter 19.1."
Renumber to conform
Line 28, strike "communication mediums" insert "communications media"
Page 46, between lines 29 and 30, insert:
"3. Shall adopt telehealth best practice guidelines and recommendations regarding the health care services that may be appropriately provided through an audio-only telehealth format and make updates, when applicable. Before making its recommendations, the advisory committee shall analyze medical literature and national practice guidelines, consider the comparative effectiveness and safety and the benefit to the patient of performing a service through an audio-only telehealth format instead of in person or through an audio-visual telehealth format, and the appropriate frequency and duration of audio-only telehealth encounters.
4. May authorize subcommittees to address select issues or services and report to the advisory committee as directed."
Renumber to conform
Line 30, strike "September" insert "December"
Line 32, after "with" strike remainder of line
Strike lines 33 through 35, insert "the advisory committee's recommendations regarding the specific health care services that are appropriate to provide through an audio-only telehealth format as a substitute for an in-person or audio-visual telehealth encounter.
6. On or before June 30, 2022, shall submit a report to the governor, the president of the senate and the speaker of the house of representatives with the advisory committee's recommendations regarding telehealth best practice guidelines for health care providers.
C. The Arizona health care cost containment system shall staff the advisory committee and provide meeting space."
Reletter to conform
Between lines 37 and 38, insert:
"36-3608. Health care provider regulatory boards and agencies; out-of-state health care providers; reports
Beginning October 1, 2021 and on or before the first of each month thereafter, each health care provider regulatory board or agency shall submit to the telehealth advisory committee on telehealth best practices established by section 36-3607 a report identifying the number and type of out-of-state health care providers who have applied for registration pursuant to section 36-3606 and the number and type of out-of-state health care providers whose registration pursuant to section 36-3606 has been approved.
Sec. 19. Delayed repeal
Section 36-3608, Arizona Revised Statutes, is repealed from and after December 31, 2025."
Renumber to conform
Page 51, line 29, after "before" insert "the earlier of thirty days after the effective date of this section or"
Line 32, after "state" strike remainder of line
Line 33, strike "professionals"; after the period insert "The department may waive rules necessary to implement the requirements of the pilot program."
Between lines 35 and 36, insert:
"B. In collaboration with interested hospitals in this state, the department shall determine:
1. The criteria necessary for a licensed hospital to be eligible for the pilot program. Eligible hospitals must demonstrate the required in-person and telehealth equipment necessary to provide acute in-home services.
2. The protocols for eligible hospitals to determine patient eligibility in the program.
3. The protocols for health care services to be provided by or under the direction of eligible hospitals to patients in the program.
C. Hospitals participating in the pilot program may use applicable protocols determined by the department to set:
1. The patient eligibility criteria.
2. The categories of licensed health care providers that may be used.
3. The services that may be outsourced by the hospital.
4. The health care services to be provided by or under the direction of the hospital.
D. Hospitals participating in the pilot program shall report patient progress and program quality outcomes as required by the department."
Reletter to conform
Page 51, line 39, strike "January 1" insert "March 31"
Page 52, strike lines 1 through 5, insert:
"1. The overall number of telehealth encounters and the number of audio-only telehealth encounters billed to health care insurers.
2. The number of telehealth encounters in this state involving out-of-state health care providers.
3. The types of services provided through telehealth encounters and through audio-only telehealth encounters.
4. The differential in payment between audio-only telehealth encounters and in-person care or audio-visual telehealth encounters.
Sec. 24. Rulemaking exemptions
Notwithstanding any other law, for the purposes of this act, each health care provider regulatory board or agency as defined in section 36-3601, Arizona Revised Statutes, as amended by this act, is exempt from the rulemaking requirements of title 41, chapter 6, Arizona Revised Statutes, for one year after the effective date of this act."
Renumber to conform
Amend title to conform