Short Title; Definitions; Payment for Telehealth Services

  1. Law
  2. Georgia Code
  3. Insurance
  4. Insurance Generally
  5. General Provisions
  6. Short Title; Definitions; Payment for Telehealth Services

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  1. This Code section shall be known and may be cited as the "Georgia Telehealth Act."
  2. As used in this Code section, the term:
    1. "Distant site" means a site at which a health care provider legally allowed to practice in this state is located while providing health care services by means of telemedicine or telehealth.
    2. "Health benefit policy" means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, executed, or renewed in this state, including, but not limited to, any health insurance plan established under Article 1 of Chapter 18 of Title 45 or under Article 7 of Chapter 4 of Title 49.
    3. "Insurer" means an accident and sickness insurer, fraternal benefit society, hospital service corporation, medical service corporation, health care corporation, health maintenance organization, provider sponsored health care corporation, managed care entity, or any similar entity authorized to issue contracts under this title or to provide health benefit policies.
    4. "Originating site" means a site in this state at which a patient is located at the time health care services are provided to him or her by means of telemedicine or telehealth, unless the term is otherwise defined with respect to the provision in which it is used; provided, however, that notwithstanding any other provision of law, insurers and providers may agree to alternative siting arrangements deemed appropriate by the parties.
    5. "Store and forward transfer" means the transmission of a patient's medical information either to or from an originating site or to or from the provider at the distant site, but does not require the patient being present nor must it be in real time.
    6. "Telehealth" means the use of information and communications technologies, including, but not limited to, telephones, remote patient monitoring devices or other electronic means which support clinical health care, provider consultation, patient and professional health related education, public health, and health administration.
    7. "Telemedicine" means a form of telehealth which is the delivery of clinical health care services by means of real time two-way audio, visual, or other telecommunications or electronic communications, including the application of secure video conferencing or store and forward transfer technology to provide or support health care delivery, which facilitate the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care by a health care provider practicing within his or her scope of practice as would be practiced in-person with a patient, and legally allowed to practice in this state, while such patient is at an originating site and the health care provider is at a distant site.
  3. It is the intent of the General Assembly to mitigate geographic discrimination in the delivery of health care by recognizing the application of and payment for covered medical care provided by means of telehealth, provided that such services are provided by a physician or by another health care practitioner or professional acting within the scope of practice of such health care practitioner or professional and in accordance with the provisions of Code Section 43-34-31.
  4. Each insurer proposing to issue a health benefit policy shall provide coverage for the cost of health care services provided through telehealth or telemedicine as directed through regulations promulgated by the department.
  5. An insurer shall not exclude a service for coverage solely because the service is provided through telemedicine services and is not provided through in-person consultation or contact between a health care provider and a patient for services appropriately provided through telemedicine services.
  6. An insurer shall reimburse the treating provider or the consulting provider for the diagnosis, consultation, or treatment of the insured delivered through telemedicine services on the same basis and at least at the rate that the insurer is responsible for coverage for the provision of the same service through in-person consultation or contact; provided, however, that nothing in this subsection shall require a health care provider or telemedicine company to accept more reimbursement than they are willing to charge. Payment for telemedicine interactions shall include reasonable compensation to the originating or distant site for the transmission cost incurred during the delivery of health care services.
  7. No insurer shall impose any annual or lifetime dollar maximum on coverage for telemedicine 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 Code section any copayment, 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 health benefit policy.
  8. No insurer shall require its insureds to use telemedicine services in lieu of in-person consultation or contact.
  9. On and after January 1, 2020, every health benefit policy that is issued, amended, or renewed shall include payment for services that are covered under such health benefit policy and are appropriately provided through telehealth in accordance with Code Section 43-34-31, this Code section, and generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided.

(Code 1981, §33-24-56.4, enacted by Ga. L. 2005, p. 481, § 3/HB 291; Ga. L. 2009, p. 859, § 11/HB 509; Ga. L. 2011, p. 752, § 33/HB 142; Ga. L. 2019, p. 386, § 56/SB 133; Ga. L. 2019, p. 512, § 1/SB 118.)

The 2019 amendments. The first 2019 amendment, effective July 1, 2019, in paragraph (b)(1), substituted "the state" for "the State of Georgia"; and, in paragraph (b)(2), deleted "hospital service corporation, medical service corporation," following "fraternal benefits society,". The second 2019 amendment, effective January 1, 2020, substituted "telemedicine" for "telehealth" in the middle of subsections (c) and (i); substituted "Telehealth" for "Telemedicine" in subsection (a); rewrote subsection (b), which read: "(b) As used in this Code section, the term:

"(1) 'Health benefit policy' means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, executed, or renewed in this state, including, but not limited to, those contracts executed by the State of Georgia on behalf of state employees under Article 1 of Chapter 18 of Title 45, by an insurer.

"(2) 'Insurer' means an accident and sickness insurer, fraternal benefit society, hospital service corporation, medical service corporation, health care corporation, health maintenance organization, preferred provider organization, provider sponsored health care corporation, managed care entity, or any similar entity authorized to issue contracts under this title or to provide health benefit policies.

"(3) 'Telemedicine' means the practice, by a duly licensed physician or other health care provider acting within the scope of such provider's practice, of health care delivery, diagnosis, consultation, treatment, or transfer of medical data by means of audio, video, or data communications which are used during a medical visit with a patient or which are used to transfer medical data obtained during a medical visit with a patient. Standard telephone, facsimile transmissions, unsecured e-mail, or a combination thereof do not constitute telemedicine services."; added subsections (d) through (h); redesignated former subsection (d) as subsection (i); and, in subsection (i), substituted "January 1, 2020" for "July 1, 2005", inserted "this Code section,", and deleted the last sentence, which read: "The coverage required in this Code section may be subject to all terms and conditions of the applicable health benefit plan." See the Code Commission notes regarding the effect of these amendments.

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 2019, the amendment of subsection (b) of this Code section by Ga. L. 2019, p. 386, § 56/SB 133, was treated as impliedly repealed and superseded by Ga. L. 2019, p. 512, § 1/SB 118, due to irreconcilable conflict.

RESEARCH REFERENCES

Authorized or Prohibited Practice of Telemedicine, 183 Am. Jur. POF.3d 353.


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