H.F. 218 Section 1. LEGISLATIVE FINDINGS. The general assembly 1 finds and recognizes all of the following: 2 1. Access to health care facilities and health care 3 professionals is critically important to the citizens of Iowa. 4 2. Telehealth uses electronic technology to overcome a 5 geographic distance between patients and health care providers 6 for the purpose of intervention, clinical management, or 7 assessing, monitoring, or educating patients. 8 3. The provision of telehealth results in demonstrated 9 cost-effectiveness, improvements in disease management, 10 and improved patient outcomes and studies by the American 11 telemedicine association and others have demonstrated 12 significant reductions in hospitalizations and otherwise 13 necessary medical care as a result of telehealth intervention. 14 4. Geography, weather, availability of specialists, 15 transportation, and other factors can create barriers to 16 accessing appropriate health care, including behavioral health 17 care, and one way to provide, ensure, or enhance access to 18 care given these barriers is through the appropriate use of 19 technology to allow health care consumers access to qualified 20 health care professionals. 21 5. Additionally, the utilization of telehealth will 22 further the maintenance and improvement of the physical 23 and economic health of patients in medically underserved 24 communities by retaining the source of health care in local 25 areas, strengthening the health infrastructure, and preserving 26 health-care-related jobs. 27 6. A need exists in this state to embrace efforts that 28 will encourage health insurers and health care professionals 29 to support the use of telehealth and that will also encourage 30 all state agencies to evaluate and amend their policies and 31 rules to remove any regulatory barriers prohibiting the use of 32 telehealth. 33 7. Recognition exists that the full potential of delivering 34 health care services through telehealth cannot be realized 35 -1- LSB 1423YH (5) 86 pf/rj 1/ 11

H.F. 218 without the assurance of payment and the resolution of existing 1 legal and policy barriers to such payment. 2 8. The purpose of the Iowa telehealth Act is to provide a 3 framework for health care professionals to utilize in providing 4 telehealth to Iowans in a manner that provides efficient and 5 effective access to quality health care. 6 Sec. 2. NEW SECTION . 147B.1 Title. 7 This chapter shall be known and may be cited as the “Iowa 8 Telehealth Act” . 9 Sec. 3. NEW SECTION . 147B.2 Definitions. 10 As used in this chapter, unless the context otherwise 11 requires: 12 1. “Distant site” means the site at which a health care 13 professional delivering the service is located at the time the 14 telehealth service is provided. 15 2. “Health care professional” means a person who is 16 licensed, certified, or otherwise authorized under chapter 17 147A, 148, 148A, 148B, 148C, 149, 151, 152, 152B, 152E, 153, 18 154, 154B, 154C, 154D, 154F, or 155A to provide health care in 19 the ordinary course of business or practice of a profession or 20 in an approved education or training program, as long as the 21 person is operating within the person’s professional scope of 22 practice. 23 3. “Remote patient monitoring” means using telehealth to 24 enable the health care professional to monitor and manage a 25 patient’s medical, functional, and environmental needs if such 26 needs can be appropriately met through telehealth intervention. 27 4. “Store-and-forward telehealth” means the use of 28 asynchronous communications between a patient and a health care 29 professional or between a referring health care professional 30 and a medical specialist at a distant site, supported by 31 telecommunications technology for the purpose of diagnosis, 32 consultation, treatment, or therapeutic assistance in the 33 care of the patient, including the transferring of medical 34 data from one site to another through the use of a camera 35 -2- LSB 1423YH (5) 86 pf/rj 2/ 11

H.F. 218 or similar device that records or stores an image that is 1 sent or forwarded via telecommunications to another site for 2 consultation. 3 5. “Telehealth” means the use of real-time, interactive 4 audio or video telecommunications or electronic technology, 5 remote patient monitoring, or store-and-forward telehealth by 6 a health care professional to deliver health care services 7 to a patient within the scope of practice of the health care 8 professional, for the purposes of diagnosis, consultation, 9 treatment, transfer of medical data, or exchange of medical 10 education information. “Telehealth” does not include an 11 audio-only telephone call, electronic mail message, or 12 facsimile transmission. 13 Sec. 4. NEW SECTION . 147.163 Telehealth. 14 1. A health care professional licensed by a board created 15 under this chapter, as appropriate to the scope of practice 16 of the profession, may employ the technology of telehealth by 17 applying telehealth within the professional’s scope of practice 18 or by using telehealth technology under the direction and 19 supervision of another health care professional who is using 20 telehealth technology within the supervising professional’s 21 scope of practice. A health care professional’s employment 22 of telehealth acting under the direction and supervision of 23 another health care professional who is using telehealth within 24 that health care professional’s scope of practice shall not be 25 interpreted as practicing the supervising professional’s health 26 care profession without a license. However, any health care 27 professional employing telehealth must hold a current valid 28 license to practice the respective profession in the state and 29 be trained, educated, and knowledgeable regarding the health 30 care service provided and technology used and shall not perform 31 duties for which the professional does not have sufficient 32 training, education, and knowledge. Failure to have sufficient 33 training, education, and knowledge is grounds for disciplinary 34 action by the respective board. 35 -3- LSB 1423YH (5) 86 pf/rj 3/ 11

H.F. 218 2. The applicable board that exercises regulatory or 1 rulemaking authority over an affected profession under this 2 chapter, or the department in the absence of an applicable 3 board, shall adopt rules to administer this chapter. 4 3. The standard of care for a professional using telehealth 5 to provide health care services to a patient shall be the same 6 as the standard of care required of that professional for the 7 provision of in-person health care services to a patient. 8 4. The type of setting where telehealth is provided for the 9 patient or by the health care professional shall not be limited 10 if the delivery of health care services is appropriately 11 provided through telehealth. 12 5. This chapter shall not be construed to conflict with 13 or supersede the provisions of chapter 147A, 148, 148A, 148B, 14 148C, 149, 151, 152, 152B, 152E, 153, 154, 154B, 154C, 154D, 15 154F, or 155A relating to the licensure of the respective 16 health care professional. 17 6. This chapter shall not be construed to alter the scope 18 of practice of any health care professional, authorize the 19 delivery of health care services in a setting or manner not 20 otherwise authorized by law, or limit a patient’s right to 21 choose in-person contact with a health care professional for 22 the delivery of health care services for which telehealth is 23 available. 24 7. If a health care professional provides services pursuant 25 to and in compliance with section 135.24 via telehealth in 26 accordance with this chapter, the provisions of section 135.24 27 including those relating to immunity from civil liability shall 28 apply to such health care professional. 29 Sec. 5. NEW SECTION . 514C.30 Telehealth. 30 1. Notwithstanding the uniformity of treatment requirements 31 of section 514C.6, a contract, policy, or plan providing for 32 third-party payment or prepayment for health, medical, or 33 surgical coverage benefits shall not deny coverage on the basis 34 that the services are provided as telehealth if the services 35 -4- LSB 1423YH (5) 86 pf/rj 4/ 11

H.F. 218 would be covered if provided and shall not require in-person 1 contact between a health care professional and a patient as a 2 prerequisite for payment for services appropriately provided 3 through telehealth in accordance with generally accepted health 4 care practices and standards prevailing in the applicable 5 professional community at the time the services are provided. 6 Health care services provided through in-person consultations 7 or through telehealth shall be treated as equivalent services 8 for the purposes of coverage. 9 2. This section shall not be interpreted as preventing 10 a third-party payment provider from imposing deductibles or 11 copayment or coinsurance requirements for a health care service 12 provided through telehealth if the deductible, copayment, or 13 coinsurance does not exceed the deductible, copayment, or 14 coinsurance applicable to in-person consultation for the same 15 health care service. A third-party payment provider shall not 16 impose annual or lifetime maximums on coverage of telehealth 17 unless the annual or lifetime maximum applies in the aggregate 18 to all items and services under the contract, policy, or plan. 19 3. This section shall not be interpreted to require a 20 third-party payment provider to provide reimbursement for 21 a health care service that is not a covered benefit or to 22 reimburse a health care professional who is not a covered 23 provider under the contract, policy, or plan. 24 4. This section shall not be interpreted to preclude a 25 third-party payment provider from performing utilization review 26 to determine the appropriateness of telehealth in the delivery 27 of health care services if the determination is made in the 28 same manner as those regarding the same health care service 29 when delivered in person. 30 5. This section shall not be interpreted to authorize a 31 third-party payment provider to require the use of telehealth 32 when the health care professional determines use of telehealth 33 is not appropriate. 34 6. The provisions of this section shall apply to all of the 35 -5- LSB 1423YH (5) 86 pf/rj 5/ 11

H.F. 218 following classes of third-party payment provider contracts, 1 policies, or plans delivered, issued for delivery, continued, 2 or renewed in this state on or after January 1, 2016: 3 a. Individual or group accident and sickness insurance 4 providing coverage on an expense-incurred basis. 5 b. An individual or group hospital or medical service 6 contract issued pursuant to chapter 509, 514, or 514A. 7 c. An individual or group health maintenance organization 8 contract regulated under chapter 514B. 9 d. An individual or group Medicare supplemental policy, 10 unless coverage pursuant to such policy is preempted by federal 11 law. 12 e. A plan established pursuant to chapter 509A for public 13 employees. 14 7. This section shall not apply to accident-only, specified 15 disease, short-term hospital or medical, hospital confinement 16 indemnity, credit, dental, vision, long-term care, basic 17 hospital, and medical-surgical expense coverage as defined 18 by the commissioner, disability income insurance coverage, 19 coverage issued as a supplement to liability insurance, 20 workers’ compensation or similar insurance, or automobile 21 medical payment insurance. 22 8. The commissioner of insurance shall adopt rules pursuant 23 to chapter 17A as necessary to administer this section. 24 9. For the purposes of this section, “health care 25 professional” and “telehealth” mean as defined in section 26 147B.2, as enacted in this Act. 27 Sec. 6. MEDICAID PROGRAM —— REIMBURSEMENT FOR 28 TELEHEALTH. The department of human services shall adopt 29 rules to provide for coverage of telehealth under the 30 Medicaid program. The rules shall provide that in-person 31 contact between a health care professional and a patient 32 is not required as a prerequisite for payment for services 33 appropriately provided through telehealth in accordance 34 with generally accepted health care practices and standards 35 -6- LSB 1423YH (5) 86 pf/rj 6/ 11

H.F. 218 prevailing in the applicable professional community at 1 the time the services are provided. Health care services 2 provided through in-person consultations or through telehealth 3 shall be treated as equivalent services for the purposes 4 of reimbursement. As used in this section, “health care 5 professional” and “telehealth” mean as defined in section 6 147B.2, as enacted in this Act. 7 Sec. 7. STUDY ON USE OF TELEHEALTH. The department of 8 public health, in collaboration with the department of human 9 services and the insurance division of the department of 10 commerce, shall convene and conduct a study regarding options 11 for implementing telehealth and telehealth coverage and 12 reimbursement. The department of public health shall submit 13 a final report of its findings and recommendations to the 14 governor and the general assembly by December 15, 2015. 15 EXPLANATION 16 The inclusion of this explanation does not constitute agreement with 17 the explanation’s substance by the members of the general assembly. 18 This bill relates to telehealth and creates the Iowa 19 telehealth Act. The bill provides legislative findings 20 and purposes regarding the use of telehealth and provides 21 definitions. 22 The bill provides that a health care professional licensed 23 by a professional licensing board under Code chapter 147 24 (health-related professions), as appropriate to the scope 25 of practice of the profession, may employ the technology of 26 telehealth by applying telehealth within the professional’s 27 scope of practice or by employing telehealth technology 28 under the direction and supervision of another health care 29 professional who is using telehealth technology within the 30 supervising professional’s scope of practice. A health care 31 professional’s employment of telehealth technology under the 32 direction and supervision of another health care professional 33 who is acting within that health care professional’s scope of 34 practice shall not be interpreted as practicing the supervising 35 -7- LSB 1423YH (5) 86 pf/rj 7/ 11

H.F. 218 professional’s health care profession without a license. A 1 health care professional employing telehealth technology must 2 hold a current valid license and must be trained, educated, 3 and knowledgeable regarding the health care service provided 4 and technology used and is prohibited from performing duties 5 for which the professional does not have sufficient training, 6 education, and knowledge. Failure to have sufficient training, 7 education, and knowledge is grounds for disciplinary action by 8 the respective board. 9 The bill directs the appropriate board that exercises 10 regulatory or rulemaking authority over a profession within 11 whose scope of practice telehealth may be employed or the 12 department, to adopt rules, to administer the requirements 13 relating to the provision of telehealth by such professionals. 14 The bill provides that the standard of care for a 15 professional, whether using telehealth or providing the care 16 in person, is the same. The type of setting where telehealth 17 is provided for the patient or by the health care professional 18 is not to be limited if the delivery of health care services is 19 appropriately provided through telehealth. The bill is not to 20 be construed to conflict with or supersede the provisions of 21 the health care professionals licensing chapters relating to 22 the licensure of the respective health care professional or to 23 alter the scope of practice of any health care professional, 24 authorize the delivery of health care services in a setting 25 or manner not otherwise authorized by law, or limit a 26 patient’s right to choose in-person contact with a health care 27 professional for the delivery of health care services for which 28 telehealth is available. The bill also provides that if a 29 health care professional provides services pursuant to and in 30 compliance with Code section 135.24 relating to the volunteer 31 health care provider program, via telehealth, the provisions of 32 Code section 135.24 including those relating to immunity from 33 civil liability shall apply to such health care professional. 34 The bill provides that beginning January 1, 2016, a 35 -8- LSB 1423YH (5) 86 pf/rj 8/ 11

H.F. 218 contract, policy, or plan providing for third-party payment or 1 prepayment for health, medical, or surgical coverage benefits 2 shall not deny coverage on the basis that the services are 3 provided via telehealth if the services would be covered if 4 provided in person and shall not require in-person contact 5 between a health care professional and a patient as a 6 prerequisite for payment for services appropriately provided 7 through telehealth in accordance with generally accepted health 8 care practices and standards prevailing in the applicable 9 professional community at the time the services are provided. 10 Health care services provided through in-person consultations 11 or through telehealth shall be treated as equivalent services 12 for the purposes of coverage. 13 The provision is not to be interpreted as preventing a 14 third-party payment provider from imposing deductibles or 15 copayment or coinsurance requirements for a health care service 16 provided through telehealth if the deductible, copayment, or 17 coinsurance does not exceed the deductible, copayment, or 18 coinsurance applicable to an in-person consultation for the 19 same health care service. The bill provides that a third-party 20 payment provider shall not impose annual or lifetime maximums 21 on coverage of telehealth unless the annual or lifetime maximum 22 applies in the aggregate to all items and services under the 23 contract, policy, or plan. 24 The bill provides that the Code section is not to be 25 interpreted to require a third-party payment provider to 26 provide reimbursement for a health care service that is not 27 a covered benefit or to reimburse a health care professional 28 who is not a covered provider under the contract, policy, 29 or plan; to preclude a third-party payment provider from 30 performing utilization review to determine the appropriateness 31 of telehealth in the delivery of health care services if the 32 determination is made in the same manner as those regarding 33 the same health care service when delivered in person; or to 34 authorize a third-party payment provider to require the use of 35 -9- LSB 1423YH (5) 86 pf/rj 9/ 11

H.F. 218 telehealth when the health care professional determines use of 1 telehealth is not appropriate. 2 The Code section applies to individual or group accident and 3 sickness insurance providing coverage on an expense-incurred 4 basis; an individual or group hospital or medical service 5 contract issued pursuant to Code chapter 509, 514, or 514A; an 6 individual or group health maintenance organization contract 7 regulated under Code chapter 514B; an individual or group 8 Medicare supplemental policy, unless coverage pursuant to such 9 policy is preempted by federal law; and a plan established 10 pursuant to Code chapter 509A for public employees. The 11 provision does not apply to accident-only, specified disease, 12 short-term hospital or medical, hospital confinement indemnity, 13 credit, dental, vision, long-term care, basic hospital, 14 and medical-surgical expense coverage as defined by the 15 commissioner, disability income insurance coverage, coverage 16 issued as a supplement to liability insurance, workers’ 17 compensation or similar insurance, or automobile medical 18 payment insurance. 19 The commissioner of insurance is directed to adopt rules 20 pursuant to Code chapter 17A as necessary to administer the 21 provision. 22 The bill directs the department of human services to 23 adopt rules to provide for coverage of telehealth under the 24 Medicaid program. The rules are to provide that in-person 25 contact between a health care professional and a patient 26 is not required as a prerequisite for payment for services 27 appropriately provided through telehealth in accordance 28 with generally accepted health care practices and standards 29 prevailing in the applicable professional community at the 30 time the services are provided. Health care services provided 31 through in-person consultations or through telehealth are 32 to be treated as equivalent services for the purposes of 33 reimbursement. 34 The bill directs the department of public health, in 35 -10- LSB 1423YH (5) 86 pf/rj 10/ 11

H.F. 218 collaboration with the department of human services and the 1 insurance division of the department of commerce, to convene 2 and conduct a study regarding options for implementing 3 telehealth and telehealth coverage and reimbursement. The 4 department of public health is directed to submit a final 5 report of its findings and recommendations to the governor and 6 the general assembly by December 15, 2015. 7 -11- LSB 1423YH (5) 86 pf/rj 11/ 11