HF 317 (LSB 1131YH (10) 86)

HOUSE FILE 317

BY  DAWSON, HEDDENS, and WESSEL-KROESCHELL

A BILL FOR

An Act relating to the provision of telehealth services by mental health professionals relative to insurance coverage and reimbursement under the medical assistance program.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  514C.30  Telehealth services provided by mental health professionals.
   1.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a contract, policy, or plan providing for third-party payment or prepayment for health, medical, or surgical coverage benefits shall not require face-to-face contact between a mental health professional and a patient as a prerequisite for payment for services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services are provided. Health care services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of coverage.
   2.  This section shall not be interpreted as preventing a third-party payment provider from imposing deductibles or copayment or coinsurance requirements for a health care service provided through telehealth if the deductible, copayment, or coinsurance does not exceed the deductible, copayment, or coinsurance applicable to an in-person consultation for the same health care service.
   3.  The provisions of this section shall apply to all of the following classes of third-party payment provider contracts, policies, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2016:
   a.  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   b.  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   c.  An individual or group health maintenance organization contract regulated under chapter 514B.
   d.  An individual or group Medicare supplemental policy, unless coverage pursuant to such policy is preempted by federal law.
   e.  A plan established pursuant to chapter 509A for public employees.
   4.  This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, long-term care, basic hospital, and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   5.  As used in this section:
   a.  “Mental health professional” means the same as defined in section 228.1.
   b.  “Telehealth” or “telehealth services”, as it pertains to the delivery of health care services, means synchronous video conferencing, remote patient monitoring, transmission of asynchronous health images, or other health transmissions supported by mobile devices, or other telecommunications technology used for the purpose of diagnosis, consultation, treatment, transfer of medical data, or exchange of medical education information by means of audio, video, or data communications. “Telehealth” or “telehealth services” does not include an audio-only telephone call, electronic mail message, or facsimile transmission.
   6.  The commissioner of insurance shall adopt rules pursuant to chapter 17A as necessary to administer this section.
    Sec. 2.  MEDICAID PROGRAM —— REIMBURSEMENT FOR TELEHEALTH.  The department of human services shall adopt rules to provide for coverage of telehealth services provided by a mental health professional under the Medicaid program. The rules shall provide that face-to-face contact between a mental health professional and a patient is not required as a prerequisite for payment for services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services are provided. Health care services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of reimbursement. For the purposes of this section, “mental health professional” and “telehealth” or “telehealth services” means the same as defined in section 514C.30, as enacted in this Act.
EXPLANATION
The inclusion of this explanation does not constitute agreement with

the explanation’s substance by the members of the general assembly.
   This bill relates to telehealth services provided by a mental health professional.
   The bill provides that beginning January 1, 2016, a contract, policy, or plan providing for third-party payment or prepayment for health, medical, or surgical coverage benefits shall not require face-to-face contact between a mental health professional and a patient as a prerequisite for payment for services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services are provided. Health care services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of coverage.
   The provision is not to be interpreted as preventing a third-party payment provider from imposing deductibles or copayment or coinsurance requirements for a health care service provided through telehealth if the deductible, copayment, or coinsurance does not exceed the deductible, copayment, or coinsurance applicable to an in-person consultation for the same health care service. The section applies to individual or group accident and sickness insurance providing coverage on an expense-incurred basis; an individual or group hospital or medical service contract issued pursuant to Code chapter 509, 514, or 514A; an individual or group health maintenance organization contract regulated under Code chapter 514B; an individual or group Medicare supplemental policy, unless coverage pursuant to such policy is preempted by federal law; and a plan established pursuant to Code chapter 509A for public employees. The provision does not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, long-term care, basic hospital, and medical-surgical expense coverage as defined by the commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
   The commissioner of insurance is directed to adopt rules pursuant to Code chapter 17A as necessary to administer the provision. The bill defines “mental health professional” and “telehealth” or “telehealth services”.
   The bill directs the department of human services to adopt rules to provide for coverage of telehealth services provided by a mental health professional under the Medicaid program. The rules are to provide that face-to-face contact between a mental health professional and a patient is not required as a prerequisite for payment for services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services are provided. Health care services provided through in-person consultations or through telehealth are to be treated as equivalent services for the purposes of reimbursement.