HF 600 (LSB 1423HV (2) 86)

HOUSE FILE 600

BY  COMMITTEE ON HUMAN RESOURCES

(SUCCESSOR TO HF 218)

A BILL FOR

An Act relating to telehealth and professional licensure, insurance coverage, and reimbursement under the medical assistance program.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  LEGISLATIVE FINDINGS.  The general assembly finds and recognizes all of the following:
   1.  Access to health care facilities and health care professionals is critically important to the citizens of Iowa.
   2.  Telehealth uses electronic technology to overcome a geographic distance between patients and health care providers for the purpose of intervention, clinical management, or assessing, monitoring, or educating patients.
   3.  The provision of telehealth results in demonstrated cost-effectiveness, improvements in disease management, and improved patient outcomes and studies by the American telemedicine association and others have demonstrated significant reductions in hospitalizations and otherwise necessary medical care as a result of telehealth intervention.
   4.  Geography, weather, availability of specialists, transportation, and other factors can create barriers to accessing appropriate health care, including behavioral health care, and one way to provide, ensure, or enhance access to care given these barriers is through the appropriate use of technology to allow health care consumers access to qualified health care professionals.
   5.  Additionally, the utilization of telehealth will further the maintenance and improvement of the physical and economic health of patients in medically underserved communities by retaining the source of health care in local areas, strengthening the health infrastructure, and preserving health-care-related jobs.
   6.  A need exists in this state to embrace efforts that will encourage health insurers and health care professionals to support the use of telehealth and that will also encourage all state agencies to evaluate and amend their policies and rules to remove any regulatory barriers prohibiting the use of telehealth.
   7.  Recognition exists that the full potential of delivering health care services through telehealth cannot be realized without the assurance of payment and the resolution of existing legal and policy barriers to such payment.
   8.  The purpose of the Iowa telehealth Act is to provide a framework for health care professionals to utilize in providing telehealth to Iowans in a manner that provides efficient and effective access to quality health care.
    Sec. 2.  NEW SECTION.  147B.1  Title.

   This chapter shall be known and may be cited as the “Iowa Telehealth Act”.
    Sec. 3.  NEW SECTION.  147B.2  Definitions.

   As used in this chapter, unless the context otherwise requires:

   1.  “Distant site” means the site at which a health care professional delivering the service is located at the time the telehealth service is provided.
   2.  “Health care professional” means a person who is licensed, certified, or otherwise authorized or permitted by the law of this state to administer health care in the ordinary course of business or in the practice of a profession, or in an approved education or training program, as long as the person is operating within the person’s professional scope of practice.
   3.  “Remote patient monitoring” means using telehealth to enable the health care professional to monitor and manage a patient’s medical, functional, and environmental needs if such needs can be appropriately met through telehealth intervention.
   4.  “Store-and-forward telehealth” means the use of asynchronous communications between a patient and a health care professional or between a referring health care professional and a medical specialist at a distant site, supported by telecommunications technology for the purpose of diagnosis, consultation, treatment, or therapeutic assistance in the care of the patient, including the transferring of medical data from one site to another through the use of a camera or similar device that records or stores an image that is sent or forwarded via telecommunications to another site for consultation.
   5.  “Telehealth” means the use of real-time, interactive audio or video telecommunications or electronic technology, remote patient monitoring, or store-and-forward telehealth by a health care professional to deliver health care services to a patient within the scope of practice of the health care professional, for the purposes of diagnosis, consultation, treatment, transfer of medical data, or exchange of medical education information. “Telehealth” does not include an audio-only telephone call, electronic mail message, or facsimile transmission.
    Sec. 4.  NEW SECTION.  147.163  Telehealth.
   1.  A health care professional licensed by a board created under this chapter, as appropriate to the scope of practice of the profession, may employ the technology of telehealth by applying telehealth within the professional’s scope of practice or by using telehealth technology under the direction and supervision of another health care professional who is using telehealth technology within the supervising professional’s scope of practice. A health care professional’s employment of telehealth acting under the direction and supervision of another health care professional who is using telehealth within that health care professional’s scope of practice shall not be interpreted as practicing the supervising professional’s health care profession without a license. However, any health care professional employing telehealth must hold a current valid license to practice the respective profession in the state and be trained, educated, and knowledgeable regarding the health care service provided and technology used and shall not perform duties for which the professional does not have sufficient training, education, and knowledge. Failure to have sufficient training, education, and knowledge is grounds for disciplinary action by the respective board.
   2.  The applicable board that exercises regulatory or rulemaking authority over an affected profession under this chapter, or the department in the absence of an applicable board, shall adopt rules to administer this chapter.
   3.  The standard of care for a professional using telehealth to provide health care services to a patient shall be the same as the standard of care required of that professional for the provision of in-person health care services to a patient. 
   4.  The type of setting where telehealth is provided for the patient or by the health care professional shall not be limited if the delivery of health care services is appropriately provided through telehealth.
   5.  This chapter shall not be construed to conflict with or supersede provisions otherwise applicable to the licensure of health care professionals.
   6.  This chapter shall not be construed to alter the scope of practice of any health care professional, authorize the delivery of health care services in a setting or manner not otherwise authorized by law, or limit a patient’s right to choose in-person contact with a health care professional for the delivery of health care services for which telehealth is available. 
   7.  If a health care professional provides services pursuant to and in compliance with section 135.24 via telehealth in accordance with this chapter, the provisions of section 135.24 including those relating to immunity from civil liability shall apply to such health care professional.
    Sec. 5.  NEW SECTION.  514C.30  Telehealth.
   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 may provide coverage for services provided as telehealth if the services would be covered if provided in-person. If coverage is provided for telehealth under this section, coverage shall not require in-person contact between a health care 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. If coverage is provided under this section, health care services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of coverage.
   2.  If health care coverage is provided for telehealth under this section, all of the following shall apply:
   a.  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 in-person consultation for the same health care service. A third-party payment provider shall not impose annual or lifetime maximums on coverage of telehealth unless the annual or lifetime maximum applies in the aggregate to all items and services under the contract, policy, or plan.
   b.  This section shall not be interpreted to require a third-party payment provider to provide reimbursement for a health care service that is not a covered benefit or to reimburse a health care professional who is not a covered provider under the contract, policy, or plan.
   c.  This section shall not be interpreted to preclude a third-party payment provider from performing utilization review to determine the appropriateness of telehealth in the delivery of health care services if the determination is made in the same manner as those regarding the same health care service when delivered in person.
   d.  This section shall not be interpreted to authorize a third-party payment provider to require the use of telehealth when the health care professional determines use of telehealth is not appropriate.
   e.  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:
   (1)  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   (2)  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   (3)  An individual or group health maintenance organization contract regulated under chapter 514B.
   (4)  An individual or group Medicare supplemental policy, unless coverage pursuant to such policy is preempted by federal law.
   (5)  A plan established pursuant to chapter 509A for public employees.
   f.  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.
   3.  The commissioner of insurance shall adopt rules pursuant to chapter 17A as necessary to administer this section.
   4.  For the purposes of this section, “health care professional” and “telehealth” mean as defined in section 147B.2, as enacted in this Act.
    Sec. 6.  MEDICAID PROGRAM —— REIMBURSEMENT FOR TELEHEALTH.  The department of human services shall adopt rules to provide for coverage of telehealth under the Medicaid program. The rules shall provide that in-person contact between a health care 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. As used in this section, “health care professional” and “telehealth” mean as defined in section 147B.2, as enacted in this Act.
    Sec. 7.  STUDY ON USE OF TELEHEALTH.  The department of public health, in collaboration with the department of human services, shall convene and conduct a study regarding options for implementing telehealth and telehealth coverage and reimbursement. The division of insurance of the department of commerce shall be available for consultation as needed. The department of public health shall submit a final report of its findings and recommendations to the governor and the general assembly by December 15, 2015.
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 and creates the Iowa telehealth Act. The bill provides legislative findings and purposes regarding the use of telehealth and provides definitions.
   The bill provides that a health care professional, as appropriate to the scope of practice of the profession, may employ the technology of telehealth by applying telehealth within the professional’s scope of practice or by employing telehealth technology under the direction and supervision of another health care professional who is using telehealth technology within the supervising professional’s scope of practice. A health care professional’s employment of telehealth technology under the direction and supervision of another health care professional who is acting within that health care professional’s scope of practice shall not be interpreted as practicing the supervising professional’s health care profession without a license. A health care professional employing telehealth technology must hold a current valid license and must be trained, educated, and knowledgeable regarding the health care service provided and technology used and is prohibited from performing duties for which the professional does not have sufficient training, education, and knowledge. Failure to have sufficient training, education, and knowledge is grounds for disciplinary action by the respective board.
   The bill directs the appropriate board that exercises regulatory or rulemaking authority over a profession within whose scope of practice telehealth may be employed or the department, to adopt rules, to administer the requirements relating to the provision of telehealth by such professionals. 
   The bill provides that the standard of care for a professional, whether using telehealth or providing the care in person, is the same. The type of setting where telehealth is provided for the patient or by the health care professional is not to be limited if the delivery of health care services is appropriately provided through telehealth. The bill is not to be construed to conflict with or supersede the provisions of the health care professionals licensure or to alter the scope of practice of any health care professional, authorize the delivery of health care services in a setting or manner not otherwise authorized by law, or limit a patient’s right to choose in-person contact with a health care professional for the delivery of health care services for which telehealth is available. The bill also provides that if a health care professional provides services pursuant to and in compliance with Code section 135.24 relating to the volunteer health care provider program, via telehealth, the provisions of Code section 135.24 including those relating to immunity from civil liability shall apply to such health care professional.
   The bill provides that a contract, policy, or plan providing for third-party payment or prepayment for health, medical, or surgical coverage benefits may cover telehealth. If telehealth coverage is provided on or after January 1, 2016, the contract, policy, or plan shall not deny coverage on the basis that the services are provided via telehealth if the services would be covered if provided in person and shall not require in-person contact between a health care 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 bill provides that a third-party payment provider shall not impose annual or lifetime maximums on coverage of telehealth unless the annual or lifetime maximum applies in the aggregate to all items and services under the contract, policy, or plan.
   The bill provides that the Code section is not to be interpreted to require a third-party payment provider to provide reimbursement for a health care service that is not a covered benefit or to reimburse a health care professional who is not a covered provider under the contract, policy, or plan; to preclude a third-party payment provider from performing utilization review to determine the appropriateness of telehealth in the delivery of health care services if the determination is made in the same manner as those regarding the same health care service when delivered in person; or to authorize a third-party payment provider to require the use of telehealth when the health care professional determines use of telehealth is not appropriate.
   The bill specifies the types of third-party payment provider contracts, policies, or plans to which the bill applies and those exempt from its application.
   The commissioner of insurance is directed to adopt rules pursuant to Code chapter 17A as necessary to administer the provision.
   The bill directs the department of human services to adopt rules to provide for coverage of telehealth under the Medicaid program. The rules are to provide that in-person contact between a health care 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.
   The bill directs the department of public health, in collaboration with the department of human services, to convene and conduct a study regarding options for implementing telehealth and telehealth coverage and reimbursement. The division of insurance is required to be available for consultation as needed. The department of public health is directed to submit a final report of its findings and recommendations to the governor and the general assembly by December 15, 2015.