S.F. 2100 Section 1. NEW SECTION . 280A.1 Definitions. 1 As used in this section, unless the context otherwise 2 requires: 3 1. “Accredited nonpublic school” means any school, other 4 than a public school, that is accredited pursuant to section 5 256.11 for any and all levels for grades one through twelve. 6 2. “Area education agency” means an area education agency 7 established pursuant to chapter 273. 8 3. “Behavioral health screening” or “screening” means a 9 screening and assessment performed using a universal behavioral 10 health screening and assessment tool, approved for use by the 11 department of education in consultation with the department of 12 public health and the department of human services, to identify 13 factors that place children at higher risk for behavioral 14 health conditions, to determine appropriate treatment or 15 intervention, and to identify the need for referral for 16 appropriate services. 17 4. “Behavioral health services” means services provided 18 by a health care professional operating within the scope of 19 the health care professional’s practice which address mental, 20 emotional, medical, or behavioral conditions, illnesses, 21 diseases, or problems. 22 5. “Health care professional” means a physician or other 23 health care practitioner licensed, accredited, registered, or 24 certified to perform specified health care services consistent 25 with state law. 26 6. “In-person encounter” means that the mental health 27 professional and the student are in the physical presence of 28 each other and are in the same physical location during the 29 provision of behavioral health services. 30 7. “Mental health professional” means the same as defined 31 in section 228.1. 32 8. “Patient” means a student receiving a behavioral health 33 screening or other behavioral health services in accordance 34 with this chapter. 35 -1- LSB 6047XS (1) 88 pf/rh 1/ 13

S.F. 2100 9. “Primary care provider” means the personal provider 1 trained to provide the first contact and continuous and 2 comprehensive care to a patient and includes but is not limited 3 to any of the following licensed or certified health care 4 professionals who provide primary care: 5 a. A physician who is a family or general practitioner or a 6 pediatrician. 7 b. An advanced registered nurse practitioner. 8 c. A physician assistant. 9 d. A chiropractor. 10 10. “Provider-patient relationship” means the relationship 11 between the patient and the mental health professional that 12 meets the requirements for commencement and establishment of 13 a valid provider-patient relationship as specified in this 14 chapter. 15 11. “Public school” means any school directly supported in 16 whole or in part by taxation. 17 12. “School district” means a school district described in 18 chapter 274. 19 13. “Student” means a person enrolled in and attending an 20 accredited nonpublic school or a public school in grades one 21 through twelve. 22 14. “Telemedicine” means the practice of medicine using 23 electronic audio-visual communications and information 24 technologies or other means, including interactive audio with 25 asynchronous store-and-forward transmission, between a licensee 26 in one location and a patient in another location with or 27 without an intervening health care provider. “Telemedicine” 28 includes asynchronous store-and-forward technologies, remote 29 monitoring, and real-time interactive services, including 30 teleradiology and telepathology. “Telemedicine” does not 31 include the provision of medical services only through an 32 audio-only telephone, email messages, facsimile transmissions, 33 or U.S. mail or other parcel service, or any combination of 34 these means. 35 -2- LSB 6047XS (1) 88 pf/rh 2/ 13

S.F. 2100 Sec. 2. NEW SECTION . 280A.2 Behavioral health screenings 1 and assessments in school settings. 2 1. a. A school district, an accredited nonpublic school, 3 or an area education agency may contract with a mental health 4 professional or a nationally accredited behavioral health 5 care organization to provide behavioral health screenings to 6 students in person or via telemedicine. 7 b. (1) A behavioral health screening may be conducted 8 following provision of written consent by the student’s parent 9 or guardian for the student to participate in such screening 10 and to allow for the release of the results of the screening to 11 the student’s primary care provider. 12 (2) The consent shall also allow for the disclosure of the 13 results of such screenings to the school district, accredited 14 nonpublic school, or area education agency, if the mental 15 health professional believes there is a credible threat to the 16 health and safety of the student or others. 17 2. If a mental health professional conducts an initial 18 behavioral health screening on the premises of a public school, 19 an accredited nonpublic school, or an area education agency and 20 determines that a student should be referred for additional 21 behavioral health services, all of the following shall apply: 22 a. The mental health professional shall notify the parent or 23 guardian of the student of the results of the screening. 24 b. The mental health professional shall notify the student’s 25 primary care provider. If the student does not have a primary 26 care provider, the mental health professional shall provide 27 a listing of local primary care providers to the parent or 28 guardian. 29 Sec. 3. NEW SECTION . 280A.3 Establishment of 30 provider-patient relationship for services provided via 31 telemedicine in a school setting. 32 1. A mental health professional who provides services 33 via telemedicine in a public school, an accredited nonpublic 34 school, or an area education agency shall establish a valid 35 -3- LSB 6047XS (1) 88 pf/rh 3/ 13

S.F. 2100 provider-patient relationship with the student who receives 1 telemedicine services. 2 2. The provider-patient relationship commences when all of 3 the following conditions are met: 4 a. The student with the health-related matter seeks 5 assistance from a mental health professional. 6 b. The mental health professional agrees to undertake 7 diagnosis and treatment of the student. 8 c. The student agrees to be treated by the mental health 9 professional whether or not there has been an in-person 10 encounter between the mental health professional and the 11 student. 12 3. A valid provider-patient relationship may be established 13 through any of the following means: 14 a. Through an in-person encounter which includes an 15 in-person medical interview and physical examination conducted 16 under the standard of care required for an in-person encounter. 17 b. Through consultation with a primary care provider who has 18 an established relationship with the patient and who agrees to 19 participate in or supervise the patient’s care. 20 4. The parent or guardian of a student shall be given 21 the opportunity to consent prior to the student receiving 22 behavioral health services via telemedicine under this chapter 23 after a provider-patient relationship is established pursuant 24 to this section. The school district shall maintain any such 25 consent form completed by a parent or guardian. 26 Sec. 4. NEW SECTION . 280A.4 Behavioral health services 27 provided via telemedicine in a school setting. 28 1. A public school, accredited nonpublic school, or an 29 area education agency may provide access to behavioral health 30 services via telemedicine on the premises of the public school, 31 accredited nonpublic school, or area education agency. If 32 a public school, an accredited nonpublic school, or an area 33 education agency provides such access, the school or area 34 education agency shall do all of the following: 35 -4- LSB 6047XS (1) 88 pf/rh 4/ 13

S.F. 2100 a. Provide a secure, confidential, and private room for such 1 services and the technology necessary to conduct telemedicine 2 services. 3 b. Maintain parent or guardian consent forms for the 4 provision of such services. Consent forms shall be required 5 for each academic year in which the student receives such 6 services. 7 c. Maintain scheduling requests for student appointments 8 for such services and provide the student access to the room by 9 a school nurse or other appropriately trained school or area 10 education agency employee. 11 d. Ensure that no school or area education agency employee 12 is present in the same room as the student during the provision 13 of such services. 14 e. Provide information to the student participating 15 in telemedicine services about how and to whom to report 16 inappropriate behavior by a mental health professional. 17 f. Provide access to the student’s parent or guardian to 18 participate in any of the student’s telemedicine sessions. 19 2. The public school, accredited nonpublic school, or area 20 education agency shall not have access to or handle any of the 21 student’s medical records or be responsible for billing for the 22 telemedicine services provided. 23 3. A mental health professional with prescribing authority 24 who provides telemedicine services in accordance with this 25 section shall not prescribe any new medication to a student 26 during a telemedicine session. However, a mental health 27 professional with prescribing authority may initiate new 28 prescriptions, alter the dosage of an existing medication, or 29 discontinue an existing medication for the treatment of the 30 student’s behavioral health condition after consultation with 31 the student’s parent or guardian. 32 4. a. Prior to the initiation of behavioral health services 33 via telemedicine in accordance with this section, the student’s 34 primary care provider and the mental health professional 35 -5- LSB 6047XS (1) 88 pf/rh 5/ 13

S.F. 2100 providing the telemedicine services shall consult to develop 1 a plan for the purpose of coordinating the student’s medical 2 care. 3 b. The plan shall ensure regular contact between the 4 student’s primary care provider and the student’s mental 5 health professional, and the sharing of such records as may be 6 necessary to jointly manage the student’s medical care. 7 c. If the student receiving telemedicine services does not 8 have a primary care provider, the mental health professional 9 shall provide a listing of local primary care providers to the 10 student’s parent or guardian. 11 5. The mental health professional shall notify the 12 student’s parent or guardian of the time and place for each 13 scheduled telemedicine session and specify the means available 14 for the parent or guardian to participate in the session. 15 6. Protected health information, including but not limited 16 to medical records and medical billing information, created 17 by the mental health professional or primary care provider 18 shall not be shared with or disclosed to a public school, 19 accredited nonpublic school, or area education agency, unless 20 disclosure is necessary to prevent or lessen a serious and 21 imminent threat to the health or safety of the student or to a 22 clearly identifiable person or persons and the mental health 23 professional determines the student has the apparent intent and 24 ability to carry out the threat. 25 7. A school district, an accredited nonpublic school, 26 an area education agency, the board of directors of a school 27 district or an area education agency, authorities in charge of 28 the accredited nonpublic school, and employees of the school 29 district, accredited nonpublic school or area education agency, 30 shall not be liable for any injury arising from the provision 31 of voluntary behavioral health screenings or behavioral health 32 services in accordance with this chapter, provided such person 33 has acted reasonably and in good faith. 34 Sec. 5. NEW SECTION . 514C.35 Behavioral health services 35 -6- LSB 6047XS (1) 88 pf/rh 6/ 13

S.F. 2100 provided via telemedicine in a school setting —— coverage. 1 1. As used in this section, unless the context otherwise 2 requires: 3 a. “Accredited nonpublic school” means any school, other 4 than a public school, that is accredited pursuant to section 5 256.11 for any and all levels for grades one through twelve. 6 b. “Area education agency” means an area education agency 7 established pursuant to chapter 273. 8 c. “Behavioral health services” means services provided 9 by a health care professional operating within the scope of 10 the health care professional’s practice which address mental, 11 emotional, medical, or behavioral conditions, illnesses, 12 diseases, or problems. 13 d. “Health care professional” means a physician or other 14 health care practitioner licensed, accredited, registered, or 15 certified to perform specified health care services consistent 16 with state law. 17 e. “In-person encounter” means that the mental health 18 professional and the student are in the physical presence of 19 each other and are in the same physical location during the 20 provision of behavioral health services. 21 f. “Mental health professional” means the same as defined 22 in section 228.1. 23 g. “Patient” means a student receiving a behavioral health 24 screening or other behavioral health services in accordance 25 with this chapter. 26 h. “Primary care provider” means the personal provider 27 trained to provide the first contact and continuous and 28 comprehensive care to a patient and includes but is not limited 29 to any of the following licensed or certified health care 30 professionals who provide primary care: 31 (1) A physician who is a family or general practitioner or a 32 pediatrician. 33 (2) An advanced registered nurse practitioner. 34 (3) A physician assistant. 35 -7- LSB 6047XS (1) 88 pf/rh 7/ 13

S.F. 2100 (4) A chiropractor. 1 i. “Provider-patient relationship” means the relationship 2 between the patient and the mental health professional that 3 meets the requirements for commencement and establishment of 4 a valid provider-patient relationship as specified in this 5 chapter. 6 j. “Public school” means any school directly supported in 7 whole or in part by taxation. 8 k. “School” means a public or accredited nonpublic school, 9 or an area education agency that provides premises for teaching 10 any grade from kindergarten through grade twelve. 11 l. “School district” means a school district described in 12 chapter 274. 13 m. “Student” means a person enrolled in and attending an 14 accredited nonpublic school or a public school in grades one 15 through twelve. 16 n. “Telemedicine” means the practice of medicine using 17 electronic audio-visual communications and information 18 technologies or other means, including interactive audio with 19 asynchronous store-and-forward transmission, between a licensee 20 in one location and a patient in another location with or 21 without an intervening health care provider. “Telemedicine” 22 includes asynchronous store-and-forward technologies, remote 23 monitoring, and real-time interactive services, including 24 teleradiology and telepathology. “Telemedicine” does not 25 include the provision of medical services only through an 26 audio-only telephone, email messages, facsimile transmissions, 27 or U.S. mail or other parcel service, or any combination of 28 these means. 29 2. a. Notwithstanding the uniformity of treatment 30 requirements of section 514C.6, a policy, contract, or plan 31 providing for third-party payment or prepayment of health or 32 medical expenses shall provide coverage and treat as equivalent 33 services, behavioral health services provided by a mental 34 health professional to a student through an in-person encounter 35 -8- LSB 6047XS (1) 88 pf/rh 8/ 13

S.F. 2100 or via telemedicine pursuant to chapter 280A. 1 b. Coverage shall be provided if all of the following 2 conditions are met: 3 (1) If behavioral health services are provided by a mental 4 health professional via telemedicine to a student on the 5 premises of a public school, an accredited nonpublic school, or 6 an area education agency, the behavioral health services are 7 provided in accordance with chapter 280A. 8 (2) The mental health services provided are provided in 9 accordance with evidence-based standards of practice and relate 10 only to behavioral health. 11 (3) The mental health professional has an existing 12 provider-patient relationship with the student as specified in 13 chapter 280A. 14 (4) The student’s parent or guardian has consented to the 15 treatment and to release of the student’s medical records 16 associated with the telemedicine services to the student’s 17 primary care provider. 18 (5) The mental health services provided are required in 19 accordance with the student’s individual education plan. 20 3. This section applies to the following classes of 21 third-party payment provider policies, contracts, or plans 22 delivered, issued for delivery, continued, or renewed in this 23 state on or after January 1, 2021: 24 a. Individual or group accident and sickness insurance 25 providing coverage on an expense-incurred basis. 26 b. An individual or group hospital or medical service 27 contract issued pursuant to chapter 509, 514, or 514A. 28 c. An individual or group health maintenance organization 29 contract regulated under chapter 514B. 30 d. A plan established pursuant to chapter 509A for public 31 employees. 32 4. This section shall not apply to accident-only, 33 specified disease, short-term hospital or medical, hospital 34 confinement indemnity, credit, dental, vision, Medicare 35 -9- LSB 6047XS (1) 88 pf/rh 9/ 13

S.F. 2100 supplement, long-term care, basic hospital and medical-surgical 1 expense coverage as defined by the commissioner, disability 2 income insurance coverage, coverage issued as a supplement 3 to liability insurance, workers’ compensation or similar 4 insurance, or automobile medical payment insurance. 5 5. The commissioner of insurance, in collaboration with the 6 state board of education, may adopt rules pursuant to chapter 7 17A as necessary to administer this section. 8 Sec. 6. MEDICAID —— TELEMEDICINE SERVICES PROVIDED IN 9 SCHOOL SETTINGS —— REIMBURSEMENT. 10 1. For the purposes of this section: 11 a. “Accredited nonpublic school” means any school, other 12 than a public school, that is accredited pursuant to section 13 256.11 for any and all levels for grades one through twelve. 14 b. “Area education agency” means an area education agency 15 established pursuant to chapter 273. 16 c. “Behavioral health services” means services provided 17 by a health care professional operating within the scope of 18 the health care professional’s practice which address mental, 19 emotional, medical, or behavioral conditions, illnesses, 20 diseases, or problems. 21 d. “Health care professional” means a physician or other 22 health care practitioner licensed, accredited, registered, or 23 certified to perform specified health care services consistent 24 with state law. 25 e. “In-person encounter” means that the mental health 26 professional and the student are in the physical presence of 27 each other and are in the same physical location during the 28 provision of behavioral health services. 29 f. “Mental health professional” means the same as defined 30 in section 228.1. 31 g. “Patient” means a student receiving a behavioral health 32 screening or other behavioral health services in accordance 33 with this chapter. 34 h. “Primary care provider” means the personal provider 35 -10- LSB 6047XS (1) 88 pf/rh 10/ 13

S.F. 2100 trained to provide the first contact and continuous and 1 comprehensive care to a patient and includes but is not limited 2 to any of the following licensed or certified health care 3 professionals who provide primary care: 4 (1) A physician who is a family or general practitioner or a 5 pediatrician. 6 (2) An advanced registered nurse practitioner. 7 (3) A physician assistant. 8 (4) A chiropractor. 9 i. “Provider-patient relationship” means the relationship 10 between the patient and the mental health professional that 11 meets the requirements for commencement and establishment of 12 a valid provider-patient relationship as specified in this 13 chapter. 14 j. “Public school” means any school directly supported in 15 whole or in part by taxation. 16 k. “School” means a public or accredited nonpublic school, 17 or an area education agency that provides premises for teaching 18 any grade from kindergarten through grade twelve. 19 l. “School district” means a school district described in 20 chapter 274. 21 m. “Student” means a person enrolled in and attending an 22 accredited nonpublic school or a public school in grades one 23 through twelve. 24 n. “Telemedicine” means the practice of medicine using 25 electronic audio-visual communications and information 26 technologies or other means, including interactive audio with 27 asynchronous store-and-forward transmission, between a licensee 28 in one location and a patient in another location with or 29 without an intervening health care provider. “Telemedicine” 30 includes asynchronous store-and-forward technologies, remote 31 monitoring, and real-time interactive services, including 32 teleradiology and telepathology. “Telemedicine” does not 33 include the provision of medical services only through an 34 audio-only telephone, email messages, facsimile transmissions, 35 -11- LSB 6047XS (1) 88 pf/rh 11/ 13

S.F. 2100 or U.S. mail or other parcel service, or any combination of 1 these means. 2 2. a. The department of human services shall require, 3 contractually and in accordance with rules adopted pursuant 4 to chapter 17A, that under both fee-for-service and managed 5 care administered Medicaid, behavioral health services provided 6 through an in-person encounter or via telemedicine pursuant to 7 chapter 280A shall be treated as equivalent services for the 8 purposes of reimbursement. 9 b. Coverage shall be provided if all of the following 10 conditions are met: 11 (1) If the mental health services are provided by a mental 12 health professional via telemedicine to a student on the 13 premises of a public school, an accredited nonpublic school, or 14 an area education agency, the behavioral health services are 15 provided in accordance with chapter 280A. 16 (2) The mental health services are provided in accordance 17 with evidence-based standards of practice and relate only to 18 behavioral health. 19 (3) The mental health professional has an existing 20 provider-patient relationship with the student as specified in 21 chapter 280A. 22 (4) The student’s parent or guardian has consented to the 23 treatment and to release of the student’s medical records 24 associated with the telemedicine services to the student’s 25 primary care provider. 26 (5) The mental health services provided are required in 27 accordance with the student’s individual education plan. 28 EXPLANATION 29 The inclusion of this explanation does not constitute agreement with 30 the explanation’s substance by the members of the general assembly. 31 This bill provides for the provision of behavioral health 32 screenings and services through a school setting both in person 33 and via telemedicine. 34 The bill authorizes a school district, an accredited 35 -12- LSB 6047XS (1) 88 pf/rh 12/ 13

S.F. 2100 nonpublic school, or an area education agency to contract 1 with a mental health professional or a nationally accredited 2 behavioral health care organization to provide behavioral 3 health screenings to students in person or via telemedicine, 4 upon written consent by the student’s parent or guardian and 5 to allow for the release of the results of the screening to the 6 student’s primary care provider. 7 The bill specifies the requirements for the establishment 8 of a provider-patient relationship for purposes of mental 9 health professionals providing behavioral health services 10 via telemedicine in a public school, an accredited nonpublic 11 school, or an area education agency setting. 12 The bill authorizes a public school, accredited nonpublic 13 school, and area education agency to provide access to 14 behavioral health services via telemedicine on the premises 15 of the public school, accredited nonpublic school, or area 16 education agency, specifies the parameters for the provision of 17 such services, and provides immunity for entities that provide 18 such services acting reasonably and in good faith. 19 The bill requires that both private health insurance 20 coverage and the Medicaid program are to provide coverage 21 and treat as equivalent services, behavioral health services 22 provided by a mental health professional to a student through 23 an in-person encounter or via telemedicine pursuant to the 24 bill. 25 -13- LSB 6047XS (1) 88 pf/rh 13/ 13