House File 632 H-1222 Amend House File 632 as follows: 1 1. Page 1, before line 1 by inserting: 2 < DIVISION I 3 VARIOUS PROVISIONS INVOLVING INSURANCE AND THE 4 INSURANCE DIVISION > 5 2. Page 23, after line 30 by inserting: 6 < DIVISION II 7 TELEHEALTH COVERAGE 8 Sec. ___. LEGISLATIVE FINDINGS. The general 9 assembly finds and recognizes all of the following: 10 1. Access to health care facilities and health care 11 professionals is critically important to the citizens 12 of Iowa. 13 2. Telehealth uses electronic technology to 14 overcome a geographic distance between patients and 15 health care providers for the purpose of intervention, 16 clinical management, or assessing, monitoring, or 17 educating patients. 18 3. The provision of telehealth results in 19 demonstrated cost-effectiveness, improvements in 20 disease management, and improved patient outcomes and 21 studies by the American telemedicine association and 22 others have demonstrated significant reductions in 23 hospitalizations and otherwise necessary medical care 24 as a result of telehealth intervention. 25 4. Geography, weather, availability of specialists, 26 transportation, and other factors can create barriers 27 to accessing appropriate health care, including 28 behavioral health care, and one way to provide, ensure, 29 or enhance access to care given these barriers is 30 through the appropriate use of technology to allow 31 health care consumers access to qualified health care 32 professionals. 33 5. Additionally, the utilization of telehealth 34 will further the maintenance and improvement of the 35 physical and economic health of patients in medically 36 underserved communities by retaining the source of 37 health care in local areas, strengthening the health 38 infrastructure, and preserving health-care-related 39 jobs. 40 6. A need exists in this state to embrace efforts 41 that will encourage health insurers and health care 42 professionals to support the use of telehealth and that 43 will also encourage all state agencies to evaluate and 44 amend their policies and rules to remove any regulatory 45 barriers prohibiting the use of telehealth. 46 7. Recognition exists that the full potential of 47 delivering health care services through telehealth 48 cannot be realized without the assurance of payment and 49 the resolution of existing legal and policy barriers 50 -1- HF632.1447 (2) 86 av/rj 1/ 6 #1. #2.

to such payment. 1 8. The purpose of the Iowa telehealth Act is to 2 provide a framework for health care professionals to 3 utilize in providing telehealth to Iowans in a manner 4 that provides efficient and effective access to quality 5 health care. 6 Sec. ___. NEW SECTION . 147B.1 Title. 7 This chapter shall be known and may be cited as the 8 “Iowa Telehealth Act” . 9 Sec. ___. NEW SECTION . 147B.2 Definitions. 10 As used in this chapter, unless the context 11 otherwise requires: 12 1. “Distant site” means the site at which a health 13 care professional delivering the service is located at 14 the time the telehealth service is provided. 15 2. “Health care professional” means a person who 16 is licensed, certified, or otherwise authorized or 17 permitted by the law of this state to administer health 18 care in the ordinary course of business or in the 19 practice of a profession, or in an approved education 20 or training program, as long as the person is operating 21 within the person’s professional scope of practice. 22 3. “Remote patient monitoring” means using 23 telehealth to enable the health care professional to 24 monitor and manage a patient’s medical, functional, and 25 environmental needs if such needs can be appropriately 26 met through telehealth intervention. 27 4. “Store-and-forward telehealth” means the use of 28 asynchronous communications between a patient and a 29 health care professional or between a referring health 30 care professional and a medical specialist at a distant 31 site, supported by telecommunications technology for 32 the purpose of diagnosis, consultation, treatment, or 33 therapeutic assistance in the care of the patient, 34 including the transferring of medical data from one 35 site to another through the use of a camera or similar 36 device that records or stores an image that is sent or 37 forwarded via telecommunications to another site for 38 consultation. 39 5. “Telehealth” means the use of real-time, 40 interactive audio or video telecommunications or 41 electronic technology, remote patient monitoring, 42 or store-and-forward telehealth by a health care 43 professional to deliver health care services to a 44 patient within the scope of practice of the health 45 care professional, for the purposes of diagnosis, 46 consultation, treatment, transfer of medical data, 47 or exchange of medical education information. 48 “Telehealth” does not include an audio-only telephone 49 call, electronic mail message, or facsimile 50 -2- HF632.1447 (2) 86 av/rj 2/ 6

transmission. 1 Sec. ___. NEW SECTION . 147B.3 Telehealth. 2 1. A health care professional, as appropriate to 3 the scope of practice of the profession, may employ 4 the technology of telehealth by applying telehealth 5 within the professional’s scope of practice or by 6 using telehealth technology under the direction and 7 supervision of another health care professional who 8 is using telehealth technology within the supervising 9 professional’s scope of practice. A health care 10 professional’s employment of telehealth acting under 11 the direction and supervision of another health care 12 professional who is using telehealth within that 13 health care professional’s scope of practice shall 14 not be interpreted as practicing the supervising 15 professional’s health care profession without a license 16 or appropriate authorization. However, any health care 17 professional employing telehealth must hold a current 18 valid license or appropriate authorization to practice 19 the respective profession in the state and be trained, 20 educated, and knowledgeable regarding the health care 21 service provided and technology used and shall not 22 perform duties for which the professional does not have 23 sufficient training, education, and knowledge. Failure 24 to have sufficient training, education, and knowledge 25 is grounds for disciplinary action by the respective 26 board or regulatory authority. 27 2. The applicable board or regulatory authority 28 that exercises regulatory or rulemaking authority 29 over an affected profession under this chapter, or the 30 department in the absence of an applicable board or 31 regulatory authority, shall adopt rules to administer 32 this chapter. 33 3. The standard of care for a professional using 34 telehealth to provide health care services to a patient 35 shall be the same as the standard of care required of 36 that professional for the provision of in-person health 37 care services to a patient. 38 4. The type of setting where telehealth is provided 39 for the patient or by the health care professional 40 shall not be limited if the delivery of health care 41 services is appropriately provided through telehealth. 42 5. This chapter shall not be construed to conflict 43 with or supersede provisions otherwise applicable 44 to the licensure or regulation of health care 45 professionals. 46 6. This chapter shall not be construed to alter 47 the scope of practice of any health care professional, 48 authorize the delivery of health care services in a 49 setting or manner not otherwise authorized by law, or 50 -3- HF632.1447 (2) 86 av/rj 3/ 6

limit a patient’s right to choose in-person contact 1 with a health care professional for the delivery of 2 health care services for which telehealth is available. 3 7. If a health care professional provides services 4 pursuant to and in compliance with section 135.24 5 via telehealth in accordance with this chapter, the 6 provisions of section 135.24 including those relating 7 to immunity from civil liability shall apply to such 8 health care professional. 9 Sec. ___. NEW SECTION . 514C.30 Telehealth. 10 1. Notwithstanding the uniformity of treatment 11 requirements of section 514C.6, a contract, policy, or 12 plan providing for third-party payment or prepayment 13 for health, medical, or surgical coverage benefits may 14 provide coverage for services provided as telehealth if 15 the services would be covered if provided in person. 16 Coverage for telehealth shall reflect generally 17 accepted health care practices and standards, as well 18 as medical care management requirements applicable to 19 in-person services. 20 2. If health care coverage is provided for 21 telehealth under this section, all of the following 22 shall apply: 23 a. This section shall not be interpreted as 24 preventing a third-party payment provider from imposing 25 deductibles or copayment or coinsurance requirements 26 for a health care service provided through telehealth 27 if the deductible, copayment, or coinsurance does 28 not exceed the deductible, copayment, or coinsurance 29 applicable to in-person consultation for the same 30 health care service. A third-party payment provider 31 shall not impose annual or lifetime maximums on 32 coverage of telehealth unless the annual or lifetime 33 maximum applies in the aggregate to all items and 34 services under the contract, policy, or plan. 35 b. This section shall not be interpreted to require 36 a third-party payment provider to provide reimbursement 37 for a health care service that is not a covered benefit 38 or to reimburse a health care professional who is not a 39 covered provider under the contract, policy, or plan. 40 c. This section shall not be interpreted to 41 preclude a third-party payment provider from performing 42 utilization review to determine the appropriateness of 43 telehealth in the delivery of health care services if 44 the determination is made in the same manner as those 45 regarding the same health care service when delivered 46 in person. 47 d. This section shall not be interpreted to 48 authorize a third-party payment provider to require the 49 use of telehealth when the health care professional 50 -4- HF632.1447 (2) 86 av/rj 4/ 6

determines use of telehealth is not appropriate. 1 e. The provisions of this section shall apply to 2 all of the following classes of third-party payment 3 provider contracts, policies, or plans delivered, 4 issued for delivery, continued, or renewed in this 5 state on or after January 1, 2016: 6 (1) Individual or group accident and sickness 7 insurance providing coverage on an expense-incurred 8 basis. 9 (2) An individual or group hospital or medical 10 service contract issued pursuant to chapter 509, 514, 11 or 514A. 12 (3) An individual or group health maintenance 13 organization contract regulated under chapter 514B. 14 (4) An individual or group Medicare supplemental 15 policy, unless coverage pursuant to such policy is 16 preempted by federal law. 17 (5) A plan established pursuant to chapter 509A for 18 public employees. 19 f. This section shall not apply to accident-only, 20 specified disease, short-term hospital or medical, 21 hospital confinement indemnity, credit, dental, vision, 22 long-term care, basic hospital, and medical-surgical 23 expense coverage as defined by the commissioner, 24 disability income insurance coverage, coverage issued 25 as a supplement to liability insurance, workers’ 26 compensation or similar insurance, or automobile 27 medical payment insurance. 28 3. The commissioner of insurance shall adopt rules 29 pursuant to chapter 17A as necessary to administer this 30 section. 31 4. For the purposes of this section, “health care 32 professional” and “telehealth” mean as defined in 33 section 147B.2, as enacted in this Act. 34 Sec. ___. MEDICAID PROGRAM —— REIMBURSEMENT FOR 35 TELEHEALTH. The department of human services shall 36 adopt rules to provide for coverage of telehealth under 37 the Medicaid program. The rules shall provide that 38 in-person contact between a health care professional 39 and a patient is not required as a prerequisite for 40 payment for services appropriately provided through 41 telehealth in accordance with generally accepted 42 health care practices and standards prevailing in the 43 applicable professional community at the time the 44 services are provided. Health care services provided 45 through in-person consultations or through telehealth 46 shall be treated as equivalent services for the 47 purposes of reimbursement. As used in this section, 48 “health care professional” and “telehealth” mean as 49 defined in section 147B.2, as enacted in this Act. 50 -5- HF632.1447 (2) 86 av/rj 5/ 6

Sec. ___. STUDY ON USE OF TELEHEALTH. The 1 department of public health, in collaboration with 2 the department of human services, shall convene and 3 conduct a study regarding options for implementing 4 telehealth and telehealth coverage and reimbursement. 5 The division of insurance of the department of commerce 6 shall be available for consultation as needed. The 7 department of public health shall submit a final report 8 of its findings and recommendations to the governor and 9 the general assembly by December 15, 2015. > 10 3. Title page, line 2, after < commerce > by 11 inserting < and involving insurance coverage of 12 telehealth, including professional licensure and 13 reimbursement under the medical assistance program, > 14 4. Title page, line 3, after < effective > by 15 inserting < and applicability > 16 5. By renumbering as necessary. 17 ______________________________ FORBES of Polk -6- HF632.1447 (2) 86 av/rj 6/ 6 #3. #4. #5.