House File 632 H-1241 Amend House File 632 as follows: 1 1. Page 5, after line 31 by inserting: 2 < Sec. ___. NEW SECTION . 505.33 Telehealth —— 3 standards. 4 1. As used in this section: 5 a. “Distant site” means the site at which a health 6 care professional delivering the service is located at 7 the time the telehealth service is provided. 8 b. “Health care professional” means a person who 9 is licensed, certified, or otherwise authorized or 10 permitted by the law of this state to administer health 11 care in the ordinary course of business or in the 12 practice of a profession, or in an approved education 13 or training program, as long as the person is operating 14 within the person’s professional scope of practice. 15 c. “Remote patient monitoring” means using 16 telehealth to enable the health care professional to 17 monitor and manage a patient’s medical, functional, and 18 environmental needs if such needs can be appropriately 19 met through telehealth intervention. 20 d. “Store-and-forward telehealth” means the use of 21 asynchronous communications between a patient and a 22 health care professional or between a referring health 23 care professional and a medical specialist at a distant 24 site, supported by telecommunications technology for 25 the purpose of diagnosis, consultation, treatment, or 26 therapeutic assistance in the care of the patient, 27 including the transferring of medical data from one 28 site to another through the use of a camera or similar 29 device that records or stores an image that is sent or 30 forwarded via telecommunications to another site for 31 consultation. 32 e. “Telehealth” means the use of real-time, 33 interactive audio or video telecommunications or 34 electronic technology, remote patient monitoring, 35 or store-and-forward telehealth by a health care 36 professional to deliver health care services to a 37 patient within the scope of practice of the health 38 care professional, for the purposes of diagnosis, 39 consultation, treatment, transfer of medical data, 40 or exchange of medical education information. 41 “Telehealth” does not include an audio-only telephone 42 call, electronic mail message, or facsimile 43 transmission. 44 2. The commissioner of insurance shall develop, by 45 rule, coverage standards for a contract, policy, or 46 plan providing for third-party payment or prepayment 47 for health, medical, or surgical coverage benefits 48 that elects to provide coverage for services provided 49 as telehealth. The coverage standards for telehealth 50 -1- HF632.1522 (4) 86 pf/rj 1/ 4 #1.

shall reflect generally accepted health care practices 1 and standards, as well as medical care management 2 requirements applicable to in-person services. 3 3. In developing the coverage standards, the 4 commissioner of insurance shall consult with applicable 5 boards and regulatory authorities that exercise 6 regulatory or rulemaking authority over an affected 7 health care professional to ensure all of the 8 following: 9 a. A health care professional, as appropriate to 10 the scope of practice of the profession, may employ 11 the technology of telehealth by applying telehealth 12 within the professional’s scope of practice or by 13 using telehealth technology under the direction and 14 supervision of another health care professional who 15 is using telehealth technology within the supervising 16 professional’s scope of practice. A health care 17 professional’s employment of telehealth acting under 18 the direction and supervision of another health care 19 professional who is using telehealth within that 20 health care professional’s scope of practice shall 21 not be interpreted as practicing the supervising 22 professional’s health care profession without a license 23 or appropriate authorization. However, any health care 24 professional employing telehealth must hold a current 25 valid license or appropriate authorization to practice 26 the respective profession in the state and be trained, 27 educated, and knowledgeable regarding the health care 28 service provided and technology used and shall not 29 perform duties for which the professional does not have 30 sufficient training, education, and knowledge. Failure 31 to have sufficient training, education, and knowledge 32 is grounds for disciplinary action by the respective 33 board or regulatory authority. 34 b. The applicable board or regulatory authority 35 that exercises regulatory or rulemaking authority 36 over an affected profession under this section, or 37 the department of public health in the absence of an 38 applicable board or regulatory authority, adopts rules 39 to administer this section. 40 c. The standard of care for a professional using 41 telehealth to provide health care services to a patient 42 shall be the same as the standard of care required of 43 that professional for the provision of in-person health 44 care services to a patient. 45 d. The type of setting where telehealth is provided 46 for the patient or by the health care professional 47 shall not be limited if the delivery of health care 48 services is appropriately provided through telehealth. 49 e. This section shall not be construed to conflict 50 -2- HF632.1522 (4) 86 pf/rj 2/ 4

with or supersede provisions otherwise applicable 1 to the licensure or regulation of health care 2 professionals. 3 f. This section shall not be construed to alter 4 the scope of practice of any health care professional, 5 authorize the delivery of health care services in a 6 setting or manner not otherwise authorized by law, or 7 limit a patient’s right to choose in-person contact 8 with a health care professional for the delivery of 9 health care services for which telehealth is available. 10 g. If a health care professional provides services 11 pursuant to and in compliance with section 135.24 12 via telehealth in accordance with this section, the 13 provisions of section 135.24 including those relating 14 to immunity from civil liability shall apply to such 15 health care professional. 16 4. The rules shall specify that if coverage for 17 telehealth is provided, all of the following shall 18 apply: 19 a. The rules shall not be interpreted as preventing 20 a third-party payment provider from imposing 21 deductibles or copayment or coinsurance requirements 22 for a health care service provided through telehealth 23 if the deductible, copayment, or coinsurance does 24 not exceed the deductible, copayment, or coinsurance 25 applicable to in-person consultation for the same 26 health care service. A third-party payment provider 27 shall not impose annual or lifetime maximums on 28 coverage of telehealth unless the annual or lifetime 29 maximum applies in the aggregate to all items and 30 services under the contract, policy, or plan. 31 b. The rules shall not be interpreted to require a 32 third-party payment provider to provide reimbursement 33 for a health care service that is not a covered benefit 34 or to reimburse a health care professional who is not a 35 covered provider under the contract, policy, or plan. 36 c. The rules shall not be interpreted to preclude 37 a third-party payment provider from performing 38 utilization review to determine the appropriateness of 39 telehealth in the delivery of health care services if 40 the determination is made in the same manner as those 41 regarding the same health care service when delivered 42 in person. 43 d. The rules shall not be interpreted to authorize 44 a third-party payment provider to require the use of 45 telehealth when the health care professional determines 46 use of telehealth is not appropriate. 47 e. The rules shall apply to all of the following 48 classes of third-party payment provider contracts, 49 policies, or plans delivered, issued for delivery, 50 -3- HF632.1522 (4) 86 pf/rj 3/ 4

continued, or renewed in this state on or after January 1 1, 2016: 2 (1) Individual or group accident and sickness 3 insurance providing coverage on an expense-incurred 4 basis. 5 (2) An individual or group hospital or medical 6 service contract issued pursuant to chapter 509, 514, 7 or 514A. 8 (3) An individual or group health maintenance 9 organization contract regulated under chapter 514B. 10 (4) An individual or group Medicare supplemental 11 policy, unless coverage pursuant to such policy is 12 preempted by federal law. 13 (5) A plan established pursuant to chapter 509A for 14 public employees. 15 f. The rules shall not apply to accident-only, 16 specified disease, short-term hospital or medical, 17 hospital confinement indemnity, credit, dental, vision, 18 long-term care, basic hospital, and medical-surgical 19 expense coverage as defined by the commissioner, 20 disability income insurance coverage, coverage issued 21 as a supplement to liability insurance, workers’ 22 compensation or similar insurance, or automobile 23 medical payment insurance. > 24 2. By renumbering as necessary. 25 ______________________________ FORBES of Polk -4- HF632.1522 (4) 86 pf/rj 4/ 4 #2.