H.F. 2160 Section 1. LEGISLATIVE FINDINGS. The general assembly 1 finds and recognizes all of the following: 2 1. Telemedicine services are those services that use 3 electronic technology to overcome a geographic distance 4 between patients and health care providers for the purpose of 5 intervention, clinical management, or assessing, monitoring, 6 or educating patients. 7 2. The provision of telemedicine services results in 8 demonstrated cost-effectiveness, improvements in disease 9 management, and improved patient outcomes and studies have 10 demonstrated significant reductions in hospitalizations and 11 otherwise necessary medical care as a result of telemedicine 12 intervention. 13 3. Geography, weather, availability of specialists, 14 transportation, and other factors can create barriers to 15 accessing appropriate health care, including behavioral health 16 care, and one way to provide, ensure, or enhance access to 17 care given these barriers is through the appropriate use of 18 technology to allow health care consumers access to qualified 19 health care providers. 20 4. There is a need in this state to embrace efforts that 21 will encourage health insurers and health care providers to 22 support the use of telemedicine and that will also encourage 23 all state agencies to evaluate and amend their policies and 24 rules to remove any regulatory barriers prohibiting the use of 25 telemedicine services. 26 Sec. 2. NEW SECTION . 147.161 Telemedicine. 27 1. A health care professional licensed by a board created 28 under this chapter, as appropriate to the scope of practice 29 of the profession, may employ the technology of telemedicine 30 by applying telemedicine within the professional’s scope 31 of practice or by using telemedicine technology under the 32 direction and supervision of another health care professional 33 who is using telemedicine technology within the supervising 34 professional’s scope of practice. A health care professional’s 35 -1- LSB 5728YH (5) 85 pf/rj 1/ 7

H.F. 2160 employment of telemedicine technology acting under the 1 direction and supervision of another health care professional 2 who is using telemedicine technology within that health care 3 professional’s scope of practice shall not be interpreted 4 as practicing the supervising professional’s health care 5 profession without a license. However, any health care 6 professional employing telemedicine technology must be trained, 7 educated, and knowledgeable regarding the health care service 8 provided and technology used and shall not perform duties for 9 which the professional does not have sufficient training, 10 education, and knowledge. Failure to have sufficient training, 11 education, and knowledge is grounds for disciplinary action by 12 the respective board. 13 2. The department, in consultation with those boards that 14 exercise regulatory or rulemaking authority over a profession 15 within whose scope of practice telemedicine may be employed, 16 shall adopt rules, as necessary, to implement the requirements 17 of this section relating to the provision of telemedicine 18 services by such professionals and shall amend any rules that 19 conflict with the authorization of the use of telemedicine as 20 provided in this section. 21 3. As used in this section, “telemedicine” or “telemedicine 22 services” , as it pertains to the delivery of health care 23 services, means synchronous video conferencing, remote patient 24 monitoring, transmission of asynchronous health images, or 25 other health transmissions supported by mobile devices, or 26 other telecommunications technology used for the purpose of 27 diagnosis, consultation, treatment, transfer of medical data, 28 or exchange of medical education information by means of audio, 29 video, or data communications. “Telemedicine” or “telemedicine 30 services” does not include an audio-only telephone call, 31 electronic mail message, or facsimile transmission. 32 Sec. 3. NEW SECTION . 514C.30 Telemedicine services. 33 1. Notwithstanding the uniformity of treatment requirements 34 of section 514C.6, a contract, policy, or plan providing for 35 -2- LSB 5728YH (5) 85 pf/rj 2/ 7

H.F. 2160 third-party payment or prepayment for health, medical, or 1 surgical coverage benefits shall not require face-to-face 2 contact between a health care provider and a patient as a 3 prerequisite for payment for services appropriately provided 4 through telemedicine in accordance with generally accepted 5 health care practices and standards prevailing in the 6 applicable professional community at the time the services are 7 provided. Health care services provided through in-person 8 consultations or through telemedicine shall be treated as 9 equivalent services for the purposes of coverage. 10 2. This section shall not be interpreted as preventing 11 a third-party payment provider from imposing deductibles or 12 copayment or coinsurance requirements for a health care service 13 provided through telemedicine if the deductible, copayment, 14 or coinsurance does not exceed the deductible, copayment, or 15 coinsurance applicable to an in-person consultation for the 16 same health care service. 17 3. The provisions of this section shall apply to all of the 18 following classes of third-party payment provider contracts, 19 policies, or plans delivered, issued for delivery, continued, 20 or renewed in this state on or after January 1, 2015: 21 a. Individual or group accident and sickness insurance 22 providing coverage on an expense-incurred basis. 23 b. An individual or group hospital or medical service 24 contract issued pursuant to chapter 509, 514, or 514A. 25 c. An individual or group health maintenance organization 26 contract regulated under chapter 514B. 27 d. An individual or group Medicare supplemental policy, 28 unless coverage pursuant to such policy is preempted by federal 29 law. 30 e. A plan established pursuant to chapter 509A for public 31 employees. 32 4. This section shall not apply to accident-only, specified 33 disease, short-term hospital or medical, hospital confinement 34 indemnity, credit, dental, vision, long-term care, basic 35 -3- LSB 5728YH (5) 85 pf/rj 3/ 7

H.F. 2160 hospital, and medical-surgical expense coverage as defined 1 by the commissioner, disability income insurance coverage, 2 coverage issued as a supplement to liability insurance, 3 workers’ compensation or similar insurance, or automobile 4 medical payment insurance. 5 5. The commissioner of insurance shall adopt rules pursuant 6 to chapter 17A as necessary to administer this section. 7 Sec. 4. MEDICAID PROGRAM —— REIMBURSEMENT FOR 8 TELEMEDICINE. The department of human services shall adopt 9 rules to provide for coverage of telemedicine services 10 under the Medicaid program. The rules shall provide that 11 face-to-face contact between a health care provider and a 12 patient is not required as a prerequisite for payment for 13 services appropriately provided through telemedicine in 14 accordance with generally accepted health care practices 15 and standards prevailing in the applicable professional 16 community at the time the services are provided. Health care 17 services provided through in-person consultations or through 18 telemedicine shall be treated as equivalent services for the 19 purposes of reimbursement. For the purposes of this section, 20 “telemedicine” or “telemedicine services” means the same as 21 defined in section 514C.30, as enacted in this Act. 22 Sec. 5. STUDY ON USE OF TELEMEDICINE. The department of 23 public health, in collaboration with the department of human 24 services and the division of insurance of the department of 25 commerce, shall convene and conduct a study regarding options 26 for implementing telemedicine services and coverage. The 27 department of public health shall submit a final report of its 28 findings and recommendations to the governor and the general 29 assembly by December 15, 2014. 30 EXPLANATION 31 The inclusion of this explanation does not constitute agreement with 32 the explanation’s substance by the members of the general assembly. 33 This bill relates to telemedicine. The bill provides 34 legislative findings regarding the use of telemedicine 35 -4- LSB 5728YH (5) 85 pf/rj 4/ 7

H.F. 2160 services. 1 The bill provides that a health care professional licensed 2 by a professional licensing board under Code chapter 147 3 (health-related professions), as appropriate to the scope 4 of practice of the profession, may employ the technology of 5 telemedicine by applying telemedicine within the professional’s 6 scope of practice or by employing telemedicine technology 7 under the direction and supervision of another health care 8 professional who is using telemedicine technology within the 9 supervising professional’s scope of practice. A health care 10 professional’s employment of telemedicine technology under the 11 direction and supervision of another health care professional 12 who is acting within that health care professional’s scope of 13 practice shall not be interpreted as practicing the supervising 14 professional’s health care profession without a license. A 15 health care professional employing telemedicine technology must 16 be trained, educated, and knowledgeable regarding the health 17 care service provided and technology used and is prohibited 18 from performing duties for which the professional does not have 19 sufficient training, education, and knowledge. Failure to have 20 sufficient training, education, and knowledge is grounds for 21 disciplinary action by the respective board. 22 The bill directs the department of public health, in 23 consultation with those boards that exercise regulatory or 24 rulemaking authority over a profession within whose scope 25 of practice telemedicine may be employed, to adopt rules, 26 as necessary, to implement the requirements relating to the 27 provision of telemedicine services by such professionals and to 28 amend any rules that conflict with the authorization of the use 29 of telemedicine as provided in the bill. 30 The bill defines “telemedicine” or “telemedicine services” 31 for the purpose of the professional licensure provisions. 32 The bill provides that beginning January 1, 2015, a 33 contract, policy, or plan providing for third-party payment or 34 prepayment for health, medical, or surgical coverage benefits 35 -5- LSB 5728YH (5) 85 pf/rj 5/ 7

H.F. 2160 shall not require face-to-face contact between a health 1 care provider and a patient as a prerequisite for payment 2 for services appropriately provided through telemedicine in 3 accordance with generally accepted health care practices 4 and standards prevailing in the applicable professional 5 community at the time the services are provided. Health care 6 services provided through in-person consultations or through 7 telemedicine shall be treated as equivalent services for the 8 purposes of coverage. 9 The provision is not to be interpreted as preventing a 10 third-party payment provider from imposing deductibles or 11 copayment or coinsurance requirements for a health care service 12 provided through telemedicine if the deductible, copayment, 13 or coinsurance does not exceed the deductible, copayment, or 14 coinsurance applicable to an in-person consultation for the 15 same health care service. The section applies to individual 16 or group accident and sickness insurance providing coverage 17 on an expense-incurred basis; an individual or group hospital 18 or medical service contract issued pursuant to Code chapter 19 509, 514, or 514A; an individual or group health maintenance 20 organization contract regulated under Code chapter 514B; an 21 individual or group Medicare supplemental policy, unless 22 coverage pursuant to such policy is preempted by federal law; 23 and a plan established pursuant to Code chapter 509A for public 24 employees. The provision does not apply to accident-only, 25 specified disease, short-term hospital or medical, hospital 26 confinement indemnity, credit, dental, vision, long-term 27 care, basic hospital, and medical-surgical expense coverage 28 as defined by the commissioner, disability income insurance 29 coverage, coverage issued as a supplement to liability 30 insurance, workers’ compensation or similar insurance, or 31 automobile medical payment insurance. 32 The commissioner of insurance is directed to adopt rules 33 pursuant to Code chapter 17A as necessary to administer the 34 provision. The bill defines telemedicine services for the 35 -6- LSB 5728YH (5) 85 pf/rj 6/ 7

H.F. 2160 purpose of the insurance provision. 1 The bill directs the department of human services to 2 adopt rules to provide for coverage of telemedicine services 3 under the Medicaid program. The rules are to provide that 4 face-to-face contact between a health care provider and a 5 patient is not required as a prerequisite for payment for 6 services appropriately provided through telemedicine in 7 accordance with generally accepted health care practices 8 and standards prevailing in the applicable professional 9 community at the time the services are provided. Health care 10 services provided through in-person consultations or through 11 telemedicine are to be treated as equivalent services for the 12 purposes of reimbursement. 13 The bill directs the department of public health, in 14 collaboration with the department of human services and 15 the division of insurance of the department of commerce, to 16 convene and conduct a study regarding options for implementing 17 telemedicine services and coverage. The department of public 18 health is directed to submit a final report of its findings and 19 recommendations to the governor and the general assembly by 20 December 15, 2014. 21 -7- LSB 5728YH (5) 85 pf/rj 7/ 7