HF 2160 (LSB 5728YH (5) 85)

HOUSE FILE 2160

BY  BERRY and MURPHY

A BILL FOR

An Act relating to telemedicine relative to 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.  Telemedicine services are those services that use 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.
   2.  The provision of telemedicine services results in demonstrated cost-effectiveness, improvements in disease management, and improved patient outcomes and studies have demonstrated significant reductions in hospitalizations and otherwise necessary medical care as a result of telemedicine intervention.
   3.  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 providers.
   4.  There is a need in this state to embrace efforts that will encourage health insurers and health care providers to support the use of telemedicine 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 telemedicine services.
    Sec. 2.  NEW SECTION.  147.161  Telemedicine.
   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 telemedicine by applying telemedicine within the professional’s scope of practice or by using telemedicine technology under the direction and supervision of another health care professional who is using telemedicine technology within the supervising professional’s scope of practice. A health care professional’s employment of telemedicine technology acting under the direction and supervision of another health care professional who is using telemedicine technology 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 telemedicine technology must 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 department, in consultation with those boards that exercise regulatory or rulemaking authority over a profession within whose scope of practice telemedicine may be employed, shall adopt rules, as necessary, to implement the requirements of this section relating to the provision of telemedicine services by such professionals and shall amend any rules that conflict with the authorization of the use of telemedicine as provided in this section.
   3.  As used in this section, “telemedicine” or “telemedicine services”, as it pertains to the delivery of health care services, means synchronous video conferencing, remote patient monitoring, transmission of asynchronous health images, or other health transmissions supported by mobile devices, or other telecommunications technology used for the purpose of diagnosis, consultation, treatment, transfer of medical data, or exchange of medical education information by means of audio, video, or data communications. “Telemedicine” or “telemedicine services” does not include an audio-only telephone call, electronic mail message, or facsimile transmission.
    Sec. 3.  NEW SECTION.  514C.30  Telemedicine services.
   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 shall not require face-to-face contact between a health care provider and a patient as a prerequisite for payment for services appropriately provided through telemedicine 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 telemedicine shall be treated as equivalent services for the purposes of coverage.
   2.  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 telemedicine 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.
   3.  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, 2015:
   a.  Individual or group accident and sickness insurance providing coverage on an expense-incurred basis.
   b.  An individual or group hospital or medical service contract issued pursuant to chapter 509, 514, or 514A.
   c.  An individual or group health maintenance organization contract regulated under chapter 514B.
   d.  An individual or group Medicare supplemental policy, unless coverage pursuant to such policy is preempted by federal law.
   e.  A plan established pursuant to chapter 509A for public employees.
   4.  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.
   5.  The commissioner of insurance shall adopt rules pursuant to chapter 17A as necessary to administer this section.
    Sec. 4.  MEDICAID PROGRAM —— REIMBURSEMENT FOR TELEMEDICINE.  The department of human services shall adopt rules to provide for coverage of telemedicine services under the Medicaid program. The rules shall provide that face-to-face contact between a health care provider and a patient is not required as a prerequisite for payment for services appropriately provided through telemedicine 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 telemedicine shall be treated as equivalent services for the purposes of reimbursement. For the purposes of this section, “telemedicine” or “telemedicine services” means the same as defined in section 514C.30, as enacted in this Act.
    Sec. 5.  STUDY ON USE OF TELEMEDICINE.  The department of public health, in collaboration with the department of human services and the division of insurance of the department of commerce, shall convene and conduct a study regarding options for implementing telemedicine services and coverage. 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, 2014.
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 telemedicine. The bill provides legislative findings regarding the use of telemedicine services.
   The bill provides that a health care professional licensed by a professional licensing board under Code chapter 147 (health-related professions), as appropriate to the scope of practice of the profession, may employ the technology of telemedicine by applying telemedicine within the professional’s scope of practice or by employing telemedicine technology under the direction and supervision of another health care professional who is using telemedicine technology within the supervising professional’s scope of practice. A health care professional’s employment of telemedicine 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 telemedicine technology 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 department of public health, in consultation with those boards that exercise regulatory or rulemaking authority over a profession within whose scope of practice telemedicine may be employed, to adopt rules, as necessary, to implement the requirements relating to the provision of telemedicine services by such professionals and to amend any rules that conflict with the authorization of the use of telemedicine as provided in the bill.
   The bill defines “telemedicine” or “telemedicine services” for the purpose of the professional licensure provisions.
   The bill provides that beginning January 1, 2015, a contract, policy, or plan providing for third-party payment or prepayment for health, medical, or surgical coverage benefits shall not require face-to-face contact between a health care provider and a patient as a prerequisite for payment for services appropriately provided through telemedicine 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 telemedicine 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 telemedicine 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 section applies to individual or group accident and sickness insurance providing coverage on an expense-incurred basis; an individual or group hospital or medical service contract issued pursuant to Code chapter 509, 514, or 514A; an individual or group health maintenance organization contract regulated under Code chapter 514B; an individual or group Medicare supplemental policy, unless coverage pursuant to such policy is preempted by federal law; and a plan established pursuant to Code chapter 509A for public employees. The provision does 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.
   The commissioner of insurance is directed to adopt rules pursuant to Code chapter 17A as necessary to administer the provision. The bill defines telemedicine services for the purpose of the insurance provision.
   The bill directs the department of human services to adopt rules to provide for coverage of telemedicine services under the Medicaid program. The rules are to provide that face-to-face contact between a health care provider and a patient is not required as a prerequisite for payment for services appropriately provided through telemedicine 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 telemedicine 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 and the division of insurance of the department of commerce, to convene and conduct a study regarding options for implementing telemedicine services and coverage. 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, 2014.