H.F. 317 Section 1. NEW SECTION . 514C.30 Telehealth services 1 provided by mental health professionals. 2 1. Notwithstanding the uniformity of treatment requirements 3 of section 514C.6, a contract, policy, or plan providing for 4 third-party payment or prepayment for health, medical, or 5 surgical coverage benefits shall not require face-to-face 6 contact between a mental health professional and a patient as a 7 prerequisite for payment for services appropriately provided 8 through telehealth in accordance with generally accepted health 9 care practices and standards prevailing in the applicable 10 professional community at the time the services are provided. 11 Health care services provided through in-person consultations 12 or through telehealth shall be treated as equivalent services 13 for the purposes of coverage. 14 2. This section shall not be interpreted as preventing 15 a third-party payment provider from imposing deductibles or 16 copayment or coinsurance requirements for a health care service 17 provided through telehealth if the deductible, copayment, or 18 coinsurance does not exceed the deductible, copayment, or 19 coinsurance applicable to an in-person consultation for the 20 same health care service. 21 3. The provisions of this section shall apply to all of the 22 following classes of third-party payment provider contracts, 23 policies, or plans delivered, issued for delivery, continued, 24 or renewed in this state on or after January 1, 2016: 25 a. Individual or group accident and sickness insurance 26 providing coverage on an expense-incurred basis. 27 b. An individual or group hospital or medical service 28 contract issued pursuant to chapter 509, 514, or 514A. 29 c. An individual or group health maintenance organization 30 contract regulated under chapter 514B. 31 d. An individual or group Medicare supplemental policy, 32 unless coverage pursuant to such policy is preempted by federal 33 law. 34 e. A plan established pursuant to chapter 509A for public 35 -1- LSB 1131YH (10) 86 pf/nh 1/ 4

H.F. 317 employees. 1 4. This section shall not apply to accident-only, specified 2 disease, short-term hospital or medical, hospital confinement 3 indemnity, credit, dental, vision, long-term care, basic 4 hospital, and medical-surgical expense coverage as defined 5 by the commissioner, disability income insurance coverage, 6 coverage issued as a supplement to liability insurance, 7 workers’ compensation or similar insurance, or automobile 8 medical payment insurance. 9 5. As used in this section: 10 a. “Mental health professional” means the same as defined 11 in section 228.1. 12 b. “Telehealth” or “telehealth services” , as it pertains 13 to the delivery of health care services, means synchronous 14 video conferencing, remote patient monitoring, transmission 15 of asynchronous health images, or other health transmissions 16 supported by mobile devices, or other telecommunications 17 technology used for the purpose of diagnosis, consultation, 18 treatment, transfer of medical data, or exchange of medical 19 education information by means of audio, video, or data 20 communications. “Telehealth” or “telehealth services” does not 21 include an audio-only telephone call, electronic mail message, 22 or facsimile transmission. 23 6. The commissioner of insurance shall adopt rules pursuant 24 to chapter 17A as necessary to administer this section. 25 Sec. 2. MEDICAID PROGRAM —— REIMBURSEMENT FOR 26 TELEHEALTH. The department of human services shall adopt 27 rules to provide for coverage of telehealth services provided 28 by a mental health professional under the Medicaid program. 29 The rules shall provide that face-to-face contact between a 30 mental health professional and a patient is not required as a 31 prerequisite for payment for services appropriately provided 32 through telehealth in accordance with generally accepted health 33 care practices and standards prevailing in the applicable 34 professional community at the time the services are provided. 35 -2- LSB 1131YH (10) 86 pf/nh 2/ 4

H.F. 317 Health care services provided through in-person consultations 1 or through telehealth shall be treated as equivalent services 2 for the purposes of reimbursement. For the purposes of this 3 section, “mental health professional” and “telehealth” or 4 “telehealth services” means the same as defined in section 5 514C.30, as enacted in this Act. 6 EXPLANATION 7 The inclusion of this explanation does not constitute agreement with 8 the explanation’s substance by the members of the general assembly. 9 This bill relates to telehealth services provided by a 10 mental health professional. 11 The bill provides that beginning January 1, 2016, a 12 contract, policy, or plan providing for third-party payment or 13 prepayment for health, medical, or surgical coverage benefits 14 shall not require face-to-face contact between a mental health 15 professional and a patient as a prerequisite for payment 16 for services appropriately provided through telehealth in 17 accordance with generally accepted health care practices and 18 standards prevailing in the applicable professional community 19 at the time the services are provided. Health care services 20 provided through in-person consultations or through telehealth 21 shall be treated as equivalent services for the purposes of 22 coverage. 23 The provision is not to be interpreted as preventing a 24 third-party payment provider from imposing deductibles or 25 copayment or coinsurance requirements for a health care service 26 provided through telehealth if the deductible, copayment, or 27 coinsurance does not exceed the deductible, copayment, or 28 coinsurance applicable to an in-person consultation for the 29 same health care service. The section applies to individual 30 or group accident and sickness insurance providing coverage 31 on an expense-incurred basis; an individual or group hospital 32 or medical service contract issued pursuant to Code chapter 33 509, 514, or 514A; an individual or group health maintenance 34 organization contract regulated under Code chapter 514B; an 35 -3- LSB 1131YH (10) 86 pf/nh 3/ 4

H.F. 317 individual or group Medicare supplemental policy, unless 1 coverage pursuant to such policy is preempted by federal law; 2 and a plan established pursuant to Code chapter 509A for public 3 employees. The provision does not apply to accident-only, 4 specified disease, short-term hospital or medical, hospital 5 confinement indemnity, credit, dental, vision, long-term 6 care, basic hospital, and medical-surgical expense coverage 7 as defined by the commissioner, disability income insurance 8 coverage, coverage issued as a supplement to liability 9 insurance, workers’ compensation or similar insurance, or 10 automobile medical payment insurance. 11 The commissioner of insurance is directed to adopt rules 12 pursuant to Code chapter 17A as necessary to administer the 13 provision. The bill defines “mental health professional” and 14 “telehealth” or “telehealth services”. 15 The bill directs the department of human services to adopt 16 rules to provide for coverage of telehealth services provided 17 by a mental health professional under the Medicaid program. 18 The rules are to provide that face-to-face contact between a 19 mental health professional and a patient is not required as a 20 prerequisite for payment for services appropriately provided 21 through telehealth in accordance with generally accepted health 22 care practices and standards prevailing in the applicable 23 professional community at the time the services are provided. 24 Health care services provided through in-person consultations 25 or through telehealth are to be treated as equivalent services 26 for the purposes of reimbursement. 27 -4- LSB 1131YH (10) 86 pf/nh 4/ 4