H.F. 404 Section 1. NEW SECTION . 147.161 Telehealth. 1 1. A health care professional licensed by a board created 2 under this chapter, as appropriate to the scope of practice 3 of the profession, may employ the technology of telehealth by 4 applying telehealth within the professional’s scope of practice 5 or by using telehealth technology under the direction and 6 supervision of another health care professional who is using 7 telehealth technology within the supervising professional’s 8 scope of practice. A health care professional’s employment 9 of telehealth technology acting under the direction and 10 supervision of another health care professional who is using 11 telehealth technology within that health care professional’s 12 scope of practice shall not be interpreted as practicing 13 the supervising professional’s health care profession 14 without a license. However, any health care professional 15 employing telehealth technology must be trained, educated, and 16 knowledgeable regarding the health care service provided and 17 technology used and shall not perform duties for which the 18 professional does not have sufficient training, education, and 19 knowledge. Failure to have sufficient training, education, and 20 knowledge is grounds for disciplinary action by the respective 21 board. 22 2. The department, in consultation with those boards that 23 exercise regulatory or rulemaking authority over a profession 24 within whose scope of practice telehealth may be employed, 25 shall adopt rules, as necessary, to implement the requirements 26 of this section relating to the provision of telehealth 27 services by such professionals and shall amend any rules that 28 conflict with the authorization of the use of telehealth as 29 provided in this section. 30 3. As used in this section, “telehealth” or “telehealth 31 services” , as it pertains to the delivery of health care 32 services, means synchronous video conferencing, remote patient 33 monitoring, transmission of asynchronous health images, or 34 other health transmissions supported by mobile devices, or 35 -1- LSB 2355HH (2) 86 pf/nh 1/ 6

H.F. 404 other telecommunications technology used for the purpose of 1 diagnosis, consultation, treatment, transfer of medical data, 2 or exchange of medical education information by means of audio, 3 video, or data communications. “Telehealth” or “telehealth 4 services” does not include an audio-only telephone call, 5 electronic mail message, or facsimile transmission. 6 Sec. 2. NEW SECTION . 514C.30 Telehealth services. 7 1. Notwithstanding the uniformity of treatment requirements 8 of section 514C.6, a contract, policy, or plan providing for 9 third-party payment or prepayment for health, medical, or 10 surgical coverage benefits shall not require face-to-face 11 contact between a health care provider and a patient as a 12 prerequisite for payment for services appropriately provided 13 through telehealth in accordance with generally accepted health 14 care practices and standards prevailing in the applicable 15 professional community at the time the services are provided. 16 Health care services provided through in-person consultations 17 or through telehealth shall be treated as equivalent services 18 for the purposes of coverage. 19 2. This section shall not be interpreted as preventing 20 a third-party payment provider from imposing deductibles or 21 copayment or coinsurance requirements for a health care service 22 provided through telehealth if the deductible, copayment, or 23 coinsurance does not exceed the deductible, copayment, or 24 coinsurance applicable to an in-person consultation for the 25 same health care service. 26 3. The provisions of this section shall apply to all of the 27 following classes of third-party payment provider contracts, 28 policies, or plans delivered, issued for delivery, continued, 29 or renewed in this state on or after January 1, 2016: 30 a. Individual or group accident and sickness insurance 31 providing coverage on an expense-incurred basis. 32 b. An individual or group hospital or medical service 33 contract issued pursuant to chapter 509, 514, or 514A. 34 c. An individual or group health maintenance organization 35 -2- LSB 2355HH (2) 86 pf/nh 2/ 6

H.F. 404 contract regulated under chapter 514B. 1 d. An individual or group Medicare supplemental policy, 2 unless coverage pursuant to such policy is preempted by federal 3 law. 4 e. A plan established pursuant to chapter 509A for public 5 employees. 6 4. This section shall not apply to accident-only, specified 7 disease, short-term hospital or medical, hospital confinement 8 indemnity, credit, dental, vision, long-term care, basic 9 hospital, and medical-surgical expense coverage as defined 10 by the commissioner, disability income insurance coverage, 11 coverage issued as a supplement to liability insurance, 12 workers’ compensation or similar insurance, or automobile 13 medical payment insurance. 14 5. The commissioner of insurance shall adopt rules pursuant 15 to chapter 17A as necessary to administer this section. 16 Sec. 3. MEDICAID PROGRAM —— REIMBURSEMENT FOR 17 TELEHEALTH. The department of human services shall adopt 18 rules to provide for coverage of telehealth services under the 19 Medicaid program. The rules shall provide that face-to-face 20 contact between a health care provider and a patient is 21 not required as a prerequisite for payment for services 22 appropriately provided through telehealth in accordance 23 with generally accepted health care practices and standards 24 prevailing in the applicable professional community at 25 the time the services are provided. Health care services 26 provided through in-person consultations or through telehealth 27 shall be treated as equivalent services for the purposes of 28 reimbursement. For the purposes of this section, “telehealth” 29 or “telehealth services” means the same as defined in section 30 514C.30, as enacted in this Act. 31 EXPLANATION 32 The inclusion of this explanation does not constitute agreement with 33 the explanation’s substance by the members of the general assembly. 34 This bill relates to telehealth. The bill provides 35 -3- LSB 2355HH (2) 86 pf/nh 3/ 6

H.F. 404 legislative findings regarding the use of telehealth 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 telehealth by applying telehealth within the professional’s 6 scope of practice or by employing telehealth technology 7 under the direction and supervision of another health care 8 professional who is using telehealth technology within the 9 supervising professional’s scope of practice. A health care 10 professional’s employment of telehealth 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 telehealth 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 telehealth may be employed, to adopt rules, as 26 necessary, to implement the requirements relating to the 27 provision of telehealth services by such professionals and to 28 amend any rules that conflict with the authorization of the use 29 of telehealth as provided in the bill. 30 The bill defines “telehealth” or “telehealth services” for 31 the purpose of the professional licensure provisions. 32 The bill provides that beginning January 1, 2016, a 33 contract, policy, or plan providing for third-party payment or 34 prepayment for health, medical, or surgical coverage benefits 35 -4- LSB 2355HH (2) 86 pf/nh 4/ 6

H.F. 404 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 telehealth in 3 accordance with generally accepted health care practices and 4 standards prevailing in the applicable professional community 5 at the time the services are provided. Health care services 6 provided through in-person consultations or through telehealth 7 shall be treated as equivalent services for the purposes of 8 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 telehealth if the deductible, copayment, or 13 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 telehealth services for the 35 -5- LSB 2355HH (2) 86 pf/nh 5/ 6

H.F. 404 purpose of the insurance provision. 1 The bill directs the department of human services to 2 adopt rules to provide for coverage of telehealth services 3 under the Medicaid program. The rules are to provide that 4 face-to-face contact between a health care provider and 5 a patient is not required as a prerequisite for payment 6 for services appropriately provided through telehealth in 7 accordance with generally accepted health care practices and 8 standards prevailing in the applicable professional community 9 at the time the services are provided. Health care services 10 provided through in-person consultations or through telehealth 11 are to be treated as equivalent services for the purposes of 12 reimbursement. 13 -6- LSB 2355HH (2) 86 pf/nh 6/ 6