H.F. 600 Section 1. LEGISLATIVE FINDINGS. The general assembly 1 finds and recognizes all of the following: 2 1. Access to health care facilities and health care 3 professionals is critically important to the citizens of Iowa. 4 2. Telehealth uses electronic technology to overcome a 5 geographic distance between patients and health care providers 6 for the purpose of intervention, clinical management, or 7 assessing, monitoring, or educating patients. 8 3. The provision of telehealth results in demonstrated 9 cost-effectiveness, improvements in disease management, 10 and improved patient outcomes and studies by the American 11 telemedicine association and others have demonstrated 12 significant reductions in hospitalizations and otherwise 13 necessary medical care as a result of telehealth intervention. 14 4. Geography, weather, availability of specialists, 15 transportation, and other factors can create barriers to 16 accessing appropriate health care, including behavioral health 17 care, and one way to provide, ensure, or enhance access to 18 care given these barriers is through the appropriate use of 19 technology to allow health care consumers access to qualified 20 health care professionals. 21 5. Additionally, the utilization of telehealth will 22 further the maintenance and improvement of the physical 23 and economic health of patients in medically underserved 24 communities by retaining the source of health care in local 25 areas, strengthening the health infrastructure, and preserving 26 health-care-related jobs. 27 6. A need exists in this state to embrace efforts that 28 will encourage health insurers and health care professionals 29 to support the use of telehealth and that will also encourage 30 all state agencies to evaluate and amend their policies and 31 rules to remove any regulatory barriers prohibiting the use of 32 telehealth. 33 7. Recognition exists that the full potential of delivering 34 health care services through telehealth cannot be realized 35 -1- LSB 1423HV (2) 86 pf/rj 1/ 10

H.F. 600 without the assurance of payment and the resolution of existing 1 legal and policy barriers to such payment. 2 8. The purpose of the Iowa telehealth Act is to provide a 3 framework for health care professionals to utilize in providing 4 telehealth to Iowans in a manner that provides efficient and 5 effective access to quality health care. 6 Sec. 2. NEW SECTION . 147B.1 Title. 7 This chapter shall be known and may be cited as the “Iowa 8 Telehealth Act” . 9 Sec. 3. NEW SECTION . 147B.2 Definitions. 10 As used in this chapter, unless the context otherwise 11 requires: 12 1. “Distant site” means the site at which a health care 13 professional delivering the service is located at the time the 14 telehealth service is provided. 15 2. “Health care professional” means a person who is 16 licensed, certified, or otherwise authorized or permitted by 17 the law of this state to administer health care in the ordinary 18 course of business or in the practice of a profession, or 19 in an approved education or training program, as long as the 20 person is operating within the person’s professional scope of 21 practice. 22 3. “Remote patient monitoring” means using telehealth to 23 enable the health care professional to monitor and manage a 24 patient’s medical, functional, and environmental needs if such 25 needs can be appropriately met through telehealth intervention. 26 4. “Store-and-forward telehealth” means the use of 27 asynchronous communications between a patient and a health care 28 professional or between a referring health care professional 29 and a medical specialist at a distant site, supported by 30 telecommunications technology for the purpose of diagnosis, 31 consultation, treatment, or therapeutic assistance in the 32 care of the patient, including the transferring of medical 33 data from one site to another through the use of a camera 34 or similar device that records or stores an image that is 35 -2- LSB 1423HV (2) 86 pf/rj 2/ 10

H.F. 600 sent or forwarded via telecommunications to another site for 1 consultation. 2 5. “Telehealth” means the use of real-time, interactive 3 audio or video telecommunications or electronic technology, 4 remote patient monitoring, or store-and-forward telehealth by 5 a health care professional to deliver health care services 6 to a patient within the scope of practice of the health care 7 professional, for the purposes of diagnosis, consultation, 8 treatment, transfer of medical data, or exchange of medical 9 education information. “Telehealth” does not include an 10 audio-only telephone call, electronic mail message, or 11 facsimile transmission. 12 Sec. 4. NEW SECTION . 147.163 Telehealth. 13 1. A health care professional licensed by a board created 14 under this chapter, as appropriate to the scope of practice 15 of the profession, may employ the technology of telehealth by 16 applying telehealth within the professional’s scope of practice 17 or by using telehealth technology under the direction and 18 supervision of another health care professional who is using 19 telehealth technology within the supervising professional’s 20 scope of practice. A health care professional’s employment 21 of telehealth acting under the direction and supervision of 22 another health care professional who is using telehealth within 23 that health care professional’s scope of practice shall not be 24 interpreted as practicing the supervising professional’s health 25 care profession without a license. However, any health care 26 professional employing telehealth must hold a current valid 27 license to practice the respective profession in the state and 28 be trained, educated, and knowledgeable regarding the health 29 care service provided and technology used and shall not perform 30 duties for which the professional does not have sufficient 31 training, education, and knowledge. Failure to have sufficient 32 training, education, and knowledge is grounds for disciplinary 33 action by the respective board. 34 2. The applicable board that exercises regulatory or 35 -3- LSB 1423HV (2) 86 pf/rj 3/ 10

H.F. 600 rulemaking authority over an affected profession under this 1 chapter, or the department in the absence of an applicable 2 board, shall adopt rules to administer this chapter. 3 3. The standard of care for a professional using telehealth 4 to provide health care services to a patient shall be the same 5 as the standard of care required of that professional for the 6 provision of in-person health care services to a patient. 7 4. The type of setting where telehealth is provided for the 8 patient or by the health care professional shall not be limited 9 if the delivery of health care services is appropriately 10 provided through telehealth. 11 5. This chapter shall not be construed to conflict with or 12 supersede provisions otherwise applicable to the licensure of 13 health care professionals. 14 6. This chapter shall not be construed to alter the scope 15 of practice of any health care professional, authorize the 16 delivery of health care services in a setting or manner not 17 otherwise authorized by law, or limit a patient’s right to 18 choose in-person contact with a health care professional for 19 the delivery of health care services for which telehealth is 20 available. 21 7. If a health care professional provides services pursuant 22 to and in compliance with section 135.24 via telehealth in 23 accordance with this chapter, the provisions of section 135.24 24 including those relating to immunity from civil liability shall 25 apply to such health care professional. 26 Sec. 5. NEW SECTION . 514C.30 Telehealth. 27 1. Notwithstanding the uniformity of treatment requirements 28 of section 514C.6, a contract, policy, or plan providing for 29 third-party payment or prepayment for health, medical, or 30 surgical coverage benefits may provide coverage for services 31 provided as telehealth if the services would be covered if 32 provided in-person. If coverage is provided for telehealth 33 under this section, coverage shall not require in-person 34 contact between a health care professional and a patient as a 35 -4- LSB 1423HV (2) 86 pf/rj 4/ 10

H.F. 600 prerequisite for payment for services appropriately provided 1 through telehealth in accordance with generally accepted health 2 care practices and standards prevailing in the applicable 3 professional community at the time the services are provided. 4 If coverage is provided under this section, health care 5 services provided through in-person consultations or through 6 telehealth shall be treated as equivalent services for the 7 purposes of coverage. 8 2. If health care coverage is provided for telehealth under 9 this section, all of the following shall apply: 10 a. 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 telehealth if the deductible, copayment, or 14 coinsurance does not exceed the deductible, copayment, or 15 coinsurance applicable to in-person consultation for the same 16 health care service. A third-party payment provider shall not 17 impose annual or lifetime maximums on coverage of telehealth 18 unless the annual or lifetime maximum applies in the aggregate 19 to all items and services under the contract, policy, or plan. 20 b. This section shall not be interpreted to require a 21 third-party payment provider to provide reimbursement for 22 a health care service that is not a covered benefit or to 23 reimburse a health care professional who is not a covered 24 provider under the contract, policy, or plan. 25 c. This section shall not be interpreted to preclude a 26 third-party payment provider from performing utilization review 27 to determine the appropriateness of telehealth in the delivery 28 of health care services if the determination is made in the 29 same manner as those regarding the same health care service 30 when delivered in person. 31 d. This section shall not be interpreted to authorize a 32 third-party payment provider to require the use of telehealth 33 when the health care professional determines use of telehealth 34 is not appropriate. 35 -5- LSB 1423HV (2) 86 pf/rj 5/ 10

H.F. 600 e. The provisions of this section shall apply to all of the 1 following classes of third-party payment provider contracts, 2 policies, or plans delivered, issued for delivery, continued, 3 or renewed in this state on or after January 1, 2016: 4 (1) Individual or group accident and sickness insurance 5 providing coverage on an expense-incurred basis. 6 (2) An individual or group hospital or medical service 7 contract issued pursuant to chapter 509, 514, or 514A. 8 (3) An individual or group health maintenance organization 9 contract regulated under chapter 514B. 10 (4) An individual or group Medicare supplemental policy, 11 unless coverage pursuant to such policy is preempted by federal 12 law. 13 (5) A plan established pursuant to chapter 509A for public 14 employees. 15 f. This section shall not apply to accident-only, specified 16 disease, short-term hospital or medical, hospital confinement 17 indemnity, credit, dental, vision, long-term care, basic 18 hospital, and medical-surgical expense coverage as defined 19 by the commissioner, disability income insurance coverage, 20 coverage issued as a supplement to liability insurance, 21 workers’ compensation or similar insurance, or automobile 22 medical payment insurance. 23 3. The commissioner of insurance shall adopt rules pursuant 24 to chapter 17A as necessary to administer this section. 25 4. For the purposes of this section, “health care 26 professional” and “telehealth” mean as defined in section 27 147B.2, as enacted in this Act. 28 Sec. 6. MEDICAID PROGRAM —— REIMBURSEMENT FOR 29 TELEHEALTH. The department of human services shall adopt 30 rules to provide for coverage of telehealth under the 31 Medicaid program. The rules shall provide that in-person 32 contact between a health care professional and a patient 33 is not required as a prerequisite for payment for services 34 appropriately provided through telehealth in accordance 35 -6- LSB 1423HV (2) 86 pf/rj 6/ 10

H.F. 600 with generally accepted health care practices and standards 1 prevailing in the applicable professional community at 2 the time the services are provided. Health care services 3 provided through in-person consultations or through telehealth 4 shall be treated as equivalent services for the purposes 5 of reimbursement. As used in this section, “health care 6 professional” and “telehealth” mean as defined in section 7 147B.2, as enacted in this Act. 8 Sec. 7. STUDY ON USE OF TELEHEALTH. The department of 9 public health, in collaboration with the department of human 10 services, shall convene and conduct a study regarding options 11 for implementing telehealth and telehealth coverage and 12 reimbursement. The division of insurance of the department of 13 commerce shall be available for consultation as needed. The 14 department of public health shall submit a final report of its 15 findings and recommendations to the governor and the general 16 assembly by December 15, 2015. 17 EXPLANATION 18 The inclusion of this explanation does not constitute agreement with 19 the explanation’s substance by the members of the general assembly. 20 This bill relates to telehealth and creates the Iowa 21 telehealth Act. The bill provides legislative findings 22 and purposes regarding the use of telehealth and provides 23 definitions. 24 The bill provides that a health care professional, as 25 appropriate to the scope of practice of the profession, may 26 employ the technology of telehealth by applying telehealth 27 within the professional’s scope of practice or by employing 28 telehealth technology under the direction and supervision 29 of another health care professional who is using telehealth 30 technology within the supervising professional’s scope 31 of practice. A health care professional’s employment of 32 telehealth technology under the direction and supervision of 33 another health care professional who is acting within that 34 health care professional’s scope of practice shall not be 35 -7- LSB 1423HV (2) 86 pf/rj 7/ 10

H.F. 600 interpreted as practicing the supervising professional’s health 1 care profession without a license. A health care professional 2 employing telehealth technology must hold a current valid 3 license and must be trained, educated, and knowledgeable 4 regarding the health care service provided and technology 5 used and is prohibited from performing duties for which the 6 professional does not have sufficient training, education, and 7 knowledge. Failure to have sufficient training, education, and 8 knowledge is grounds for disciplinary action by the respective 9 board. 10 The bill directs the appropriate board that exercises 11 regulatory or rulemaking authority over a profession within 12 whose scope of practice telehealth may be employed or the 13 department, to adopt rules, to administer the requirements 14 relating to the provision of telehealth by such professionals. 15 The bill provides that the standard of care for a 16 professional, whether using telehealth or providing the care 17 in person, is the same. The type of setting where telehealth 18 is provided for the patient or by the health care professional 19 is not to be limited if the delivery of health care services 20 is appropriately provided through telehealth. The bill is not 21 to be construed to conflict with or supersede the provisions 22 of the health care professionals licensure or to alter the 23 scope of practice of any health care professional, authorize 24 the delivery of health care services in a setting or manner 25 not otherwise authorized by law, or limit a patient’s right 26 to choose in-person contact with a health care professional 27 for the delivery of health care services for which telehealth 28 is available. The bill also provides that if a health care 29 professional provides services pursuant to and in compliance 30 with Code section 135.24 relating to the volunteer health 31 care provider program, via telehealth, the provisions of Code 32 section 135.24 including those relating to immunity from civil 33 liability shall apply to such health care professional. 34 The bill provides that a contract, policy, or plan providing 35 -8- LSB 1423HV (2) 86 pf/rj 8/ 10

H.F. 600 for third-party payment or prepayment for health, medical, or 1 surgical coverage benefits may cover telehealth. If telehealth 2 coverage is provided on or after January 1, 2016, the contract, 3 policy, or plan shall not deny coverage on the basis that the 4 services are provided via telehealth if the services would be 5 covered if provided in person and shall not require in-person 6 contact between a health care 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 The provision is not to be interpreted as preventing a 15 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. The bill provides that a third-party 21 payment provider shall not impose annual or lifetime maximums 22 on coverage of telehealth unless the annual or lifetime maximum 23 applies in the aggregate to all items and services under the 24 contract, policy, or plan. 25 The bill provides that the Code section is not to be 26 interpreted to require a third-party payment provider to 27 provide reimbursement for a health care service that is not 28 a covered benefit or to reimburse a health care professional 29 who is not a covered provider under the contract, policy, 30 or plan; to preclude a third-party payment provider from 31 performing utilization review to determine the appropriateness 32 of telehealth in the delivery of health care services if the 33 determination is made in the same manner as those regarding 34 the same health care service when delivered in person; or to 35 -9- LSB 1423HV (2) 86 pf/rj 9/ 10

H.F. 600 authorize a third-party payment provider to require the use of 1 telehealth when the health care professional determines use of 2 telehealth is not appropriate. 3 The bill specifies the types of third-party payment provider 4 contracts, policies, or plans to which the bill applies and 5 those exempt from its application. 6 The commissioner of insurance is directed to adopt rules 7 pursuant to Code chapter 17A as necessary to administer the 8 provision. 9 The bill directs the department of human services to 10 adopt rules to provide for coverage of telehealth under the 11 Medicaid program. The rules are to provide that in-person 12 contact between a health care professional and a patient 13 is not required as a prerequisite for payment for services 14 appropriately provided through telehealth in accordance 15 with generally accepted health care practices and standards 16 prevailing in the applicable professional community at the 17 time the services are provided. Health care services provided 18 through in-person consultations or through telehealth are 19 to be treated as equivalent services for the purposes of 20 reimbursement. 21 The bill directs the department of public health, in 22 collaboration with the department of human services, to 23 convene and conduct a study regarding options for implementing 24 telehealth and telehealth coverage and reimbursement. The 25 division of insurance is required to be available for 26 consultation as needed. The department of public health 27 is directed to submit a final report of its findings and 28 recommendations to the governor and the general assembly by 29 December 15, 2015. 30 -10- LSB 1423HV (2) 86 pf/rj 10/ 10