House Study Bill 502 - Introduced HOUSE FILE _____ BY (PROPOSED COMMITTEE ON HUMAN RESOURCES BILL BY CHAIRPERSON MILLER) A BILL FOR An Act requiring coverage of telehealth under a group health 1 insurance plan for employees of the state, and including 2 applicability provisions. 3 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 4 TLSB 5404YC (4) 86 pf/rj

H.F. _____ Section 1. NEW SECTION . 514C.31 Telehealth coverage. 1 1. For the purposes of this section: 2 a. “Distant site” means the site at which a health care 3 professional is located while providing telehealth. 4 b. “Health care professional” means a person who is 5 licensed, certified, otherwise authorized or permitted by the 6 law of this state to administer health care services in the 7 ordinary course of business, in the practice of a profession, 8 or in an approved education or training program, as long as the 9 person is operating within the person’s professional scope of 10 practice. 11 c. “Originating site” means the site at which a patient 12 is located at the time health care service is provided via 13 telehealth or where store-and-forward telehealth originates. 14 d. “Remote patient monitoring” means remotely monitoring and 15 managing a patient’s medical, functional, and environmental 16 needs via information and communication technologies. 17 e. “Store-and-forward interactions” means the use of 18 asynchronous communications by a health care professional 19 via information and communications technologies for the 20 purpose of diagnosis, consultation, treatment, or therapeutic 21 assistance in the care of a patient. “Store-and-forward 22 interactions” includes transferring of medical data from one 23 site to another through the use of a camera or similar device 24 that records or stores an image that is sent or forwarded via 25 telecommunications to another site for consultation. 26 f. “Telehealth” means the mode of delivery of health care 27 services by a health care professional within the scope of 28 practice of the health care professional via information 29 and communications technologies to support and facilitate 30 patient care including through clinical health care, provider 31 consultation, patient diagnosis, consultation and treatment, 32 education, care management and self-management, transfer of 33 medical data, and exchange of medical education information. 34 “Telehealth” includes real-time synchronous interactions between 35 -1- LSB 5404YC (4) 86 pf/rj 1/ 4

H.F. _____ a patient at an originating site and a health care professional 1 at a distant site, store-and-forward interactions, and remote 2 patient monitoring. “Telehealth” does not include the use of 3 facsimile, audio-only telephone, texting, or electronic mail. 4 2. Notwithstanding the uniformity of treatment requirements 5 of section 514C.6, a group plan established pursuant to chapter 6 509A for employees of the state providing for third-party 7 payment or prepayment of health, medical, and surgical coverage 8 benefits shall provide coverage benefits to covered individuals 9 for telehealth. 10 3. The commissioner shall adopt rules pursuant to chapter 11 17A to administer this section. The rules shall provide that 12 in-person contact between a health care professional and a 13 patient is not required as a prerequisite for payment for 14 health care services appropriately provided through telehealth 15 in accordance with generally accepted health care practices 16 and standards prevailing in the applicable professional 17 community at the time the health care services are provided. 18 Additionally, the rules shall provide that health care services 19 provided through in-person consultations or through telehealth 20 shall be treated as equivalent services for the purposes of 21 reimbursement. 22 4. Coverage required pursuant to this section shall be 23 subject to copayment, deductible, and coinsurance provisions, 24 and any other general exclusions or limitations of a group plan 25 to the same extent as other health care services covered by the 26 group plan. 27 5. This section shall not be construed to limit benefits 28 which are otherwise available to an individual under a group 29 plan. 30 6. This section shall not apply to accident-only, 31 specified disease, short-term hospital or medical, hospital 32 confinement indemnity, credit, dental, vision, Medicare 33 supplement, long-term care, basic hospital and medical-surgical 34 expense coverage as defined by the commissioner, disability 35 -2- LSB 5404YC (4) 86 pf/rj 2/ 4

H.F. _____ income insurance coverage, coverage issued as a supplement 1 to liability insurance, workers’ compensation or similar 2 insurance, or automobile medical payment insurance, or 3 individual accident and sickness policies issued to individuals 4 or to individual members of a member association. 5 7. This section applies to plans established pursuant to 6 chapter 509A for employees of the state that are delivered, 7 issued for delivery, continued, or renewed in this state on or 8 after January 1, 2017. 9 EXPLANATION 10 The inclusion of this explanation does not constitute agreement with 11 the explanation’s substance by the members of the general assembly. 12 This bill requires that a group plan established for 13 employees of the state providing for third-party payment or 14 prepayment of health, medical, and surgical coverage benefits 15 shall provide coverage benefits to covered individuals for 16 telehealth. The bill directs the commissioner of insurance to 17 adopt rules to administer the bill. The rules are to provide 18 that in-person contact between a health care professional and 19 a patient is not required as a prerequisite for payment for 20 health care services appropriately provided through telehealth 21 in accordance with generally accepted health care practices and 22 standards prevailing in the applicable professional community 23 at the time the health care services are provided, and that 24 health care services provided through in-person consultations 25 or through telehealth shall be treated as equivalent services 26 for the purposes of reimbursement. 27 The coverage provided is subject to copayment, deductible, 28 and coinsurance provisions, and any other general exclusions or 29 limitations of a group plan to the same extent as other health 30 care services covered by the group plan. The bill is not to be 31 construed to limit benefits which are otherwise available to 32 an individual under a group plan. The bill applies to plans 33 established pursuant to Code chapter 509A for employees of the 34 state that are delivered, issued for delivery, continued, or 35 -3- LSB 5404YC (4) 86 pf/rj 3/ 4

H.F. _____ renewed in this state on or after January 1, 2017. 1 The bill defines “distant site”, “health care professional”, 2 “originating site”, “remote patient monitoring”, 3 “store-and-forward interactions”, and “telehealth”. 4 -4- LSB 5404YC (4) 86 pf/rj 4/ 4