SF 2100 (LSB 6047XS (1) 88)

SENATE FILE 2100

BY  MILLER-MEEKS

A BILL FOR

An Act relating to the provision of behavioral health services including via telemedicine in a school setting.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:

    Section 1.  NEW SECTION.  280A.1  Definitions.
   As used in this section, unless the context otherwise requires:
   1.  “Accredited nonpublic school” means any school, other than a public school, that is accredited pursuant to section 256.11 for any and all levels for grades one through twelve.
   2.  “Area education agency” means an area education agency established pursuant to chapter 273.
   3.  “Behavioral health screening” or “screening” means a screening and assessment performed using a universal behavioral health screening and assessment tool, approved for use by the department of education in consultation with the department of public health and the department of human services, to identify factors that place children at higher risk for behavioral health conditions, to determine appropriate treatment or intervention, and to identify the need for referral for appropriate services.
   4.  “Behavioral health services” means services provided by a health care professional operating within the scope of the health care professional’s practice which address mental, emotional, medical, or behavioral conditions, illnesses, diseases, or problems.
   5.  “Health care professional” means a physician or other health care practitioner licensed, accredited, registered, or certified to perform specified health care services consistent with state law.
   6.  “In-person encounter” means that the mental health professional and the student are in the physical presence of each other and are in the same physical location during the provision of behavioral health services.
   7.  “Mental health professional” means the same as defined in section 228.1.
   8.  “Patient” means a student receiving a behavioral health screening or other behavioral health services in accordance with this chapter.
   9.  “Primary care provider” means the personal provider trained to provide the first contact and continuous and comprehensive care to a patient and includes but is not limited to any of the following licensed or certified health care professionals who provide primary care:
   a.  A physician who is a family or general practitioner or a pediatrician. 
   b.  An advanced registered nurse practitioner.
   c.  A physician assistant.
   d.  A chiropractor.
   10.  “Provider-patient relationship” means the relationship between the patient and the mental health professional that meets the requirements for commencement and establishment of a valid provider-patient relationship as specified in this chapter.
   11.  “Public school” means any school directly supported in whole or in part by taxation.
   12.  “School district” means a school district described in chapter 274.
   13.  “Student” means a person enrolled in and attending an accredited nonpublic school or a public school in grades one through twelve.
   14.  “Telemedicine” means the practice of medicine using electronic audio-visual communications and information technologies or other means, including interactive audio with asynchronous store-and-forward transmission, between a licensee in one location and a patient in another location with or without an intervening health care provider. “Telemedicine” includes asynchronous store-and-forward technologies, remote monitoring, and real-time interactive services, including teleradiology and telepathology. “Telemedicine” does not include the provision of medical services only through an audio-only telephone, email messages, facsimile transmissions, or U.S. mail or other parcel service, or any combination of these means.
    Sec. 2.  NEW SECTION.  280A.2  Behavioral health screenings and assessments in school settings.
   1.  a.  A school district, an accredited nonpublic school, or an area education agency may contract with a mental health professional or a nationally accredited behavioral health care organization to provide behavioral health screenings to students in person or via telemedicine. 
   b.  (1)  A behavioral health screening may be conducted following provision of written consent by the student’s parent or guardian for the student to participate in such screening and to allow for the release of the results of the screening to the student’s primary care provider.
   (2)  The consent shall also allow for the disclosure of the results of such screenings to the school district, accredited nonpublic school, or area education agency, if the mental health professional believes there is a credible threat to the health and safety of the student or others. 
   2.  If a mental health professional conducts an initial behavioral health screening on the premises of a public school, an accredited nonpublic school, or an area education agency and determines that a student should be referred for additional behavioral health services, all of the following shall apply:
   a.  The mental health professional shall notify the parent or guardian of the student of the results of the screening.
   b.  The mental health professional shall notify the student’s primary care provider. If the student does not have a primary care provider, the mental health professional shall provide a listing of local primary care providers to the parent or guardian.
    Sec. 3.  NEW SECTION.  280A.3  Establishment of provider-patient relationship for services provided via telemedicine in a school setting. 
   1.  A mental health professional who provides services via telemedicine in a public school, an accredited nonpublic school, or an area education agency shall establish a valid provider-patient relationship with the student who receives telemedicine services.
   2.  The provider-patient relationship commences when all of the following conditions are met:
   a.  The student with the health-related matter seeks assistance from a mental health professional.
   b.  The mental health professional agrees to undertake diagnosis and treatment of the student.
   c.  The student agrees to be treated by the mental health professional whether or not there has been an in-person encounter between the mental health professional and the student.
   3.  A valid provider-patient relationship may be established through any of the following means:
   a.  Through an in-person encounter which includes an in-person medical interview and physical examination conducted under the standard of care required for an in-person encounter.
   b.  Through consultation with a primary care provider who has an established relationship with the patient and who agrees to participate in or supervise the patient’s care.
   4.  The parent or guardian of a student shall be given the opportunity to consent prior to the student receiving behavioral health services via telemedicine under this chapter after a provider-patient relationship is established pursuant to this section. The school district shall maintain any such consent form completed by a parent or guardian.
    Sec. 4.  NEW SECTION.  280A.4  Behavioral health services provided via telemedicine in a school setting.
   1.  A public school, accredited nonpublic school, or an area education agency may provide access to behavioral health services via telemedicine on the premises of the public school, accredited nonpublic school, or area education agency. If a public school, an accredited nonpublic school, or an area education agency provides such access, the school or area education agency shall do all of the following:
   a.  Provide a secure, confidential, and private room for such services and the technology necessary to conduct telemedicine services.
   b.  Maintain parent or guardian consent forms for the provision of such services. Consent forms shall be required for each academic year in which the student receives such services.
   c.  Maintain scheduling requests for student appointments for such services and provide the student access to the room by a school nurse or other appropriately trained school or area education agency employee.
   d.  Ensure that no school or area education agency employee is present in the same room as the student during the provision of such services.
   e.  Provide information to the student participating in telemedicine services about how and to whom to report inappropriate behavior by a mental health professional.
   f.  Provide access to the student’s parent or guardian to participate in any of the student’s telemedicine sessions.
   2.  The public school, accredited nonpublic school, or area education agency shall not have access to or handle any of the student’s medical records or be responsible for billing for the telemedicine services provided.
   3.  A mental health professional with prescribing authority who provides telemedicine services in accordance with this section shall not prescribe any new medication to a student during a telemedicine session. However, a mental health professional with prescribing authority may initiate new prescriptions, alter the dosage of an existing medication, or discontinue an existing medication for the treatment of the student’s behavioral health condition after consultation with the student’s parent or guardian.
   4.  a.  Prior to the initiation of behavioral health services via telemedicine in accordance with this section, the student’s primary care provider and the mental health professional providing the telemedicine services shall consult to develop a plan for the purpose of coordinating the student’s medical care. 
   b.  The plan shall ensure regular contact between the student’s primary care provider and the student’s mental health professional, and the sharing of such records as may be necessary to jointly manage the student’s medical care. 
   c.  If the student receiving telemedicine services does not have a primary care provider, the mental health professional shall provide a listing of local primary care providers to the student’s parent or guardian. 
   5.  The mental health professional shall notify the student’s parent or guardian of the time and place for each scheduled telemedicine session and specify the means available for the parent or guardian to participate in the session.
   6.  Protected health information, including but not limited to medical records and medical billing information, created by the mental health professional or primary care provider shall not be shared with or disclosed to a public school, accredited nonpublic school, or area education agency, unless disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of the student or to a clearly identifiable person or persons and the mental health professional determines the student has the apparent intent and ability to carry out the threat.
   7.  A school district, an accredited nonpublic school, an area education agency, the board of directors of a school district or an area education agency, authorities in charge of the accredited nonpublic school, and employees of the school district, accredited nonpublic school or area education agency, shall not be liable for any injury arising from the provision of voluntary behavioral health screenings or behavioral health services in accordance with this chapter, provided such person has acted reasonably and in good faith.
    Sec. 5.  NEW SECTION.  514C.35  Behavioral health services provided via telemedicine in a school setting —— coverage.
   1.  As used in this section, unless the context otherwise requires:
   a.  “Accredited nonpublic school” means any school, other than a public school, that is accredited pursuant to section 256.11 for any and all levels for grades one through twelve.
   b.  “Area education agency” means an area education agency established pursuant to chapter 273.
   c.  “Behavioral health services” means services provided by a health care professional operating within the scope of the health care professional’s practice which address mental, emotional, medical, or behavioral conditions, illnesses, diseases, or problems.
   d.  “Health care professional” means a physician or other health care practitioner licensed, accredited, registered, or certified to perform specified health care services consistent with state law.
   e.  “In-person encounter” means that the mental health professional and the student are in the physical presence of each other and are in the same physical location during the provision of behavioral health services. 
   f.  “Mental health professional” means the same as defined in section 228.1.
   g.  “Patient” means a student receiving a behavioral health screening or other behavioral health services in accordance with this chapter.
   h.  “Primary care provider” means the personal provider trained to provide the first contact and continuous and comprehensive care to a patient and includes but is not limited to any of the following licensed or certified health care professionals who provide primary care:
   (1)  A physician who is a family or general practitioner or a pediatrician. 
   (2)  An advanced registered nurse practitioner.
   (3)  A physician assistant.
   (4)  A chiropractor.
   i.  “Provider-patient relationship” means the relationship between the patient and the mental health professional that meets the requirements for commencement and establishment of a valid provider-patient relationship as specified in this chapter.
   j.  “Public school” means any school directly supported in whole or in part by taxation.
   k.  “School” means a public or accredited nonpublic school, or an area education agency that provides premises for teaching any grade from kindergarten through grade twelve.
   l.  “School district” means a school district described in chapter 274.
   m.  “Student” means a person enrolled in and attending an accredited nonpublic school or a public school in grades one through twelve.
   n.  “Telemedicine” means the practice of medicine using electronic audio-visual communications and information technologies or other means, including interactive audio with asynchronous store-and-forward transmission, between a licensee in one location and a patient in another location with or without an intervening health care provider. “Telemedicine” includes asynchronous store-and-forward technologies, remote monitoring, and real-time interactive services, including teleradiology and telepathology. “Telemedicine” does not include the provision of medical services only through an audio-only telephone, email messages, facsimile transmissions, or U.S. mail or other parcel service, or any combination of these means.
   2.  a.  Notwithstanding the uniformity of treatment requirements of section 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall provide coverage and treat as equivalent services, behavioral health services provided by a mental health professional to a student through an in-person encounter or via telemedicine pursuant to chapter 280A.
   b.  Coverage shall be provided if all of the following conditions are met:
   (1)  If behavioral health services are provided by a mental health professional via telemedicine to a student on the premises of a public school, an accredited nonpublic school, or an area education agency, the behavioral health services are provided in accordance with chapter 280A.
   (2)  The mental health services provided are provided in accordance with evidence-based standards of practice and relate only to behavioral health. 
   (3)  The mental health professional has an existing provider-patient relationship with the student as specified in chapter 280A. 
   (4)  The student’s parent or guardian has consented to the treatment and to release of the student’s medical records associated with the telemedicine services to the student’s primary care provider. 
   (5)  The mental health services provided are required in accordance with the student’s individual education plan.
   3.  This section applies to the following classes of third-party payment provider policies, contracts, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2021:
   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.  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, Medicare supplement, 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, in collaboration with the state board of education, may adopt rules pursuant to chapter 17A as necessary to administer this section.
    Sec. 6.  MEDICAID —— TELEMEDICINE SERVICES PROVIDED IN SCHOOL SETTINGS —— REIMBURSEMENT.
   1.  For the purposes of this section:
   a.  “Accredited nonpublic school” means any school, other than a public school, that is accredited pursuant to section 256.11 for any and all levels for grades one through twelve.
   b.  “Area education agency” means an area education agency established pursuant to chapter 273.
   c.  “Behavioral health services” means services provided by a health care professional operating within the scope of the health care professional’s practice which address mental, emotional, medical, or behavioral conditions, illnesses, diseases, or problems.
   d.  “Health care professional” means a physician or other health care practitioner licensed, accredited, registered, or certified to perform specified health care services consistent with state law.
   e.  “In-person encounter” means that the mental health professional and the student are in the physical presence of each other and are in the same physical location during the provision of behavioral health services.
   f.  “Mental health professional” means the same as defined in section 228.1.
   g.  “Patient” means a student receiving a behavioral health screening or other behavioral health services in accordance with this chapter.
   h.  “Primary care provider” means the personal provider trained to provide the first contact and continuous and comprehensive care to a patient and includes but is not limited to any of the following licensed or certified health care professionals who provide primary care:
   (1)  A physician who is a family or general practitioner or a pediatrician. 
   (2)  An advanced registered nurse practitioner.
   (3)  A physician assistant.
   (4)  A chiropractor.
   i.  “Provider-patient relationship” means the relationship between the patient and the mental health professional that meets the requirements for commencement and establishment of a valid provider-patient relationship as specified in this chapter.
   j.  “Public school” means any school directly supported in whole or in part by taxation.
   k.  “School” means a public or accredited nonpublic school, or an area education agency that provides premises for teaching any grade from kindergarten through grade twelve.
   l.  “School district” means a school district described in chapter 274.
   m.  “Student” means a person enrolled in and attending an accredited nonpublic school or a public school in grades one through twelve. 
   n.  “Telemedicine” means the practice of medicine using electronic audio-visual communications and information technologies or other means, including interactive audio with asynchronous store-and-forward transmission, between a licensee in one location and a patient in another location with or without an intervening health care provider. “Telemedicine” includes asynchronous store-and-forward technologies, remote monitoring, and real-time interactive services, including teleradiology and telepathology. “Telemedicine” does not include the provision of medical services only through an audio-only telephone, email messages, facsimile transmissions, or U.S. mail or other parcel service, or any combination of these means.
   2.  a.  The department of human services shall require, contractually and in accordance with rules adopted pursuant to chapter 17A, that under both fee-for-service and managed care administered Medicaid, behavioral health services provided through an in-person encounter or via telemedicine pursuant to chapter 280A shall be treated as equivalent services for the purposes of reimbursement.
   b.  Coverage shall be provided if all of the following conditions are met:
   (1)  If the mental health services are provided by a mental health professional via telemedicine to a student on the premises of a public school, an accredited nonpublic school, or an area education agency, the behavioral health services are provided in accordance with chapter 280A.
   (2)  The mental health services are provided in accordance with evidence-based standards of practice and relate only to behavioral health. 
   (3)  The mental health professional has an existing provider-patient relationship with the student as specified in chapter 280A.
   (4)  The student’s parent or guardian has consented to the treatment and to release of the student’s medical records associated with the telemedicine services to the student’s primary care provider.
   (5)  The mental health services provided are required in accordance with the student’s individual education plan.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
the explanation’s substance by the members of the general assembly.
   This bill provides for the provision of behavioral health screenings and services through a school setting both in person and via telemedicine. 
   The bill authorizes a school district, an accredited nonpublic school, or an area education agency to contract with a mental health professional or a nationally accredited behavioral health care organization to provide behavioral health screenings to students in person or via telemedicine, upon written consent by the student’s parent or guardian and to allow for the release of the results of the screening to the student’s primary care provider. 
   The bill specifies the requirements for the establishment of a provider-patient relationship for purposes of mental health professionals providing behavioral health services via telemedicine in a public school, an accredited nonpublic school, or an area education agency setting.
   The bill authorizes a public school, accredited nonpublic school, and area education agency to provide access to behavioral health services via telemedicine on the premises of the public school, accredited nonpublic school, or area education agency, specifies the parameters for the provision of such services, and provides immunity for entities that provide such services acting reasonably and in good faith.
   The bill requires that both private health insurance coverage and the Medicaid program are to provide coverage and treat as equivalent services, behavioral health services provided by a mental health professional to a student through an in-person encounter or via telemedicine pursuant to the bill.