S.F. 2261 Section 1. NEW SECTION . 280A.1 Definitions. 1 As used in this section, unless the context otherwise 2 requires: 3 1. “Accredited nonpublic school” means any school, other 4 than a public school, that is accredited pursuant to section 5 256.11 for any and all levels for grades one through twelve. 6 2. “Area education agency” means an area education agency 7 established pursuant to chapter 273. 8 3. “Behavioral health screening” or “screening” means a 9 screening and assessment performed using a universal behavioral 10 health screening and assessment tool, approved for use by the 11 department of education in consultation with the department of 12 public health and the department of human services, to identify 13 factors that place children at higher risk for behavioral 14 health conditions, to determine appropriate treatment or 15 intervention, and to identify the need for referral for 16 appropriate services. 17 4. “Behavioral health services” means services provided 18 by a health care professional operating within the scope of 19 the health care professional’s practice which address mental, 20 emotional, medical, or behavioral conditions, illnesses, 21 diseases, or problems. 22 5. “Health care professional” means a physician or other 23 health care practitioner licensed, accredited, registered, or 24 certified to perform specified health care services consistent 25 with state law. 26 6. “In-person encounter” means that the mental health 27 professional and the student are in the physical presence of 28 each other and are in the same physical location during the 29 provision of behavioral health services. 30 7. “Mental health professional” means the same as defined 31 in section 228.1. 32 8. “Patient” means a student receiving a behavioral health 33 screening or other behavioral health services in accordance 34 with this chapter. 35 -1- LSB 6047SV (3) 88 pf/rh 1/ 8

S.F. 2261 9. “Primary care provider” means the personal provider 1 trained to provide the first contact and continuous and 2 comprehensive care to a patient and includes but is not limited 3 to any of the following licensed or certified health care 4 professionals who provide primary care: 5 a. A physician who is a family or general practitioner or a 6 pediatrician. 7 b. An advanced registered nurse practitioner. 8 c. A physician assistant. 9 10. “Provider-patient relationship” means the relationship 10 between the patient and the mental health professional that 11 meets the requirements for commencement and establishment of 12 a valid provider-patient relationship as specified in this 13 chapter. 14 11. “Public school” means any school directly supported in 15 whole or in part by taxation. 16 12. “School district” means a school district described in 17 chapter 274. 18 13. “Student” means a person enrolled in and attending an 19 accredited nonpublic school or a public school in grades one 20 through twelve. 21 14. “Telehealth” means the same as defined in section 22 514C.34. 23 Sec. 2. NEW SECTION . 280A.2 Behavioral health screenings 24 and assessments in school settings. 25 1. a. A school district, an accredited nonpublic school, 26 or an area education agency may contract with a mental health 27 professional or a nationally accredited behavioral health 28 care organization to provide behavioral health screenings to 29 students in person. 30 b. (1) A behavioral health screening may be conducted 31 following provision of written consent by the student’s parent 32 or guardian for the student to participate in such screening 33 and to allow for the release of the results of the screening to 34 the student’s primary care provider. 35 -2- LSB 6047SV (3) 88 pf/rh 2/ 8

S.F. 2261 (2) The consent shall also allow for the disclosure of the 1 results of such screenings to the school district, accredited 2 nonpublic school, or area education agency, if the mental 3 health professional believes there is a credible threat to the 4 health and safety of the student or others. 5 2. If a mental health professional conducts an initial 6 behavioral health screening on the premises of a public school, 7 an accredited nonpublic school, or an area education agency and 8 determines that a student should be referred for additional 9 behavioral health services, all of the following shall apply: 10 a. The mental health professional shall notify the parent or 11 guardian of the student of the results of the screening. 12 b. The mental health professional shall notify the student’s 13 primary care provider. If the student does not have a primary 14 care provider, the mental health professional shall provide 15 a listing of local primary care providers to the parent or 16 guardian. 17 Sec. 3. NEW SECTION . 280A.3 Establishment of 18 provider-patient relationship for services provided via 19 telehealth in a school setting. 20 1. A mental health professional who provides services 21 via telehealth in a public school, an accredited nonpublic 22 school, or an area education agency shall establish a valid 23 provider-patient relationship with the student who receives 24 telehealth services. 25 2. The provider-patient relationship commences when all of 26 the following conditions are met: 27 a. The student with the health-related matter with the 28 consent of the student’s parent or guardian seeks assistance 29 from a mental health professional. 30 b. The mental health professional agrees to undertake 31 diagnosis and treatment of the student. 32 c. The student’s parent or guardian agrees to have the 33 student treated by the mental health professional. 34 3. A valid provider-patient relationship may be established 35 -3- LSB 6047SV (3) 88 pf/rh 3/ 8

S.F. 2261 through an in-person encounter which includes an in-person 1 medical interview and physical examination conducted under the 2 standard of care required for an in-person encounter. 3 4. The parent or guardian of a student shall consent 4 prior to the student receiving behavioral health services 5 via telehealth under this chapter after a provider-patient 6 relationship is established pursuant to this section. The 7 school district shall maintain any such consent form completed 8 by a parent or guardian. 9 Sec. 4. NEW SECTION . 280A.4 Behavioral health services 10 provided via telehealth in a school setting. 11 1. A public school, accredited nonpublic school, or an 12 area education agency may provide access to behavioral health 13 services via telehealth on the premises of the public school, 14 accredited nonpublic school, or area education agency. If 15 a public school, an accredited nonpublic school, or an area 16 education agency provides such access, the school or area 17 education agency shall do all of the following: 18 a. Provide a secure, confidential, and private room for such 19 services and the technology necessary to conduct telehealth 20 services. 21 b. Maintain parent or guardian consent forms for the 22 provision of such services. Consent forms shall be required 23 for each academic year in which the student receives such 24 services. 25 c. Maintain scheduling requests for student appointments 26 for such services and provide the student access to the room by 27 a school nurse or other appropriately trained school or area 28 education agency employee. 29 d. Ensure that no school or area education agency employee 30 is present in the same room as the student during the provision 31 of such services. 32 e. Provide information to the student participating 33 in telehealth services about how and to whom to report 34 inappropriate behavior by a mental health professional. 35 -4- LSB 6047SV (3) 88 pf/rh 4/ 8

S.F. 2261 f. Provide access to the student’s parent or guardian to 1 participate in any of the student’s telehealth sessions. 2 2. The public school, accredited nonpublic school, or area 3 education agency shall not have access to or handle any of the 4 student’s medical records or be responsible for billing for the 5 telehealth services provided. 6 3. A mental health professional with prescribing authority 7 who provides telehealth services in accordance with this 8 section shall not prescribe any new medication to a student 9 during a telehealth session. However, a mental health 10 professional with prescribing authority may initiate new 11 prescriptions, alter the dosage of an existing medication, or 12 discontinue an existing medication for the treatment of the 13 student’s behavioral health condition after consultation with 14 the student’s parent or guardian. 15 4. a. Prior to the initiation of behavioral health services 16 via telehealth in accordance with this section, the student’s 17 primary care provider and the mental health professional 18 providing the telehealth services shall consult to develop a 19 plan for the purpose of coordinating the student’s medical 20 care. 21 b. The plan shall ensure regular contact between the 22 student’s primary care provider and the student’s mental 23 health professional, and the sharing of such records as may be 24 necessary to jointly manage the student’s medical care. 25 c. If the student receiving telehealth services does not 26 have a primary care provider, the mental health professional 27 shall provide a listing of local primary care providers to the 28 student’s parent or guardian. 29 5. The mental health professional shall notify the 30 student’s parent or guardian of the time and place for each 31 scheduled telehealth session and specify the means available 32 for the parent or guardian to participate in the session. 33 6. Protected health information, including but not limited 34 to medical records and medical billing information, created 35 -5- LSB 6047SV (3) 88 pf/rh 5/ 8

S.F. 2261 by the mental health professional or primary care provider 1 shall not be shared with or disclosed to a public school, 2 accredited nonpublic school, or area education agency, unless 3 disclosure is necessary to prevent or lessen a serious and 4 imminent threat to the health or safety of the student or to a 5 clearly identifiable person or persons and the mental health 6 professional determines the student has the apparent intent and 7 ability to carry out the threat. 8 7. A school district, an accredited nonpublic school, 9 an area education agency, the board of directors of a school 10 district or an area education agency, authorities in charge of 11 the accredited nonpublic school, and employees of the school 12 district, accredited nonpublic school or area education agency, 13 shall not be liable for any injury arising from the provision 14 of voluntary behavioral health screenings or behavioral health 15 services in accordance with this chapter, provided such person 16 has acted reasonably and in good faith. 17 Sec. 5. NEW SECTION . 514C.35 Behavioral health services 18 provided in a school —— coverage. 19 1. Notwithstanding the uniformity of treatment requirements 20 of section 514C.6, a policy, contract, or plan providing for 21 third-party payment or prepayment of health or medical expenses 22 shall not deny coverage or payment for behavioral health 23 services, including behavioral health services provided via 24 telehealth, solely because the services are delivered in a 25 school. 26 2. Nothing in this section shall be interpreted to do any 27 of the following: 28 a. Require an insurer to pay for behavioral health services 29 that are otherwise excluded from coverage under a policy, 30 contract, or plan. 31 b. Require an insurer to pay for behavioral health services 32 that are provided by an individual employed by or under 33 contract with a school district or an educational service 34 agency in a regular full-time or part-time position, or any 35 -6- LSB 6047SV (3) 88 pf/rh 6/ 8

S.F. 2261 other party that has not entered into a provider agreement with 1 the insurer. 2 c. Prevent application of any other provision of a policy, 3 contract, or plan. 4 3. This section applies to third-party payment provider 5 policies, contracts, or plans delivered, issued for delivery, 6 continued, or renewed in this state on or after January 1, 7 2021, and to claims for reimbursement under such policies, 8 contracts, or plans incurred on or after January 1, 2021. 9 4. For the purposes of this section: 10 a. “Behavioral health services” means services provided 11 by a health care professional operating within the scope of 12 the health care professional’s practice which address mental, 13 emotional, medical, or behavioral conditions, illnesses, 14 diseases, or problems. 15 b. “Educational service agency” means a governmental 16 agency or government entity which is established and operated 17 exclusively for the purpose of providing educational services 18 to one or more educational institutions. 19 c. “Health care professional” means a physician or other 20 health care practitioner licensed, accredited, registered, or 21 certified to perform specified health care services consistent 22 with state law. 23 d. “School” means all of the following: 24 (1) A any school, other than a public school, that is 25 accredited pursuant to section 256.11 for any and all levels 26 for grades one through twelve. 27 (2) Any school directly supported in whole or in part by 28 taxation. 29 (3) An area education agency established pursuant to 30 chapter 273. 31 e. “School district” means a school district described in 32 chapter 274. 33 f. “Telehealth” means the same as defined in section 34 514C.34. 35 -7- LSB 6047SV (3) 88 pf/rh 7/ 8

S.F. 2261 EXPLANATION 1 The inclusion of this explanation does not constitute agreement with 2 the explanation’s substance by the members of the general assembly. 3 This bill provides for the provision of behavioral health 4 screenings and services through a school setting, including in 5 person and via telehealth. 6 The bill authorizes a school district, an accredited 7 nonpublic school, or an area education agency to contract 8 with a mental health professional or a nationally accredited 9 behavioral health care organization to provide behavioral 10 health screenings to students in person, upon written consent 11 by the student’s parent or guardian and to allow for the 12 release of the results of the screening to the student’s 13 primary care provider. 14 The bill specifies the requirements for the establishment 15 of a provider-patient relationship for purposes of mental 16 health professionals providing behavioral health services via 17 telehealth in a public school, an accredited nonpublic school, 18 or an area education agency setting. 19 The bill authorizes a public school, accredited nonpublic 20 school, and area education agency to provide access to 21 behavioral health services via telehealth on the premises 22 of the public school, accredited nonpublic school, or area 23 education agency, specifies the parameters for the provision of 24 such services, and provides immunity for entities that provide 25 such services acting reasonably and in good faith. 26 The bill prohibits the denial of private health insurance 27 coverage or payment for behavioral health services, including 28 the provision of such services via telehealth solely because 29 the services are delivered in a school. 30 -8- LSB 6047SV (3) 88 pf/rh 8/ 8