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- SF 2261 (4) 88 pf/rh/mb 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- SF 2261 (4) 88 pf/rh/mb 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- SF 2261 (4) 88 pf/rh/mb 3/ 8

S.F. 2261 through any of the following means: 1 a. Through an in-person encounter which includes an 2 in-person medical interview and physical examination conducted 3 under the standard of care required for an in-person encounter. 4 b. Through consultation with a primary care provider who has 5 an established relationship with the patient and who agrees to 6 participate in or supervise the patient’s care. 7 c. Through telehealth, if the standard of care does 8 not require an in-person encounter, in accordance with 9 evidence-based standards of practice and telehealth practice 10 guidelines that address the clinical and technological aspects 11 of telehealth, and the student’s parent or guardian is present. 12 4. The parent or guardian of a student shall consent 13 prior to the student receiving behavioral health services 14 via telehealth under this chapter after a provider-patient 15 relationship is established pursuant to this section. The 16 school district shall maintain any such consent form completed 17 by a parent or guardian. 18 Sec. 4. NEW SECTION . 280A.4 Behavioral health services 19 provided via telehealth in a school setting. 20 1. A public school, accredited nonpublic school, or an 21 area education agency may provide access to behavioral health 22 services via telehealth on the premises of the public school, 23 accredited nonpublic school, or area education agency. If 24 a public school, an accredited nonpublic school, or an area 25 education agency provides such access, the school or area 26 education agency shall do all of the following: 27 a. Provide a secure, confidential, and private room for such 28 services and the technology necessary to conduct telehealth 29 services. 30 b. Maintain parent or guardian consent forms for the 31 provision of such services. Consent forms shall be required 32 for each academic year in which the student receives such 33 services. 34 c. Maintain scheduling requests for student appointments 35 -4- SF 2261 (4) 88 pf/rh/mb 4/ 8

S.F. 2261 for such services and provide the student access to the room by 1 a school nurse or other appropriately trained school or area 2 education agency employee. 3 d. Ensure that no school or area education agency employee 4 is present in the same room as the student during the provision 5 of such services. 6 e. Provide information to the student participating 7 in telehealth services about how and to whom to report 8 inappropriate behavior by a mental health professional. 9 f. Provide access to the student’s parent or guardian to 10 participate in any of the student’s telehealth sessions. 11 2. The public school, accredited nonpublic school, or area 12 education agency shall not have access to or handle any of the 13 student’s medical records or be responsible for billing for the 14 telehealth services provided. 15 3. A mental health professional with prescribing authority 16 who provides telehealth services in accordance with this 17 section shall not prescribe any new medication to a student 18 during a telehealth session. However, a mental health 19 professional with prescribing authority may initiate new 20 prescriptions, alter the dosage of an existing medication, or 21 discontinue an existing medication for the treatment of the 22 student’s behavioral health condition after consultation with 23 the student’s parent or guardian. 24 4. a. Prior to the initiation of behavioral health services 25 via telehealth in accordance with this section, the student’s 26 primary care provider and the mental health professional 27 providing the telehealth services shall consult to develop a 28 plan for the purpose of coordinating the student’s medical 29 care. 30 b. The plan shall ensure regular contact between the 31 student’s primary care provider and the student’s mental 32 health professional, and the sharing of such records as may be 33 necessary to jointly manage the student’s medical care. 34 c. If the student receiving telehealth services does not 35 -5- SF 2261 (4) 88 pf/rh/mb 5/ 8

S.F. 2261 have a primary care provider, the mental health professional 1 shall provide a listing of local primary care providers to the 2 student’s parent or guardian. 3 5. The mental health professional shall notify the 4 student’s parent or guardian of the time and place for each 5 scheduled telehealth session and specify the means available 6 for the parent or guardian to participate in the session. 7 6. Protected health information, including but not limited 8 to medical records and medical billing information, created 9 by the mental health professional or primary care provider 10 shall not be shared with or disclosed to a public school, 11 accredited nonpublic school, or area education agency, unless 12 disclosure is necessary to prevent or lessen a serious and 13 imminent threat to the health or safety of the student or to a 14 clearly identifiable person or persons and the mental health 15 professional determines the student has the apparent intent and 16 ability to carry out the threat. 17 7. A school district, an accredited nonpublic school, 18 an area education agency, the board of directors of a school 19 district or an area education agency, authorities in charge of 20 the accredited nonpublic school, and employees of the school 21 district, accredited nonpublic school or area education agency, 22 shall not be liable for any injury arising from the provision 23 of voluntary behavioral health screenings or behavioral health 24 services in accordance with this chapter, provided such person 25 has acted reasonably and in good faith. 26 Sec. 5. NEW SECTION . 514C.35 Behavioral health services 27 provided in a school —— coverage. 28 1. Notwithstanding the uniformity of treatment requirements 29 of section 514C.6, a policy, contract, or plan providing for 30 third-party payment or prepayment of health or medical expenses 31 shall not deny coverage or payment for behavioral health 32 services, including behavioral health services provided via 33 telehealth, solely because the services are delivered in a 34 school. 35 -6- SF 2261 (4) 88 pf/rh/mb 6/ 8

S.F. 2261 2. Nothing in this section shall be interpreted to do any 1 of the following: 2 a. Require an insurer to pay for behavioral health services 3 that are otherwise excluded from coverage under a policy, 4 contract, or plan. 5 b. Require an insurer to pay for behavioral health services 6 that are provided by an individual employed by or under 7 contract with a school district or an educational service 8 agency in a regular full-time or part-time position, or any 9 other party that has not entered into a provider agreement with 10 the insurer. 11 c. Prevent application of any other provision of a policy, 12 contract, or plan. 13 3. This section applies to third-party payment provider 14 policies, contracts, or plans delivered, issued for delivery, 15 continued, or renewed in this state on or after January 1, 16 2021, and to claims for reimbursement under such policies, 17 contracts, or plans incurred on or after January 1, 2021. 18 4. For the purposes of this section: 19 a. “Behavioral health services” means services provided 20 by a health care professional operating within the scope of 21 the health care professional’s practice which address mental, 22 emotional, medical, or behavioral conditions, illnesses, 23 diseases, or problems. 24 b. “Educational service agency” means a governmental 25 agency or government entity which is established and operated 26 exclusively for the purpose of providing educational services 27 to one or more educational institutions. 28 c. “Health care professional” means a physician or other 29 health care practitioner licensed, accredited, registered, or 30 certified to perform specified health care services consistent 31 with state law. 32 d. “School” means all of the following: 33 (1) A any school, other than a public school, that is 34 accredited pursuant to section 256.11 for any and all levels 35 -7- SF 2261 (4) 88 pf/rh/mb 7/ 8