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Senate Study Bill 1240 - IntroducedA Bill ForAn Act 1relating to the provision of behavioral health services
2including via telemedicine in a school setting.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 280A.1 Definitions.
2As used in this section, unless the context otherwise
3requires:
41. “Accredited nonpublic school” means any school, other
5than a public school, that is accredited pursuant to section
6256.11 for any and all levels for grades one through twelve.
72. “Area education agency” means an area education agency
8established pursuant to chapter 273.
93. “Behavioral health screening” or “screening” means a
10screening and assessment performed using a universal behavioral
11health screening and assessment tool, approved for use by the
12department of education in consultation with the department of
13public health and the department of human services, to identify
14factors that place children at higher risk for behavioral
15health conditions, to determine appropriate treatment or
16intervention, and to identify the need for referral for
17appropriate services.
184. “Behavioral health services” means services provided
19by a health care professional operating within the scope of
20the health care professional’s practice which address mental,
21emotional, medical, or behavioral conditions, illnesses,
22diseases, or problems.
235. “Health care professional” means a physician or other
24health care practitioner licensed, accredited, registered, or
25certified to perform specified health care services consistent
26with state law.
276. “In-person encounter” means that the mental health
28professional and the student are in the physical presence of
29each other and are in the same physical location during the
30provision of behavioral health services.
317. “Mental health professional” means the same as defined
32in section 228.1.
338. “Patient” means a student receiving a behavioral health
34screening or other behavioral health services in accordance
35with this chapter.
-1- 19. “Primary care provider” means the personal provider
2trained to provide the first contact and continuous and
3comprehensive care to a patient and includes but is not limited
4to any of the following licensed or certified health care
5professionals who provide primary care:
6a. A physician who is a family or general practitioner or a
7pediatrician.
8b. An advanced registered nurse practitioner.
9c. A physician assistant.
10d. A chiropractor.
1110. “Provider-patient relationship” means the relationship
12between the patient and the mental health professional that
13meets the requirements for commencement and establishment of
14a valid provider-patient relationship as specified in this
15chapter.
1611. “Public school” means any school directly supported in
17whole or in part by taxation.
1812. “School district” means a school district described in
19chapter 274.
2013. “Student” means a person enrolled in and attending an
21accredited nonpublic school or a public school in grades one
22through twelve.
2314. “Telemedicine” means the practice of medicine using
24electronic audio-visual communications and information
25technologies or other means, including interactive audio with
26asynchronous store-and-forward transmission, between a licensee
27in one location and a patient in another location with or
28without an intervening health care provider. “Telemedicine”
29includes asynchronous store-and-forward technologies, remote
30monitoring, and real-time interactive services, including
31teleradiology and telepathology. “Telemedicine” does not
32include the provision of medical services only through an
33audio-only telephone, email messages, facsimile transmissions,
34or U.S. mail or other parcel service, or any combination of
35these means.
-2-1 Sec. 2. NEW SECTION. 280A.2 Behavioral health screenings
2and assessments in school settings.
31. a. A school district, an accredited nonpublic school,
4or an area education agency may contract with a mental health
5professional or a nationally accredited behavioral health
6care organization to provide behavioral health screenings to
7students in person or via telemedicine.
8b. (1) A behavioral health screening may be conducted
9following provision of written consent by the student’s parent
10or guardian for the student to participate in such screening
11and to allow for the release of the results of the screening to
12the student’s primary care provider.
13(2) The consent shall also allow for the disclosure of the
14results of such screenings to the school district, accredited
15nonpublic school, or area education agency, if the mental
16health professional believes there is a credible threat to the
17health and safety of the student or others.
182. If a mental health professional conducts an initial
19behavioral health screening on the premises of a public school,
20an accredited nonpublic school, or an area education agency and
21determines that a student should be referred for additional
22behavioral health services, all of the following shall apply:
23a. The mental health professional shall notify the parent or
24guardian of the student of the results of the screening.
25b. The mental health professional shall notify the student’s
26primary care provider. If the student does not have a primary
27care provider, the mental health professional shall provide
28a listing of local primary care providers to the parent or
29guardian.
30 Sec. 3. NEW SECTION. 280A.3 Establishment of
31provider-patient relationship for services provided via
32telemedicine in a school setting.
331. A mental health professional who provides services
34via telemedicine in a public school, an accredited nonpublic
35school, or an area education agency shall establish a valid
-3-1provider-patient relationship with the student who receives
2telemedicine services.
32. The provider-patient relationship commences when all of
4the following conditions are met:
5a. The student with the health-related matter seeks
6assistance from a mental health professional.
7b. The mental health professional agrees to undertake
8diagnosis and treatment of the student.
9c. The student agrees to be treated by the mental health
10professional whether or not there has been an in-person
11encounter between the mental health professional and the
12student.
133. A valid provider-patient relationship may be established
14through any of the following means:
15a. Through an in-person encounter which includes an
16in-person medical interview and physical examination conducted
17under the standard of care required for an in-person encounter.
18b. Through consultation with a primary care provider who has
19an established relationship with the patient and who agrees to
20participate in or supervise the patient’s care.
214. The parent or guardian of a student shall be given
22the opportunity to consent prior to the student receiving
23behavioral health services via telemedicine under this chapter
24after a provider-patient relationship is established pursuant
25to this section. The school district shall maintain any such
26consent form completed by a parent or guardian.
27 Sec. 4. NEW SECTION. 280A.4 Behavioral health services
28provided via telemedicine in a school setting.
291. A public school, accredited nonpublic school, or an
30area education agency may provide access to behavioral health
31services via telemedicine on the premises of the public school,
32accredited nonpublic school, or area education agency. If
33a public school, an accredited nonpublic school, or an area
34education agency provides such access, the school or area
35education agency shall do all of the following:
-4- 1a. Provide a secure, confidential, and private room for such
2services and the technology necessary to conduct telemedicine
3services.
4b. Maintain parent or guardian consent forms for the
5provision of such services. Consent forms shall be required
6for each academic year in which the student receives such
7services.
8c. Maintain scheduling requests for student appointments
9for such services and provide the student access to the room by
10a school nurse or other appropriately trained school or area
11education agency employee.
12d. Ensure that no school or area education agency employee
13is present in the same room as the student during the provision
14of such services.
15e. Provide information to the student participating
16in telemedicine services about how and to whom to report
17inappropriate behavior by a mental health professional.
18f. Provide access to the student’s parent or guardian to
19participate in any of the student’s telemedicine sessions.
202. The public school, accredited nonpublic school, or area
21education agency shall not have access to or handle any of the
22student’s medical records or be responsible for billing for the
23telemedicine services provided.
243. A mental health professional with prescribing authority
25who provides telemedicine services in accordance with this
26section shall not prescribe any new medication to a student
27during a telemedicine session. However, a mental health
28professional with prescribing authority may initiate new
29prescriptions, alter the dosage of an existing medication, or
30discontinue an existing medication for the treatment of the
31student’s behavioral health condition after consultation with
32the student’s parent or guardian.
334. a. Prior to the initiation of behavioral health services
34via telemedicine in accordance with this section, the student’s
35primary care provider and the mental health professional
-5-1providing the telemedicine services shall consult to develop
2a plan for the purpose of coordinating the student’s medical
3care.
4b. The plan shall ensure regular contact between the
5student’s primary care provider and the student’s mental
6health professional, and the sharing of such records as may be
7necessary to jointly manage the student’s medical care.
8c. If the student receiving telemedicine services does not
9have a primary care provider, the mental health professional
10shall provide a listing of local primary care providers to the
11student’s parent or guardian.
125. The mental health professional shall notify the
13student’s parent or guardian of the time and place for each
14scheduled telemedicine session and specify the means available
15for the parent or guardian to participate in the session.
166. Protected health information, including but not limited
17to medical records and medical billing information, created
18by the mental health professional or primary care provider
19shall not be shared with or disclosed to a public school,
20accredited nonpublic school, or area education agency, unless
21disclosure is necessary to prevent or lessen a serious and
22imminent threat to the health or safety of the student or to a
23clearly identifiable person or persons and the mental health
24professional determines the student has the apparent intent and
25ability to carry out the threat.
267. A school district, an accredited nonpublic school,
27an area education agency, the board of directors of a school
28district or an area education agency, authorities in charge of
29the accredited nonpublic school, and employees of the school
30district, accredited nonpublic school or area education agency,
31shall not be liable for any injury arising from the provision
32of voluntary behavioral health screenings or behavioral health
33services in accordance with this chapter, provided such person
34has acted reasonably and in good faith.
35 Sec. 5. NEW SECTION. 514C.35 Behavioral health services
-6-1provided via telemedicine in a school setting — coverage.
21. As used in this section, unless the context otherwise
3requires:
4a. “Accredited nonpublic school” means any school, other
5than a public school, that is accredited pursuant to section
6256.11 for any and all levels for grades one through twelve.
7b. “Area education agency” means an area education agency
8established pursuant to chapter 273.
9c. “Behavioral health services” means services provided
10by a health care professional operating within the scope of
11the health care professional’s practice which address mental,
12emotional, medical, or behavioral conditions, illnesses,
13diseases, or problems.
14d. “Health care professional” means a physician or other
15health care practitioner licensed, accredited, registered, or
16certified to perform specified health care services consistent
17with state law.
18e. “In-person encounter” means that the mental health
19professional and the student are in the physical presence of
20each other and are in the same physical location during the
21provision of behavioral health services.
22f. “Mental health professional” means the same as defined
23in section 228.1.
24g. “Patient” means a student receiving a behavioral health
25screening or other behavioral health services in accordance
26with this chapter.
27h. “Primary care provider” means the personal provider
28trained to provide the first contact and continuous and
29comprehensive care to a patient and includes but is not limited
30to any of the following licensed or certified health care
31professionals who provide primary care:
32(1) A physician who is a family or general practitioner or a
33pediatrician.
34(2) An advanced registered nurse practitioner.
35(3) A physician assistant.
-7- 1(4) A chiropractor.
2i. “Provider-patient relationship” means the relationship
3between the patient and the mental health professional that
4meets the requirements for commencement and establishment of
5a valid provider-patient relationship as specified in this
6chapter.
7j. “Public school” means any school directly supported in
8whole or in part by taxation.
9k. “School” means a public or accredited nonpublic school,
10or an area education agency that provides premises for teaching
11any grade from kindergarten through grade twelve.
12l. “School district” means a school district described in
13chapter 274.
14m. “Student” means a person enrolled in and attending an
15accredited nonpublic school or a public school in grades one
16through twelve.
17n. “Telemedicine” means the practice of medicine using
18electronic audio-visual communications and information
19technologies or other means, including interactive audio with
20asynchronous store-and-forward transmission, between a licensee
21in one location and a patient in another location with or
22without an intervening health care provider. “Telemedicine”
23includes asynchronous store-and-forward technologies, remote
24monitoring, and real-time interactive services, including
25teleradiology and telepathology. “Telemedicine” does not
26include the provision of medical services only through an
27audio-only telephone, email messages, facsimile transmissions,
28or U.S. mail or other parcel service, or any combination of
29these means.
302. a. Notwithstanding the uniformity of treatment
31requirements of section 514C.6, a policy, contract, or plan
32providing for third-party payment or prepayment of health or
33medical expenses shall provide coverage and treat as equivalent
34services, behavioral health services provided by a mental
35health professional to a student through an in-person encounter
-8-1or via telemedicine pursuant to chapter 280A.
2b. Coverage shall be provided if all of the following
3conditions are met:
4(1) If behavioral health services are provided by a mental
5health professional via telemedicine to a student on the
6premises of a public school, an accredited nonpublic school, or
7an area education agency, the behavioral health services are
8provided in accordance with chapter 280A.
9(2) The mental health services provided are provided in
10accordance with evidence-based standards of practice and relate
11only to behavioral health.
12(3) The mental health professional has an existing
13provider-patient relationship with the student as specified in
14chapter 280A.
15(4) The student’s parent or guardian has consented to the
16treatment and to release of the student’s medical records
17associated with the telemedicine services to the student’s
18primary care provider.
19(5) The mental health services provided are required in
20accordance with the student’s individual education plan.
213. This section applies to the following classes of
22third-party payment provider policies, contracts, or plans
23delivered, issued for delivery, continued, or renewed in this
24state on or after January 1, 2020:
25a. Individual or group accident and sickness insurance
26providing coverage on an expense-incurred basis.
27b. An individual or group hospital or medical service
28contract issued pursuant to chapter 509, 514, or 514A.
29c. An individual or group health maintenance organization
30contract regulated under chapter 514B.
31d. A plan established pursuant to chapter 509A for public
32employees.
334. This section shall not apply to accident-only,
34specified disease, short-term hospital or medical, hospital
35confinement indemnity, credit, dental, vision, Medicare
-9-1supplement, long-term care, basic hospital and medical-surgical
2expense coverage as defined by the commissioner, disability
3income insurance coverage, coverage issued as a supplement
4to liability insurance, workers’ compensation or similar
5insurance, or automobile medical payment insurance.
65. The commissioner of insurance, in collaboration with the
7state board of education, may adopt rules pursuant to chapter
817A as necessary to administer this section.
9 Sec. 6. MEDICAID — TELEMEDICINE SERVICES PROVIDED IN
10SCHOOL SETTINGS — REIMBURSEMENT.
111. For the purposes of this section:
12a. “Accredited nonpublic school” means any school, other
13than a public school, that is accredited pursuant to section
14256.11 for any and all levels for grades one through twelve.
15b. “Area education agency” means an area education agency
16established pursuant to chapter 273.
17c. “Behavioral health services” means services provided
18by a health care professional operating within the scope of
19the health care professional’s practice which address mental,
20emotional, medical, or behavioral conditions, illnesses,
21diseases, or problems.
22d. “Health care professional” means a physician or other
23health care practitioner licensed, accredited, registered, or
24certified to perform specified health care services consistent
25with state law.
26e. “In-person encounter” means that the mental health
27professional and the student are in the physical presence of
28each other and are in the same physical location during the
29provision of behavioral health services.
30f. “Mental health professional” means the same as defined
31in section 228.1.
32g. “Patient” means a student receiving a behavioral health
33screening or other behavioral health services in accordance
34with this chapter.
35h. “Primary care provider” means the personal provider
-10-1trained to provide the first contact and continuous and
2comprehensive care to a patient and includes but is not limited
3to any of the following licensed or certified health care
4professionals who provide primary care:
5(1) A physician who is a family or general practitioner or a
6pediatrician.
7(2) An advanced registered nurse practitioner.
8(3) A physician assistant.
9(4) A chiropractor.
10i. “Provider-patient relationship” means the relationship
11between the patient and the mental health professional that
12meets the requirements for commencement and establishment of
13a valid provider-patient relationship as specified in this
14chapter.
15j. “Public school” means any school directly supported in
16whole or in part by taxation.
17k. “School” means a public or accredited nonpublic school,
18or an area education agency that provides premises for teaching
19any grade from kindergarten through grade twelve.
20l. “School district” means a school district described in
21chapter 274.
22m. “Student” means a person enrolled in and attending an
23accredited nonpublic school or a public school in grades one
24through twelve.
25n. “Telemedicine” means the practice of medicine using
26electronic audio-visual communications and information
27technologies or other means, including interactive audio with
28asynchronous store-and-forward transmission, between a licensee
29in one location and a patient in another location with or
30without an intervening health care provider. “Telemedicine”
31includes asynchronous store-and-forward technologies, remote
32monitoring, and real-time interactive services, including
33teleradiology and telepathology. “Telemedicine” does not
34include the provision of medical services only through an
35audio-only telephone, email messages, facsimile transmissions,
-11-1or U.S. mail or other parcel service, or any combination of
2these means.
32. a. The department of human services shall require,
4contractually and in accordance with rules adopted pursuant
5to chapter 17A, that under both fee-for-service and managed
6care administered Medicaid, behavioral health services provided
7through an in-person encounter or via telemedicine pursuant to
8chapter 280A shall be treated as equivalent services for the
9purposes of reimbursement.
10b. Coverage shall be provided if all of the following
11conditions are met:
12(1) If the mental health services are provided by a mental
13health professional via telemedicine to a student on the
14premises of a public school, an accredited nonpublic school, or
15an area education agency, the behavioral health services are
16provided in accordance with chapter 280A.
17(2) The mental health services are provided in accordance
18with evidence-based standards of practice and relate only to
19behavioral health.
20(3) The mental health professional has an existing
21provider-patient relationship with the student as specified in
22chapter 280A.
23(4) The student’s parent or guardian has consented to the
24treatment and to release of the student’s medical records
25associated with the telemedicine services to the student’s
26primary care provider.
27(5) The mental health services provided are required in
28accordance with the student’s individual education plan.
29EXPLANATION
30The inclusion of this explanation does not constitute agreement with
31the explanation’s substance by the members of the general assembly.
32This bill provides for the provision of behavioral health
33screenings and services through a school setting both in person
34and via telemedicine.
35The bill authorizes a school district, an accredited
-12-1nonpublic school, or an area education agency to contract
2with a mental health professional or a nationally accredited
3behavioral health care organization to provide behavioral
4health screenings to students in person or via telemedicine,
5upon written consent by the student’s parent or guardian and
6to allow for the release of the results of the screening to the
7student’s primary care provider.
8The bill specifies the requirements for the establishment
9of a provider-patient relationship for purposes of mental
10health professionals providing behavioral health services
11via telemedicine in a public school, an accredited nonpublic
12school, or an area education agency setting.
13The bill authorizes a public school, accredited nonpublic
14school, and area education agency to provide access to
15behavioral health services via telemedicine on the premises
16of the public school, accredited nonpublic school, or area
17education agency, specifies the parameters for the provision of
18such services, and provides immunity for entities that provide
19such services acting reasonably and in good faith.
20The bill requires that both private health insurance
21coverage and the Medicaid program are to provide coverage
22and treat as equivalent services, behavioral health services
23provided by a mental health professional to a student through
24an in-person encounter or via telemedicine pursuant to the
25bill.
-13-pf/rh
2including via telemedicine in a school setting.
3BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1 Section 1. NEW SECTION. 280A.1 Definitions.
2As used in this section, unless the context otherwise
3requires:
41. “Accredited nonpublic school” means any school, other
5than a public school, that is accredited pursuant to section
6256.11 for any and all levels for grades one through twelve.
72. “Area education agency” means an area education agency
8established pursuant to chapter 273.
93. “Behavioral health screening” or “screening” means a
10screening and assessment performed using a universal behavioral
11health screening and assessment tool, approved for use by the
12department of education in consultation with the department of
13public health and the department of human services, to identify
14factors that place children at higher risk for behavioral
15health conditions, to determine appropriate treatment or
16intervention, and to identify the need for referral for
17appropriate services.
184. “Behavioral health services” means services provided
19by a health care professional operating within the scope of
20the health care professional’s practice which address mental,
21emotional, medical, or behavioral conditions, illnesses,
22diseases, or problems.
235. “Health care professional” means a physician or other
24health care practitioner licensed, accredited, registered, or
25certified to perform specified health care services consistent
26with state law.
276. “In-person encounter” means that the mental health
28professional and the student are in the physical presence of
29each other and are in the same physical location during the
30provision of behavioral health services.
317. “Mental health professional” means the same as defined
32in section 228.1.
338. “Patient” means a student receiving a behavioral health
34screening or other behavioral health services in accordance
35with this chapter.
-1- 19. “Primary care provider” means the personal provider
2trained to provide the first contact and continuous and
3comprehensive care to a patient and includes but is not limited
4to any of the following licensed or certified health care
5professionals who provide primary care:
6a. A physician who is a family or general practitioner or a
7pediatrician.
8b. An advanced registered nurse practitioner.
9c. A physician assistant.
10d. A chiropractor.
1110. “Provider-patient relationship” means the relationship
12between the patient and the mental health professional that
13meets the requirements for commencement and establishment of
14a valid provider-patient relationship as specified in this
15chapter.
1611. “Public school” means any school directly supported in
17whole or in part by taxation.
1812. “School district” means a school district described in
19chapter 274.
2013. “Student” means a person enrolled in and attending an
21accredited nonpublic school or a public school in grades one
22through twelve.
2314. “Telemedicine” means the practice of medicine using
24electronic audio-visual communications and information
25technologies or other means, including interactive audio with
26asynchronous store-and-forward transmission, between a licensee
27in one location and a patient in another location with or
28without an intervening health care provider. “Telemedicine”
29includes asynchronous store-and-forward technologies, remote
30monitoring, and real-time interactive services, including
31teleradiology and telepathology. “Telemedicine” does not
32include the provision of medical services only through an
33audio-only telephone, email messages, facsimile transmissions,
34or U.S. mail or other parcel service, or any combination of
35these means.
-2-1 Sec. 2. NEW SECTION. 280A.2 Behavioral health screenings
2and assessments in school settings.
31. a. A school district, an accredited nonpublic school,
4or an area education agency may contract with a mental health
5professional or a nationally accredited behavioral health
6care organization to provide behavioral health screenings to
7students in person or via telemedicine.
8b. (1) A behavioral health screening may be conducted
9following provision of written consent by the student’s parent
10or guardian for the student to participate in such screening
11and to allow for the release of the results of the screening to
12the student’s primary care provider.
13(2) The consent shall also allow for the disclosure of the
14results of such screenings to the school district, accredited
15nonpublic school, or area education agency, if the mental
16health professional believes there is a credible threat to the
17health and safety of the student or others.
182. If a mental health professional conducts an initial
19behavioral health screening on the premises of a public school,
20an accredited nonpublic school, or an area education agency and
21determines that a student should be referred for additional
22behavioral health services, all of the following shall apply:
23a. The mental health professional shall notify the parent or
24guardian of the student of the results of the screening.
25b. The mental health professional shall notify the student’s
26primary care provider. If the student does not have a primary
27care provider, the mental health professional shall provide
28a listing of local primary care providers to the parent or
29guardian.
30 Sec. 3. NEW SECTION. 280A.3 Establishment of
31provider-patient relationship for services provided via
32telemedicine in a school setting.
331. A mental health professional who provides services
34via telemedicine in a public school, an accredited nonpublic
35school, or an area education agency shall establish a valid
-3-1provider-patient relationship with the student who receives
2telemedicine services.
32. The provider-patient relationship commences when all of
4the following conditions are met:
5a. The student with the health-related matter seeks
6assistance from a mental health professional.
7b. The mental health professional agrees to undertake
8diagnosis and treatment of the student.
9c. The student agrees to be treated by the mental health
10professional whether or not there has been an in-person
11encounter between the mental health professional and the
12student.
133. A valid provider-patient relationship may be established
14through any of the following means:
15a. Through an in-person encounter which includes an
16in-person medical interview and physical examination conducted
17under the standard of care required for an in-person encounter.
18b. Through consultation with a primary care provider who has
19an established relationship with the patient and who agrees to
20participate in or supervise the patient’s care.
214. The parent or guardian of a student shall be given
22the opportunity to consent prior to the student receiving
23behavioral health services via telemedicine under this chapter
24after a provider-patient relationship is established pursuant
25to this section. The school district shall maintain any such
26consent form completed by a parent or guardian.
27 Sec. 4. NEW SECTION. 280A.4 Behavioral health services
28provided via telemedicine in a school setting.
291. A public school, accredited nonpublic school, or an
30area education agency may provide access to behavioral health
31services via telemedicine on the premises of the public school,
32accredited nonpublic school, or area education agency. If
33a public school, an accredited nonpublic school, or an area
34education agency provides such access, the school or area
35education agency shall do all of the following:
-4- 1a. Provide a secure, confidential, and private room for such
2services and the technology necessary to conduct telemedicine
3services.
4b. Maintain parent or guardian consent forms for the
5provision of such services. Consent forms shall be required
6for each academic year in which the student receives such
7services.
8c. Maintain scheduling requests for student appointments
9for such services and provide the student access to the room by
10a school nurse or other appropriately trained school or area
11education agency employee.
12d. Ensure that no school or area education agency employee
13is present in the same room as the student during the provision
14of such services.
15e. Provide information to the student participating
16in telemedicine services about how and to whom to report
17inappropriate behavior by a mental health professional.
18f. Provide access to the student’s parent or guardian to
19participate in any of the student’s telemedicine sessions.
202. The public school, accredited nonpublic school, or area
21education agency shall not have access to or handle any of the
22student’s medical records or be responsible for billing for the
23telemedicine services provided.
243. A mental health professional with prescribing authority
25who provides telemedicine services in accordance with this
26section shall not prescribe any new medication to a student
27during a telemedicine session. However, a mental health
28professional with prescribing authority may initiate new
29prescriptions, alter the dosage of an existing medication, or
30discontinue an existing medication for the treatment of the
31student’s behavioral health condition after consultation with
32the student’s parent or guardian.
334. a. Prior to the initiation of behavioral health services
34via telemedicine in accordance with this section, the student’s
35primary care provider and the mental health professional
-5-1providing the telemedicine services shall consult to develop
2a plan for the purpose of coordinating the student’s medical
3care.
4b. The plan shall ensure regular contact between the
5student’s primary care provider and the student’s mental
6health professional, and the sharing of such records as may be
7necessary to jointly manage the student’s medical care.
8c. If the student receiving telemedicine services does not
9have a primary care provider, the mental health professional
10shall provide a listing of local primary care providers to the
11student’s parent or guardian.
125. The mental health professional shall notify the
13student’s parent or guardian of the time and place for each
14scheduled telemedicine session and specify the means available
15for the parent or guardian to participate in the session.
166. Protected health information, including but not limited
17to medical records and medical billing information, created
18by the mental health professional or primary care provider
19shall not be shared with or disclosed to a public school,
20accredited nonpublic school, or area education agency, unless
21disclosure is necessary to prevent or lessen a serious and
22imminent threat to the health or safety of the student or to a
23clearly identifiable person or persons and the mental health
24professional determines the student has the apparent intent and
25ability to carry out the threat.
267. A school district, an accredited nonpublic school,
27an area education agency, the board of directors of a school
28district or an area education agency, authorities in charge of
29the accredited nonpublic school, and employees of the school
30district, accredited nonpublic school or area education agency,
31shall not be liable for any injury arising from the provision
32of voluntary behavioral health screenings or behavioral health
33services in accordance with this chapter, provided such person
34has acted reasonably and in good faith.
35 Sec. 5. NEW SECTION. 514C.35 Behavioral health services
-6-1provided via telemedicine in a school setting — coverage.
21. As used in this section, unless the context otherwise
3requires:
4a. “Accredited nonpublic school” means any school, other
5than a public school, that is accredited pursuant to section
6256.11 for any and all levels for grades one through twelve.
7b. “Area education agency” means an area education agency
8established pursuant to chapter 273.
9c. “Behavioral health services” means services provided
10by a health care professional operating within the scope of
11the health care professional’s practice which address mental,
12emotional, medical, or behavioral conditions, illnesses,
13diseases, or problems.
14d. “Health care professional” means a physician or other
15health care practitioner licensed, accredited, registered, or
16certified to perform specified health care services consistent
17with state law.
18e. “In-person encounter” means that the mental health
19professional and the student are in the physical presence of
20each other and are in the same physical location during the
21provision of behavioral health services.
22f. “Mental health professional” means the same as defined
23in section 228.1.
24g. “Patient” means a student receiving a behavioral health
25screening or other behavioral health services in accordance
26with this chapter.
27h. “Primary care provider” means the personal provider
28trained to provide the first contact and continuous and
29comprehensive care to a patient and includes but is not limited
30to any of the following licensed or certified health care
31professionals who provide primary care:
32(1) A physician who is a family or general practitioner or a
33pediatrician.
34(2) An advanced registered nurse practitioner.
35(3) A physician assistant.
-7- 1(4) A chiropractor.
2i. “Provider-patient relationship” means the relationship
3between the patient and the mental health professional that
4meets the requirements for commencement and establishment of
5a valid provider-patient relationship as specified in this
6chapter.
7j. “Public school” means any school directly supported in
8whole or in part by taxation.
9k. “School” means a public or accredited nonpublic school,
10or an area education agency that provides premises for teaching
11any grade from kindergarten through grade twelve.
12l. “School district” means a school district described in
13chapter 274.
14m. “Student” means a person enrolled in and attending an
15accredited nonpublic school or a public school in grades one
16through twelve.
17n. “Telemedicine” means the practice of medicine using
18electronic audio-visual communications and information
19technologies or other means, including interactive audio with
20asynchronous store-and-forward transmission, between a licensee
21in one location and a patient in another location with or
22without an intervening health care provider. “Telemedicine”
23includes asynchronous store-and-forward technologies, remote
24monitoring, and real-time interactive services, including
25teleradiology and telepathology. “Telemedicine” does not
26include the provision of medical services only through an
27audio-only telephone, email messages, facsimile transmissions,
28or U.S. mail or other parcel service, or any combination of
29these means.
302. a. Notwithstanding the uniformity of treatment
31requirements of section 514C.6, a policy, contract, or plan
32providing for third-party payment or prepayment of health or
33medical expenses shall provide coverage and treat as equivalent
34services, behavioral health services provided by a mental
35health professional to a student through an in-person encounter
-8-1or via telemedicine pursuant to chapter 280A.
2b. Coverage shall be provided if all of the following
3conditions are met:
4(1) If behavioral health services are provided by a mental
5health professional via telemedicine to a student on the
6premises of a public school, an accredited nonpublic school, or
7an area education agency, the behavioral health services are
8provided in accordance with chapter 280A.
9(2) The mental health services provided are provided in
10accordance with evidence-based standards of practice and relate
11only to behavioral health.
12(3) The mental health professional has an existing
13provider-patient relationship with the student as specified in
14chapter 280A.
15(4) The student’s parent or guardian has consented to the
16treatment and to release of the student’s medical records
17associated with the telemedicine services to the student’s
18primary care provider.
19(5) The mental health services provided are required in
20accordance with the student’s individual education plan.
213. This section applies to the following classes of
22third-party payment provider policies, contracts, or plans
23delivered, issued for delivery, continued, or renewed in this
24state on or after January 1, 2020:
25a. Individual or group accident and sickness insurance
26providing coverage on an expense-incurred basis.
27b. An individual or group hospital or medical service
28contract issued pursuant to chapter 509, 514, or 514A.
29c. An individual or group health maintenance organization
30contract regulated under chapter 514B.
31d. A plan established pursuant to chapter 509A for public
32employees.
334. This section shall not apply to accident-only,
34specified disease, short-term hospital or medical, hospital
35confinement indemnity, credit, dental, vision, Medicare
-9-1supplement, long-term care, basic hospital and medical-surgical
2expense coverage as defined by the commissioner, disability
3income insurance coverage, coverage issued as a supplement
4to liability insurance, workers’ compensation or similar
5insurance, or automobile medical payment insurance.
65. The commissioner of insurance, in collaboration with the
7state board of education, may adopt rules pursuant to chapter
817A as necessary to administer this section.
9 Sec. 6. MEDICAID — TELEMEDICINE SERVICES PROVIDED IN
10SCHOOL SETTINGS — REIMBURSEMENT.
111. For the purposes of this section:
12a. “Accredited nonpublic school” means any school, other
13than a public school, that is accredited pursuant to section
14256.11 for any and all levels for grades one through twelve.
15b. “Area education agency” means an area education agency
16established pursuant to chapter 273.
17c. “Behavioral health services” means services provided
18by a health care professional operating within the scope of
19the health care professional’s practice which address mental,
20emotional, medical, or behavioral conditions, illnesses,
21diseases, or problems.
22d. “Health care professional” means a physician or other
23health care practitioner licensed, accredited, registered, or
24certified to perform specified health care services consistent
25with state law.
26e. “In-person encounter” means that the mental health
27professional and the student are in the physical presence of
28each other and are in the same physical location during the
29provision of behavioral health services.
30f. “Mental health professional” means the same as defined
31in section 228.1.
32g. “Patient” means a student receiving a behavioral health
33screening or other behavioral health services in accordance
34with this chapter.
35h. “Primary care provider” means the personal provider
-10-1trained to provide the first contact and continuous and
2comprehensive care to a patient and includes but is not limited
3to any of the following licensed or certified health care
4professionals who provide primary care:
5(1) A physician who is a family or general practitioner or a
6pediatrician.
7(2) An advanced registered nurse practitioner.
8(3) A physician assistant.
9(4) A chiropractor.
10i. “Provider-patient relationship” means the relationship
11between the patient and the mental health professional that
12meets the requirements for commencement and establishment of
13a valid provider-patient relationship as specified in this
14chapter.
15j. “Public school” means any school directly supported in
16whole or in part by taxation.
17k. “School” means a public or accredited nonpublic school,
18or an area education agency that provides premises for teaching
19any grade from kindergarten through grade twelve.
20l. “School district” means a school district described in
21chapter 274.
22m. “Student” means a person enrolled in and attending an
23accredited nonpublic school or a public school in grades one
24through twelve.
25n. “Telemedicine” means the practice of medicine using
26electronic audio-visual communications and information
27technologies or other means, including interactive audio with
28asynchronous store-and-forward transmission, between a licensee
29in one location and a patient in another location with or
30without an intervening health care provider. “Telemedicine”
31includes asynchronous store-and-forward technologies, remote
32monitoring, and real-time interactive services, including
33teleradiology and telepathology. “Telemedicine” does not
34include the provision of medical services only through an
35audio-only telephone, email messages, facsimile transmissions,
-11-1or U.S. mail or other parcel service, or any combination of
2these means.
32. a. The department of human services shall require,
4contractually and in accordance with rules adopted pursuant
5to chapter 17A, that under both fee-for-service and managed
6care administered Medicaid, behavioral health services provided
7through an in-person encounter or via telemedicine pursuant to
8chapter 280A shall be treated as equivalent services for the
9purposes of reimbursement.
10b. Coverage shall be provided if all of the following
11conditions are met:
12(1) If the mental health services are provided by a mental
13health professional via telemedicine to a student on the
14premises of a public school, an accredited nonpublic school, or
15an area education agency, the behavioral health services are
16provided in accordance with chapter 280A.
17(2) The mental health services are provided in accordance
18with evidence-based standards of practice and relate only to
19behavioral health.
20(3) The mental health professional has an existing
21provider-patient relationship with the student as specified in
22chapter 280A.
23(4) The student’s parent or guardian has consented to the
24treatment and to release of the student’s medical records
25associated with the telemedicine services to the student’s
26primary care provider.
27(5) The mental health services provided are required in
28accordance with the student’s individual education plan.
29EXPLANATION
30The inclusion of this explanation does not constitute agreement with
31the explanation’s substance by the members of the general assembly.
32This bill provides for the provision of behavioral health
33screenings and services through a school setting both in person
34and via telemedicine.
35The bill authorizes a school district, an accredited
-12-1nonpublic school, or an area education agency to contract
2with a mental health professional or a nationally accredited
3behavioral health care organization to provide behavioral
4health screenings to students in person or via telemedicine,
5upon written consent by the student’s parent or guardian and
6to allow for the release of the results of the screening to the
7student’s primary care provider.
8The bill specifies the requirements for the establishment
9of a provider-patient relationship for purposes of mental
10health professionals providing behavioral health services
11via telemedicine in a public school, an accredited nonpublic
12school, or an area education agency setting.
13The bill authorizes a public school, accredited nonpublic
14school, and area education agency to provide access to
15behavioral health services via telemedicine on the premises
16of the public school, accredited nonpublic school, or area
17education agency, specifies the parameters for the provision of
18such services, and provides immunity for entities that provide
19such services acting reasonably and in good faith.
20The bill requires that both private health insurance
21coverage and the Medicaid program are to provide coverage
22and treat as equivalent services, behavioral health services
23provided by a mental health professional to a student through
24an in-person encounter or via telemedicine pursuant to the
25bill.
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