House File 348 - IntroducedA Bill ForAn Act 1relating to health insurance coverage for telehealth.
2BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
1   Section 1.  NEW SECTION.  514C.31  Telehealth coverage.
   21.  As used in this section, unless the context otherwise
3requires:
   4a.  “Distant site” means the site at which a health care
5professional delivering services through telehealth is located
6at the time the telehealth service is provided.
   7b.  “Health care professional” means a person who is
8licensed, certified, or otherwise authorized or permitted by
9the law of this state to administer health care in the ordinary
10course of business or in the practice of a profession, or
11in an approved education or training program, as long as the
12person is operating within the person’s professional scope of
13practice.
   14c.  “Originating site” means the site at which a patient
15is located at the time services are provided by a health care
16professional through telehealth.
   17d.  “Professional relationship” means a relationship
18established between a health care professional and a patient
19that meets any of the following conditions:
   20(1)  The health care professional has previously conducted
21an in-person examination of the patient and is available to
22provide appropriate follow-up health care services, when
23necessary, at medically necessary intervals.
   24(2)  The health care professional personally knows the
25patient and the patient’s relevant health status through an
26ongoing personal or professional relationship, and is available
27to provide appropriate follow-up health care services, when
28necessary, at medically necessary intervals.
   29(3)  The health care services provided via telehealth are
30provided by a health care professional in consultation with,
31or upon referral by, another health care professional who has
32an ongoing relationship with the patient and who has agreed to
33supervise the patient’s treatment, including follow-up health
34care services.
   35(4)  An on-call or cross-coverage arrangement exists between
-1-1the health care professional and the patient’s regular treating
2health care professional.
   3(5)  A professional relationship exists in other
4circumstances as defined by rule of the professional board
5having jurisdiction over the health care professional.
   6e.  “Remote patient monitoring” means using telehealth to
7enable the health care professional to monitor and manage a
8patient’s medical, functional, and environmental needs if such
9needs can be appropriately met through telehealth intervention.
   10f.  “Store-and-forward technology” means the asynchronous
11communications between a patient and a health care professional
12or between a referring health care professional and a medical
13specialist at a distant site, supported by telecommunications
14technology for the purpose of diagnosis, consultation,
15treatment, or therapeutic assistance in the provision of
16care to the patient, including the transferring of medical
17data from one site to another through the use of a camera
18or similar device that records or stores an image that is
19sent or forwarded via telecommunications to another site for
20consultation.
   21g.  “Telehealth” includes the use of real-time, interactive
22audio or video telecommunications or electronic technology,
23remote patient monitoring, or store-and-forward technology by
24a health care professional to deliver health care services
25to a patient within the scope of practice of the health care
26professional, for the purposes of diagnosis, consultation,
27treatment, transfer of medical data, or exchange of medical
28education information. “Telehealth” does not include an
29audio-only telephone call, electronic mail message, or
30facsimile transmission.
   312.  a.  Notwithstanding the uniformity of treatment
32requirements of section 514C.6, a contract, policy, or plan
33providing for third-party payment or prepayment for health,
34medical, or surgical coverage benefits shall provide coverage
35for health care services provided as telehealth if the services
-2-1would be covered if provided in person. Health care services
2provided in-person or through telehealth shall be treated as
3equivalent services for the purposes of coverage.
   4b.  Telehealth coverage shall only be provided pursuant
5to paragraph “a” if the health care professional providing
6telehealth at a distant site to a patient located at an
7originating site in this state has a professional relationship
8with the patient. However, a health care professional shall
9not be required to have a professional relationship with a
10patient if either of the following applies:
   11(1)  In an emergency where the life or health of the patient
12is in danger or imminent danger.
   13(2)  The health care professional is only providing
14information of a generic nature, not specific to the individual
15patient.
   163.  If health care coverage is provided for telehealth under
17this section, all of the following shall apply:
      18a.  This section shall not be interpreted as preventing
19a third-party payment provider from imposing deductibles or
20copayment or coinsurance requirements for a health care service
21provided through telehealth if the deductible, copayment, or
22coinsurance does not exceed the deductible, copayment, or
23coinsurance applicable to in-person consultation for the same
24health care service. A third-party payment provider shall not
25impose annual or lifetime maximums on coverage of telehealth
26unless the annual or lifetime maximum applies in the aggregate
27to all items and health care services under the contract,
28policy, or plan.
      29b.  This section shall not be interpreted to require a
30third-party payment provider to provide reimbursement for
31a health care service that is not a covered benefit or to
32reimburse a health care professional who is not a covered
33provider under the contract, policy, or plan.
      34c.  This section shall not be interpreted to preclude a
35third-party payment provider from performing utilization review
-3-1to determine the appropriateness of telehealth in the delivery
2of health care services if the determination is made in the
3same manner as those regarding the same health care service
4when delivered in person.
      5d.  This section shall not be interpreted to authorize a
6third-party payment provider to require the use of telehealth
7when the health care professional determines use of telehealth
8is not appropriate.
      9e.  The provisions of this section shall apply to all of the
10following classes of third-party payment provider contracts,
11policies, or plans delivered, issued for delivery, continued,
12or renewed in this state on or after January 1, 2018:
      13(1)  Individual or group accident and sickness insurance
14providing coverage on an expense-incurred basis.
      15(2)  An individual or group hospital or medical service
16contract issued pursuant to chapter 509, 514, or 514A.
      17(3)  An individual or group health maintenance organization
18contract regulated under chapter 514B.
      19(4)  An individual or group Medicare supplemental policy,
20unless coverage pursuant to such policy is preempted by federal
21law.
      22(5)  A plan established pursuant to chapter 509A for public
23employees.
      24f.  This section shall not apply to accident-only, specified
25disease, short-term hospital or medical, hospital confinement
26indemnity, credit, dental, vision, long-term care, basic
27hospital, and medical-surgical expense coverage as defined
28by the commissioner, disability income insurance coverage,
29coverage issued as a supplement to liability insurance,
30workers’ compensation or similar insurance, or automobile
31medical payment insurance.
      324.  The commissioner of insurance shall adopt rules pursuant
33to chapter 17A as necessary to administer this section.
34EXPLANATION
35The inclusion of this explanation does not constitute agreement with
-4-1the explanation’s substance by the members of the general assembly.
   2This bill relates to health insurance coverage for
3telehealth.
   4The bill provides definitions relative to telehealth
5and requires that a contract, policy, or plan providing for
6third-party payment or prepayment for health, medical, or
7surgical coverage benefits cover telehealth. On or after
8January 1, 2018, the contract, policy, or plan shall not
9deny coverage of telehealth services on the basis that the
10services are provided via telehealth if the services would be
11covered if provided in person. Health care services provided
12through in-person consultations or through telehealth shall be
13treated as equivalent services for the purposes of coverage.
14Telehealth coverage is only to be provided if the health
15care professional providing telehealth at a distant site to
16a patient located at an originating site in this state has a
17professional relationship with the patient. This requirement
18does not apply, however, in an emergency where the life or
19health of the patient is in danger or imminent danger; or if
20the health care professional is only providing information of a
21generic nature, not specific to the individual patient.
   22The provision is not to be interpreted as preventing a
23third-party payment provider from imposing deductibles or
24copayment or coinsurance requirements for a health care service
25provided through telehealth if the deductible, copayment, or
26coinsurance does not exceed the deductible, copayment, or
27coinsurance applicable to an in-person consultation for the
28same health care service. The bill provides that a third-party
29payment provider shall not impose annual or lifetime maximums
30on coverage of telehealth unless the annual or lifetime maximum
31applies in the aggregate to all items and health care services
32under the contract, policy, or plan.
   33The bill provides that the Code section is not to be
34interpreted to require a third-party payment provider to
35provide reimbursement for a health care service that is not
-5-1a covered benefit or to reimburse a health care professional
2who is not a covered provider under the contract, policy,
3or plan; to preclude a third-party payment provider from
4performing utilization review to determine the appropriateness
5of telehealth in the delivery of health care services if the
6determination is made in the same manner as those regarding
7the same health care service when delivered in person; or to
8authorize a third-party payment provider to require the use of
9telehealth when the health care professional determines use of
10telehealth is not appropriate.
   11The bill specifies the types of third-party payment provider
12contracts, policies, or plans to which the bill applies and
13those exempt from its application.
   14The commissioner of insurance is directed to adopt rules
15pursuant to Code chapter 17A as necessary to administer the
16bill.
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