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Senate Study Bill 1168 - 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. “Health care professional” means a person who is
5licensed, certified, or otherwise authorized or permitted by
6the law of this state to administer health care in the ordinary
7course of business or in the practice of a profession, or
8in an approved education or training program, as long as the
9person is operating within the person’s professional scope of
10practice.
11b. “Telehealth” means the use of real-time, interactive
12audio or video telecommunications or electronic technology,
13remote patient monitoring, or store-and-forward telehealth by
14a health care professional to deliver health care services
15to a patient within the scope of practice of the health care
16professional, for the purposes of diagnosis, consultation,
17treatment, transfer of medical data, or exchange of medical
18education information. “Telehealth” does not include an
19audio-only telephone call, electronic mail message, or
20facsimile transmission.
212. Notwithstanding the uniformity of treatment requirements
22of section 514C.6, a contract, policy, or plan providing for
23third-party payment or prepayment for health, medical, or
24surgical coverage benefits shall provide coverage for services
25provided as telehealth if the services would be covered if
26provided in-person. If coverage is provided for telehealth
27under this section, coverage shall not require in-person
28contact between a health care professional and a patient as a
29prerequisite for payment for services appropriately provided
30through telehealth in accordance with generally accepted health
31care practices and standards prevailing in the applicable
32professional community at the time the services are provided.
33If coverage is provided under this section, health care
34services provided through in-person consultations or through
35telehealth shall be treated as equivalent services for the
-1-1purposes of coverage.
23. If health care coverage is provided for telehealth under
3this section, all of the following shall apply:
4a. This section shall not be interpreted as preventing
5a third-party payment provider from imposing deductibles or
6copayment or coinsurance requirements for a health care service
7provided through telehealth if the deductible, copayment, or
8coinsurance does not exceed the deductible, copayment, or
9coinsurance applicable to in-person consultation for the same
10health care service. A third-party payment provider shall not
11impose annual or lifetime maximums on coverage of telehealth
12unless the annual or lifetime maximum applies in the aggregate
13to all items and services under the contract, policy, or plan.
14b. This section shall not be interpreted to require a
15third-party payment provider to provide reimbursement for
16a health care service that is not a covered benefit or to
17reimburse a health care professional who is not a covered
18provider under the contract, policy, or plan.
19c. This section shall not be interpreted to preclude a
20third-party payment provider from performing utilization review
21to determine the appropriateness of telehealth in the delivery
22of health care services if the determination is made in the
23same manner as those regarding the same health care service
24when delivered in person.
25d. This section shall not be interpreted to authorize a
26third-party payment provider to require the use of telehealth
27when the health care professional determines use of telehealth
28is not appropriate.
29e. The provisions of this section shall apply to all of the
30following classes of third-party payment provider contracts,
31policies, or plans delivered, issued for delivery, continued,
32or renewed in this state on or after January 1, 2018:
33(1) Individual or group accident and sickness insurance
34providing coverage on an expense-incurred basis.
35(2) An individual or group hospital or medical service
-2-1contract issued pursuant to chapter 509, 514, or 514A.
2(3) An individual or group health maintenance organization
3contract regulated under chapter 514B.
4(4) An individual or group Medicare supplemental policy,
5unless coverage pursuant to such policy is preempted by federal
6law.
7(5) A plan established pursuant to chapter 509A for public
8employees.
9f. This section shall not apply to accident-only, specified
10disease, short-term hospital or medical, hospital confinement
11indemnity, credit, dental, vision, long-term care, basic
12hospital, and medical-surgical expense coverage as defined
13by the commissioner, disability income insurance coverage,
14coverage issued as a supplement to liability insurance,
15workers’ compensation or similar insurance, or automobile
16medical payment insurance.
174. The commissioner of insurance shall adopt rules pursuant
18to chapter 17A as necessary to administer this section.
19EXPLANATION
20The inclusion of this explanation does not constitute agreement with
21the explanation’s substance by the members of the general assembly.
22This bill relates to health insurance coverage for
23telehealth.
24The bill provides definitions relative to telehealth
25and requires that a contract, policy, or plan providing for
26third-party payment or prepayment for health, medical, or
27surgical coverage benefits cover telehealth. On or after
28January 1, 2018, the contract, policy, or plan shall not
29deny coverage of telehealth services on the basis that the
30services are provided via telehealth if the services would be
31covered if provided in person and shall not require in-person
32contact between a health care professional and a patient as a
33prerequisite for payment for services appropriately provided
34through telehealth in accordance with generally accepted health
35care practices and standards prevailing in the applicable
-3-1professional community at the time the services are provided.
2Health care services provided through in-person consultations
3or through telehealth shall be treated as equivalent services
4for the purposes of coverage.
5The provision is not to be interpreted as preventing a
6third-party payment provider from imposing deductibles or
7copayment or coinsurance requirements for a health care service
8provided through telehealth if the deductible, copayment, or
9coinsurance does not exceed the deductible, copayment, or
10coinsurance applicable to an in-person consultation for the
11same health care service. The bill provides that a third-party
12payment provider shall not impose annual or lifetime maximums
13on coverage of telehealth unless the annual or lifetime maximum
14applies in the aggregate to all items and services under the
15contract, policy, or plan.
16The bill provides that the Code section is not to be
17interpreted to require a third-party payment provider to
18provide reimbursement for a health care service that is not
19a covered benefit or to reimburse a health care professional
20who is not a covered provider under the contract, policy,
21or plan; to preclude a third-party payment provider from
22performing utilization review to determine the appropriateness
23of telehealth in the delivery of health care services if the
24determination is made in the same manner as those regarding
25the same health care service when delivered in person; or to
26authorize a third-party payment provider to require the use of
27telehealth when the health care professional determines use of
28telehealth is not appropriate.
29The bill specifies the types of third-party payment provider
30contracts, policies, or plans to which the bill applies and
31those exempt from its application.
32The commissioner of insurance is directed to adopt rules
33pursuant to Code chapter 17A as necessary to administer the
34bill.
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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. “Health care professional” means a person who is
5licensed, certified, or otherwise authorized or permitted by
6the law of this state to administer health care in the ordinary
7course of business or in the practice of a profession, or
8in an approved education or training program, as long as the
9person is operating within the person’s professional scope of
10practice.
11b. “Telehealth” means the use of real-time, interactive
12audio or video telecommunications or electronic technology,
13remote patient monitoring, or store-and-forward telehealth by
14a health care professional to deliver health care services
15to a patient within the scope of practice of the health care
16professional, for the purposes of diagnosis, consultation,
17treatment, transfer of medical data, or exchange of medical
18education information. “Telehealth” does not include an
19audio-only telephone call, electronic mail message, or
20facsimile transmission.
212. Notwithstanding the uniformity of treatment requirements
22of section 514C.6, a contract, policy, or plan providing for
23third-party payment or prepayment for health, medical, or
24surgical coverage benefits shall provide coverage for services
25provided as telehealth if the services would be covered if
26provided in-person. If coverage is provided for telehealth
27under this section, coverage shall not require in-person
28contact between a health care professional and a patient as a
29prerequisite for payment for services appropriately provided
30through telehealth in accordance with generally accepted health
31care practices and standards prevailing in the applicable
32professional community at the time the services are provided.
33If coverage is provided under this section, health care
34services provided through in-person consultations or through
35telehealth shall be treated as equivalent services for the
-1-1purposes of coverage.
23. If health care coverage is provided for telehealth under
3this section, all of the following shall apply:
4a. This section shall not be interpreted as preventing
5a third-party payment provider from imposing deductibles or
6copayment or coinsurance requirements for a health care service
7provided through telehealth if the deductible, copayment, or
8coinsurance does not exceed the deductible, copayment, or
9coinsurance applicable to in-person consultation for the same
10health care service. A third-party payment provider shall not
11impose annual or lifetime maximums on coverage of telehealth
12unless the annual or lifetime maximum applies in the aggregate
13to all items and services under the contract, policy, or plan.
14b. This section shall not be interpreted to require a
15third-party payment provider to provide reimbursement for
16a health care service that is not a covered benefit or to
17reimburse a health care professional who is not a covered
18provider under the contract, policy, or plan.
19c. This section shall not be interpreted to preclude a
20third-party payment provider from performing utilization review
21to determine the appropriateness of telehealth in the delivery
22of health care services if the determination is made in the
23same manner as those regarding the same health care service
24when delivered in person.
25d. This section shall not be interpreted to authorize a
26third-party payment provider to require the use of telehealth
27when the health care professional determines use of telehealth
28is not appropriate.
29e. The provisions of this section shall apply to all of the
30following classes of third-party payment provider contracts,
31policies, or plans delivered, issued for delivery, continued,
32or renewed in this state on or after January 1, 2018:
33(1) Individual or group accident and sickness insurance
34providing coverage on an expense-incurred basis.
35(2) An individual or group hospital or medical service
-2-1contract issued pursuant to chapter 509, 514, or 514A.
2(3) An individual or group health maintenance organization
3contract regulated under chapter 514B.
4(4) An individual or group Medicare supplemental policy,
5unless coverage pursuant to such policy is preempted by federal
6law.
7(5) A plan established pursuant to chapter 509A for public
8employees.
9f. This section shall not apply to accident-only, specified
10disease, short-term hospital or medical, hospital confinement
11indemnity, credit, dental, vision, long-term care, basic
12hospital, and medical-surgical expense coverage as defined
13by the commissioner, disability income insurance coverage,
14coverage issued as a supplement to liability insurance,
15workers’ compensation or similar insurance, or automobile
16medical payment insurance.
174. The commissioner of insurance shall adopt rules pursuant
18to chapter 17A as necessary to administer this section.
19EXPLANATION
20The inclusion of this explanation does not constitute agreement with
21the explanation’s substance by the members of the general assembly.
22This bill relates to health insurance coverage for
23telehealth.
24The bill provides definitions relative to telehealth
25and requires that a contract, policy, or plan providing for
26third-party payment or prepayment for health, medical, or
27surgical coverage benefits cover telehealth. On or after
28January 1, 2018, the contract, policy, or plan shall not
29deny coverage of telehealth services on the basis that the
30services are provided via telehealth if the services would be
31covered if provided in person and shall not require in-person
32contact between a health care professional and a patient as a
33prerequisite for payment for services appropriately provided
34through telehealth in accordance with generally accepted health
35care practices and standards prevailing in the applicable
-3-1professional community at the time the services are provided.
2Health care services provided through in-person consultations
3or through telehealth shall be treated as equivalent services
4for the purposes of coverage.
5The provision is not to be interpreted as preventing a
6third-party payment provider from imposing deductibles or
7copayment or coinsurance requirements for a health care service
8provided through telehealth if the deductible, copayment, or
9coinsurance does not exceed the deductible, copayment, or
10coinsurance applicable to an in-person consultation for the
11same health care service. The bill provides that a third-party
12payment provider shall not impose annual or lifetime maximums
13on coverage of telehealth unless the annual or lifetime maximum
14applies in the aggregate to all items and services under the
15contract, policy, or plan.
16The bill provides that the Code section is not to be
17interpreted to require a third-party payment provider to
18provide reimbursement for a health care service that is not
19a covered benefit or to reimburse a health care professional
20who is not a covered provider under the contract, policy,
21or plan; to preclude a third-party payment provider from
22performing utilization review to determine the appropriateness
23of telehealth in the delivery of health care services if the
24determination is made in the same manner as those regarding
25the same health care service when delivered in person; or to
26authorize a third-party payment provider to require the use of
27telehealth when the health care professional determines use of
28telehealth is not appropriate.
29The bill specifies the types of third-party payment provider
30contracts, policies, or plans to which the bill applies and
31those exempt from its application.
32The commissioner of insurance is directed to adopt rules
33pursuant to Code chapter 17A as necessary to administer the
34bill.
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