Bill Text: IA HF218 | 2015-2016 | 86th General Assembly | Introduced
Bill Title: A bill for an act relating to telehealth and professional licensure, insurance coverage, and reimbursement under the medical assistance program. (See Cmte. Bill HF 600)
Sponsorship: Partisan Bill (Republican 1)
Status: (Introduced - Dead) 2015-02-19 - Passed subcommittee. [HF218 Detail]
Download: Iowa-2015-HF218-Introduced.html
House File 218 - Introduced HOUSE FILE BY HEATON A BILL FOR 1 An Act relating to telehealth and professional licensure, 2 insurance coverage, and reimbursement under the medical 3 assistance program. 4 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: TLSB 1423YH (5) 86 pf/rj PAG LIN 1 1 Section 1. LEGISLATIVE FINDINGS. The general assembly 1 2 finds and recognizes all of the following: 1 3 1. Access to health care facilities and health care 1 4 professionals is critically important to the citizens of Iowa. 1 5 2. Telehealth uses electronic technology to overcome a 1 6 geographic distance between patients and health care providers 1 7 for the purpose of intervention, clinical management, or 1 8 assessing, monitoring, or educating patients. 1 9 3. The provision of telehealth results in demonstrated 1 10 cost=effectiveness, improvements in disease management, 1 11 and improved patient outcomes and studies by the American 1 12 telemedicine association and others have demonstrated 1 13 significant reductions in hospitalizations and otherwise 1 14 necessary medical care as a result of telehealth intervention. 1 15 4. Geography, weather, availability of specialists, 1 16 transportation, and other factors can create barriers to 1 17 accessing appropriate health care, including behavioral health 1 18 care, and one way to provide, ensure, or enhance access to 1 19 care given these barriers is through the appropriate use of 1 20 technology to allow health care consumers access to qualified 1 21 health care professionals. 1 22 5. Additionally, the utilization of telehealth will 1 23 further the maintenance and improvement of the physical 1 24 and economic health of patients in medically underserved 1 25 communities by retaining the source of health care in local 1 26 areas, strengthening the health infrastructure, and preserving 1 27 health=care=related jobs. 1 28 6. A need exists in this state to embrace efforts that 1 29 will encourage health insurers and health care professionals 1 30 to support the use of telehealth and that will also encourage 1 31 all state agencies to evaluate and amend their policies and 1 32 rules to remove any regulatory barriers prohibiting the use of 1 33 telehealth. 1 34 7. Recognition exists that the full potential of delivering 1 35 health care services through telehealth cannot be realized 2 1 without the assurance of payment and the resolution of existing 2 2 legal and policy barriers to such payment. 2 3 8. The purpose of the Iowa telehealth Act is to provide a 2 4 framework for health care professionals to utilize in providing 2 5 telehealth to Iowans in a manner that provides efficient and 2 6 effective access to quality health care. 2 7 Sec. 2. NEW SECTION. 147B.1 Title. 2 8 This chapter shall be known and may be cited as the "Iowa 2 9 Telehealth Act". 2 10 Sec. 3. NEW SECTION. 147B.2 Definitions. 2 11 As used in this chapter, unless the context otherwise 2 12 requires: 2 13 1. "Distant site" means the site at which a health care 2 14 professional delivering the service is located at the time the 2 15 telehealth service is provided. 2 16 2. "Health care professional" means a person who is 2 17 licensed, certified, or otherwise authorized under chapter 2 18 147A, 148, 148A, 148B, 148C, 149, 151, 152, 152B, 152E, 153, 2 19 154, 154B, 154C, 154D, 154F, or 155A to provide health care in 2 20 the ordinary course of business or practice of a profession or 2 21 in an approved education or training program, as long as the 2 22 person is operating within the person's professional scope of 2 23 practice. 2 24 3. "Remote patient monitoring" means using telehealth to 2 25 enable the health care professional to monitor and manage a 2 26 patient's medical, functional, and environmental needs if such 2 27 needs can be appropriately met through telehealth intervention. 2 28 4. "Store=and=forward telehealth" means the use of 2 29 asynchronous communications between a patient and a health care 2 30 professional or between a referring health care professional 2 31 and a medical specialist at a distant site, supported by 2 32 telecommunications technology for the purpose of diagnosis, 2 33 consultation, treatment, or therapeutic assistance in the 2 34 care of the patient, including the transferring of medical 2 35 data from one site to another through the use of a camera 3 1 or similar device that records or stores an image that is 3 2 sent or forwarded via telecommunications to another site for 3 3 consultation. 3 4 5. "Telehealth" means the use of real=time, interactive 3 5 audio or video telecommunications or electronic technology, 3 6 remote patient monitoring, or store=and=forward telehealth by 3 7 a health care professional to deliver health care services 3 8 to a patient within the scope of practice of the health care 3 9 professional, for the purposes of diagnosis, consultation, 3 10 treatment, transfer of medical data, or exchange of medical 3 11 education information. "Telehealth" does not include an 3 12 audio=only telephone call, electronic mail message, or 3 13 facsimile transmission. 3 14 Sec. 4. NEW SECTION. 147.163 Telehealth. 3 15 1. A health care professional licensed by a board created 3 16 under this chapter, as appropriate to the scope of practice 3 17 of the profession, may employ the technology of telehealth by 3 18 applying telehealth within the professional's scope of practice 3 19 or by using telehealth technology under the direction and 3 20 supervision of another health care professional who is using 3 21 telehealth technology within the supervising professional's 3 22 scope of practice. A health care professional's employment 3 23 of telehealth acting under the direction and supervision of 3 24 another health care professional who is using telehealth within 3 25 that health care professional's scope of practice shall not be 3 26 interpreted as practicing the supervising professional's health 3 27 care profession without a license. However, any health care 3 28 professional employing telehealth must hold a current valid 3 29 license to practice the respective profession in the state and 3 30 be trained, educated, and knowledgeable regarding the health 3 31 care service provided and technology used and shall not perform 3 32 duties for which the professional does not have sufficient 3 33 training, education, and knowledge. Failure to have sufficient 3 34 training, education, and knowledge is grounds for disciplinary 3 35 action by the respective board. 4 1 2. The applicable board that exercises regulatory or 4 2 rulemaking authority over an affected profession under this 4 3 chapter, or the department in the absence of an applicable 4 4 board, shall adopt rules to administer this chapter. 4 5 3. The standard of care for a professional using telehealth 4 6 to provide health care services to a patient shall be the same 4 7 as the standard of care required of that professional for the 4 8 provision of in=person health care services to a patient. 4 9 4. The type of setting where telehealth is provided for the 4 10 patient or by the health care professional shall not be limited 4 11 if the delivery of health care services is appropriately 4 12 provided through telehealth. 4 13 5. This chapter shall not be construed to conflict with 4 14 or supersede the provisions of chapter 147A, 148, 148A, 148B, 4 15 148C, 149, 151, 152, 152B, 152E, 153, 154, 154B, 154C, 154D, 4 16 154F, or 155A relating to the licensure of the respective 4 17 health care professional. 4 18 6. This chapter shall not be construed to alter the scope 4 19 of practice of any health care professional, authorize the 4 20 delivery of health care services in a setting or manner not 4 21 otherwise authorized by law, or limit a patient's right to 4 22 choose in=person contact with a health care professional for 4 23 the delivery of health care services for which telehealth is 4 24 available. 4 25 7. If a health care professional provides services pursuant 4 26 to and in compliance with section 135.24 via telehealth in 4 27 accordance with this chapter, the provisions of section 135.24 4 28 including those relating to immunity from civil liability shall 4 29 apply to such health care professional. 4 30 Sec. 5. NEW SECTION. 514C.30 Telehealth. 4 31 1. Notwithstanding the uniformity of treatment requirements 4 32 of section 514C.6, a contract, policy, or plan providing for 4 33 third=party payment or prepayment for health, medical, or 4 34 surgical coverage benefits shall not deny coverage on the basis 4 35 that the services are provided as telehealth if the services 5 1 would be covered if provided and shall not require in=person 5 2 contact between a health care professional and a patient as a 5 3 prerequisite for payment for services appropriately provided 5 4 through telehealth in accordance with generally accepted health 5 5 care practices and standards prevailing in the applicable 5 6 professional community at the time the services are provided. 5 7 Health care services provided through in=person consultations 5 8 or through telehealth shall be treated as equivalent services 5 9 for the purposes of coverage. 5 10 2. This section shall not be interpreted as preventing 5 11 a third=party payment provider from imposing deductibles or 5 12 copayment or coinsurance requirements for a health care service 5 13 provided through telehealth if the deductible, copayment, or 5 14 coinsurance does not exceed the deductible, copayment, or 5 15 coinsurance applicable to in=person consultation for the same 5 16 health care service. A third=party payment provider shall not 5 17 impose annual or lifetime maximums on coverage of telehealth 5 18 unless the annual or lifetime maximum applies in the aggregate 5 19 to all items and services under the contract, policy, or plan. 5 20 3. This section shall not be interpreted to require a 5 21 third=party payment provider to provide reimbursement for 5 22 a health care service that is not a covered benefit or to 5 23 reimburse a health care professional who is not a covered 5 24 provider under the contract, policy, or plan. 5 25 4. This section shall not be interpreted to preclude a 5 26 third=party payment provider from performing utilization review 5 27 to determine the appropriateness of telehealth in the delivery 5 28 of health care services if the determination is made in the 5 29 same manner as those regarding the same health care service 5 30 when delivered in person. 5 31 5. This section shall not be interpreted to authorize a 5 32 third=party payment provider to require the use of telehealth 5 33 when the health care professional determines use of telehealth 5 34 is not appropriate. 5 35 6. The provisions of this section shall apply to all of the 6 1 following classes of third=party payment provider contracts, 6 2 policies, or plans delivered, issued for delivery, continued, 6 3 or renewed in this state on or after January 1, 2016: 6 4 a. Individual or group accident and sickness insurance 6 5 providing coverage on an expense=incurred basis. 6 6 b. An individual or group hospital or medical service 6 7 contract issued pursuant to chapter 509, 514, or 514A. 6 8 c. An individual or group health maintenance organization 6 9 contract regulated under chapter 514B. 6 10 d. An individual or group Medicare supplemental policy, 6 11 unless coverage pursuant to such policy is preempted by federal 6 12 law. 6 13 e. A plan established pursuant to chapter 509A for public 6 14 employees. 6 15 7. This section shall not apply to accident=only, specified 6 16 disease, short=term hospital or medical, hospital confinement 6 17 indemnity, credit, dental, vision, long=term care, basic 6 18 hospital, and medical=surgical expense coverage as defined 6 19 by the commissioner, disability income insurance coverage, 6 20 coverage issued as a supplement to liability insurance, 6 21 workers' compensation or similar insurance, or automobile 6 22 medical payment insurance. 6 23 8. The commissioner of insurance shall adopt rules pursuant 6 24 to chapter 17A as necessary to administer this section. 6 25 9. For the purposes of this section, "health care 6 26 professional" and "telehealth" mean as defined in section 6 27 147B.2, as enacted in this Act. 6 28 Sec. 6. MEDICAID PROGRAM ==== REIMBURSEMENT FOR 6 29 TELEHEALTH. The department of human services shall adopt 6 30 rules to provide for coverage of telehealth under the 6 31 Medicaid program. The rules shall provide that in=person 6 32 contact between a health care professional and a patient 6 33 is not required as a prerequisite for payment for services 6 34 appropriately provided through telehealth in accordance 6 35 with generally accepted health care practices and standards 7 1 prevailing in the applicable professional community at 7 2 the time the services are provided. Health care services 7 3 provided through in=person consultations or through telehealth 7 4 shall be treated as equivalent services for the purposes 7 5 of reimbursement. As used in this section, "health care 7 6 professional" and "telehealth" mean as defined in section 7 7 147B.2, as enacted in this Act. 7 8 Sec. 7. STUDY ON USE OF TELEHEALTH. The department of 7 9 public health, in collaboration with the department of human 7 10 services and the insurance division of the department of 7 11 commerce, shall convene and conduct a study regarding options 7 12 for implementing telehealth and telehealth coverage and 7 13 reimbursement. The department of public health shall submit 7 14 a final report of its findings and recommendations to the 7 15 governor and the general assembly by December 15, 2015. 7 16 EXPLANATION 7 17 The inclusion of this explanation does not constitute agreement with 7 18 the explanation's substance by the members of the general assembly. 7 19 This bill relates to telehealth and creates the Iowa 7 20 telehealth Act. The bill provides legislative findings 7 21 and purposes regarding the use of telehealth and provides 7 22 definitions. 7 23 The bill provides that a health care professional licensed 7 24 by a professional licensing board under Code chapter 147 7 25 (health=related professions), as appropriate to the scope 7 26 of practice of the profession, may employ the technology of 7 27 telehealth by applying telehealth within the professional's 7 28 scope of practice or by employing telehealth technology 7 29 under the direction and supervision of another health care 7 30 professional who is using telehealth technology within the 7 31 supervising professional's scope of practice. A health care 7 32 professional's employment of telehealth technology under the 7 33 direction and supervision of another health care professional 7 34 who is acting within that health care professional's scope of 7 35 practice shall not be interpreted as practicing the supervising 8 1 professional's health care profession without a license. A 8 2 health care professional employing telehealth technology must 8 3 hold a current valid license and must be trained, educated, 8 4 and knowledgeable regarding the health care service provided 8 5 and technology used and is prohibited from performing duties 8 6 for which the professional does not have sufficient training, 8 7 education, and knowledge. Failure to have sufficient training, 8 8 education, and knowledge is grounds for disciplinary action by 8 9 the respective board. 8 10 The bill directs the appropriate board that exercises 8 11 regulatory or rulemaking authority over a profession within 8 12 whose scope of practice telehealth may be employed or the 8 13 department, to adopt rules, to administer the requirements 8 14 relating to the provision of telehealth by such professionals. 8 15 The bill provides that the standard of care for a 8 16 professional, whether using telehealth or providing the care 8 17 in person, is the same. The type of setting where telehealth 8 18 is provided for the patient or by the health care professional 8 19 is not to be limited if the delivery of health care services is 8 20 appropriately provided through telehealth. The bill is not to 8 21 be construed to conflict with or supersede the provisions of 8 22 the health care professionals licensing chapters relating to 8 23 the licensure of the respective health care professional or to 8 24 alter the scope of practice of any health care professional, 8 25 authorize the delivery of health care services in a setting 8 26 or manner not otherwise authorized by law, or limit a 8 27 patient's right to choose in=person contact with a health care 8 28 professional for the delivery of health care services for which 8 29 telehealth is available. The bill also provides that if a 8 30 health care professional provides services pursuant to and in 8 31 compliance with Code section 135.24 relating to the volunteer 8 32 health care provider program, via telehealth, the provisions of 8 33 Code section 135.24 including those relating to immunity from 8 34 civil liability shall apply to such health care professional. 8 35 The bill provides that beginning January 1, 2016, a 9 1 contract, policy, or plan providing for third=party payment or 9 2 prepayment for health, medical, or surgical coverage benefits 9 3 shall not deny coverage on the basis that the services are 9 4 provided via telehealth if the services would be covered if 9 5 provided in person and shall not require in=person contact 9 6 between a health care professional and a patient as a 9 7 prerequisite for payment for services appropriately provided 9 8 through telehealth in accordance with generally accepted health 9 9 care practices and standards prevailing in the applicable 9 10 professional community at the time the services are provided. 9 11 Health care services provided through in=person consultations 9 12 or through telehealth shall be treated as equivalent services 9 13 for the purposes of coverage. 9 14 The provision is not to be interpreted as preventing a 9 15 third=party payment provider from imposing deductibles or 9 16 copayment or coinsurance requirements for a health care service 9 17 provided through telehealth if the deductible, copayment, or 9 18 coinsurance does not exceed the deductible, copayment, or 9 19 coinsurance applicable to an in=person consultation for the 9 20 same health care service. The bill provides that a third=party 9 21 payment provider shall not impose annual or lifetime maximums 9 22 on coverage of telehealth unless the annual or lifetime maximum 9 23 applies in the aggregate to all items and services under the 9 24 contract, policy, or plan. 9 25 The bill provides that the Code section is not to be 9 26 interpreted to require a third=party payment provider to 9 27 provide reimbursement for a health care service that is not 9 28 a covered benefit or to reimburse a health care professional 9 29 who is not a covered provider under the contract, policy, 9 30 or plan; to preclude a third=party payment provider from 9 31 performing utilization review to determine the appropriateness 9 32 of telehealth in the delivery of health care services if the 9 33 determination is made in the same manner as those regarding 9 34 the same health care service when delivered in person; or to 9 35 authorize a third=party payment provider to require the use of 10 1 telehealth when the health care professional determines use of 10 2 telehealth is not appropriate. 10 3 The Code section applies to individual or group accident and 10 4 sickness insurance providing coverage on an expense=incurred 10 5 basis; an individual or group hospital or medical service 10 6 contract issued pursuant to Code chapter 509, 514, or 514A; an 10 7 individual or group health maintenance organization contract 10 8 regulated under Code chapter 514B; an individual or group 10 9 Medicare supplemental policy, unless coverage pursuant to such 10 10 policy is preempted by federal law; and a plan established 10 11 pursuant to Code chapter 509A for public employees. The 10 12 provision does not apply to accident=only, specified disease, 10 13 short=term hospital or medical, hospital confinement indemnity, 10 14 credit, dental, vision, long=term care, basic hospital, 10 15 and medical=surgical expense coverage as defined by the 10 16 commissioner, disability income insurance coverage, coverage 10 17 issued as a supplement to liability insurance, workers' 10 18 compensation or similar insurance, or automobile medical 10 19 payment insurance. 10 20 The commissioner of insurance is directed to adopt rules 10 21 pursuant to Code chapter 17A as necessary to administer the 10 22 provision. 10 23 The bill directs the department of human services to 10 24 adopt rules to provide for coverage of telehealth under the 10 25 Medicaid program. The rules are to provide that in=person 10 26 contact between a health care professional and a patient 10 27 is not required as a prerequisite for payment for services 10 28 appropriately provided through telehealth in accordance 10 29 with generally accepted health care practices and standards 10 30 prevailing in the applicable professional community at the 10 31 time the services are provided. Health care services provided 10 32 through in=person consultations or through telehealth are 10 33 to be treated as equivalent services for the purposes of 10 34 reimbursement. 10 35 The bill directs the department of public health, in 11 1 collaboration with the department of human services and the 11 2 insurance division of the department of commerce, to convene 11 3 and conduct a study regarding options for implementing 11 4 telehealth and telehealth coverage and reimbursement. The 11 5 department of public health is directed to submit a final 11 6 report of its findings and recommendations to the governor and 11 7 the general assembly by December 15, 2015. LSB 1423YH (5) 86 pf/rj
