Bill Text: IA SSB1160 | 2017-2018 | 87th General Assembly | Introduced

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Bill Title: A bill for an act relating to health insurance coverage for telehealth.

Spectrum: Committee Bill

Status: (N/A - Dead) 2017-02-23 - Subcommittee Meeting: 02/27/2017 4:30PM Senate Lobbyist Lounge [SSB1160 Detail]

Download: Iowa-2017-SSB1160-Introduced.html

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Senate Study Bill 1160 - Introduced
SENATE FILE _____
BY (PROPOSED COMMITTEE ON
HUMAN RESOURCES BILL BY
CHAIRPERSON SEGEBART)
A BILL FOR
An Act relating to health insurance coverage for telehealth.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA:
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Section 1. NEW SECTION . 514C.31 Telehealth coverage.
1. As used in this section, unless the context otherwise
requires:
a. “Distant site” means the site at which a health care
professional delivering services through telehealth is located
at the time the telehealth service is provided.
b. “Health care professional” means a person who is
licensed, certified, or otherwise authorized or permitted by
the law of this state to administer health care in the ordinary
course of business or in the practice of a profession, or
in an approved education or training program, as long as the
person is operating within the person’s professional scope of
practice.
c. “Originating site” means the site at which a patient
is located at the time services are provided by a health care
professional through telehealth.
d. “Professional relationship” means a relationship
established between a health care professional and a patient
that meets any of the following conditions:
(1) The health care professional has previously conducted
an in-person examination of the patient and is available to
provide appropriate follow-up health care services, when
necessary, at medically necessary intervals.
(2) The health care professional personally knows the
patient and the patient’s relevant health status through an
ongoing personal or professional relationship, and is available
to provide appropriate follow-up health care services, when
necessary, at medically necessary intervals.
(3) The health care services provided via telehealth are
provided by a health care professional in consultation with,
or upon referral by, another health care professional who has
an ongoing relationship with the patient and who has agreed to
supervise the patient’s treatment, including follow-up health
care services.
(4) An on-call or cross-coverage arrangement exists between
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the health care professional and the patient’s regular treating
health care professional.
(5) A professional relationship exists in other
circumstances as defined by rule of the professional board
having jurisdiction over the health care professional.
e. “Remote patient monitoring” means using telehealth to
enable the health care professional to monitor and manage a
patient’s medical, functional, and environmental needs if such
needs can be appropriately met through telehealth intervention.
f. “Store-and-forward technology” means the asynchronous
communications between a patient and a health care professional
or between a referring health care professional and a medical
specialist at a distant site, supported by telecommunications
technology for the purpose of diagnosis, consultation,
treatment, or therapeutic assistance in the provision of
care to the patient, including the transferring of medical
data from one site to another through the use of a camera
or similar device that records or stores an image that is
sent or forwarded via telecommunications to another site for
consultation.
g. “Telehealth” includes the use of real-time, interactive
audio or video telecommunications or electronic technology,
remote patient monitoring, or store-and-forward technology by
a health care professional to deliver health care services
to a patient within the scope of practice of the health care
professional, for the purposes of diagnosis, consultation,
treatment, transfer of medical data, or exchange of medical
education information. “Telehealth” does not include an
audio-only telephone call, electronic mail message, or
facsimile transmission.
2. a. Notwithstanding the uniformity of treatment
requirements of section 514C.6, a contract, policy, or plan
providing for third-party payment or prepayment for health,
medical, or surgical coverage benefits shall provide coverage
for health care services provided as telehealth if the services
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would be covered if provided in person. Health care services
provided in-person or through telehealth shall be treated as
equivalent services for the purposes of coverage.
b. Telehealth coverage shall only be provided pursuant
to paragraph “a” if the health care professional providing
telehealth at a distant site to a patient located at an
originating site in this state has a professional relationship
with the patient. However, a health care professional shall
not be required to have a professional relationship with a
patient if either of the following applies:
(1) In an emergency where the life or health of the patient
is in danger or imminent danger.
(2) The health care professional is only providing
information of a generic nature, not specific to the individual
patient.
3. If health care coverage is provided for telehealth under
this section, all of the following shall apply:
a. This section shall not be interpreted as preventing
a third-party payment provider from imposing deductibles or
copayment or coinsurance requirements for a health care service
provided through telehealth if the deductible, copayment, or
coinsurance does not exceed the deductible, copayment, or
coinsurance applicable to in-person consultation for the same
health care service. A third-party payment provider shall not
impose annual or lifetime maximums on coverage of telehealth
unless the annual or lifetime maximum applies in the aggregate
to all items and health care services under the contract,
policy, or plan.
b. This section shall not be interpreted to require a
third-party payment provider to provide reimbursement for
a health care service that is not a covered benefit or to
reimburse a health care professional who is not a covered
provider under the contract, policy, or plan.
c. This section shall not be interpreted to preclude a
third-party payment provider from performing utilization review
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to determine the appropriateness of telehealth in the delivery
of health care services if the determination is made in the
same manner as those regarding the same health care service
when delivered in person.
d. This section shall not be interpreted to authorize a
third-party payment provider to require the use of telehealth
when the health care professional determines use of telehealth
is not appropriate.
e. The provisions of this section shall apply to all of the
following classes of third-party payment provider contracts,
policies, or plans delivered, issued for delivery, continued,
or renewed in this state on or after January 1, 2018:
(1) Individual or group accident and sickness insurance
providing coverage on an expense-incurred basis.
(2) An individual or group hospital or medical service
contract issued pursuant to chapter 509, 514, or 514A.
(3) An individual or group health maintenance organization
contract regulated under chapter 514B.
(4) An individual or group Medicare supplemental policy,
unless coverage pursuant to such policy is preempted by federal
law.
(5) A plan established pursuant to chapter 509A for public
employees.
f. This section shall not apply to accident-only, specified
disease, short-term hospital or medical, hospital confinement
indemnity, credit, dental, vision, long-term care, basic
hospital, and medical-surgical expense coverage as defined
by the commissioner, disability income insurance coverage,
coverage issued as a supplement to liability insurance,
workers’ compensation or similar insurance, or automobile
medical payment insurance.
4. The commissioner of insurance shall adopt rules pursuant
to chapter 17A as necessary to administer this section.
EXPLANATION
The inclusion of this explanation does not constitute agreement with
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the explanation’s substance by the members of the general assembly.
This bill relates to health insurance coverage for
telehealth.
The bill provides definitions relative to telehealth
and requires that a contract, policy, or plan providing for
third-party payment or prepayment for health, medical, or
surgical coverage benefits cover telehealth. On or after
January 1, 2018, the contract, policy, or plan shall not
deny coverage of telehealth services on the basis that the
services are provided via telehealth if the services would be
covered if provided in person. Health care services provided
through in-person consultations or through telehealth shall be
treated as equivalent services for the purposes of coverage.
Telehealth coverage is only to be provided if the health
care professional providing telehealth at a distant site to
a patient located at an originating site in this state has a
professional relationship with the patient. This requirement
does not apply, however, in an emergency where the life or
health of the patient is in danger or imminent danger; or if
the health care professional is only providing information of a
generic nature, not specific to the individual patient.
The provision is not to be interpreted as preventing a
third-party payment provider from imposing deductibles or
copayment or coinsurance requirements for a health care service
provided through telehealth if the deductible, copayment, or
coinsurance does not exceed the deductible, copayment, or
coinsurance applicable to an in-person consultation for the
same health care service. The bill provides that a third-party
payment provider shall not impose annual or lifetime maximums
on coverage of telehealth unless the annual or lifetime maximum
applies in the aggregate to all items and health care services
under the contract, policy, or plan.
The bill provides that the Code section is not to be
interpreted to require a third-party payment provider to
provide reimbursement for a health care service that is not
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a covered benefit or to reimburse a health care professional
who is not a covered provider under the contract, policy,
or plan; to preclude a third-party payment provider from
performing utilization review to determine the appropriateness
of telehealth in the delivery of health care services if the
determination is made in the same manner as those regarding
the same health care service when delivered in person; or to
authorize a third-party payment provider to require the use of
telehealth when the health care professional determines use of
telehealth is not appropriate.
The bill specifies the types of third-party payment provider
contracts, policies, or plans to which the bill applies and
those exempt from its application.
The commissioner of insurance is directed to adopt rules
pursuant to Code chapter 17A as necessary to administer the
bill.
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