Bill Text: IA SSB1168 | 2017-2018 | 87th General Assembly | Introduced
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: Greene, Garrett, and Quirmbach. [SSB1168 Detail]
Download: Iowa-2017-SSB1168-Introduced.html
Senate
Study
Bill
1168
-
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.
1
BE
IT
ENACTED
BY
THE
GENERAL
ASSEMBLY
OF
THE
STATE
OF
IOWA:
2
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Section
1.
NEW
SECTION
.
514C.31
Telehealth
coverage.
1
1.
As
used
in
this
section,
unless
the
context
otherwise
2
requires:
3
a.
“Health
care
professional”
means
a
person
who
is
4
licensed,
certified,
or
otherwise
authorized
or
permitted
by
5
the
law
of
this
state
to
administer
health
care
in
the
ordinary
6
course
of
business
or
in
the
practice
of
a
profession,
or
7
in
an
approved
education
or
training
program,
as
long
as
the
8
person
is
operating
within
the
person’s
professional
scope
of
9
practice.
10
b.
“Telehealth”
means
the
use
of
real-time,
interactive
11
audio
or
video
telecommunications
or
electronic
technology,
12
remote
patient
monitoring,
or
store-and-forward
telehealth
by
13
a
health
care
professional
to
deliver
health
care
services
14
to
a
patient
within
the
scope
of
practice
of
the
health
care
15
professional,
for
the
purposes
of
diagnosis,
consultation,
16
treatment,
transfer
of
medical
data,
or
exchange
of
medical
17
education
information.
“Telehealth”
does
not
include
an
18
audio-only
telephone
call,
electronic
mail
message,
or
19
facsimile
transmission.
20
2.
Notwithstanding
the
uniformity
of
treatment
requirements
21
of
section
514C.6,
a
contract,
policy,
or
plan
providing
for
22
third-party
payment
or
prepayment
for
health,
medical,
or
23
surgical
coverage
benefits
shall
provide
coverage
for
services
24
provided
as
telehealth
if
the
services
would
be
covered
if
25
provided
in-person.
If
coverage
is
provided
for
telehealth
26
under
this
section,
coverage
shall
not
require
in-person
27
contact
between
a
health
care
professional
and
a
patient
as
a
28
prerequisite
for
payment
for
services
appropriately
provided
29
through
telehealth
in
accordance
with
generally
accepted
health
30
care
practices
and
standards
prevailing
in
the
applicable
31
professional
community
at
the
time
the
services
are
provided.
32
If
coverage
is
provided
under
this
section,
health
care
33
services
provided
through
in-person
consultations
or
through
34
telehealth
shall
be
treated
as
equivalent
services
for
the
35
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_____
purposes
of
coverage.
1
3.
If
health
care
coverage
is
provided
for
telehealth
under
2
this
section,
all
of
the
following
shall
apply:
3
a.
This
section
shall
not
be
interpreted
as
preventing
4
a
third-party
payment
provider
from
imposing
deductibles
or
5
copayment
or
coinsurance
requirements
for
a
health
care
service
6
provided
through
telehealth
if
the
deductible,
copayment,
or
7
coinsurance
does
not
exceed
the
deductible,
copayment,
or
8
coinsurance
applicable
to
in-person
consultation
for
the
same
9
health
care
service.
A
third-party
payment
provider
shall
not
10
impose
annual
or
lifetime
maximums
on
coverage
of
telehealth
11
unless
the
annual
or
lifetime
maximum
applies
in
the
aggregate
12
to
all
items
and
services
under
the
contract,
policy,
or
plan.
13
b.
This
section
shall
not
be
interpreted
to
require
a
14
third-party
payment
provider
to
provide
reimbursement
for
15
a
health
care
service
that
is
not
a
covered
benefit
or
to
16
reimburse
a
health
care
professional
who
is
not
a
covered
17
provider
under
the
contract,
policy,
or
plan.
18
c.
This
section
shall
not
be
interpreted
to
preclude
a
19
third-party
payment
provider
from
performing
utilization
review
20
to
determine
the
appropriateness
of
telehealth
in
the
delivery
21
of
health
care
services
if
the
determination
is
made
in
the
22
same
manner
as
those
regarding
the
same
health
care
service
23
when
delivered
in
person.
24
d.
This
section
shall
not
be
interpreted
to
authorize
a
25
third-party
payment
provider
to
require
the
use
of
telehealth
26
when
the
health
care
professional
determines
use
of
telehealth
27
is
not
appropriate.
28
e.
The
provisions
of
this
section
shall
apply
to
all
of
the
29
following
classes
of
third-party
payment
provider
contracts,
30
policies,
or
plans
delivered,
issued
for
delivery,
continued,
31
or
renewed
in
this
state
on
or
after
January
1,
2018:
32
(1)
Individual
or
group
accident
and
sickness
insurance
33
providing
coverage
on
an
expense-incurred
basis.
34
(2)
An
individual
or
group
hospital
or
medical
service
35
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contract
issued
pursuant
to
chapter
509,
514,
or
514A.
1
(3)
An
individual
or
group
health
maintenance
organization
2
contract
regulated
under
chapter
514B.
3
(4)
An
individual
or
group
Medicare
supplemental
policy,
4
unless
coverage
pursuant
to
such
policy
is
preempted
by
federal
5
law.
6
(5)
A
plan
established
pursuant
to
chapter
509A
for
public
7
employees.
8
f.
This
section
shall
not
apply
to
accident-only,
specified
9
disease,
short-term
hospital
or
medical,
hospital
confinement
10
indemnity,
credit,
dental,
vision,
long-term
care,
basic
11
hospital,
and
medical-surgical
expense
coverage
as
defined
12
by
the
commissioner,
disability
income
insurance
coverage,
13
coverage
issued
as
a
supplement
to
liability
insurance,
14
workers’
compensation
or
similar
insurance,
or
automobile
15
medical
payment
insurance.
16
4.
The
commissioner
of
insurance
shall
adopt
rules
pursuant
17
to
chapter
17A
as
necessary
to
administer
this
section.
18
EXPLANATION
19
The
inclusion
of
this
explanation
does
not
constitute
agreement
with
20
the
explanation’s
substance
by
the
members
of
the
general
assembly.
21
This
bill
relates
to
health
insurance
coverage
for
22
telehealth.
23
The
bill
provides
definitions
relative
to
telehealth
24
and
requires
that
a
contract,
policy,
or
plan
providing
for
25
third-party
payment
or
prepayment
for
health,
medical,
or
26
surgical
coverage
benefits
cover
telehealth.
On
or
after
27
January
1,
2018,
the
contract,
policy,
or
plan
shall
not
28
deny
coverage
of
telehealth
services
on
the
basis
that
the
29
services
are
provided
via
telehealth
if
the
services
would
be
30
covered
if
provided
in
person
and
shall
not
require
in-person
31
contact
between
a
health
care
professional
and
a
patient
as
a
32
prerequisite
for
payment
for
services
appropriately
provided
33
through
telehealth
in
accordance
with
generally
accepted
health
34
care
practices
and
standards
prevailing
in
the
applicable
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professional
community
at
the
time
the
services
are
provided.
1
Health
care
services
provided
through
in-person
consultations
2
or
through
telehealth
shall
be
treated
as
equivalent
services
3
for
the
purposes
of
coverage.
4
The
provision
is
not
to
be
interpreted
as
preventing
a
5
third-party
payment
provider
from
imposing
deductibles
or
6
copayment
or
coinsurance
requirements
for
a
health
care
service
7
provided
through
telehealth
if
the
deductible,
copayment,
or
8
coinsurance
does
not
exceed
the
deductible,
copayment,
or
9
coinsurance
applicable
to
an
in-person
consultation
for
the
10
same
health
care
service.
The
bill
provides
that
a
third-party
11
payment
provider
shall
not
impose
annual
or
lifetime
maximums
12
on
coverage
of
telehealth
unless
the
annual
or
lifetime
maximum
13
applies
in
the
aggregate
to
all
items
and
services
under
the
14
contract,
policy,
or
plan.
15
The
bill
provides
that
the
Code
section
is
not
to
be
16
interpreted
to
require
a
third-party
payment
provider
to
17
provide
reimbursement
for
a
health
care
service
that
is
not
18
a
covered
benefit
or
to
reimburse
a
health
care
professional
19
who
is
not
a
covered
provider
under
the
contract,
policy,
20
or
plan;
to
preclude
a
third-party
payment
provider
from
21
performing
utilization
review
to
determine
the
appropriateness
22
of
telehealth
in
the
delivery
of
health
care
services
if
the
23
determination
is
made
in
the
same
manner
as
those
regarding
24
the
same
health
care
service
when
delivered
in
person;
or
to
25
authorize
a
third-party
payment
provider
to
require
the
use
of
26
telehealth
when
the
health
care
professional
determines
use
of
27
telehealth
is
not
appropriate.
28
The
bill
specifies
the
types
of
third-party
payment
provider
29
contracts,
policies,
or
plans
to
which
the
bill
applies
and
30
those
exempt
from
its
application.
31
The
commissioner
of
insurance
is
directed
to
adopt
rules
32
pursuant
to
Code
chapter
17A
as
necessary
to
administer
the
33
bill.
34
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