Bill Text: IA SSB1168 | 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: Greene, Garrett, and Quirmbach. [SSB1168 Detail]

Download: Iowa-2017-SSB1168-Introduced.html

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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.
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. “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.
b. “Telehealth” means the use of real-time, interactive
audio or video telecommunications or electronic technology,
remote patient monitoring, or store-and-forward telehealth 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. 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 services
provided as telehealth if the services would be covered if
provided in-person. If coverage is provided for telehealth
under this section, coverage shall not require in-person
contact between a health care professional and a patient as a
prerequisite for payment for services appropriately provided
through telehealth in accordance with generally accepted health
care practices and standards prevailing in the applicable
professional community at the time the services are provided.
If coverage is provided under this section, health care
services provided through in-person consultations or through
telehealth shall be treated as equivalent services for the
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S.F. _____
purposes of coverage.
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 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
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
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S.F. _____
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
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 and shall not require in-person
contact between a health care professional and a patient as a
prerequisite for payment for services appropriately provided
through telehealth in accordance with generally accepted health
care practices and standards prevailing in the applicable
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S.F. _____
professional community at the time the services are provided.
Health care services provided through in-person consultations
or through telehealth shall be treated as equivalent services
for the purposes of coverage.
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 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
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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