Iowa Code 514C.34 – Health care services delivered by telehealth — coverage
Current as of: 2024 | Check for updates
|
Other versions
Terms Used In Iowa Code 514C.34
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- Contract: A legal written agreement that becomes binding when signed.
- following: when used by way of reference to a chapter or other part of a statute mean the next preceding or next following chapter or other part. See Iowa Code 4.1
- Oversight: Committee review of the activities of a Federal agency or program.
- person: means individual, corporation, limited liability company, government or governmental subdivision or agency, business trust, estate, trust, partnership or association, or any other legal entity. See Iowa Code 4.1
- state: when applied to the different parts of the United States, includes the District of Columbia and the territories, and the words "United States" may include the said district and territories. See Iowa Code 4.1
514C.34 Health care services delivered by telehealth — coverage.
1. As used in this section, unless the context otherwise requires:
a. “”Covered person”” means the same as defined in § 514J.102.
b. “”Facility”” means the same as defined in § 514J.102.
c. “”Health care professional”” means the same as defined in § 514J.102.
d. “”Health care services”” means the same as defined in § 514J.102 and includes services for mental health conditions, illnesses, injuries, or diseases.
e. “”Health carrier”” means the same as defined in § 514J.102.
f. “”Telehealth”” means the delivery of health care services through the use of real-time interactive audio and video, or other real-time interactive electronic media, regardless of where the health care professional and the covered person are each located. “”Telehealth”” does not include the delivery of health care services delivered solely through an audio-only telephone, electronic mail message, or facsimile transmission.
2. Notwithstanding the uniformity of treatment requirements of § 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth.
3. a. Health care services that are delivered by telehealth must be appropriate and
delivered in accordance with applicable law and generally accepted health care practices and standards prevailing at the time the health care services are provided, including all rules adopted by the appropriate professional licensing board, pursuant to chapter 147, having oversight of the health care professional providing the health care services.
b. A health carrier shall not exclude a health care professional who provides services
for mental health conditions, illnesses, injuries, or diseases and who is physically located out-of-state from participating as a provider, via telehealth, under a policy, plan, or contract offered by the health carrier in the state if all of the following requirements are met:
(1) The health care professional is licensed in this state by the appropriate professional licensing board and is able to deliver health care services for mental health conditions, illnesses, injuries, or diseases via telehealth in compliance with paragraph “”a””.
(2) The health care professional is able to satisfy the same criteria that the health carrier uses to qualify a health care professional who is located in the state, and who holds the same license as the out-of-state professional, to participate as a provider, via telehealth, under a policy, plan, or contract offered by the health carrier in the state.
4. a. A health carrier shall reimburse a health care professional and a facility for health
care services provided by telehealth to a covered person for a mental health condition, illness, injury, or disease on the same basis and at the same rate as the health carrier would apply to the same health care services for a mental health condition, illness, injury, or disease provided in person to a covered person by the health care professional or the facility.
b. As a condition of reimbursement pursuant to paragraph “”a””, a health carrier shall not
require that an additional health care professional be located in the same room as a covered person while health care services for a mental health condition, illness, injury, or disease are provided via telehealth by another health care professional to the covered person.
5. This section applies to the following classes of third-party payment provider policies, contracts, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2019:
a. Individual or group accident and sickness insurance providing coverage on an
expense-incurred basis.
b. An individual or group hospital or medical service contract issued pursuant to chapter
509, 514, or 514A.
c. An individual or group health maintenance organization contract regulated under chapter 514B.
d. A plan established pursuant to chapter 509A for public employees.
6. This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the
§514C.34, SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES 2
1. As used in this section, unless the context otherwise requires:
a. “”Covered person”” means the same as defined in § 514J.102.
b. “”Facility”” means the same as defined in § 514J.102.
c. “”Health care professional”” means the same as defined in § 514J.102.
d. “”Health care services”” means the same as defined in § 514J.102 and includes services for mental health conditions, illnesses, injuries, or diseases.
e. “”Health carrier”” means the same as defined in § 514J.102.
f. “”Telehealth”” means the delivery of health care services through the use of real-time interactive audio and video, or other real-time interactive electronic media, regardless of where the health care professional and the covered person are each located. “”Telehealth”” does not include the delivery of health care services delivered solely through an audio-only telephone, electronic mail message, or facsimile transmission.
2. Notwithstanding the uniformity of treatment requirements of § 514C.6, a policy, contract, or plan providing for third-party payment or prepayment of health or medical expenses shall not discriminate between coverage benefits for health care services that are provided in person and the same health care services that are delivered through telehealth.
3. a. Health care services that are delivered by telehealth must be appropriate and
delivered in accordance with applicable law and generally accepted health care practices and standards prevailing at the time the health care services are provided, including all rules adopted by the appropriate professional licensing board, pursuant to chapter 147, having oversight of the health care professional providing the health care services.
b. A health carrier shall not exclude a health care professional who provides services
for mental health conditions, illnesses, injuries, or diseases and who is physically located out-of-state from participating as a provider, via telehealth, under a policy, plan, or contract offered by the health carrier in the state if all of the following requirements are met:
(1) The health care professional is licensed in this state by the appropriate professional licensing board and is able to deliver health care services for mental health conditions, illnesses, injuries, or diseases via telehealth in compliance with paragraph “”a””.
(2) The health care professional is able to satisfy the same criteria that the health carrier uses to qualify a health care professional who is located in the state, and who holds the same license as the out-of-state professional, to participate as a provider, via telehealth, under a policy, plan, or contract offered by the health carrier in the state.
4. a. A health carrier shall reimburse a health care professional and a facility for health
care services provided by telehealth to a covered person for a mental health condition, illness, injury, or disease on the same basis and at the same rate as the health carrier would apply to the same health care services for a mental health condition, illness, injury, or disease provided in person to a covered person by the health care professional or the facility.
b. As a condition of reimbursement pursuant to paragraph “”a””, a health carrier shall not
require that an additional health care professional be located in the same room as a covered person while health care services for a mental health condition, illness, injury, or disease are provided via telehealth by another health care professional to the covered person.
5. This section applies to the following classes of third-party payment provider policies, contracts, or plans delivered, issued for delivery, continued, or renewed in this state on or after January 1, 2019:
a. Individual or group accident and sickness insurance providing coverage on an
expense-incurred basis.
b. An individual or group hospital or medical service contract issued pursuant to chapter
509, 514, or 514A.
c. An individual or group health maintenance organization contract regulated under chapter 514B.
d. A plan established pursuant to chapter 509A for public employees.
6. This section shall not apply to accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, Medicare supplement, long-term care, basic hospital and medical-surgical expense coverage as defined by the
§514C.34, SPECIAL HEALTH AND ACCIDENT INSURANCE COVERAGES 2
commissioner, disability income insurance coverage, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, or automobile medical payment insurance.
7. The commissioner of insurance may adopt rules pursuant to chapter 17A as necessary to administer this section.
2018 Acts, ch 1055, §1; 2021 Acts, ch 177, §20 – 24; 2022 Acts, ch 1131, §76 – 78
Referred to in §280A.1, 514C.35
2021 amendments to section apply to health care services for a mental health condition, illness, injury, or disease provided by a health care professional or a facility to a covered person by telehealth on or after January 1, 2021; 2021 Acts, ch 177, §24
For applicability of 2022 amendment to subsection 3 to health carriers that deliver, issue for delivery, continue, or renew a policy, contract, or plan in this state, see 2022 Acts, ch 1131, §78; 2023 Acts, ch 66, §157, 159, 160