Iowa Telehealth Bill Could Advance ‘Pay for Quality’

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By Stephen Joyce

Iowa Gov. Kim Reynolds (R) is expected to sign legislation extending health insurance coverage to telehealth, enhancing integrated care and assisting the move toward quality health-care delivery.

The state Senate approved legislation March 20 by a 49-0 vote prohibiting an insurance policy, contract, or plan from discriminating between health-care services delivered in person and through telehealth, or real-time interactive communication between a patient and practitioner at a distant site. The bill passed the state House Feb. 26 by a 98-0 vote, and legislators and lobbyists told Bloomberg Law the governor will likely sign the bill into law.

If enacted Iowa will become the 33rd state to enact a law prohibiting insurance coverage from covering in-person care but not telehealth, according to the American Telemedicine Association. Henry Marquard, Davenport, Iowa-based Genesis Health System government and community affairs officer, told Bloomberg Law the move will provide Iowans with better access to quality care, reduce patient and therefore insurance medical costs, and allow doctors to treat patients in a more efficient manner. It can also help the push away from fee for service, when medical providers get paid for patients simply showing up for an appointment, and toward delivering quality care efficiently, Marquard said. “This is a huge, huge deal,” he said.

Though fees for consulting with individual patients could be reduced, doctors may recover or even exceed those financial losses by providing care to more patients, with whom they’ll be able to spend more time, he said. The bill doesn’t require doctors to treat patients using telehealth, but instead gives them options to do so. “It just provides more choice, more convenience and more access to available health-care providers,” Latoya Thomas, American Telemedicine Association state policy resource center director, told Bloomberg Law.

While telehealth, the word used in the Iowa bill, and telemedicine are sometimes used interchangeably, telehealth generally refers to a more broad set of health-care services.

Determining Coverage

State law requirements help determine which telehealth services will be covered by insurance in a particular state. Two states, Alaska and Arizona, elected to require insurers to cover and reimburse a more narrow set of health-care services. Insurance companies, too, may interpret their obligations under the laws differently.

Insurer Medica Holding Co., which is active in the Iowa market, generally uses a Minnesota Department of Human Services provider assurance statement for telemedicine for determining when a telehealth service might be eligible for coverage, Greg Bury, Medica spokesman, told Bloomberg Law in an email. The company then applies any state-specific benefits or coverage requirements to determine coverage policies, he said.

Insurers, providers, and patients are becoming more comfortable with the use of telehealth services as more health providers adopt their use and the array of telehealth services expands. Telehealth helps doctors integrate care for patients because specialists can help treat a patient, even if that specialist is thousands of miles away. Access to mental health services has particularly increased because of telehealth, Marquard said. But there is “still a lack of clarity as to how claims are being processed” as well as access to some telehealth services that are covered in insurance policies, Thomas said.

The legislation, HF 2305, was closely watched by health associations, insurers, and health-care providers, and no opposition was indicated on lobbying declarations.

Telemedicine is becoming more popular in Iowa, particularly in rural parts of the state, state Rep. Guy Vander Linden (R), a floor manager for the legislation, told Bloomberg Law. If enacted, the bill should lower costs for patients and insurance companies because telehealth appointments are typically less expensive than an in-person visit to the doctor, he said. A chief benefit of telehealth is its ability to increase access to care, Scott McIntyre, Iowa Hospital Association spokesman, told Bloomberg Law in an email.

Under the Iowa bill, health-care services delivered by telehealth must be “appropriate” and delivered in accordance with applicable law and professional licensing board rules prevailing at the time the health-care services are provided, the bill said. It would cover plans for public employees and individual or group accident and sickness insurance providing coverage on an expense-incurred basis or through a health maintenance organization contract.

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