Iowa Telehealth Policy
Iowa does not currently have an active PHE.
Iowa is an expansion state with full coverage parity & full Medicaid payment parity.
Iowa Medicaid-allowable originating sites receive facility fees, and include: Offices of physicians (02, 03), psychologists, social workers, behavioral health providers, habilitation services providers, and advanced registered nurse practitioners; hospitals, CAHs, FQHCs, RHCs, and school-based clinics.
Medicaid providers eligible to bill for telehealth include: Physicians, PAs, NPs, CNSs, CRNAs, nurse midwives, behavioral health providers, clinical psychologists, and FQHCs
Non-covered Medicaid services include: Group therapies, Targeted Case Management for high-risk pregnant women and infants or for individuals in need of long-term care services
Medicaid pays FQHCs a PPS rate and does not cover RPM services.
Iowa participates in the following interstate licensure compacts: Medical, eRN, PT, OT, and EMS (Psychology, Counseling, and ASLP pending)
RECIPROCITY: Providers must be licensed in Iowa to provide telehealth services to patients in Iowa
*signed by Governor June 16, 2021* For mental health services, the definition of telehealth is updated to: 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.
TELEHEALTH DEFINITION: “The delivery of health care services through the use of interactive audio and video." Telehealth does not audio-only, email, or fax communication.
SERVICE PARITY: Health policies “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.”
PAYMENT PARITY: “Health care services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of reimbursement.”
PREREQUISITES TO TELEHEALTH: In person contact is not required as a prerequisite for payment for telehealth services
REMOTE MONITORING: Not covered
ORIGINATING SITES: The offices of physicians (provider types 02, 03) and other practitioners (psychologists, social workers, behavioral health providers, habilitation services providers, and advanced registered nurse practitioners (ARNPs)), hospital, CAH, RHC, FQHC, CMHCs, AEAs and LEAs (newly added 2020)
DISTANT SITES: Physicians, NPs, PAs, nurse-midwives, CNSs, CRNAs, clinical psychologists, CSWs, behavioral health service providers (independent social workers, master social workers, marital and family therapists, mental health counselors, certified alcohol and drug counselors), FQHCs
ELIGIBLE PROVIDERS: Physicians, NPs, PAs, nurse-midwives, CNSs, CRNAs, clinical psychologists, CSWs, behavioral health service providers (independent social workers, master social workers, marital and family therapists, mental health counselors, certified alcohol and drug counselors), FQHCs
E-VISITS: Covered by Medicaid
FQHCs & RHCs:
- PROSPECTIVE PAYMENT SYSTEM (PPS) REIMBURSEMENT STRUCTURE
- FQHCs are paid based on the PPS/encounter rate if the service is PPS qualifying. This is generally the same as the reimbursement process for in-person services
- FQHCs and RHCs can serve as originating sites, and FQHCs can serve as distant sites
OTHER IA MEDICAID POLICIES:
Medicaid provider reimbursement: Generally, institutional types of providers such as hospitals and nursing facilities are reimbursed on a cost-related basis, and practitioners such as physicians, dentists, optometrists, and similar providers are reimbursed on the basis of a fee schedule
*signed by Governor June 16, 2021* For mental health services, the definition of telehealth is updated to: 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.
TELEHEALTH DEFINITION: “The delivery of health care services through the use of interactive audio and video. Telehealth does not include the delivery of health care services through an audio-only telephone, electronic mail message, or facsimile transmission.”
DEFINITION OF HEALTH CARE PROFESSIONAL: “A physician or other health care practitioner licensed, accredited, registered, or certified to perform specified health care services consistent with state law.”
SERVICE PARITY: Health policies “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”
Providers must be licensed in Iowa to practice telemedicine
Physician-patient relationships may be established in person, via consultation with another provider, OR via telemedicine encounter
HIPAA-compliant technology must be used in telemedicine provision
*published rule May 18, 2022* NURSING BOARD: Adopt amendments governing minimum standards of practice for registered nurses (RNs) and licensed practical nurses (LPNs) who provide health care services through telehealth.
A doctor of medicine or osteopathic physician may not need to examine a patient in person if the patient has been examined in person by an NP or PA.
Iowa’s mandatory nurse licensure law implies that nurses can practice telemedicine: It states that care could be provided via “telephonic, electronic, or in person means”
Board of Physician Assistants: Establishes standards of practice for physician assistants who provide patient care through telemedicine. Establishes the standard of care and requires use of HIPAA-compliant technology, as well as imposes other requirements to ensure the patient's confidential health information is secure. The new rule aligns with the Board of Medicine rules governing telemedicine, which will ensure that physician assistants and their supervising physicians will operate under uniform standards and do not need to worry about any differing or potentially conflicting telemedicine standards when coordinating remote care.
*2021-22 proposed update* All medical licensing/certifying boards must amend or adopt rules to allow health professionals under their purview to provide telehealth services via audio-only communication.
*2021-22 proposed update* Several professional boards have proposed updated standards for tele-practice, including the Board of Psychology.
DEFINITION OF HEALTH CARE PROFESSIONALS: Defined in 514C.34 (Health care services delivered by telehealth - coverage) as “a physician or other health care practitioner licensed, accredited, registered, or certified to perform specified health care services consistent with state law.”
Delivery of telehealth services: “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 then appropriate professional licensing board.”
DIETETICS: The Board of Dietetics updated telehealth policies allowing licensed providers to offer dietetic services via telehealth if they meet practice requirements (must be audio-visual real-time interactive communication).
DENTAL/ORTHODONTIC PROVIDERS: The initial exam required before beginning orthodontic treatment can be fulfilled via telehealth.
*2021-22 proposed update* All medical licensing/certifying boards must amend or adopt rules to allow health professionals under their purview to provide telehealth services via audio-only communication.
*2021-22 proposed update* OCCUPATIONAL THERAPY: Adopt the occupational therapy interstate licensure compact (see SF463 and HB201)
*2021-22 proposed update* AUDIOLOGY/SPEECH LANGUAGE PATHOLOGY: Adopt the audiology and speech language pathology interstate licensure compact (see HF500 and HSB122).
*2021-22 proposed update* Several professional boards have proposed updated standards for tele-practice, including the Board of Psychology, the Board of Speech Pathology and Audiology, the Board of Physician Assistants, the Board of Hearing Aid Specialists, and the Department of Education (for guidance on telehealth in schools).
All Iowa DHS extended regulations remain active: Iowa DHS confirmed on 2/20/22 that the end of the statewide PHE does not impact current Medicaid telehealth flexibilities
Newly eligible services (behavioral, teledentistry, PT, OT, ST),
Audio-only telehealth allowed,
RPM covered,
Established patient requirement waived,Providers can do telehealth from their homes,
Premiums/cost-sharing obligations suspended,
Expanded list of services and providers who can bill for them (including, but not limited to, physicians, physician assistants, dentists, physical therapists, occupational therapists, speech therapists, home health, hospice, behavioral health and home and community-based services (HCBS) providers),
Expanded teledentistry policy
Iowa Policy Summary Sheet
PARTNER TELEHEALTH RESOURCE CENTERS
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant numbers U1UTH42525 and G01RH32157. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.