Great Plains Telehealth Resource & Assistance Center : States : Iowa

Medicaid Policies

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

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, FQHCs can serve as distant sites
- Originating sites usually use HCPCS code Q3014 for facility fee -- FQHCs and RHCs do not bill Q3014 as a separate service because reimbursement for the related costs would occur through the annual cost settlement process.

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

Temporary COVID-19 Policies (IA Medicaid)

SERVICES NEWLY ELIGIBLE FOR TELEHEALTH:

Behavioral health, teledentistry, PT, OT, ST
Audio-only telehealth services
Codes established for REMOTE MONITORING of physiologic parameters, remote physiologic monitoring treatment management services

WAIVED REQUIREMENTS: “Established patient” requirement suspended

OTHER TEMPORARY IA MEDICAID POLICIES:

Providers can provide telehealth from their home

For medicaid managed care & fee for service:

Redefines “distant” and “originating” sites as locations of provider and patient (can provide and receive services from home)
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)

Teledentistry & managed care & fee for service:

Included in expanded list of services and providers who can bill for them
Two codes (D9995 & D0140)

Commercial Payer Policies

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.”

PAYMENT PARITY: Not explicitly required

PENDING LEGISLATION: A bill currently in senate, HF 2192, would amend the definition of telehealth to include all electronic interactive services provided regardless of the physical locations of the patient and provider (distant and originating sites). HF 2192 also establishes payment parity by requiring health carriers to reimburse providers for services in the same way that they would reimburse for the same services provided in-person.

Temporary COVID-19 Policies (IA Commercial Payers)

WAIVED REQUIREMENTS: The provision excluding audio-only telehealth is temporarily suspended

OTHER TEMPORARY IA COMMERCIAL PAYER POLICIES:

Medically necessary services delivered via telehealth must be reimbursed on the same basis and at the same rate as the health carrier would apply to the same health care services delivered in person (payment parity)

Medical Board Policies

TELEMEDICINE DEFINITION: Telemedicine includes asynchronous store and forward, remote monitoring, and real-time interactive services (including teleradiology and telepathology). Telemedicine does not include audio-only, email, or fax.

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

Telemedicine abortions are allowed

Iowa Professional Licensure Compacts

Interstate Medical Licensure Compact

Temporary COVID-19 Policies (IA Medical Board)

Out-of-state licensed practitioners can practice medicine/telemedicine in Iowa

Rules establishing preconditions/limitations/restrictions are suspended

The ban on audio-only telemedicine is suspended
The provision requiring face-to-face interaction with health care providers for certain residential and outpatient substance use disorder treatment services (Iowa Admin. Code rule 653-13.11 and rule 641-155.2) is suspended

Recent medical school graduates can seek emergency licenses

Criminal background check for initial licensure suspended

Physicians with lapsed/expired licenses can continue to practice

CME requirements temporarily suspended

Mid-Level Providers

Circumstance where standard of care may not require personal interview/examination: If the NP or PA has examined the patient in person

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”

IA license is not mandated for nurse in another compact state (eNLC)

Iowa Mid-Levels Professional Licensure Compacts

Enhanced Nurse Licensure Compact

NO Advanced Practice Registered Nurse Licensure Compact

Temporary COVID-19 Policies (IA Mid-Levels)

During the state of emergency, a current IA license is not required for nurses with licenses from other states

Granting emergency licenses for RNs, LPNs, APRNs who graduated within past 6 months

Suspending regulation prohibiting practice of PAs or nurses who have not yet gained initial license OR whose licenses have lapsed

Behavioral Health Providers

TELEMEDICINE 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, email, or fax.

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.”