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Iowa

Iowa

Click here to download the COVID-19 Virtual Visit & Reimbursement Guide for Iowa (updated 4/30/21)

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)

Expanded teledentistry policy:

  • Codes D9995 & D0140 can be billed, effective 3/13/20

 

>> CONTINUE TO IOWA: COMMERCIAL PAYER POLICIES

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