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Commercial Payer Policies

*proposed update* Prohibit private payers from excluding out of state providers from participating, via telehealth, as providers in Iowa if the provider is licensed in Iowa and able to satisfy the same criteria that the health carrier uses to qualify in-state providers who hold the same license who participate via telehealth in the health plan.

*proposed update* PAYMENT PARITY: Several pending bills discuss telehealth reimbursement parity: Private payer reimbursement parity is detailed in SSB1276, HSB278, HF893, and HF784. It is also in HF294 as mental health telehealth reimbursement parity. SF92 stipulates reimbursement parity for private payers and for the Medical Assistance program.

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”

EXPIRED: Temporary COVID-19 Policies (IA Commercial Payers)

EXPIRED JUNE 30: WAIVED REQUIREMENTS: The provision excluding audio-only telehealth is temporarily suspended

EXPIRED JUNE 30: 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)