Iowa

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Iowa Medicaid Enterprise (IME)

Administrator

Iowa Dept. of Human Services

Regional Telehealth Resource Center

Great Plains Telehealth Resource Center

Medicaid Reimbursement

Live Video: Yes
Store-and-Forward: No
Remote Patient Monitoring: No

Private Payer Law

Law Exists: Yes
Payment Parity: Yes (mental health)

Professional Requirements

Licensure Compacts: IMLC, PTC, NLC, EMS, OT
Consent Requirements: Yes

Last updated 08/17/2021

Audio Only Delivery

Medicaid: COVID-19 Provider FAQs- Telehealth

STATUS: Active, through 60 days after PHE is lifted

Medicaid:  Informational Letter on Teledentistry

STATUS: Active

Medicaid 1915(c) Waiver:  Appendix K – Children’s Mental Health; AIDS; Elderly; Intellectual Disabilities Waiver; Persons w/ Physical Disabilities; Brain Injury; Health and Disability Waivers Combined

STATUS: Expired January 26, 2021; extended through Addendum

Medicaid 1915(c) Waiver:  Appendix K Extension – Children’s Mental Health; AIDS; Elderly; Intellectual Disabilities Waiver; Persons w/ Physical Disabilities; Brain Injury; Health and Disability Waivers Combined

STATUS: Active, expires no later than six months after the expiration of the PHE

Medicaid 1915(c) Waiver: Appendix K Extension – Children’s Mental Health; AIDS; Elderly; Intellectual Disabilities Waiver; Persons w/ Physical Disabilities; Brain Injury; Health and Disability Waivers Combined

STATUS: Active, expires six months after the expiration of the PHE

Last updated 08/17/2021

Cross State Licensing

Office Of the Governor:  Emergency Proclamation on Telehealth/Telemedicine

STATUS: Expired

Office of the Governor: Emergency Proclamation on Telehealth/Telemedicine

STATUS: Active, expires Sept. 19, 2021

Last updated 08/17/2021

Easing Prescribing Requirements

Office Of the Governor:  Emergency Proclamation on Telehealth/Telemedicine

STATUS: Expired

Office Of the Governor:  Emergency Proclamation on Telehealth/Telemedicine

STATUS: Expired

Office Of the Governor: Emergency Proclamation on Provision of Telehealth Services

STATUS: Expired

Office of the Governor: Emergency Proclamation on Provision of Telehealth Services

STATUS: Expired

Last updated 08/17/2021

Miscellaneous

No Reference Found

Last updated 08/17/2021

Originating Site

Medicaid: COVID-19 Provider FAQs- Telehealth

STATUS: Active, through 60 days after PHE is lifted

Medicaid:  Informational Letter on Billing Telehealth Services

STATUS: Active

Medicaid:  Informational Letter on Telehealth

STATUS: Active

Last updated 08/17/2021

Private Payer

Office OF the Governor:  Emergency Proclamation on Telehealth/Telemedicine

STATUS: Expired

Office of the Governor:  Emergency Proclamation on Telehealth/Telemedicine

STATUS: Expired

Last updated 08/17/2021

Provider Type

Medicaid: COVID-19 Provider FAQs- Telehealth

STATUS: Active, through 60 days after PHE is lifted

Medicaid: Informational Letter on Billable Telehealth Providers

STATUS: Active, until end of PHE

Medicaid:  Informational Letter on Teledentistry

STATUS: Active

Last updated 08/17/2021

Service Expansion

Medicaid: COVID-19 Provider FAQs- Telehealth

STATUS: Active, through 60 days after PHE is lifted

Medicaid:  Informational Letter on Billing Telehealth Services

STATUS: Active

Medicaid:  Informational Letter on Telehealth

STATUS: Active

Medicaid:  Informational Letter on Teledentistry

STATUS: Active

Medicaid 1915(c) Waiver:  Appendix K – Children’s Mental Health; AIDS; Elderly; Intellectual Disabilities Waiver; Persons w/ Physical Disabilities; Brain Injury; Health and Disability Waivers Combined

STATUS: Expired January 26, 2021; extended through Addendum

Medicaid 1915(c) Waiver:  Appendix K Extension – Children’s Mental Health; AIDS; Elderly; Intellectual Disabilities Waiver; Persons w/ Physical Disabilities; Brain Injury; Health and Disability Waivers Combined

STATUS: Active, expires no later than six months after the expiration of the PHE

Medicaid 1915(c) Waiver:  Appendix K Extension – Children’s Mental Health; AIDS; Elderly; Intellectual Disabilities Waiver; Persons w/ Physical Disabilities; Brain Injury; Health and Disability Waivers Combined

STATUS: Active, expires six months after the expiration of the PHE

Last updated 08/16/2021

Definitions

No Reference Found.

Last updated 08/16/2021

Email, Phone & Fax

Note that in almost all program-specific manuals, telephonic interpretive services are allowed.

SOURCE:  Iowa Dep. of Human Services.  Provider Manual.  Ch. III Provider Specific Policies.  Physician Services. July 1, 2014, p. 63 (Accessed Jan. 2021).  For other manuals, see:  Medicaid Provider Manual.  Provider Specific Manuals. (Accessed Aug. 2021).

Case management can occur by face-to-face contact, telephone, letter, email or fax.

SOURCE:  Iowa Dep. of Human Services.  Provider Manual.  Ch. III Provider Specific Policies.  Targeted Case Management. May 1, 2018, p. 10 (Accessed Aug.  2021).

Last updated 08/16/2021

Live Video

POLICY

An in-person contact between a health care professional and a patient is not required as a prerequisite for payment for otherwise-covered services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services are provided. Health care services provided through in-person consultations or through telehealth shall be treated as equivalent services for the purposes of reimbursement.

SOURCE: IA Admin Code Sec. 441, 78.55 (249A). (Accessed Aug. 2021).

Managed care plans in Iowa’s Healthy and Well Kids in Iowa (Hawki) program, may cover telehealth and telemonitoring services, but do not appear to be mandated.

SOURCE: IA Hawki Benefits. (Accessed Aug. 2021).  

Crisis Response Services and Subacute Mental Health Services.

Payment shall be made for time spent in face-to-face services with the member.  “Face-to-face” means services in-person or using telehealth in conformance with the federal Health Insurance Portability and Accountability Act (HIPAA) privacy rules.

SOURCE:  Iowa Dep. of Human Services.  Provider Manual.  Ch. III Provider Specific Policies.  Crisis Response Services, p. 3 & 19, May 1, 2018, p. 19; Subacute Mental Health Services.  May 1, 2018, p. 9. (Accessed Aug. 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


ELIGIBLE PROVIDERS

The following providers may serve as the distant site provider:

  • Physicians
  • Nurse Practitioners
  • Physician Assistants
  • Nurse-Midwives
  • Clinical Nurse Specialists
  • Certified Registered Nurse Anesthetists
  • Clinical Psychologists
  • Clinical Social Workers
  • Federally Qualified Health Centers
  • Behavioral Health Service Providers
    • Licensed Independent Social Workers
    • Licensed Master Social Workers
    • Licensed Marital and Family Therapists
    • Licensed Mental Health Counselors
    • Certified Alcohol and Drug Counselors

SOURCE:  Iowa Dep. of Human Services.  Informational Letter No. 2103-MC-FFS. (Feb. 20, 2020). (Accessed Aug. 2021).


ELIGIBLE SITES

The following locations may serve as the originating site:

  • The offices of physicians and other practitioners (psychologists, social workers, behavioral health providers, habilitation services providers, and advanced registered nurse practitioners (ARNPs)).
  • Hospitals
  • Critical Access Hospitals
  • Community Mental Health Centers
  • Federally Qualified Health Centers
  • Rural Health Clinics
  • Area Education Agencies (AEAs) and Local Education Agencies

SOURCE:  Iowa Dep. of Human Services.  Informational Letter No. 2103-MC-FFS. (Feb. 20, 2020). (Accessed Aug. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Originating sites are paid a facility fee for telehealth services. FQHCs and RHCs would not bill Q3014 as a separate service because reimbursement for the related costs would occur through the annual cost settlement process.

SOURCE:  Iowa Dep. of Human Services.  Informational Letter No. 2103-MC-FFS. (Feb. 20, 2020). (Accessed Aug. 2021).

Last updated 08/16/2021

Miscellaneous

Iowa Medicaid uses the POS 02 code adopted by Medicare.

Iowa Medicaid will recognize Modifier 95 – Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System, as informational only.

SOURCE: IA Admin Code, 441-79.1(7)b(1) & Iowa Dep. of Human Services.  Informational Letter No. 2103-MC-FFS. (Feb. 20, 2020). (Accessed Aug. 2021).

Last updated 08/16/2021

Out of State Providers

No Reference Found

Last updated 08/16/2021

Overview

Iowa Medicaid pays for telehealth as long as it meets accepted health care practices and standards.  The Medicaid program does not have a definition for telehealth, and therefore it is unknown if the term encompasses store-and-forward or remote patient monitoring. Managed care plans in Iowa’s Healthy and Well Kids in Iowa (Hawki) program, may cover telehealth and telemonitoring services, but do not appear to be mandated.

Last updated 08/16/2021

Remote Patient Monitoring

POLICY

Managed care plans in Iowa’s Healthy and Well Kids in Iowa (Hawki) program, may cover telehealth and telemonitoring services, but do not appear to be mandated.

SOURCE: IA Hawki Benefits. (Accessed Aug. 2021).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 08/16/2021

Store and Forward

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 08/16/2021

Definitions

“Telehealth” means 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.

SOURCE: IA Code 514C.34(1)(c) as amended by IA SF 619 (2021). (Accessed Aug. 2021).

Last updated 08/16/2021

Parity

SERVICE PARITY

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 the appropriate professional licensing board having oversight of the health care professional providing the health care services.

SOURCE: IA Code 514C.34(3) (Accessed Aug. 2021).

A health carrier shall reimburse a health care professional and a facility for health care services provided by telehealth to a covered person for a mental health condition, illness, injury, or disease on the same basis and at the same rate as the health carrier would apply to the same health care services for a mental health condition, illness, injury, or disease provided in person to a covered person by the health care professional or the facility.

SOURCE: IA Code 514.34(3A) as amended by IA SF 619 (Accessed Aug. 2021).


PAYMENT PARITY

A health carrier shall reimburse a health care professional and a facility for health care services provided by telehealth to a covered person for a mental health condition, illness, injury, or disease on the same basis and at the same rate as the health carrier would apply to the same health care services for a mental health condition, illness, injury, or disease provided in person to a covered person by the health care professional or the facility.

SOURCE: IA Code 514.34(3A) as amended by IA SF 619 (Accessed Aug. 2021).

Last updated 08/16/2021

Requirements

Policies, contracts, or plans providing third-party payment or prepayment of health or medical expenses shall not discriminate between coverage benefits for health care services that are provided in-person and the same health care services provided through telehealth.

As a condition of reimbursement, a health carrier shall not require that an additional health care professional be located in the same room as a covered person while health care services for a mental health condition, illness, injury, or disease are provided via telehealth by another health care professional to the covered person.

SOURCE: IA Code 514.34(3A) as amended by IA SF 619 (Accessed Aug. 2021).

Last updated 08/17/2021

Cross State Licensing

No Reference found.

Last updated 08/16/2021

Definitions

Telecommunications and Technology Commission

“Telemedicine means use of a telecommunications system for diagnostic, clinical, consultative, data, and educational services for the delivery of health care services or related health care activities by licensed health care professionals, licensed medical professionals, and staff who function under the direction of a physician, a licensed health care professional, or hospital, for the purpose of developing a comprehensive, statewide telemedicine network or education.”

SOURCE: IA Admin. Code, 751 7.1(8D). (Accessed Aug. 2021).

Last updated 08/17/2021

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. The IMLC. (Accessed Aug. 2021).

Member of Physical Therapy Compact.

SOURCE: Physical Therapy Compact. Compact Map.  (Accessed Aug. 2021). 

Member of Nurse Licensure Compact.

SOURCE: Current NLC States and Status.  NCSBN. (Accessed Aug. 2021). 

Member of the EMS Compact.

SOURCE: Interstate Commission for EMS Personnel Practice. The EMS Compact. (Accessed Aug. 2021).

Member of Occupational Therapy Compact

SOURCE: Occupational Therapy Licensure Compact.  Map, (Accessed Sept. 2021).

Last updated 08/16/2021

Miscellaneous

Iowa provides a list of persons and entities authorized to use the fiber optic network to provide services via telemedicine. The list includes:

  • Licensed health care professionals or licensed health care professionals who function under the direction of or collaboration with a physician or a hospital;
  • Hospital or physician clinic staff members;
  • Professional boards on which health professionals serve;
  • Health care employees of facilities that do not have a contractual agreement with the hospital or physician clinic;
  • Employees of health care associations for various health care employees;
  • Professional board members where the health care professional serves as a member of the board.

SOURCE: IA Admin. Code, 751 7.11(8D). (Accessed Aug. 2021). 

Recently Adopted Rule 

A licensee may provide dietetic services to an individual or a group utilizing a telehealth visit if the dietetic services are provided in accordance with all the requirements of this chapter.

SOURCE: Iowa Administrative Code Section 645.81.17. (Effective March 3, 2021). (Accessed Aug. 2021).

An intern psychologist may also provide services via telehealth, to underserved populations, and to Medicaid members in the location of the intern psychologist’s placement, notwithstanding any change in the mental health professional shortage area designation of such location.

SOURCE: IA HF 891 (2021). (Accessed Aug. 2021). 

A licensee under the purview of the board who provides treatment for the correction of malpositions of human teeth or the initial use of orthodontic appliances shall not begin orthodontic treatment on a new patient unless one of the following conditions is met:

  • The licensee performs an initial in-person or teledentistry examination of the teeth and supporting structures of the new patient prior to beginning orthodontic treatment.
  • The new patient provides the licensee with the portion of the dental record taken within the prior six months of an in-person or teledentistry examination of the teeth and supporting structures of the new patient prior to the licensee beginning orthodontic treatment.

SOURCE: HF 685 (2021). (Accessed Aug. 2021). 

Last updated 08/17/2021

Online Prescribing

Pharmacists are prohibited from dispensing prescription drugs if the pharmacist knows or should have known that the prescription was issued solely on the basis of an Internet-based questionnaire, an Internet-based consult, or a telephone consult, and was completed without a pre-existing patient-provider relationship.

SOURCE: IA Admin. Code, 657 8.19(5). (Accessed Aug. 2021). 

A physician must be physically present with a woman at the time an abortion-inducing drug is provided.

SOURCE: IA Admin. Code, 653 13.10(3) (Accessed Aug. 2021). 

Prior to providing treatment, including issuing prescriptions, electronically or otherwise, a licensee who uses telemedicine shall interview the patient to collect the relevant medical history and perform a physical examination, when medically necessary, sufficient for the diagnosis and treatment of the patient. An Internet questionnaire that is a static set of questions provided to the patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview, does not constitute an acceptable medical interview and physical examination for the provision of treatment, including issuance of prescriptions, electronically or otherwise, by a licensee.

SOURCE: IA Admin. Code, 653 13.11(8) (Accessed Aug. 2021).

Specific requirements apply for mental health professionals establishing a provider-patient relationship in a school-based setting. See full law text for details.

A mental health professional with prescribing authority who provides telehealth services in accordance with this section shall not prescribe any new medication to a student during a telehealth session. However, a mental health professional with prescribing authority may initiate new prescriptions, alter the dosage of an existing medication, or discontinue an existing medication for the treatment of the student’s behavioral health condition after consultation with the student’s parent or guardian.

SOURCE: Senate File 2261 (2020 Session), IA Code Chapter 280A.4 & IA Admin Code 281.14.23, (Accessed Aug. 2021).

Last updated 08/17/2021

Professional Boards Standards

IA Board of Dentistry

SOURCE: IA Admin Code 650-27.12(153) (Accessed Aug. 2021).  

IA Board of Medicine

SOURCE: IA Admin Code Sec. 653.13.11 (Accessed Aug. 2021).

IA Board of Physical and Occupational Therapists

SOURCE: IA Admin Code Sec. 645-201.3 & 645-208.3. (Accessed Aug. 2021).

IA Board of Dietetics

SOURCE:  Iowa Administrative Code Section 645.81.17. (Effective March 3, 2021). (Accessed Aug. 2021)

Education Department Standards

SOURCE: Senate File 2261 (2020 Session) & IA Admin Code 281.14.23, (Accessed Aug. 2021).