Iowa

At A Glance
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MEDICAID REIMBURSEMENT

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

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

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

STATE RESOURCES

  1. Medicaid Program: Iowa Medicaid Enterprise (IME)
  2. Administrator: Iowa Dept. of Human Services
  3. Regional Telehealth Resource Center: Great Plains Telehealth Resource Center

Last updated 03/29/2022

Audio Only Delivery

Medicaid: COVID-19 Provider FAQs- Telehealth

STATUS: Active, through 60 days after PHE is lifted.  PHE ended on Feb. 15, 2022, see proclamation.

Medicaid:  Informational Letter on Teledentistry

STATUS: PHE expired.  However may still be active due to statement that all telehealth services are in effect statewide through at least 60 days after the PHE declaration is lifted.

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 03/29/2022

Cross State Licensing

Iowa Medical Board:  Grace Period for Physicians without an Iowa medical license

STATUS:  Expires May 17, 2022

Office Of the Governor:  Emergency Proclamation on Disaster Emergency, signed on Oct. 15, 2021

STATUS: Expired.

Office of the Governor: Emergency Proclamation on Telehealth/Telemedicine

STATUS: Expired.

Last updated 03/29/2022

Easing Prescribing Requirements

Office Of the Governor:  Emergency Proclamation on Disaster Emergency, signed on Oct. 15, 2021, 2021

STATUS: Expired.

Last updated 03/29/2022

Miscellaneous

No Reference Found

Last updated 03/29/2022

Originating Site

Medicaid: COVID-19 Provider FAQs- Telehealth

STATUS: Active, through 60 days after PHE is lifted.  PHE ended on Feb. 15, 2022, see proclamation.

Medicaid: Update to Billing Services Provided via Telehealth related to COVID-19

STATUS: Active for interim period.

Medicaid:  Informational Letter on Billing Telehealth Services

STATUS: PHE expired.  However may still be active due to statement that all telehealth services are in effect statewide through at least 60 days after the PHE declaration is lifted.

Medicaid:  Informational Letter on Telehealth

STATUS: PHE expired.  However may still be active due to statement that all telehealth services are in effect statewide through at least 60 days after the PHE declaration is lifted.

Last updated 03/29/2022

Private Payer

Previous COVID-19 waivers expired.

Last updated 03/29/2022

Provider Type

Medicaid: COVID-19 Provider FAQs- Telehealth

STATUS: Active, through 60 days after PHE is lifted.  PHE ended on Feb. 15, 2022, see proclamation.

Medicaid: Informational Letter on Billable Telehealth Providers

STATUS: Active, through 60 days after PHE is lifted.  PHE ended on Feb. 15, 2022, see proclamation.

Medicaid:  Informational Letter on Teledentistry

STATUS: PHE expired.  However may still be active due to statement that all telehealth services are in effect statewide through at least 60 days after the PHE declaration is lifted.

Last updated 03/29/2022

Service Expansion

Medicaid: COVID-19 Provider FAQs- Telehealth

STATUS: Active, through 60 days after PHE is lifted.  PHE ended on Feb. 15, 2022, see proclamation.

Medicaid:  Informational Letter on Billing Telehealth Services

STATUS: PHE expired.  However may still be active due to statement that all telehealth services are in effect statewide through at least 60 days after the PHE declaration is lifted.

Medicaid:  Informational Letter on Telehealth

STATUS: PHE expired.  However may still be active due to statement that all telehealth services are in effect statewide through at least 60 days after the PHE declaration is lifted.

Medicaid:  Informational Letter on Teledentistry

STATUS: PHE expired.  However may still be active due to statement that all telehealth services are in effect statewide through at least 60 days after the PHE declaration is lifted.

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 national 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 national PHE.

Last updated 03/29/2022

Definitions

Crisis Response Services

“Telehealth” is the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the Internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

SOURCE: Iowa Admin Code 441—24.20(225C) Definitions, p. 23 (Accessed Mar. 2022)

 

Last updated 03/29/2022

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. Dec. 3, 2021, p. 64 .  For other manuals, see:  Medicaid Provider Manual.  Provider Specific Manuals. (Accessed Oct. 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 Mar. 2022).

Last updated 03/29/2022

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 Mar. 2022).

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 Mar. 2022).  

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. 19, May 1, 2018; Subacute Mental Health Services.  May 1, 2018, p. 9. (Accessed Mar. 2022).


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 Mar. 2022).


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 Mar. 2022).


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 Mar. 2022).

Last updated 03/29/2022

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 Mar. 2022).

Last updated 03/29/2022

Out of State Providers

No Reference Found

Last updated 03/29/2022

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 03/29/2022

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 Mar. 2022).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 03/29/2022

Store and Forward

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

All Iowa Medicaid recipients are eligible to receive services via asynchronous teledentistry. See informational letter for billing codes.

SOURCE: Informational Letter 2224-MC-FFS-D-CVD “Asynchronous Teledentistry” (Accessed Mar. 2022)


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 03/29/2022

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)(f) (Accessed Mar. 2022).

Last updated 03/29/2022

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 Mar. 2022).

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(4a), (Accessed Mar. 2022).


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(4a), (Accessed Mar. 2022).

Last updated 03/29/2022

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(2 & 4b) (Accessed Mar. 2022).

Last updated 03/29/2022

Cross State Licensing

Psychologists

For telepsychology a psychologist must be licensed or be exempt from licensure in the jurisdiction where the patient or examinee is located.

SOURCE: Iowa Admin Code, Sec. 645-243.7, (Accessed Mar. 2022).

Physician Assistants

License Required: A physician assistant who uses telemedicine in the diagnosis and treatment of a patient located in Iowa shall hold an active Iowa physician assistant license consistent with state and federal laws.

SOURCE: Iowa Admin Code, Sec. 645-327.9, (Accessed Mar. 2022).

Hearing Aid Specialists

Conducting a telehealth appointment with a client who is physically located in Iowa during the appointment, regardless of the location of the hearing aid specialist, shall require Iowa licensure.

SOURCE: Iowa Admin Code, Sec. 645-123.5, (Accessed Mar. 2022).

Last updated 03/29/2022

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 Mar. 2022).

Psychologists

“Telepsychology” means the provision of psychological services using telecommunication technologies.

SOURCE: Iowa Admin Code, Sec. 645-243.1, (Accessed Mar. 2022).

Physician Assistant Regulations

“Asynchronous store-and-forward transmission” – the collection of a patient’s relevant health information and the subsequent transmission of the data from an originating site to a health care provider at a distant site without the presence of the patient.

“Telemedicine” – the practice of medicine using electronic audiovisual communications and information technologies or other means, including interactive audio with asynchronous store-and-forward transmission, between a licensee in one location and a patient in another location with or without an intervening health care provider. Telemedicine includes asynchronous store-and-forward technologies, remote monitoring, and real-time interactive services, including teleradiology and telepathology. Telemedicine, for the purposes of this rule establishing standards of practice, does not include the provision of medical services only through an audio-only telephone, email messages, facsimile transmissions, or U.S. mail or other parcel service, or any combination thereof.

SOURCE: Iowa Admin Code, Sec. 645-327.9, (Accessed Mar. 2022).

Medicine

“Telemedicine” means the practice of medicine using electronic audio-visual communications and information technologies or other means, including interactive audio with asynchronous store-and-forward transmission, between a licensee in one location and a patient in another location with or without an intervening health care provider. Telemedicine includes asynchronous store-and-forward technologies, remote monitoring, and real-time interactive services, including teleradiology and telepathology. Telemedicine shall not include the provision of medical services only through an audio-only telephone, email messages, facsimile transmissions, or U.S. mail or other parcel service, or any combination thereof.

SOURCE: Iowa Admin Code, Sec. 653-13.11, (Accessed Mar. 2022).

Speech Pathology and Audiology

“Telehealth visit” means the provision of speech pathology or audiology services by a licensee to a patient using technology where the licensee and the patient are not at the same physical location during the appointment.

SOURCE: Iowa Admin Code, Sec. 645-301.1, (Accessed Mar. 2022).

Nutritionists

“Telehealth visit” means the provision of dietetic services by a licensee to an individual or a group using technology where the licensee and the individual or group are not at the same physical location for the therapy session.

SOURCE:  Iowa Administrative Code Section 645.81.17. (Accessed Mar. 2022)

Last updated 03/29/2022

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. The IMLC. (Accessed Mar. 2022).

Member of Physical Therapy Compact.

SOURCE: Physical Therapy Compact. Compact Map.  (Accessed Mar. 2022). 

Member of Nurse Licensure Compact.

SOURCE: Current NLC States and Status.  NCSBN. (Accessed Mar. 2022). 

Member of the EMS Compact.

SOURCE: Interstate Commission for EMS Personnel Practice. The EMS Compact. (Accessed Mar. 2022).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 03/29/2022

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 Mar. 2022).

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: Iowa Annotated Statute Sec. 153.24, (Accessed Mar. 2022).

Last updated 03/29/2022

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.

SOURCE: IA Admin. Code, 657 8.19(5). (Accessed Mar. 2022). 

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 Mar. 2022). 

Generally, a licensee shall perform an in-person medical interview and physical examination for each patient. However, the medical interview and physical examination may not be in-person if the technology utilized in a telemedicine encounter is sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in-person. 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.

Under certain circumstances, whether or not such circumstances involve the use of telemedicine, a licensee may treat a patient who has not been personally interviewed, examined and diagnosed by the licensee.  See rule.

SOURCE: Iowa Admin Code, Sec. 653-13.11, (Accessed Mar. 2022).

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: IA Code Chapter 280A.4 (Accessed Oct. 2021).

A mental health professional with prescribing authority who provides telehealth services shall not alter the dosage of an existing medication or prescribe any new medication during a telehealth session without prior consultation with the student’s parent or guardian.

SOURCE: IA Code 281.14.24, (Accessed Mar. 2022).

Physician Assistant-Patient Relationship

A licensee who uses telemedicine shall establish a valid physician assistant-patient relationship with the person who receives telemedicine services. The physician assistant-patient relationship begins when:

  • The person with a health-related matter seeks assistance from a licensee;
  • The licensee agrees to undertake diagnosis and treatment of the person; and
  • The person agrees to be treated by the licensee whether or not there has been an in-person encounter between the physician assistant and the person.

A valid physician assistant-patient relationship may be established by:

  • In-person encounter. Through an in-person medical interview and physical examination where the standard of care would require an in-person encounter;
  • Consultation with another licensee. Through consultation with another licensee (or other health care provider) who has an established relationship with the patient and who agrees to participate in, or supervise, the patient’s care; or
  • Telemedicine encounter. Through telemedicine, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

Medical history and physical examination may be done through telemedicine if the technology utilized in a telemedicine encounter is sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person.

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.

See rule for circumstances where the standard of care may not require a licensee to personally interview or examine a patient.

Prescribing to a patient based solely on an Internet request or Internet questionnaire (i.e., a static questionnaire provided to a patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview) is prohibited. Absent a valid physician assistant-patient relationship, a licensee’s prescribing to a patient based solely on a telephonic evaluation is prohibited, with the exception of the circumstances described in subrule 327.9(21).

SOURCE: Iowa Admin Code, Sec. 645-327.9, (Accessed Mar. 2022).

Last updated 03/29/2022

Professional Boards Standards

IA Board of Dentistry

SOURCE: IA Admin Code 650-27.12(153) (Accessed Mar. 2022).

IA Board of Medicine

SOURCE: IA Admin Code Sec. 653.13.11 (Accessed Mar. 2022).

IA Board of Physical and Occupational Therapists

SOURCE: IA Admin Code Sec. 645-201.3 & 645-208.3. (Accessed Mar. 2022).

IA Board of Dietetics

SOURCE:  Iowa Administrative Code Section 645.81.17. (Accessed Mar. 2022)

Education Department Standards

SOURCE: Senate File 2261 (2020 Session) & IA Admin Code 281.14.23, (Accessed Mar. 2022).

Board of Psychology

SOURCE: Iowa Admin Code, Sec. 645-243.7, (Accessed Mar. 2022).

Board of Physician Assistants

SOURCE: Iowa Admin Code, Sec. 645-327.9, (Accessed Mar. 2022).

Board of Speech Pathology and Audiology

SOURCE: Iowa Admin Code, Sec. 645-301.1, (Accessed Mar. 2022).

Hearing Aid Specialists

SOURCE: Iowa Admin Code, Sec. 645-123.5, (Accessed Mar. 2022).