IOWA

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

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. Beginning July 1, 2019, managed care plans in Iowa’s Healthy and Well Kids in Iowa (Hawk-I) program, may cover telehealth and telemonitoring services, but do not appear to be mandated.

Live Video

Policy

Department of Human Services is required to adopt rules to provide telehealth coverage under Medicaid. Such rules must provide that in-person contact between a health care professional and a patient is not required as a prerequisite for payment.

 

Source: IA Senate File 505 (2015), Sec. 12(23), pg. 32-33. (Accessed Mar. 2019).

 

In-person contact between a health care professional and patient is not required for payment for services otherwise covered and appropriately provided through telehealth as long as it meets the generally accepted health care practices and standards prevailing in the applicable professional community.
Services provided in-person or through telehealth shall be treated as equivalent for purposes of reimbursement.

Source: IA Admin Code Sec. 441, 78.55 (249A). (Accessed Mar. 2019).

 

Beginning July 1, 2019, managed care plans in Iowa’s Healthy and Well Kids in Iowa (Hawk-I) program, may cover telehealth and telemonitoring services, but do not appear to be mandated.

Source: IA Hawk-I Benefits. (Accessed Mar. 2019).

Remote Patient Monitoring

Policy

Beginning July 1, 2019, managed care plans in Iowa’s Healthy and Well Kids in Iowa (Hawk-I) program, may cover telehealth and telemonitoring services, but do not appear to be mandated.

 

Source: IA Hawk-I Benefits. (Accessed Mar. 2019).

 

Miscellaneous

Iowa Medicaid uses the 02 POS code adopted by Medicare.

 

Source: IAC 441-79.1(7)b(1). (Accessed Mar. 2019).

Private Payer Laws

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.

 

Source: IA Code 514C.34(2) (Accessed Mar. 2019).
Definitions

“Telehealth means 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.”

 

Source: IA Code 514C.34(1)(c) (Accessed Mar. 2019).

Parity

Payment Parity

No explicit payment parity.

 

Service Parity

Health care services must be appropriately delivered by telehealth in accordance with accepted health care practices and standards, including all rules adopted by professional licensing boards.

 

Source: IA Code 514C.34(3) (Accessed Mar. 2019).

Professional Regulation /
Health & Safety

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. 2019).
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 Mar. 2019).

 

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. 2019).
Cross-State Licensing

Member of the Interstate Medical Licensure Compact.

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Source: Interstate Medical Licensure Compact. The IMLC. (Accessed Mar. 2019).

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Member of Physical Therapy Compact.

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Member of Nurse Licensure Compact.

Source: Current NLC States and Status. NCSBN. (Accessed Mar. 2019) .
Miscellaneous

Professional Board Telehealth-Specific Regulations
• IA Board of Medicine (Source: IA Admin Code Sec. 653.13.11) (Accessed Mar. 2019).
• IA Board of Physical and Occupational Therapists (Source: IA Admin Code Sec. 645-201.3 & 645-
208.3) (Accessed Mar. 2019).

 

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