Medicaid Telehealth Reimbursement
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.
Definitions
No reference found.
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.
Eligible Services/Specialties
No reference found.
Eligible Providers
No reference found.
Eligible Sites
No reference found.
Geographic Limits
No reference found.
Facility/Transmission Fee
No reference found.
Store-and-Forward
Policy
No reference found.
Eligible Services/Specialties
No reference found.
Geographic Limits
No reference found.
Transmission Fee
No reference found.
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.
Conditions
No reference found.
Provider Limitations
No reference found.
Other Restrictions
No reference found.
Email/Phone/Fax
No reference found.
Consent
No reference found.
Out of State Providers
No reference found.
Miscellaneous
Iowa Medicaid uses the 02 POS code adopted by Medicare.
Private Payer Laws
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.”
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.
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.
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.”
Consent
No reference found.
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.
Cross State Licensing
Member of the following: Nurse Licensure Compact, Physical Therapy Compact, and Interstate Medical Licensure Compact.
Miscellaneous
Click for a list of professional board telehealth-specific regulations.
Source: Center for Connected Health Policy
https://www.cchpca.org