Iowa Telehealth State Laws & Reimbursement Policies

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.

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Definitions

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.

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Eligible Services/Specialties
Eligible Providers
Eligible Sites
Geographic Limits
Facility/Transmission Fee

Store-and-Forward

Policy
Eligible Services/Specialties
Geographic Limits
Transmission Fee

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.

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Conditions
Provider Limitations
Other Restrictions

Email/Phone/Fax

Consent

Out of State Providers

Miscellaneous

Iowa Medicaid uses the 02 POS code adopted by Medicare.

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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.”

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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.

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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.

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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.”

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Consent

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.

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Cross State Licensing

Member of the following: Nurse Licensure Compact, Physical Therapy Compact, and Interstate Medical Licensure Compact.

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Miscellaneous

Click for a list of professional board telehealth-specific regulations.

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Source: Center for Connected Health Policy
https://www.cchpca.org

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