Iowa

At A Glance

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MEDICAID REIMBURSEMENT

Live Video: Yes
Store-and-Forward: Yes
Remote Patient Monitoring: Yes
Audio Only: Yes

PRIVATE PAYER LAW

Law Exists: Yes
Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

Licensure Compacts: ASLP-IC, CC, EMS, IMLC, NLC, OT, PTC, SW
Consent Requirements: Yes

STATE RESOURCES

Medicaid Program: Iowa Medicaid
Administrator: Iowa Dept. of Health and Human Services
Regional Telehealth Resource Center: Great Plains Telehealth Resource Center

Private Payer

Last updated 08/30/2024

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 Aug. 2024).

Last updated 08/30/2024

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.

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 514C.34(3) & 4a (Accessed Aug. 2024).

PAYMENT PARITY

As a condition of reimbursement pursuant to paragraph “a”, 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(4a), (Accessed Aug. 2024).

Last updated 08/30/2024

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.

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, pursuant to chapter 147, having oversight of the health care professional providing the health care services.

A health carrier shall not exclude a health care professional who provides services for mental health conditions, illnesses, injuries, or diseases and who is physically located out-of-state from participating as a provider, via telehealth, under a policy, plan, or contract offered by the health carrier in the state if all of the following requirements are met:

The health care professional is licensed in this state by the appropriate professional licensing board and is able to deliver health care services for mental health conditions, illnesses, injuries, or diseases via telehealth in compliance with paragraph “a”.
The health care professional is able to satisfy the same criteria that the health carrier uses to qualify a health care professional who is located in the state, and who holds the same license as the out-of-state professional, to participate as a provider, via telehealth, under a policy, plan, or contract offered by the health carrier in the state.

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) and 4b (Accessed Aug. 2024).

Medicaid

Last updated 08/26/2024

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. 2 (Accessed Aug. 2024)

Last updated 08/27/2024

Email, Phone & Fax

See approved procedure code list. Includes column that identifies if codes can be provided via audio-only interaction. Certain codes include telephone services in their descriptions as well.

SOURCE: IA Medicaid. Telehealth Approved Codes [see under quarterly codes dropdown], 8/8/24, (Accessed Aug. 2024).

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 Manuals. (Accessed Aug. 2024).

Targeted Case Management, Case Management, and Care Coordination

Case management can occur by face-to-face contact or by telephone.

This contact may be face-to-face or by telephone. The contact may also be by written communication, including letters, email, and fax, when the written communication directly pertains to the needs of the member. A copy of any written communication must be maintained in the case file.

SOURCE: Iowa Dep. of Human Services. Provider Manual. Ch. III Provider Specific Policies. Targeted Case Management. May 1, 2018, p. 10 (Accessed Aug. 2024).

Home and Community-Based Services (HCBS)

BI case management services shall consist of the following components as detailed in IAC Chapter 90: …

One contact per month with the member, the member’s legally authorized representative, this contact may be face-to-face or by telephone.

SOURCE: Iowa Dep. of Human Services. Provider Manual. Ch. III Provider Specific Policies. Home- and Community-Based Services (HCBS) . June 24, 2022, p. 38 (Accessed Aug. 2024).

Hospice

A hospice claim will be eligible for a SIA payment if the following criteria are met: …

The service is not provided by a social worker via telephone.

SOURCE: Iowa Dep. of Human Services. Provider Manual. Ch. III Provider Specific Policies. Hospice. Oct. 2, 2022, p. 13 (Accessed Aug. 2024).

Last updated 08/26/2024

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, as well as being in accordance with provisions under rule 653—13.11(147,148,272C). 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. 2024).

Based on this rule [see above], there is no additional payment for the telehealth components of service, associated with the underlying service being rendered. Payment for a service rendered via telehealth is the same as payment made for that service when rendered in a face-to-face (i.e., in-person) setting.

SOURCE: IA Dep. of Human Services. Informational Letter No. 1815-MC-FFS, Aug. 10, 2017, (Accessed Aug. 2024).

Crisis Response Services and Subacute Mental Health Services.

“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; IA Admin Code Sec. 441-24.20; Subacute Mental Health Services. May 1, 2018, p. 9. (Accessed Aug. 2024).

ELIGIBLE SERVICES/SPECIALTIES

See approved procedure code list.

SOURCE: IA Medicaid. New Telehealth Approved Codes [see quarterly codes dropdown], 8/8/24, (Accessed Aug. 2024).

Please visit the Iowa Medicaid PHE unwind webpage for telehealth service codes continuing post-PHE. The effective date for the discontinued telehealth service codes is December 31, 2023. After this date, claims submitted with discontinued service codes, when billed as telehealth (place of service 02 or 10), will be denied.

SOURCE: IA Dep. of Human Services. Informational Letter No. 2457-MC-FFS, Jun. 2, 2023 (Effective Dec. 31, 2023), (Accessed Aug. 2024).

IA Medicaid covers teledentistry synchronous real time encounter.

SOURCE: IA Dep. of Human Services. Informational Letter No. 2124-MC-FFS, April 6, 2020, (Accessed Aug. 2024).

Please be aware that while some services such as teledentistry will continue after the PHE, billing requirements for some other services provided via telehealth may change when the PHE is lifted.

SOURCE: IA Dep. of Human Services. Informational Letter No. 2323-MC-FFS, Mar. 11, 2022 (Effective April 1, 2023), (Accessed Aug. 2023).

Pursuant to the authority of Iowa Code section 249A.4, HHS has amended the 1915(C) HCBS AIDS/HIV, Brain Injury (BI), Health and Disability (HD), Intellectual Disability (ID) and Physical Disability (PD) Waivers. The Centers for Medicaid and Medicare services approved these amendments on April 23, 2024, retroactive to November 1, 2023. As part of the amendments the Department has made the changes listed below to the waivers. …

“Telehealth” means the delivery of SCL services using 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.
See letter for list of eligible codes.

SOURCE: IA Dep. of Human Services. Informational Letter No. 2588-MC-FFS, June 4, 2024, (Accessed Aug. 2024).

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. 2024).

ELIGIBLE SITES

All services delivered via telehealth must be billed with one of the following POS codes:

02 – telehealth provided other than in the patient’s home
- The location where health services and health-related services are provided or received, through telecommunication technology. The patient is not located in their home when receiving health services or health-related services through telecommunication technology.
10 – telehealth provided in the patient’s home
- The location where health services and health-related services are provided or received through telecommunication technology. The patient is in their home (which is a location other than a hospital or other facility where the patient receives care) when receiving health services or health related services through telecommunication technology.

As announced in IL 24573, claims submitted with service codes not included in the telehealth approved list continuing post-Public Health Emergency (PHE) and billed as telehealth (Place of service 02 or 10) after December 31, 2023 will be denied.

SOURCE: Iowa Dep. of Human Services. Informational Letter No. 2472-MC-FFS. (Sept. 11, 2023). (Accessed Aug. 2024).

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. 2024).

For the purpose of this provision, a “facility” place of service (POS) is defined as any of the following (consistent with “POS” definitions under Medicare, per the Medicare Claims Processing Manual, Chapter 12, Section 20.4.2, revised as of May 2017):

Telehealth (POS 02).

SOURCE: IA Statute 441.79.1, (Accessed Aug. 2024).

The Centers for Medicare and Medicaid (CMS) has added a new POS for telehealth to identify when individuals are receiving services via telehealth in their homes. Iowa Medicaid will adopt this POS effective April 1, 2022. The provider will bill the applicable Healthcare Common Procedure Coding System (HCPCS)/Current Procedural Terminology (CPT) codes with POS code 02 (telehealth) if the member is receiving services anywhere other than home. The provider will bill the applicable HCPCS/CPT codes with POS code 10 (telehealth patient in home) if the member is in their home. An originating site charge will not be applicable with a POS code 10. However, a distant site charge may be applicable.

POS 02: Telehealth Provided Other than in Patient’s Home Descriptor: The location where health services and health-related services are provided or received, through telecommunication technology. The patient is not located in their home when receiving health services or health-related services through telecommunication technology.
POS 10: Telehealth Provided in Patient’s Home Descriptor: The location where health services and health-related services are provided or received through telecommunication technology. The patient is located in their home (which is a location other than a hospital or other facility where the patient receives care) when receiving health services or health related services through telecommunication technology.

SOURCE: IA Dep. of Human Services. Informational Letter No. 2323-MC-FFS, Mar. 11, 2022 (Effective April 1, 2023), (Accessed Aug. 2024).

Effective March 13, 2020, the site of service differential was removed from place of service 02 (please refer to Informational Letter 1815-MC-FFS2 [see below). As discussed during the April 27, 2023, provider town hall event, the site of service differential with the place of service 02 and 10 will not be applied to telehealth claims.

SOURCE: IA Dep. of Human Services. Informational Letter No. 2457-MC-FFS, Jun. 2, 2023 (Effective Dec. 31, 2023), (Accessed Aug. 2024).

POS code 02 is defined as, “the location where health services and health related services are provided or received, through a telecommunication system”. POS code 02 is used to report that a billed service was furnished as a telehealth service from a distant site. The only portion that is considered telehealth services is when the patient was present and interacting with the distant site physician or practitioner.

An originating site is the location of a Medicaid member at the time the telehealth service is furnished. CMHCs can be an originating site. Other originating sites can include: physician offices, hospitals, and critical access hospitals (CAHs). The “telehealth” POS code (i.e., “02”) would not be used by an originating site that can bill a facility fee (i.e., Q3014), instead the originating site would continue to use the POS code that applies to the type of facility where the patient is located. Under these circumstances, a CMHC would bill POS 53 (CMHC).

CMHCs billing for services under the CMHC provider category will not have payments cut back for the SoS differential, in cases where the service is provided at POS 02 (Telehealth). Consistent with the immediately preceding paragraph, the “distant” provider would bill POS 02 for the telehealth service and the CMHC would bill POS 53. In these cases, under Medicaid, there is no separate facility bill to account for the overhead, and therefore no SoS cut would be taken, consistent with the intent of this policy.

SOURCE: IA Dep. of Human Services. Informational Letter No. 1815-MC-FFS, Aug. 10, 2017, (Accessed Aug. 2024).

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. 2024).

Last updated 08/27/2024

Miscellaneous

No later than January 1, 2025, the department of health and human services shall select one or more psychiatric medical institutions for children (PMICs) to provide access to PMIC services for children with specialized needs including problematic sexualized behaviors, a history of aggression, or a diagnosis of intellectual or developmental disability. Prior to rendering services, a selected PMIC shall be licensed pursuant to section 135H.4 and offer a payment structure that provides enhanced reimbursement, which may be used to provide increased staffing ratios, ongoing training of staff in specialized programs that provide evidence-based treatment, and appropriate services and modalities, including but not limited to telemedicine, for children and their families.

SOURCE: Section 135H.6 & House File 2402 (2024 Session), (Accessed Aug. 2024).

Last updated 08/27/2024

Out of State Providers

No Reference Found

Last updated 08/27/2024

Overview

Iowa Medicaid pays for telehealth, including audio-only interactions, for certain service codes as long as it meets accepted health care practices and standards. 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. Asynchronous telehealth for teledentistry is covered.

A list of approved reimbursable codes for telehealth in Iowa Medicaid is available and includes a variety of monitoring codes, such as remote physiologic and therapeutic codes, as well as specific codes covering services provided via phone and store-and-forward (i.e. e-visits). Additionally, there is a column in the code list that generally identifies codes eligible for audio-only reimbursement.

Last updated 08/27/2024

Remote Patient Monitoring

POLICY

Remote physiologic monitoring codes are included as permanent codes in Medicaid’s approved telehealth codes list.

SOURCE: IA Medicaid. Telehealth Approved Codes [see under quarterly codes dropdown], 8/8/24, (Accessed Aug. 2024).

CONDITIONS

No Reference Found

PROVIDER LIMITATIONS

No Reference Found

OTHER RESTRICTIONS

No Reference Found

Last updated 08/27/2024

Store and Forward

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

Certain communication technology-based codes that include store and forward (such as online digital evaluation and management services, or ‘e-visits’) are included as permanent codes in Medicaid’s approved telehealth codes list.

SOURCE: IA Medicaid. Telehealth Approved Codes [see under quarterly codes dropdown], 8/8/24, (Accessed Aug. 2024).

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 Aug. 2024)

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

Professional Requirements

Last updated 08/26/2024

Consent Requirements

The parent or guardian of a student shall consent prior to the student receiving behavioral health services via telehealth under this chapter after a provider-patient relationship is established pursuant to this section. The school district shall maintain any such consent form completed by a parent or guardian.

SOURCE: IA Code Title VII Subtitle 6 Chapter 280A.3, (Accessed Aug. 2024).

Medicine & Physician Assistants

A licensee who uses telemedicine shall ensure that the patient provides appropriate informed consent for the medical services provided, including consent for the use of telemedicine to diagnose and treat the patient, and that such informed consent is timely documented in the patient’s medical record.

See rule for more information about how professions must disclose limitations about telemedicine.

SOURCE: Iowa Admin Code, Sec. 653-13.11, Sec. 645-327.6 (Accessed Aug. 2024).

Telepsychology

A licensee will ensure informed consent for telepsychology includes a description of any limitations of services as a result of the technology utilized.

SOURCE: Iowa Admin Code, Sec. 645-243.6, (Accessed Aug. 2024).

Speech Pathology and Audiology

Prior to the first telehealth visit, a licensee will obtain informed consent from the patient specific to the services that will be provided in a telehealth visit. At a minimum, the informed consent will specifically inform the patient of the following:

The risks and limitations of the use of technology to provide speech pathology or audiology services;
The potential for unauthorized access to protected health information; and
The potential for disruption of technology during a telehealth visit.

SOURCE: Iowa Admin Code, Sec. 645-301.1, (Accessed Aug. 2024).

Board of Dietetics

Prior to the first telehealth visit, a licensee is to obtain informed consent from the individual or group specific to the services that will be provided in a telehealth visit. At a minimum, the informed consent shall specifically inform the individual or group of the following:

The risks and limitations of the use of technology to provide dietetics services;
The potential for unauthorized access to protected health information; and
The potential for disruption of technology during a telehealth visit.

SOURCE: Iowa Administrative Code Section 645.81.10, (Accessed Aug. 2024).

Hearing Aid Specialists

Prior to the first telehealth appointment with a client, the licensee will obtain informed consent from the client that is specific to the service or services that will be provided in the telehealth appointment. The informed consent will specifically inform the client of, at a minimum, the following:

The risks and limitations of the use of technology to the specific service;
The potential for unauthorized access to protected health information; and
The potential for disruption of technology during a telehealth appointment.

SOURCE: Iowa Admin Code, Sec. 645-123.5, (Accessed Aug. 2024).

Nursing – ARNPs

Prior to providing services via telehealth, the licensee shall obtain consent from the patient, or the patient’s legal guardian or legal representative, to receive services via telehealth.

SOURCE: IA Admin Code Sec. 655-7.9(152), (Accessed Aug. 2024).

Nursing – Midwives

Prior to providing services via telehealth, the CPM shall obtain consent from the client, or the client’s legal guardian or legal representative, to receive services via telehealth

SOURCE: IA Admin Code Sec. 655-16.7, (Accessed Aug. 2024).

Physical/Occupational Therapy

Prior to the first telehealth visit, a licensee shall obtain informed consent from the patient specific to the physical therapy services that will be provided in a telehealth visit. At a minimum, the informed consent shall specifically inform the patient of the following:

The risks and limitations of the use of technology to provide physical therapy services;
The potential for unauthorized access to protected health information; and
The potential for disruption of technology during a telehealth visit.

SOURCE: IA Admin Code Sec. 645-201.3 & 645-208.2. (Accessed Aug. 2024).

Last updated 08/26/2024

Cross State Licensing

Persons considered not engaged in practice: Physicians and surgeons or osteopathic physicians and surgeons of the United States army, navy, air force, marines, public health service, or other uniformed service when acting in the line of duty in this state, and holding a current, active permanent license in good standing in another state, district, or territory of the United States, or physicians and surgeons or osteopathic physicians and surgeons licensed in another state, when incidentally called into this state in consultation with a physician and surgeon or osteopathic physician and surgeon licensed in this state.

SOURCE: Iowa Code, Ch. 148.2, (Accessed Aug. 2024).

Medicine

A physician who uses telemedicine in the diagnosis and treatment of a patient located in Iowa shall hold an active Iowa medical license consistent with state and federal laws. Nothing in this rule shall be construed to supersede the exceptions to licensure contained in 653—subrule 9.2(2).

SOURCE: Iowa Admin Code, Sec. 653-13.11, (Accessed Aug. 2024).

Psychologists

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

SOURCE: Iowa Admin Code, Sec. 645-243.6, (Accessed Aug. 2024).

Physician Assistants

License Required: A physician assistant who uses telemedicine in the diagnosis and treatment of a patient located in Iowa will hold an active Iowa physician assistant license consistent with state and federal laws. Nothing in this rule will be construed to supersede the exceptions to licensure contained in rule 645—326.17(148C).

SOURCE: Iowa Admin Code, Sec. 645-327.6, (Accessed Aug. 2024).

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, requires Iowa licensure.

SOURCE: Iowa Admin Code, Sec. 645-123.5, (Accessed Aug. 2024).

Nursing

A registered nurse or licensed practical nurse who provides services through telehealth to a patient physically located in Iowa must hold an active license issued by the board or have an active privilege to practice in Iowa pursuant to the nurse licensure compact.

SOURCE: IA Admin Code Sec. 655-6.4(152), (Accessed Aug. 2024).

Board of Nursing – ARNP

An advanced registered nurse practitioner who provides services through telehealth to a patient physically located in Iowa must be licensed by the board. A licensee who provides services through telehealth to a patient physically located in another state shall be subject to the laws and jurisdiction of the state where the patient is physically located.

SOURCE: IA Admin Code Sec. 655-7.9(152), (Accessed Aug. 2024).

Board of Nursing – Midwives

A CPM who provides services through telehealth to a client physically located in Iowa must be licensed by the board. A CPM who provides services through telehealth to a client physically located in another state shall be subject to the laws and jurisdiction of the state where the client is physically located.

SOURCE: IA Admin Code Sec. 655-16.7, (Accessed Aug. 2024).

Dietitian

Any licensee who provides a telehealth visit to an individual or a group located in Iowa shall be licensed in Iowa

SOURCE: IA Admin Code Sec. 645-81.10, (Accessed Aug. 2024).

Occupational Therapy

Any occupational therapist or occupational therapy assistant who provides an occupational therapy telehealth visit to a patient located in Iowa shall be licensed in Iowa.

SOURCE: IA Admin Code 645-208.3. (Accessed Aug. 2024).

Physical Therapy

Any physical therapist or physical therapist assistant who provides a physical therapy telehealth visit to a patient located in Iowa shall be licensed in Iowa or have a compact privilege issued by the physical therapy compact commission

SOURCE: IA Admin Code Sec. 645-201.3, (Accessed Aug. 2024).

Speech Language Pathology/Audiology

Speech pathology or audiology services in Iowa through telephonic, electronic, or other means constitute the practice of speech pathology or audiology and require Iowa licensure, regardless of the location of the speech/language pathologist or audiologist.

SOURCE: Iowa Admin Code, Sec. 645-301.1, (Accessed Aug. 2024).

Last updated 08/26/2024

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. 2024).

Multiple Professions Regulations

“Asynchronous store-and-forward transmission” means 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” means 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. 645-327.6, Iowa Admin Code, Sec. 653-13.11, IA Admin Code Sec. 655-7.1, (Accessed Aug. 2024).

“Telehealth” means the practice of nursing 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. Telehealth includes asynchronous store-and-forward technologies, remote monitoring, and real-time interactive services, including teleradiology and telepathology. Telehealth, for the purposes of this rule, shall not include the provision of nursing services only through an audio-only telephone, email messages, facsimile transmissions, or U.S. mail or other parcel service, or any combination thereof.

SOURCE: IA Admin Code Sec. 655-6.1(152), IA Admin Code Sec. 655-7.1 (Accessed Aug. 2024).

Psychologists

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

SOURCE: Iowa Admin Code, Sec. 645-243.1, (Accessed Aug. 2024).

Physical & Occupational Therapy

Telehealth visit means the provision of occupational/physical therapy services by a licensee to a patient using technology where the licensee and the patient are not at the same physical location for the physical/occupational therapy session.

SOURCE: IA Admin Code Sec. 645-201.3, & 645.208.3, (Accessed Aug. 2024).

Dietitians

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: IA Admin Code Sec. 645-81.10, (Accessed Aug. 2024).

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 Aug. 2024).

Hearing Aid Dispenser

A “telehealth appointment” is one wherein the licensee provides testing or adjustment services to a client using technology where the hearing aid specialist and the client are not at the same physical location during the appointment.

SOURCE: Iowa Admin Code, Sec. 645-123.5, (Accessed Aug. 2024).

Last updated 08/26/2024

Licensure Compacts

Member of Audiology and Speech Language Pathology Interstate Compact.

SOURCE: ASLP-IC Compact, Compact Map, (Accessed Aug. 2024).

Member of Counseling Compact.

SOURCE: Counseling Compact, Compact Map, (Accessed Aug. 2024).

Member of the EMS Compact.

SOURCE: Interstate Commission for EMS Personnel Practice. The EMS Compact. (Accessed Aug. 2024).

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. The IMLC. (Accessed Aug. 2024).

Member of Nurse Licensure Compact.

SOURCE: Current NLC States and Status. NCSBN. (Accessed Aug. 2024).

Member of Occupational Therapy Licensure Compact.

SOURCE: Occupational Therapy Compact, Compact Map, (Accessed Aug. 2024).

Member of Physical Therapy Compact.

SOURCE: Physical Therapy Compact. Compact Map. (Accessed Aug. 2024).

Member of Social Worker Compact

SOURCE: HF 2512 (2024 Session) & Social Work Compact, Compact Map, (Accessed Aug. 2024).

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

Last updated 08/26/2024

Miscellaneous

The following persons and entities may use or access the network for data and video services including access to the Internet if the use is for telemedicine or educational purposes:

Licensed health care professionals or licensed health care professionals who function under the direction of or in collaboration with a physician or a hospital, or both, for example, other doctors, students, nurses, physician’s assistants, therapists, clinical social workers, psychologists;
Hospital or physician clinic staff members;
Professional boards on which health professionals serve, for example, a nurse serving on the board of the American Cancer Society;
Patients acting under the direction of a licensed health care professional;
Health care employees of facilities that have a contractual agreement with the hospital or physician;
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, for example, Association of Iowa Hospitals and Health Systems, Iowa Medical Society, Iowa Osteopathic Medical Association, Iowa Chiropractic Society, Iowa Nurses Association;
Professional board members where a health care professional serves as a member of a board, for example, a physician serving on the board of the American Cancer Society

SOURCE: IA Admin. Code, 751 7.11(8D). (Accessed Aug. 2024).

The department of health and human services shall review the department’s administrative rules regarding psychiatric medical institutions for children (PMICs) and shall update the rules, informed by the findings of the association of children’s residential centers” most recent nationwide survey and scan of psychiatric residential treatment facilities, and the recommendations of the coalition for family and children’s services in Iowa, to do all of the following: ..

Allow licensed professionals, based on competencies rather than license type, to order the use of restraints or seclusions and to conduct post- restraint or seclusion assessments, including via telehealth, to increase response times and expand access to care. The department of inspections, appeals, and licensing shall adopt rules pursuant to chapter 17A to administer this subsection.

SOURCE: Section 135H.6 & House File 2402 (2024 Session), (Accessed Aug. 2024).

Last updated 08/26/2024

Online Prescribing

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 Aug. 2024).

When inducing an abortion by providing an abortion-inducing drug, a physician must be physically present with the woman at the time the abortion-inducing drug is provided.

SOURCE: IA Admin. Code, 653 13.10(3) (Accessed Aug. 2024).

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 Aug. 2024).

If a mental health professional provides behavioral health services via telehealth on school/AEA premises, the mental health professional will first establish a valid provider-patient relationship. The provider-patient relationship is established when:

The student, with the consent of the student’s parent or guardian when the student has not yet reached the age of majority, seeks help from a mental health professional;
The mental health professional agrees to provide treatment of the student; and
The student’s parent or guardian agrees to have the student treated by the mental health professional.

If a provider-patient relationship is established and the student has not yet reached the age of majority, parent or guardian consent will be obtained prior to the student receiving behavioral health services via telehealth in a school or AEA setting and is necessary each academic year that the student receives telehealth services.

SOURCE: IA Admin Code 281.14.22, (Accessed Aug. 2024).

Behavioral health services provided via telehealth in a school setting: Iowa Code section 280A.4 is incorporated by this reference.

[see code above]

SOURCE: IA Admin Code 281.14.23, (Accessed Aug. 2024).

The pharmacy and professional pharmacy staff shall ensure that the prescription drug or medication order, regardless of the means of transmission, has been issued for a legitimate medical purpose by a prescriber acting in the usual course of the prescriber’s professional practice. A pharmacist shall not dispense a prescription drug if the pharmacist knows or should have known that the prescription was issued solely on the basis of an Internet-based questionnaire.

SOURCE: IA Admin. Code, 657 8.19(5). (Accessed Aug. 2024).

Physician Assistant-Patient Relationship

A licensee who uses telemedicine will 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.

Generally, a licensee will 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 will 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.

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. 645-327.6, (Accessed Aug. 2024).

Nursing – ARNPs

Prior to providing services through telehealth, the licensee shall first establish a practitioner-patient relationship. A practitioner-patient relationship is established when:

The person with a health-related matter seeks assistance from the licensee;
The licensee agrees to provide services; and
The person agrees to be treated, or the person’s legal guardian or legal representative agrees to the person’s being treated, by the licensee regardless of whether there has been a previous in-person
encounter between the licensee and the person.

A practitioner-patient relationship can be established through an in-person encounter, consultation with another licensee or health care provider, or telehealth encounter.

Notwithstanding paragraphs 7.9(5) “a” and “b,” services may be provided through telehealth without first establishing a practitioner-patient relationship in the following settings or circumstances:

Institutional settings;
Licensed or certified nursing facilities, residential care facilities, intermediate care facilities, assisted living facilities, and hospice settings;
In response to an emergency or disaster;
Informal consultations with another health care provider performed by a licensee outside of the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
Episodic consultations by a specialist located in another jurisdiction who provides consultation services upon request to a licensee;
A substitute licensee acting on behalf and at the designation of an absent licensee or other health care provider in the same specialty on an on-call or cross-coverage basis; or
When a sexually transmitted disease has been diagnosed in a patient, a licensee prescribes or dispenses antibiotics to the patient’s named sexual partner(s) for the treatment of the sexually transmitted disease as recommended by the U.S. Centers for Disease Control and Prevention.

A licensee providing services through telehealth may issue a prescription to a patient as long as the issuance of such prescription is consistent with the standard of care applicable to the in-person setting.

SOURCE: IA Admin Code Sec. 655-7.9(152), (Accessed Aug. 2024).

Nursing – Midwives

Prior to initiating contact with a client for the purpose of providing services to the client using telehealth, a CPM shall:

Review the client’s history and all relevant medical records; and
Determine as to each unique client encounter whether the CPM will be able to provide the same standard of care using telehealth as would be provided if the services were provided in person

Prior to providing services through telehealth, the CPM shall first establish a CPM-client relationship. A CPM-client relationship is established when:

The client seeks assistance from the CPM;
The CPM agrees to provide services; and
The client agrees to be treated, or the client’s legal guardian or legal representative agrees to the client being treated, by the CPM regardless of whether there has been a previous in-person encounter between the CPM and the client.

A CPM-client relationship can be established through an in-person encounter, consultation with another CPM or health care provider, or telehealth encounter.

Notwithstanding paragraphs 16.7(5)“a” and “b,” services may be provided through telehealth without first establishing a CPM-client relationship in the following settings or circumstances:

In response to an emergency or disaster;
Via informal consultations with another health care provider performed by a CPM outside of the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or
exchange of direct or indirect compensation;
A substitute CPM acting on behalf and at the designation of an absent CPM in the same specialty on an on-call or cross-coverage basis

SOURCE: IA Admin Code Sec. 655-16.7, (Accessed Aug. 2024).

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 Aug. 2024).

Last updated 08/26/2024