Iowa Board of Medicine to adopt a final telemedicine disciplinary rule in April – House Energy and Commerce Committee considers legislation to expand Medicare recognition of telemedicine – IBM pursues Interstate Medical Licensure by Compact to, among other things, facilitate telemedicine practice in Iowa
The Iowa Board of Medicine (IBM) has reviewed public comments received on its proposed disciplinary rule for physicians using telemedicine in Iowa and, in light of those comments, has elected to make changes to those rules. Once drafting is complete, the IBM will post the rule as amended for public comment on the changes. The IBM intends to adopt a final rule at its April 2-3, 2015 meeting.
On the national front, the House Energy and Commerce Committee is looking at draft legislation that would expand upon current geographic and technological parameters for Medicare payment of telehealth services. Medicare now pays for a very limited number (75 service codes) of Part B medical services delivered via telecommunications and only if the system used is real-time interactive audio and video and only if the patient receiving the services is at an originating site located in a rural Health Professional Shortage Area (HPSA) either outside of a Metropolitan Statistical Area (MSA) or in a rural census tract or in a county outside of a MSA (unless a Medicare telemedicine demonstration project). Originating sites in recognized geographic areas can be in the offices of a physician or other practitioner; a hospital or critical access hospital (CAH); a rural health clinic; a federally qualified health center (FQHC); a hospital/CAH-based renal dialysis center; a skilled nursing facility (SNF); or a community mental health center (CMHC). The following practitioners are recognized by Medicare as providers of telehealth services: physicians; nurse practitioners, nurse-midwives, clinical nurse specialists and CRNAs; physician assistants; clinical psychologists and clinical social workers (subject to limitations); and registered dieticians or nutrition professionals.
The “Advancing Telehealth Opportunities in Medicare” is one section (Section 4181) of the “21st Century Cures Act,” a 400-page bipartisan legislative proposal under discussion in the House. The telehealth portion directs HHS to develop a Medicare telehealth payment methodology that does not increase program costs and gives HHS authority under specified conditions to relax current geographic, site, and practitioner limitations for payment for telehealth services provided to Medicare beneficiaries.
The House Energy and Commerce Committee accepted testimony regarding this draft telehealth proposal in January with a goal of introducing legislation sometime in February. While commenters generally supported the draft’s intent, many suggested that the bill proposal did not go far enough to ease current geographic and site limitations and embrace a broader range of “store and forward” and other telecommunication technologies.
About compact medical licensure in Iowa
The IBM has introduced legislation into the General Assembly seeking authorization for Iowa’s participation in an interstate medical licensure system via compact. Compact medical licensure allows a physician licensed in a “home” state to become licensed in other compact signatory states via the compact process. Senate Study Bill 1019 and House Study Bill 20, companion bills to approve Iowa’s participation in the compact, are now under subcommittee review in their respective legislative chambers.
The design for interstate medical licensure by compact was developed by the Federation of State Medical Boards (FSMB); the IBM was a participant in that process. The compact licensure process is similar in many respects to expedited licensure currently provided for in IBM rules.
At least seven (7) states must pass legislation authorizing participation for the compact to effective. The FSMB reports that in addition to Iowa, ten (10) states have introduced compact legislation: Minnesota, Montana, Nebraska, Oklahoma, South Dakota, Texas, Utah, Vermont, West Virginia, and Wyoming. An interstate medical licensure compact commission would administer the compact; each signatory state would have two (2) representatives on the commission. Actual licensure and discipline of physicians in compact states remains with the licensing boards.
Organizations in support of Iowa’s legislation include the Iowa Medical Society; the Iowa Hospital Association; the Iowa Academy of Family Physicians; the Iowa Chapter of the American Academy of Pediatrics; the Iowa Psychiatric Society; the Iowa Osteopathic Medical Association; and several health systems, including Unity Point, Mercy Network, Cedar Rapids PHO, Genesis Health System, and Gunderson Lutheran Health. The American Medical Association endorsed the compact in November. The draft federal “21st Century Cures” legislation discussed above includes a “Sense of Congress” provision encouraging compact medical licensure to facilitate multistate practice and the provision of telehealth services across state lines.
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