IBM Releases Amended Telemedicine Rules
Date of Publication (February 13, 2015)
As we have previously reported, IMS has been closely involved with the Iowa Board of Medicine (IBM) in the development of its rules to establish standards of practice for physicians who use telemedicine. At a hearing last month, IMS offered formal comments to the board regarding these proposed rules. The latest draft of the rules was distributed Thursday, and the majority of the issues IMS raised were addressed. In several instances, the exact language IMS proposed was incorporated.
Specifically, IMS expressed concern over a provision requiring providers to disclose to each patient fees for services, cost-sharing responsibilities, and how payment is to be made. Because this information is not required for in-person encounters, and this information is frequently difficult to obtain, IMS proposed that disclosure only be required if fees are expected to differ from what they would be in an in-person encounter. The IBM agreed with IMS, and included IMS’ proposed language.
The rule outline three avenues for a valid physician-patient relationship to be established for the purposes of appropriate telemedical practice: first, through a traditional in-person medical interview and physical where the standard of care would require an in-person encounter; second, through consultation with another licensee; or third, through telemedicine, if the standard of care does not require an in-person encounter. Under the original draft, relationships established solely via telemedicine had to conform with guidelines established by nationally recognized medical specialty organizations. The problem with that language, IMS pointed out, is that only four medical specialties have nationally recognized societies. IMS suggested that the language addressing nationally recognized societies be removed. The new draft has removed that language and instead requires practitioners work in accordance with evidence-based guidelines that “address the clinical and technological aspects of telemedicine.” While not a verbatim version of the IMS suggestion, this change is consistent with the spirit of our recommendation.
At the urging of IMS, the IBM also amended the rules to clarify that prescribing based solely upon an internet questionnaire or internet consultation is prohibited, as is prescribing based solely upon a telephonic evaluation except in instances where the physician has a previously established relationship with the patient. This rule change will ensure that out of state entities looking to remotely expand their practices into the state of Iowa must establish a true telemedical system to appropriately evaluate patients and must adhere to the same standards as Iowa physicians, rather than simply offering a toll-free number or an online portal to conduct a brief consultation and issue a prescription.
The rules also require physicians to ensure that nonphysician providers under their supervision are qualified and trained to provide services within the scope of the nonphysician’s practice. IMS recommended that language be added that eliminates this requirement in the event of an emergency situation. The new draft does not adopt this suggestion. Rather, the new rules grant greater flexibility to allow for a systematic process to ensure nonphysician providers are qualified and trained to provide services within their scope, rather than personally assessing each nonphysician provider’s credentials as was the case under the previous draft of the rules.
Finally, the IBM also amended the rules to strike the provision prohibiting the use of telemedicine for any services or prescriptions, which state or federal regulations restrict to only being administered by a physician. Viewed by some as a second attempt aimed at prohibiting the use of telemedicine for the administration of abortion inducing medications, this rule section would have also had implications for a handful of other medications and treatments. The latest draft of the rules instead reiterates that these rules do not contradict or supersede the board’s existing rule banning telemedicine for the use of abortion inducing medications. That rule is currently scheduled to be heard before the Iowa Supreme Court next month. Planned Parenthood of the Heartland had publicly stated that it was prepared to also legally challenge this latest set of telemedicine rules if this original provision was not removed. Such a legal challenge would almost certainly have come with a judicial stay on the effective date of the rules until the case had been decided. With these changes released this week, Planned Parenthood has indicated that it is no longer considering legal action on this rule package; the rules are set to go into effect as planned, with final adoption expected when the IBM meets in April.