As we wrap up the second week of session, the legislature has begun to settle into a new rhythm with hybrid virtual and in-person subcommittee and committee meetings beginning to meet frequently to complete their work. Discussions continue behind the scenes on our tort reform efforts and a number of bills of interest to the medical community have begun to move through the legislative process.
This week saw action on IMS priority legislation SSB 1042 and companion bill HSB 92. These bills would expand the popular Rural Physician Loan Repayment Program, which provides up to $200,000 in loan repayment for a physician who agrees to practice in a rural area, and add additional flexibility to program requirements. The legislation would make the following changes:
- OB/GYNs are added to the list of specialties who qualify for loan repayment.
- Eligible service areas would be expanded to include mental health shortage areas for psychiatrists enrolled with the program.
- Physicians would be able to enter into a part-time practice arrangement in exchange for a longer service commitment.
- The program would be directed to establish more accurate geographic standards for qualifying rural communities.
This joint effort by IMS, the Iowa Academy of Family Physicians, and the Iowa Psychiatric Society, passed out of subcommittee and committee in the Senate this week and is now eligible for consideration by the full Senate. The House companion was introduced this week and is expected to have a subcommittee hearing soon.
This week saw the introduction of a new scope of practice proposal for the state of Iowa. HSB 71, which is being proposed by the Iowa Dental Board (IDB), would allow dentists to administer the influenza and COVID-19 vaccines. Over the summer and fall, proponents for the bill engaged with IMS as they developed this proposal. At IMS’ request, the bill was narrowed to remove dental administration of the HPV vaccine and restrict dentists’ ability to delegate administration to dental support staff.
The IMS Committee on Legislation discussed the proposal at length and recommended further narrowing the bill to remove administration of the COVID-19 vaccine and limit administration of the flu vaccine to not include children or elderly adults. IMS also requested patient notifications if the dentist administering the vaccine does not accept medical insurance, which is the case with the vast majority of community dentists, as this would result in patients having to pay cash for immunizations that are covered at no patient expense under many medical insurance plans. These recommendations were rejected. In conversations with legislators this week, there are a number of concerns with the current proposal, primarily with the authority for dentists to administer the new COVID-19 vaccines. The bill’s future is uncertain.
Telehealth Coverage & Parity
Several pieces of legislation were introduced this week pertaining to telehealth coverage and payment policy. As the medical community knows well, telehealth utilization has expanded dramatically over the past, in large part due to the easing of coverage restrictions and expansion of commercial payment parity to ensure that telehealth services are reimbursed at the same rate as in-person services. In preparation for the end of many of these temporary measures, likely in the latter half of 2021, policymakers are focused on updating policy and ensuring sustainable payment rates long-term.
Legislation introduced this week included the following:
- HF 88 – Modifying Code and Statutory Telehealth Definitions to Recognize Audio-Only Telehealth.
- HF 89 – Requiring Commercial Insurers to Reimburse Behavioral Health Services Provided via Telehealth at 100% of In-Person Rates.
- SF 92 – Modifying Code and Statutory Telehealth Definitions to Recognize Audio-Only Telehealth, and Require Commercial Insurers to Pay 100% of In-Person Rates for All Telehealth Services.
Following the dramatic increase in telehealth utilization during the first months of the pandemic, Wellmark retained an outside consultant to develop a new telehealth payment model, which they are proposing as a non-legislative alternative to the bills being put forward. Wellmark has also announced that it will extend 100% telehealth payment parity until at least June 30,2021, to ensure full parity during the pandemic. The IMS Committee on Legislation is currently evaluating the details of the long-term Wellmark proposal. Discussions on this proposal and these pieces of legislation will continue in the coming weeks.