New Iowa Telehealth Regulations

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The Board of Physician Assistants and Board of Speech Pathology and Audiology released new telehealth regulations effective September 29, 2021, for physician assistants speech-language pathologists, and audiologists.

What this means for physician assistants

For physician assistants, the new rule 645—327.9 provides standards for the practice of telemedicine including:

  • Standards of patient care
  • Establishing the physician-patient relationship through a telemedicine encounter
  • Interview of medical history and physical examination requirements
  • Delegation of telemedicine services to a non-physician assistant healthcare provider
  • Technology requirements and practices to safeguard the patient’s confidential health information

The new rule aligns with the Board of Medicine rules governing telemedicine in an effort to provide uniform standards for physician assistants and their supervising physicians. Physician assistants are to use evidence-based telemedicine practice guidelines and standards of practice and will be held to the same standards of care and professional ethics as would be applied in a traditional in-person setting.

Prior to providing treatment, physician assistants are required to interview the patient to collect relevant medical history. Internet questionnaires with a static set of questions that illicit static answers from the patient are inadequate; instead, an adaptive, interactive, and responsive online interview is proper. Physician assistants can delegate telemedicine services to a non-physician assistant healthcare provider if proper procedures are in place as outlined in 327.9(10).

As with in-person treatment, a physician assistant must ensure that all telemedicine encounters comply with HIPAA and that the technology used also complies with HIPAA and relevant safety laws, rules, regulations, and codes. The new rule also requires that a physician-patient relationship be properly established during the visit; prescribing to a patient based solely on an internet request or questionnaire is prohibited.

However, the rule also describes several situations which allow a physician assistant to treat a patient who has not been personally interviewed, examined, and diagnosed by that particular physician assistant.

What this means for speech-language pathologists and audiologists

For speech pathologists and audiologists, a new chapter 645—301 “Practice of Speech Pathologists and Audiologists” was added to the Iowa Administrative Code that sets forth minimum standards of care for telehealth appointments including:

  • HIPAA-compliant technology providing for two-way, real-time communication
  • Informed consent process prior to the telehealth appointment
  • Telehealth appointment documentation

Speech-language pathologists and audiologists will be held to the same standard of care as someone of the same position who provides such services in person. If the same quality of care cannot be achieved using technology, a telehealth visit is not appropriate.

Prior to the first telehealth appointment, a speech-language pathologist or audiologist must obtain informed consent from the patient specific to the services that will be provided in the visit. At a minimum, patients must be informed of any potential risks and/or limitations with receiving services online rather than in-person with the provider, the potential for unauthorized access to protected health information, and the potential for a technology malfunction during the visit.

The technology used during the telehealth appointment must be HIPAA-compliant, which includes audio and video equipment that allows two-way, real-time communication between the provider and patient. Speech-language pathologists and audiologists must also notate in the clinical record when speech pathology or audiology services are provided through a telehealth visit.

The big picture

These new regulations further solidify the importance of telehealth as part of the modern healthcare delivery model, especially during the COVID-19 pandemic, where people are relying on virtual access more than ever. As telehealth’s reach continues to broaden it is important that healthcare providers are staying updated with the latest regulations and guidance.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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