Managing Healthcare Compliance in Iowa

Sarah Jones
Outline of Iowa over healthcare photo

Navigating healthcare compliance in Iowa is a journey unique to the state, shaped by its distinct regulations and mandates. One such regulation is the telehealth parity law, becoming even more important for administrators and compliance managers as telehealth gains popularity.

All healthcare facilities in Iowa, from sprawling hospitals to small clinics, must carefully navigate the state’s regulations with accuracy. They need a dynamic system to track, interpret, and adapt to the nuances of local legislation. This article serves as a compass to guide you through the complexities of healthcare compliance in Iowa, avoiding penalties and delivering quality care,

Iowa Healthcare Compliance Resources

Let’s start with the important state government agencies you’ll need to work with:

  • The Iowa Department of Health and Human Services (HHS) formed through the merger of the Departments of Human Services and Public Health, is dedicated to enhancing the well-being of Iowans by providing a comprehensive range of health and social services across the state.
  • The Iowa Hospital Association (IHA) is a statewide organization advocating for and supporting Iowa’s hospitals and health systems through leadership, representation, and various services to enhance healthcare delivery and patient care in the state.
  • The Department of Medicaid within the Iowa Department of Health and Human Services Public is responsible for administering Medicaid programs in Iowa, offering health care coverage and services to eligible low-income individuals and families across the state.
  • The Board of Medicine within the Iowa Department of Inspections, Appeals, & Licensing oversees the licensure and regulation of physicians, ensuring medical standards and ethical practices are maintained in the state’s healthcare system.
  • The Iowa Board of Behavioral Science Examiners, a regulatory body under the Iowa Department of Public Health, is responsible for the licensing, oversight, and ethical regulation of behavioral health professionals, including licensed mental health counselors and marriage and family therapists.

These agencies help maintain the integrity and quality of healthcare services in Iowa, protecting the public and promoting patient safety. The resources provided by these Iowa state agencies are essential for promoting public health, ensuring access to healthcare, supporting healthcare professionals, and enhancing overall health outcomes for the residents of Iowa.

Regulations Unique to Iowa

To meet the standards of healthcare compliance in Iowa, there are a few additional regulations. For example, Iowa’s mission to maintain an efficient and fair health system is reflected in the Certificate of Need program and regulations.

Certificate of Need Required

Healthcare leaders and compliance managers in Iowa need to be aware of the Certificate of Need (CON) program. To obtain a CON, applications are submitted to the Department of Inspections, Appeals, & Licensing, which requires a review process for initiating or changing health services. A CON is needed for hospitals, nursing facilities, ambulatory surgery centers (ASCs), or anyone purchasing medical equipment costing more than $1.5 million. This process, overseen by the State Health Facilities Council, ensures that healthcare system developments are both orderly and economical, aligning with the state’s goals for an efficient healthcare system.

Telehealth Parity Law

Iowa state passed a telehealth parity law in 2019 that significantly modernized providers’ practice options. The law ensures payers do not discriminate between coverage benefits for healthcare services that are provided in person and the same services delivered through telehealth. Even before telehealth gained momentum in 2020, the path was paved for Iowa providers to offer virtual appointments, expanding revenue opportunity and broadening patient access to healthcare, including across state lines. Importantly, the law also extends to mental health care, allowing for online consultations with psychiatrists, psychologists, and therapists.

Medical Cannabis Program Regulations

In Iowa, the Medical Cannabis Program within the Bureau of Cannabis Regulation at the Iowa Department of Health and Human Services (HHS) is structured to safely treat patients with qualifying medical conditions. Physicians, physician assistants, advanced registered nurse practitioners, podiatrists, pharmacists, and pharmacy technicians are all able to provide cannabis certification to patients if the treatment is reasonable and appropriate. Providers are not required to obtain special credentials or continuing medical education (CME). According to regulations, the provider must determine a qualifying condition, provide written certification, and give the patient information about the therapeutic uses, risks, and benefits of medical cannabis. Under Iowa Code chapter 124E.12, healthcare practitioners are protected from disciplinary action related to medical cannabis, as long as their practices are compliant.

Tips To Manage Healthcare Compliance in Iowa

Effectively managing healthcare compliance in Iowa is a critical responsibility for healthcare organizations, as it ensures the delivery of high-quality care while adhering to legal and regulatory requirements. Here are some key strategies to help healthcare organizations manage compliance effectively:

  • Conduct State-Specific Training: Provide ongoing training and education to staff that is customized to your state’s regulations as well as your facility. If using a learning management system, ensure the vendor offers Iowa-approved training.
  • Organize Policies By Requirement: Including “IA” in every document that is required by the state will make it much easier for you to find these documents in an online system when a surveyor is onsite. It is also best practice to include the standard you are meeting for additional clarity.
  • Establish a System for Monitoring Risk: Being able to identify compliance risks before they become incidents or violations can save the entire organization time and money. Identifying trends and consistently reviewing reports can signal issues, such as training not being completed or a large number of incidents in one location.
  • Use Compliance Management Software: Accreditation surveyors say organizations that use compliance software are more prepared for onsite visits and surveys. The software helps to keep documents and policies organized, ensures training content is up to date, and makes reporting easy.

By implementing these strategies and fostering a culture of compliance within your healthcare organization, you can effectively manage healthcare compliance, reduce risks, and provide the best possible care to your patients while staying within legal boundaries.

Credentialing Compliance in Iowa

For providers and credentialing teams across the state, understanding the provider enrollment process with Medicaid in Iowa is key. The thorough process begins by submitting a comprehensive application to the Iowa Medicaid Enterprise (IME) Provider Enrollment Unit. The application is used to verify provider compliance with federal and state regulations. Once enrolled, providers must then complete Managed Care Organization (MCO) credentialing. Throughout the process, provider documentation required includes a completed Iowa Medicaid Universal Provider Enrollment Application (470-0254), Electronic Funds Transfer (EFT) Authorization Form, Provider Agreement, W-9 IRS Form, and a designated contact person. It’s important to note that services rendered prior to the enrollment effective date are not eligible for payment. The entire Iowa Medicaid enrollment process ensures that only qualified and compliant providers are part of the state’s program.

Meet Iowa Compliance Requirements With MedTrainer 

While the path may be complex, healthcare providers who prioritize compliance will not only avoid legal troubles but also enhance the quality of care they provide to their patients in Iowa

MedTrainer’s all-in-one compliance platform can streamline management of Iowa healthcare compliance. MedTrainer seamlessly consolidates your organization’s policies, incident reports, safety plans, HR documents, contracts, and more. This centralized repository ensures all employees have easy access to essential information. The course library is curated to align with regulatory and accreditation requirements, and courses are regularly added and updated to ensure the most current information. Learn more about MedTrainer today!