Telehealth: Iowa Administrative Code Chapter 6 and 7 Rules
by Jimmy Reyes, DNP, Ph.D.(c), AGNP, RN, FRE
Telehealth rules in Chapters 6 and 7 became effective on June 22, 2022 and the purpose is to provide guidance to licensed practical nurses, registered nurses, and APRNs on the practitioner provider relationship, consent to telehealth visits, the use of technology, record keeping, and follow-up care. In essence, the rules provide additional guidance on the effective and safe use of telehealth technology. According to the literature, telehealth is the use of digital information and communication technologies to access health care services remotely and manage the health care of a patient (ATA, 2019; Kruse et al., 2017; NONPF, 2018). Technologies can include computers and mobile devices, such as tablets and smartphones. This may be technology the patient use from home.
In addition, a nurse or other health care professional may provide telehealth from a primary care office or federally qualified health center, such as in rural areas. Telehealth can also be technology that the health care provider uses to improve or support health care services. Per Iowa Administrative Code, Chapter 7.9(5), Prior to providing services through telehealth, the licensee shall first establish a practitioner-patient relationship. A practitioner-patient relationship is established when:
- The person with a health-related matter seeks assistance from the licensee
- The licensee agrees to provide services
- The person agrees to be treated, or the person’s legal guardian or legal representative
agrees to the person’s being treated, by the licensee regardless of whether there has
been a previous in-person encounter between the licensee and the person.
In addition, a practitioner-patient relationship can be established through an in-person encounter, consultation with another licensee or health care provider, or telehealth encounter. Some services may be provided through telehealth without first establishing a practitioner-patient relationship in the following settings or circumstances:
- Institutional settings
- Licensed or certified nursing facilities, residential care facilities, intermediate care
facilities, assisted living facilities, and hospice settings
- In response to an emergency or disaster
- Informal consultations with another health care provider performed by a licensee
outside of the context of a contractual relationship, or on an irregular or infrequent
basis, without the expectation or exchange of direct or indirect compensation
- Episodic consultations by a specialist located in another jurisdiction who provides
consultation services upon request to a licensee
- A substitute licensee acting on behalf and at the designation of an absent licensee or
other health care provider in the same specialty on an on-call or cross-coverage basis; - When a sexually transmitted disease has been diagnosed in a patient, a licensee
prescribes or dispenses antibiotics to the patient’s named sexual partner(s) for the
treatment of the sexually transmitted disease as recommended by the U.S. Centers for
Disease Control and Prevention.
A licensee who provides services through telehealth shall be held to the same standard of care as is applicable to in-person settings. A licensee shall not perform any service via telehealth unless the same standard of care can be achieved as if the service was performed in person. Prior to initiating contact with a patient for the purpose of providing services to the patient using telehealth, a licensee shall:
- Review the patient’s history and all relevant medical records
- Determine as to each unique patient encounter whether the licensee will be able to
provide the same standard of care using telehealth as would be provided if the services
were provided in person.
Additionally, prior to providing services via telehealth, the licensee shall obtain consent from the patient, or the patient’s legal guardian or legal representative, to receive services via telehealth. Lastly, a licensee who provides services through telehealth to a patient physically located in Iowa must be licensed by the Iowa board of nursing. A licensee who provides services through telehealth to a patient physically located in another state shall be subject to the laws and jurisdiction of the state where the patient is physically located.
Telehealth rules and regulations may be reviewed in the following web links:
https://www.legis.iowa.gov/docs/iac/rule/05-18-2022.655.6.4.pdf
https://www.legis.iowa.gov/docs/iac/rule/05-18-2022.655.7.9.pdf
References:
American Telemedicine Association. (ATA). (2019). Telehealth basics. Retrieved from
https://www.americantelemed.org/resource/why-telemedicine/.
Iowa Administrative Code. (IAC). (2022). 6.4(152) Telehealth. Retrieved from
https://www.legis.iowa.gov/docs/iac/rule/05-18-2022.655.6.4.pdf
Iowa Administrative Code. (IAC). (2022). 7.9(152) Standards of practice for telehealth. Retrieved from https://www.legis.iowa.gov/docs/iac/rule/05-18-2022.655.7.9.pdf
Kruse C. S., Krowski N., Rodriguez B., Tran L., Vela J., Brooks M. (2017). Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open, 7, e016242.
Yearly Reminders
by Kathleen R. Weinberg, MSN, RN
As a licensed nurse you are responsible for following the laws, rules and regulations which govern your profession. The following are reminders of what you need to do to retain your license and suggestions to involve yourself in the nursing profession.
1. Routinely check the IBON Online Verification System to determine your license expiration date.
2. Remember the Board of Nursing no longer issues paper nursing licenses.
3. A licensee may renew a license beginning 60 days prior to the license expiration date on the wallet card.
4. At the time of renewal make sure you have completed your continuing education requirements.
5. For renewal of a three year license, the requirement is 36 contact hours.
6. For renewal of a license that has been issued for less than three years, the requirement is 36 contact hours.
7. Maintain records of the continuing education you have received in your licensing cycle.
8. If you are chosen for a random audit of your continuing education, complete the audit following the directions.
9. If you regularly examine, attend, counsel or treat dependent adults or children in Iowa, have you completed the Mandatory Training course for dependent adults and the Mandatory Training course for children within the last 3 years? These courses must be completed every 3 years.
10. At the time of initial licensure or renewal answer all questions honestly, specifically relating to your continuing education and criminal history.
11. Does the board office have your current address on file? If not, submit your current address in writing to the board office or submit by email.
12. Do you know the address for the Iowa Board of Nursing’s website? www.nursing.iowa.gov Mark it as a favorite and refer to it often!
13. Do you know where to find the Iowa Administrative Rules for nursing, 655IAC? They can be found on the IBON Website!
14. Do you know who your legislator is?
15. Have you explored the option of joining a professional nursing organization and asked yourself how you can become involved in your profession?
16. Board staff is here to help answer your questions, it is always better to ask then to assume you have the correct answer. The main number to the board office is 515-281-3255.
Specific to the Advanced Registered Nurse Practitioner (ARNP):
1. ARNPs must hold an active RN license.
2. For an Iowa ARNP license you must submit a copy of your current certification card from the applicable national certifying body and documentation of your RN license if from another compact state.
3. The continuing education required by the national certifying body is deemed to meet the
continuing education requirement mandated by Iowa law for license renewal. Documentation of current certification in itself verifies compliance.
4. ARNP’s who regularly examine, attend, counsel or treat children or adults in Iowa are required to complete the Mandatory Training course for dependent adults and the Mandatory Training course for children every 3 years.
In summary nurses are accountable and responsible to follow the rules and regulations which govern their licensure and practice. I encourage you to stay informed and to follow these reminders for licensure.
As always, thank you for your continued commitment to the nursing profession and for the wonderful care you provide to Iowa citizens.
I wish you all a safe, healthy and happy 2023!!!
Best regards, Kathy
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