Medicaid – IAC 441 Human Services Department – Section 77 Conditions of Participation
77.26(2) Temporarily licensed marital and family therapists. Any person who holds a temporary license to practice marital and family therapy pursuant to Iowa Code section 154D.7 is eligible to participate when the temporarily licensed marital and family therapist provides treatment under the supervision of a qualified marital and family therapist as determined by the board of behavioral science by rule. Claims for payment for such services must be submitted by the supervising licensed marital and family therapist.
77.26(6) Temporarily licensed mental health counselors. Any person temporarily licensed by the board of behavioral science as a mental health counselor pursuant to Iowa Code section 154D.7 is eligible to participate when the temporarily licensed mental health counselor provides treatment under the supervision of a qualified mental health counselor as determined by the board of behavioral science by rule. Claims for payment for such services must be submitted by the supervising licensed mental health counselor.
Division XXVII of the Iowa HHS budget bill (SF2418 – 87th General Assembly, 2018)
A bill signed in 2018 clarified the rules entitling licensed behavioral health clinicians payment for their services. https://www.legis.iowa.gov/legislation/BillBook?ga=87&ba=SF2418 This starts on Page 93, COVERAGE OF BEHAVIORAL HEALTH SERVICES PROVIDED BY CERTAIN PROVIDERS. Iowa clinicians were struggling for insurance companies to reimburse our temporary licensed LMHCs and LMFTs, so this bill includes the additional language for clarification:
The rules shall also provide that a mental health counselor (and licensed marriage and family therapist), who holds a temporary license to practice mental health counseling or marriage and family therapy pursuant to section 1540.7, is entitled to payment under this section for behavioral health services provided to recipients of medical assistance, when such services are provided under the supervision of a qualified supervisor as determined by the board of behavioral science by rule, and claims for payment for such services are submitted by the qualified supervisor.
5. Entitlement to payment under this section is applicable to services provided to recipients of medical assistance under both the fee-for-service and managed care payment and delivery systems. Neither the fee-for-service nor the managed care payment and delivery system shall impose a practice or supervision restriction which is inconsistent with or more restrictive than the authority already granted by law, including the authority to provide supervision in person or remotely through electronic means as specified by rule of the
applicable licensing board.
Private Insurance
Iowa Insurance Division dated 6-7-18:
Without speaking to the Medicaid portion (which would be under DHS authority) or any licensure portion (which would be handled under the authority of either IDPH or the appropriate board), there are two caveats that must be met for the commercial payer to pay for services rendered by provisionally licensed providers.
1. The benefit must be in the individual’s policy. If the benefit is not in the policy the commercial payer would not cover the service.
2. The licensed provider overseeing the provisionally licensed provider must have a contract with the commercial payer for the commercial payer to pay for services rendered by provisionally licensed providers.
So, if a policy already contains benefits for a licensed clinician (as identified in the statute), then provisionally licensed clinicians would be able to provide benefits and bill for services. If the policy does not contain benefits for those licensed clinicians, the policy is not required to make payment for those licensed clinicians or provisionally licensed clinicians. If the benefit is not part of the policy, carriers are not required to add it to the policy.
According to another email dated 1-15-19 from McElhaney, the Insurance Division did not write any Administrative Rules around the legislation.