Section 441.78.24. Psychologists.

Payment will be approved for services authorized by state law when they are provided by the psychologist in the psychologist’s office, a hospital, nursing facility, or residential care facility.

       78.24(1) Payment for covered services provided by the psychologist shall be made on a fee for service basis.

        a.           Payment shall be made only for time spent in face-to-face consultation with the client.

        b.           Time spent with clients shall be rounded to the quarter hour.

       78.24(2) Payment will be approved for the following psychological procedures:

        a.           Individual outpatient psychotherapy or other psychological procedures not to exceed one hour per week or 40 hours in any 12-month period, or

        b.           Couple, marital, family, or group outpatient therapy not to exceed one and one-half hours per week or 60 hours in any 12-month period, or

        c.           A combination of individual and group therapy not to exceed the cost of 40 individual therapy hours in any 12-month period.

        d.           Psychological examinations and testing for purposes of evaluation, placement, psychotherapy, or assessment of therapeutic progress, not to exceed eight hours in any 12-month period.

        e.           Mileage at the same rate as in 78.1(8) when the following conditions are met:

       (1)             It is necessary for the psychologist to travel outside of the home community, and

       (2)             There is no qualified mental health professional more immediately available in the community, and

       (3)             The member has a medical condition which prohibits travel.

        f.            Covered procedures necessary to maintain continuity of psychological treatment during periods of hospitalization or convalescence for physical illness.

        g.           Procedures provided within a licensed hospital, residential treatment facility, day hospital, or nursing home as part of an approved treatment plan and a psychologist is not employed by the facility.

       78.24(3) Payment will not be approved for the following services:

        a.           Psychological examinations performed without relationship to evaluations or psychotherapy for a specific condition, symptom, or complaint.

        b.           Psychological examinations covered under Part B of Medicare, except for the Part B Medicare deductible and coinsurance.

        c.           Psychological examinations employing unusual or experimental instrumentation.

        d.           Individual and group psychotherapy without specification of condition, symptom, or complaint.

        e.           Sensitivity training, marriage enrichment, assertiveness training, growth groups or marathons, or psychotherapy for nonspecific conditions of distress such as job dissatisfaction or general unhappiness.

       78.24(4) Rescinded IAB 10/12/94, effective 12/1/94.

       78.24(5) The following services shall require review by a consultant to the department.

        a.           Protracted therapy beyond 16 visits. These cases shall be reviewed following the sixteenth therapy session and periodically thereafter.

        b.           Any service which does not appear necessary or appears to fall outside the scope of what is professionally appropriate or necessary for a particular condition.

This rule is intended to implement Iowa Code sections 249A.4 and 249A.15.