Can LMSWs bill insurance?
Division XXVII of the Iowa HHS budget bill (SF2418 – 87th General Assembly, 2018)
Expressly spelled out that LMSWs may bill for their services under their LISW supervisors.
Below is the text of an email that received from Chance McElhaney, Communications Director and Legislative Liaison at the 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.
LMSWs were already allowed to bill under LISWs, so while DHS did write rules on the 2018 legislation, the new rules did not included social workers, because social workers were already in the Administrative Code.
See pg. 646
Chapter 77.26 (3) which deals with LISWs and
77.26 (4) which talks about LMSWs