DC State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

District of Columbia
Medicaid Program: District of Columbia Medicaid

Program Administrator: District of Columbia Dept. of Health Care Finance

Regional Telehealth Resource Center:

Mid-Atlantic Telehealth Resource Center
PO Box 800711

Charlottesville, VA 22908-0711
(434) 906-4960 / (855) MATRC4U
www.matrc.org

STATE LAW MEDICAID PROGRAM

Definition of telemedicine/telehealth

“Telehealth” means the delivery of healthcare services through the use of interactive audio, video, or other electronic media used for the purpose of diagnosis, consultation, or treatment; provided, that services delivered through audio-only telephones, electronic mail messages, or facsimile transmissions are not included.

Source: DC Code Sec. 31-3861.

Telehealth is defined as the delivery of healthcare services through the use of interactive audio, video, or other electronic media used for the purpose of diagnosis, consultation, or treatment, provided, that services delivered through audio-only telephones, electronic mail messages, or facsimile transmissions are not included. For the purposes of coverage by the Department of Health Care Finance (DHCF), telehealth and telemedicine shall be deemed synonymous.

Telemedicine is a service delivery model that delivers healthcare services through a two-way, real time interactive video-audio communication for the purpose of evaluation, diagnosis, consultation, or treatment.

Source: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910, .99 & Physicians Billing Manual. DC Medicaid. 6/13/2017. Sec. 12-7. Pgs. 53-56. (accessed Oct. 2017).

Live Video Reimbursement

Medicaid is required to pay for telehealth services if the same service would be covered when delivered in person.

Source: DC Code 31-3863.

Effective June 23, 2016 DC Medical Assistance Program will reimburse eligible providers for eligible healthcare services rendered via telemedicine in DC.

Patient must be with a provider at the originating site.

Must be an approved telemedicine provider. The following providers are considered an eligible originating site, as well as eligible distant site provider:

Hospital

Nursing facility

Federally Qualified Health Center

Clinic

Physician Group/Office

Nurse Practitioner Group/Office

DCPS

DCPCS

Core Service Agency

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW MEDICAID PROGRAM

Distant site providers may only bill for the appropriate
codes outlined (see manual).
Special reimbursement parameters for FQHCs:
When FQHC is originating site: An FQHC
provider must deliver an FQHC-eligible service
in order to be reimbursed the appropriate PPS
or fee for service (FFS) rate at the originating
site;
When FQHC is distant site: An FQHC provider
must deliver an FQHC-eligible service in order
to be reimbursed the appropriate PPS or FFS
rate; and
When FQHC is Originating and Distant Site: In
instances where the originating site is an FQHC,
the distant site is an FQHC, and both sites
deliver a service eligible for the same clinic
visit/encounter all-inclusive PPS code, only the
distant site will be eligible to be reimbursed for
the appropriate PPS rate for an FQHC-eligible
service.
Covered Services:
Evaluation and management
Consultation
Behavioral healthcare services
Rehabilitation services including speech therapy
Source: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910, .99 &
Physicians Billing Manual. DC Medicaid. 6/13/2017. Sec. 12-7.
Pgs. 53-56. (accessed Oct. 2017).
A telemedicine visit meets the definition of an encounter
for a FQHC.
Source: DC Municipal Regulation. Title 29, Chapter 45, Sec. 4599.

Store and Forward Reimbursement

No reference found. No reimbursement for store and forward.
Source: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910, .99 &
Physicians Billing Manual. DC Medicaid. 6/13/2017. Sec. 12-7.
Pgs. 53-56. (accessed Oct. 2017).

Remote Patient Monitoring Reimbursement

No reference found. No reimbursement for remote patient monitoring.
Source: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910, .99 &
Physicians Billing Manual. DC Medicaid. 6/13/2017. Sec. 12-7.
Pgs. 53-56. (accessed Oct. 2017).

Email/Phone/FAX

No reimbursement requirement for audio-only DC Medicaid does not reimburse for service delivery

telephones, electronic mail messages or facsimile using audio-only telephones, e-mail messages or
transmissions. facsimile transmissions.

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW MEDICAID PROGRAM

Source: Code Sec. 31-3861. Source: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910, .99 &

Physicians Billing Manual. DC Medicaid. 6/13/2017. Sec. 12-7.
Pgs. 53-56. (accessed Oct. 2017).

Online Prescribing

No reference found. No reference found.

Consent

No reference found. Written consent required.

Source: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910, .99 &
Physicians Billing Manual. DC Medicaid. 6/13/2017. Sec. 12-7.
Pgs. 53-56. (accessed Oct. 2017).

Location

No reference found. Eligible originating sites:
Hospital
Nursing facility
Federally Qualified Health Center
Clinic
Physician Group/Office
Nurse Practitioner Group/Office
DCPS
DCPCS
Core Service Agency
Source: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910, .99 &
Physicians Billing Manual. DC Medicaid. 6/13/2017. Sec. 12-7.
Pgs. 53-56. (accessed Oct. 2017).

Cross-State Licensing

No reference found. No reference found.

Private Payers

Private payers are required to pay for telehealth services No reference found.
if the same service would be covered when delivered in
person.
A health insurer may not impose any annual or lifetime
dollar maximum on coverage for telehealth services.
Source: DC Code Sec. 31-3862.

Site/Transmission Fee

No reference found. No transaction or facility fee.
Source: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910, .99 &
Physicians Billing Manual. DC Medicaid. 6/13/2017. Sec. 12-7.
Pgs. 53-56. (accessed Oct. 2017).

Miscellaneous

DHCF required to send a Telemedicine Program Evaluation survey to providers, effective Jan. 1, 2017.

Source: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910, .99.

Telemedicine section also appears in Provider Manuals on:
FQHCs

Clinics

© 2017 Public Health Institute Center for Connected Health Policy

STATE LAW MEDICAID PROGRAM

Inpatient Hospital

Outpatient Hospital

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