Washington 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

Washington Medicaid

Washington

Medicaid Program: Washington Medicaid

Medicaid Program Administrator: Washington State Health Care Authority

Regional Telehealth Resource Center: Northwest Regional Telehealth Resource Center 2900 12th Ave. N., Ste. 30W
Billings, MT 59101
(888) 662-5601
www.nrtrc.org

STATE LAW/REGULATIONS IMEDICAID PROGRAM
Definition of telemedicine/telehealth
_” Te lemedici n e m ea n s t h e de l i ve ry of hea lth ca r e
serv ices th r o u gh t h e u se o f int e r act iv e a u d io a n d v id eo
t ech n o logy , p e rm itt in g r ea l-t im e co m m u n ica tion b etwee n the pa t ient at t he o r igi n at ing s it e a n d t h e provide r , fo r t he p u rpose of diag n os is, consu lt a t io n , or treatme nt. For purposes of this section only, ‘telemedicine’ does not include the use of audio-only telephone, facsimile, or email.”

Source: Revised Code of WA Sec. 70.41.020.

“Telemedicine means the use of tele-monitoring to enhance the delivery of certain home health skilled nursing services through:

⦁ The collection of clinical data and the transmission of such data between a patient at a distant location and the home health provider through electronic processing technologies. Objective clinical data that may be transmitted includes, but is not limited to, weight, blood pressure, pulse, respirations, blood glucose, and pulse oximetry;
⦁ The provision of certain education related to health care services using audio, video, or data communication instead of a face-to-face visit.”

Source: WA Admin. Code Sec. 182-551-2010.

“Telehealth means providing physical therapy via electronic communication where the physical therapist or physical therapist assistant and the patient are not at the same physical location.”

Source: WA Admin. Code Sec. 246-915-187.

Telemedicine is when a health care practitioner uses HIPAA-compliant, interactive, real-time audio and video telecommunications (including web-based applications) “Telemedicine is when a health care practitioner uses HIPAA-compliantinteractive real-time audio and video telecommunications (including web-based applications) or store and forward technology to deliver covered services that are within his or her scope of practice to a client at a site other than the site where the provider is located.”

Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 76 (Apr. 1, 2017); School Based Health Care Services, p. 28 (Jan,
1, 2017) (Accessed Mar. 2017).

STATE LAWIREGULATIONS MEDICAID PROGRAM
to de live r cove red serv ices that are within his or her scope of practice to a client at a site other than the site where the provider is located. Using telemedicine enables the health care practitioner and the client to interact in real-time communication as if they were having a face-to-face session. Telemedicine allows clients, particularly those in medically underserved areas of the state, improved access to essential health care services that may not otherwise be available without traveling long distances.

Source: WA Admin. Code Sec. 182-531-1730.
Live Video Reimbursement
Insu rers (including em plo yee healt h p lans and Med icaid Managed Care) must reimburse for live video, with some limitations.

(See private payer section)

Source: Revised Code of WA Sec. 48.43,435.

Telemedicine is covered by the Department.

Source: WA Admin. Code Sec. 182-531-0100. Yes, for patients with fee-for-service coverage when it is medically necessary. The referring provider is responsible for determining and documenting medical necessity.

Client must be present and participating in telemedicine visit. Clients under the Family Planning, TAKE CHARGE, First Steps, and School Based Health Care Service program are also eligible for telemedicine through fee-for-service.

For patients with managed care plan coverage, telehealthservices will not be reimbursed separately. All services must be arranged and provided by primary care providers. It is not mandatory that the plan pay for telehealth services.

WA Medicaid covers prenatal genetic counseling via telemedicine.

Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p.
76 & 171 (Apr. 1, 2017).

Applied Behavior Analysis (ABA) for Clients Age 20 and Younger:
⦁ Eligible telemedicine services:
⦁ Program supervision when the child is present
⦁ Family training, which does not require the child’s presence

See ABA fee schedule for telemedicine billing instructions.

Source: WA State Health Care Authority, Medicaid Provider Guide, Applied Behavior Analysis for Clients 20 and Younger, p. 35 (Jan. 1, 2017) & 182-531A-1200. (Accessed Mar. 2017),
Store and Foiward Reimbursement
Insu rers (including em plo yee heal th p lans and Med icaid Managed Care) must reimburse for store-and forward, with some limitations. Store and forward is reimbursed when there is an associated office visit between the client and the referring health care provider.

STATE LAWIREGULATIONS MEDICAID PROGRAM

(See private payer section)

Store and forward reimbursement is available only for covered services specified in the negotiated agreement between the health plan and health care provider.

If the services are provided via store and forward, there must be an associated office visit between the patient and referring health care provider.

Source: Revised Code of WA Sec. 48.43,435.
Source: WA State Health Care Authority, Medicaid Provider Guide, Physician -Related Svcs.II-lea/th Care Professional Svcs., p. 74 (Apr. 1, 2017). (Accessed Mar. 2017).
Remote Patient Monitoring Reimbursement
(see M ed ica id co lumn ) T he Med ica id age ncy co vers the de livery of home health services through telemedicine.

Services are provided for clients who have been diagnosed with an unstable condition, and who may be at risk for hospitalization or a more costly level of care.

Coverage is limited to one telemedicine interaction, per patient, per day, based on the ordering licensed practitioner’s care plan.

Eligible services:

⦁ Assessment and monitoring of clinical data including, but not limited to, vital signs, pain levels and other biometric measures specified in the plan of care;
⦁ Assessment of response to previous changes in the plan of care;
⦁ Detection of condition changes based on the telemedicine encounter that may indicate the need for a change in the plan of care.
⦁ Implementation of a management plan

Must be provided by a Registered Nurse or Licensed Practical Nurse.

The Medicaid agency does not require prior authorization for the delivery of home health services through telemedicine.

Source: WA State Health Care Authority, Medicaid Provider Guide, Home Health Svcs. (Acute Care Svcs.), p. 26-28 (Jan. 1, 2017). (Accessed Mar. 2017).

Home health monitoring not covered in Applied Behavior Analysis Program for clients Age 20 or younger.

Source: WA State Health Care Authority, Medicaid Provider Guide, Applied Behavior Analysis for Clients 20 and Younger, p. 4’J ( Jan. 1, 2017). (Accessed Mar. 2017).

STATE LAWIREGULATIONS MEDICAID PROGRAM
Email/Phone/FAX
No reference found. No reimbursement for email.
No reimbursement for telephone. No reimbursement for FAX.

Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 74 (Apr. 1, 2017). (Accessed Mar. 2017).
Online Prescribing
The WA Medical Quality Assurance Commission has issued guidelines on the use of the Internet in medical practices. A guideline does not have the force of law, but can be considered by the Commission to be the standard of practice in the state.

A documented patient evaluation, including history and physical evaluation adequate to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided, must be obtained prior to providing treatment, including issuing prescriptions, electronically or otherwise.

Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in in-person settings.

Treatment, including issuing a prescription, based solely on an online questionnaire or consultation does not constitute an acceptable standard of care.

Source: Washington Medical Quality Assurance
Commission, Guidelines for Appropriate Use of the Internet in Medical Practice, No reference found.
Consent
No reference found. No reference found.
Location
Eligible Originating Sites (Medicaid)
⦁ Clinics;
⦁ Dental offices;
⦁ Home or any location determined appropriate by the individual receiving the service;
⦁ Hospitals- inpatient or outpatient;
⦁ Neurodevelopmental centers;
⦁ Schools;
⦁ Rural health clinic;
⦁ Federally qualified health center;
⦁ Physician’s or other health care provider’s office; Eligible originating sites:

⦁ Clinics
⦁ Community mental health/chemical dependency settings
⦁ Dental offices
⦁ Federally qualified health center (FQHC)
⦁ Home or any location determined appropriate by the individual receiving service
⦁ Hospitals (inpatient and outpatient)
⦁ Neurodevelopmental centers
⦁ Physician or other health professional’s office
⦁ Rural health clinics (RHC)

STATE LAWIREGULATIONS MEDICAID PROGRAM
⦁ Community mental health center/chemical dependency settings;
⦁ Skilled nursing facility; or
⦁ Renal dialysis center

Originating sites may not distinguish between rural and urban originating sites.

Source: Revised Code of WA Sec. 41.05700 & Admin Code 182- 531-1730.

Eligible Originating Sites (private payers)
⦁ Hospital
⦁ Rural health clinic
⦁ Federally qualified health center
⦁ Physician’s or other health care provider’s office
⦁ Community mental health center
⦁ Skilled nursing facility
⦁ Renal dialysis center, except an independent renal dialysis center
⦁ Home (Effective Jan. 1, 2018)
⦁ Originating sites may not distinguish between rural and urban originating sites.

Source: RCW 48.43.735. ⦁ Schools
⦁ Skilled nursing facilities

Originating site provider responsible for determining and documenting that telemedicine is medically necessary.

Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 75 (Apr. 1, 2017). (Accessed Mar. 2017).

When the originating site is a school, the school district must submit a claim on behalf of both the originating and distant site.
Source: WA State Health Care Authority, Medicaid Provider Guide, School Based Health Care Services, p. 27 (Jan. 1, 2017 (Accessed Mar. 2017).
Cross-State Licensing
No reference found. No reference found.
PrivatePayers
Insurers (including employee health plans and Med icaid Managed Care) must reimburse a provider for services delivered through telemedicine or store and forward if:
⦁ The plan provides coverage when provided in­ person;
⦁ The health care service is medically necessary; and
⦁ The health care service is a service recognized as an essential health benefit under section 1302(b) of the federal patient protection and affordable care act.

Source: RCW 48.43.735. No refere nce found.
Site!Transmissoi n Fee
An originating site (other than a home ) can charge a facility fee, but it is subject to a negotiated agreement between the originating site and the health plan.

Source: RCW 48.43.735. Facility fees for originating sites, except inpatient hospitals.

Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 65 (Apr. 1, 2017). (Accessed Mar. 2017).

STATE LAWIREGULATIONS MEDICAID PROGRAM
Miscellaneous
Physical Therapy
Licensed physical therapists and physical therapist assistants may provide physical therapy via telehealth. The clinical record must indicate that the physical therapy occurred via telehealth.

Source: WA Admin. Code Sec. 246-915-187. Requires the use of modifier 95 or GT. The GT modifier may be discontinued at a later date.

A new point of service code 02 has been created.

Source: WA State Health Can: Auth-Ority, Medicaid Provider Gulde, Physician-Related Svcs./Health Care Professional Svcs., p. 65 (Apr. 1, 2017). (Accessed Mar. 2017).

Comm ent: WA Sta te requ ires a prov ide r d irec tory to be updated monthly. For each health plan, the associated provider directory must include information about available telemedicine services and specifically described for each provider.

Source: WA Admin. Code Sec. 284-43-204.

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