West Virginia 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

West Virginia Medicaid

West Virginia

Medicaid Program: West Virginia Medicaid

Medicaid Program Administrator: Bureau for Medical Services, under the West Virginia Dept. of Health and Human Resources

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/REGULATIONS MEDICAID PROGRAM
Definition of telemedicine/telehealth
“Practice of telemedicine means the practice of medicine using communication tools such as electronic communication, information technology or other means of interaction between a licensed health care professional in one location and a patient in another location, with or without an intervening health care provider, and typically involves secure real time audio/video conferencing or similar secure audio/video services, remote monitoring, interactive video and store and forward digital image or health data technology to provide or support health care delivery by replicating the interaction of a traditional in person encounter between a provider and a patient. The practice of telemedicine occurs in this state when the patient receiving health care services through a telemedicine encounter is physically located in this state.”

Source: WV Code Sec. 30-3-13.

“Telemedicine technologies” means technologies and devices which enable secure electronic communications and information exchange in the practice of telemedicine, and typically involve the application of secure real-time audio/video conferencing or similar secure video services, remote monitoring, or store and forward digital image technology to provide or support healthcare delivery by replicating the interaction of a traditional in-person encounter between a physician or podiatrist and a patient.

Source: WV Code Sec. 30-3-13 & 30-14–12d (SB 47- 2016).

“Telehealth” means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care “Telehealth: The use of electronic information and telecommunications technologies to provide professional health care; is often used to connect practitioners and clinical experts in large hospitals or academic medical centers with patients in smaller hospitals or critical access hospitals which are typically located in more remote locations; and can assure that these remotely located patients enjoy the same access to potentially life-saving technologies and expertise that are available to patients in more populated parts of the country.”

“The telecommunication system is defined as an interactive audio and video system that permits real­ time communication between the member at the originating site and the practitioner at the distant site. The telecommunication technology must allow the treating practitioner at the distant site to perform a medical examination of the member that substitutes for an in-person encounter.”

Source: WV Dept of Health and Human Svcs. Medicaid Provider Manual, Chapter-519.17 Practitioner Services: Telehealth Services. Revised Jan. 15, 2016 (accessed Mar. 2017).

Telehealth – for purposes of Medicaid, telemedicine seeks to improve a patient’s health by permitting two­ way, real time interactive communication between the patient, and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that include, at a minimum, audio and video equipment.

Source: WV Dept of Health and Human Svcs. Medicaid Provider Manual, Chapter-200 Definitions and Acronyms. Nov. 1, 2016 (accessed Mar. 2017).

STATE LAW/REGULATtONS MEDICAID PROGRAM
management and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site.

Source: WV Code Sec. 16-5Y-2 (SB 454- 2016).

”Telehealth” means the use of electronic information and telecommunications technologies to support long­ distance clinical health care, patient and professional health-related education, public health and health administration.

Source: WV Code, Ch. 16, Article 2D, Sec. 16-2D-2.
Live Video Reimbursement
No reference found. West Virginia Medicaid reimburses for a limited number of telehealth services that are provided to enrolled members by enrolled practitioners via a telecommunication system. WV Medicaid utilizes CMS guidance on Telehealth Services. Limited to specific CPT codes (not necessarily consistent with CMS reimbursement).

Authorized distant site providers include:

1. Physicians;
2. Physician Assistants (PA);
3. Advanced Practice Registered Nurses (APRN)/Nurse Practitioners (NP)
4. APRN/Certified Nurse Midwife (CNM);
5. APRN/Clinical Nurse Specialists (CNS);
6. Licensed Psychologists (LP); and
7. Licensed Independent Clinical Social Worker (LICSW)

RHCs and FQHCs are not authorized to serve as distant sites for telehealth consultations, which is the location of the practitioner, and many not bill or include the cost of a visit on the cost report.

Source: WV Dept of Health and Human Svcs. Medicaid Provider Manual, Chapter-519.17 Practitioner Services: Telehealth Services. Revised Jan. 15, 2016 (accessed Mar. 2017).

Targeted case management can be conducted through telemedicine with the exception of the required 90 day face-to-face encounter with the targeted case manager.

Source: WV Dept of Health and Human Svcs., Medicaid Provider Manual, Chapter 523: Targeted Case Management, p. 13 (Jul. 1, 2016), Accessed Mar. 2017.

WV Medicaid encourages providers to render services via telehealth in the Behavioral Health Clinic Services program.

Source: WV Dept of Health and Human Services Medicaid

STATE LAW/REGULATtONS MEDICAID PROGRAM
Provider Manual, Chapter-502 Covered Services Limftatlons, And Exclusions ForBehavioral Health Clinic Services, p. 15 (Oct. 13, 2015); Behavioral Health Rehabilitation Services, p. 13 (Apr. 1,
2016); Psychological Services, p. 9 (Apr. 1, 2015); Psychiatric Services, p. 9 (Oct. 9, 2015); Licensed Independent Clinical Social Worlrer, p. 8 (Jul. 1, 2015); School-Based Health Services, p. 10
(Aug. 1, 2015). (Accessed Mar. 2017)
Store and Forward Reimbursement
No reference found. No reimbursement. WV Medicaid only reimburses for real-time communications.

Source: WV Dept of Health and Human Svcs. Medicaid Provider Manual, Chapter-519.17 Practitioner Services: Telehealth Services. Revised Jan. 19, 2016 (accessed Mar. 2017).
Remote Patient Monitoring Reimbursement
No reference found. No reference found.
Email/Phone/FAX
No reference found. No reimbursement for FAX.
No reimbursement for telephone. No reimbursement for email.

Source: WV Dept of Health and Human Svcs. Medicaid Provider Manual, Chapter-519.17.2 Non-Covered Services: Telehealth Services. Revised Jan. 15, 2016 (accessed Mar. 2017).
Online Prescribing
A “valid patient-practitioner relationship” can be established through telemedicine in a manner approved by the appropriate board.

Source: WV Code Sec. 30-5-4.

A physician-patient relationship cannot be established through audio only communication, text communications or any combination thereof.

A physician-patient relationship can be established through real-time video conferencing or store and forward (for pathology and radiology).

A physician or podiatrist who solely utilizes telemedicine may not prescribe to that patient any controlled substance in Schedule II of the Uniform Controlled Substances Act. A physician or podiatrist may not prescribe any pain-relieving controlled substance listed in Schedule II through V as part of a course of treatment for chronic non-malignant pain solely based on a telemedicine encounter.
Source: WV Code Sec. 30-3-13 & 30-14–12d (SB 47- 2016).

Prohibits providers from issuing prescriptions, via electronic or other means, for persons without establishing an ongoing physician-patient relationship, wherein the physician has obtained information No reference found.

STATE LAW/REGULATtONS MEDICAID PROGRAM
adequate to support the prescription. Exceptions:
⦁ Documented emergencies;
⦁ On-call or cross-coverage situations;
⦁ Where patient care is rendered in consultation with another physician who has an ongoing relationship with the patient, and who has agreed to supervise the patient’s treatment, including use of any prescribed medications.

Source: WV Code Sec. 11-1A-12.
Consent
Must obtain consent.

Source: WV Code Sec. 30-3-13 & 30-14-12d (SB 47- 2016). Patient consent must be obtained.

Source: WV Dept of Health and Human Svcs. Medicaid Provider Manual, Chapter-502 Covered Svcs. Limitations, And Exclusions For Behavioral Health Clinic Services, p. 15 (Oct. 13, 2015); Behavioral Health Rehabilitation Services, p. 13 (Jul. 1, 2014);
Psychological Services, p. 9 (Apr. 1, 2015); Psychiatric Services,
p. 9 (Oct. 9, 2015); Licensed Independent Clinical Social Worker,
p. 8 (Jul. 1, 2015); School-Based Health Services, p. 10 (Aug. 1, 2015). (Accessed Mar. 2017).
Location
No reference found. Authorized originating sites:
⦁ Offices of physicians or practitioners;
⦁ Private Psychological Practices;
⦁ Hospitals;
⦁ Rural Health Clinics (RHCs);
⦁ Federally Qualified Health Centers (FQHCs);
⦁ Hospital-based or CAH-based Renal Dialysis Centers (including satellites);
⦁ Skilled Nursing Facilities (SNF); and
⦁ Community Mental Health Centers (CMHC).

Independent Renal Dialysis Facilities are not eligible originating sites.

WV Medicaid does not limit telehealth services to members in non-metropolitan statistical professional shortage areas as defined by CMS telehealth guidance.
Source: WV Dept of Health and Human Svcs. Medicaid Provider Manual, Chapter-519.17 Practitioner Services: Telehealth Services. Revised Jan. 15, 2016 (accessed Mar. 2017).
Cross-State Licensing
WV adopted the Federation of State Medical Board (FSMB)’s model language for an interstate medical licensure compact.

Source: WV House Bill 2496 (2015).

Must hold active unexpired WV license. No reference found.

STATE LAW/REGULATtONS MEDICAID PROGRAM

Source : WV Code Sec. 30-3-13 & 30-14- 12d (SB 47- 2016) .
Priv ate Payers
No reference found. No reference found.
Site/Transmission Fee
No reference found. An originating site can bill for a facility fee.

Source: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter-519.17 Practitioner Services: Telehealth Services. Revised Jan. 19, 2016 (accessed Mar. 2017).
Miscellaneous
Additional instructions regarding telehealth standards and billing available in the following manuals: Behavioral Health Clinic (Ch. 502); Behavioral Health Rehabilitation (Ch. 503); Psychological Services (Ch. 521); Psychiatric Services (Ch. 536); Licensed Independent Clinical Social Worker (Ch. 537); School- Based Health Services (Ch. 538). Limited to specific CPT codes.

Source: WV Dept of Health and Human Svcs. Medicaid Provider Manual, Chapter-502 Covered Svcs., Limitations, And Exclusions For Behavioral Health Clinic Services, p. 15 (Oct. 13, 2015); Chapter 503 Behavioral Health Rehabilitation Services, p. 13 (April 25, 2016); Psychological Services, p. 9 (Apr. 1, 2015);
Psychiatric Services, p. 9 (Oct 9, 2015); Licensed Independent Clinical Social Worker, p. 8 (Jul. 1, 2015); School-Based Health Services, p. 10 (Aug. 1, 2015). (Accessed Mar. 2017)

Professional Board Regulation:
⦁ Board of Examiners for Speech-Language Pathology and Audiology (YvV Admin. Law Sec. 29-1-15)

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