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                                                                                 Center for Connected Health Policy

           Virginia


             Medicaid Program: Virginia Medicaid

           Medicaid Program Administrator:  State Dept. of Medical Assistance Services (DMAS)

           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
            Telemedicine services means the use of interactive   “Telemedicine is the real-time or near real-time
            audio, video, or other electronic media used for the   exchange of information for diagnosing and treating
            purpose of diagnosis, consultation, or treatment.   medical conditions. Telemedicine utilizes audio/video
            ‘Telemedicine services’ do not include an audio-only   connections linking medical practitioners in one locality
            telephone, electronic mail message, or facsimile   with medical practitioners in another locality.”
            transmission.”
                                                               Source: VA Dept. of Medical Assistant Svcs., Medicaid Provider
            Source: VA Code Annotated Sec. 38.2-3418.16 (2012).   Manual, Physician/Practitioner Manual, Covered Svcs. and
                                                               Limitations, p. 25 (Apr. 2, 2012).

                                                               “Telemedicine is the real-time or near real-time
                                                               exchange of information for diagnosing and treating
                                                               medical conditions.”
                                                               Source:  VA Dept. of Medical Assistant Svcs., Medicaid Provider
                                                               Manual, Psychiatric Services Provider Manual, Covered Svcs. and
                                                               Limitations, p. 36 (Dec. 30, 2013).

                                                               Telemedicine service providers provide real-time two-
                                                               way transfer of medical data and information using an
                                                               interactive audio/video connection for the purposes of
                                                               medical diagnosis and treatment.

                                                               Source: Physician Provider Manual. Ch II: Provider Participation
                                                               Requirements (Jul., 18, 2014) pg. 11.
            Live Video Reimbursement
            Virginia statute requires coverage of telemedicine (which  Yes, for all Medicaid recipients irrespective of fee-for-
            includes live video) by private insurers, subject to their   service or managed care organization coverage.
            terms and conditions.
                                                               Eligible services:
            Source: VA Code Annotated Sec. 38.2-3418.16 (2012).
                                                                   •   Office visits;
                                                                   •   Individual psychotherapy;
                                                                   •   Psychiatric diagnostic interview examinations;
                                                                   •   Pharmacologic management;
                                                                   •   Colposcopy;
                                                                   •   Obstetric ultrasound;
                                                                   •   Fetal echocardiography:
                                                                   •   Cardiography interpretation and report only;
                                                                   •   Echocardiography;

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                   •   Speech therapy services.

                                                               Eligible providers:

                                                                   •   Physicians;
                                                                   •   Nurse practitioners;
                                                                   •   Nurse midwives;
                                                                   •   Clinical nurse specialists;
                                                                   •   Clinical psychologists;
                                                                   •   Clinical social workers;
                                                                   •   Licensed professional counselors;
                                                                   •   Speech pathologists (speech therapy only).

                                                               Source: VA Dept. of Medical Assistant Svcs., Medicaid Provider
                                                               Manual, Physician/Practitioner Manual, Covered Svcs. and
                                                               Limitations, p. 25 (Apr. 2, 2012).

                                                               Speech therapy reimbursement for the speech-language
                                                               pathologist at the remote location and a qualified school
                                                               aide with the child during the tele-practice session.

                                                               Source: VA Dept. of Medical Assistant Svcs., Medicaid Provider
                                                               Manual, Local Education Agency Provider Manual, Covered Svcs.
                                                               and Limitations, p. 11 (May 12, 2014).
            Store and Forward Reimbursement

            No reference found.                                CCHP has been informed by a source in Virginia’s
                                                               Department of Medical Assistance Services that they do
                                                               cover diabetic retinopathy screening and dermatology by
                                                               store and forward.  Additionally, radiology will be added
                                                               shortly.

                                                               A telemedicine coverage memo to providers is expected
                                                               to be released in the coming months.
            Remote Patient Monitoring Reimbursement

            No reference found.                                No reference found.
            Email/Phone/FAX
            No reimbursement for email.                        No reference found.
            No reimbursement for telephone.
            No reimbursement for FAX.

            Source: VA Code Annotated Sec. 38.2-3418.16 (2012).
            Online Prescribing

            Practitioners prescribing controlled substances must   No reference found.
            have a “bona fide” relationship with the patient.

            Requirements:

               •   Obtaining a medical or drug history;
               •   Informing the patient about the benefits and
                   risks of the drug;
               •   Conducting a patient exam, either physically or


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                   by the use of instrumentation and diagnostic
                   equipment, through which images and medical
                   records may be transmitted electronically.

            Source: VA Code Annotated Sec. 54.1-3303.
            Consent
            No reference found.                                No reference found.
            Location

            No reference found.                                Providers must by physically present in Virginia during
                                                               the telemedicine encounter.

                                                               Source:  VA Dept. of Medical Assistant Svcs., Medicaid Provider
                                                               Manual, Psychiatric Services Provider Manual, Covered Svcs. and
                                                               Limitations, p. 36 (Dec. 30, 2013).


            Cross-State Licensing
             No reference found.                               Providers must be licensed in Virginia and enrolled in
                                                               the state Medicaid program in which they practice
                                                               medicine.

                                                               Source: Physician Provider Manual. Ch II: Provider Participation
                                                               Requirements (Jul., 18, 2014) pg. 11.
            Private Payers
            Requires coverage of telemedicine services, subject to   No reference found.
            contract terms and conditions.

            Reimbursement must be the same as in-person
            services.

            Source: VA Code Annotated Sec. 38.2-3418.16 (2012).
            Site/Transmission Fee

            Reimbursement allowed, but not required.           Reimburse a facility fee.

            Source: VA Code Annotated Sec. 38.2-3418.16 (2012).
            Miscellaneous




















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