﻿<?xml version="1.0" encoding="utf-8"?><Search><pages Count="5"><page Index="1"><![CDATA[



                                                                                 Center for Connected Health Policy

           Washington


           Medicaid Program: Washington Medicaid

           Medicaid Program Administrator: Washington State Health Care Authority

           Regional Telehealth Resource Center:
           Northwest Regional Telehealth Resource Center
                  th
           2900 12  Ave. N., Ste. 30W
           Billings, MT 59101
           (888) 662-5601
           www.nrtrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM
            Definition of telemedicine/telehealth
            “Telemedicine means the use of tele-monitoring to   “Telemedicine is when a health care practitioner uses
            enhance the delivery of certain home health skilled   interactive real-time audio and video
            nursing services through:                          telecommunications to deliver covered services that are
                                                               within his or her scope of practice to a client at a site
               •   The collection of clinical data and the     other than the site where the provider is located.”
                   transmission of such data between a patient at a
                   distant location and the home health provider   Source: WA State Health Care Authority, Medicaid Provider
                   through electronic processing technologies.   Guide, Physician-Related Svcs./Health Care Professional Svcs., p.
                                                               45 (Jan. 1, 2015).
                   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.

            Emergency Rule (Expires 4/22/15)
            Telemedicine is when a health care practitioner uses
            HIPAA-compliant, interactive, real-time audio and video
            telecommunications (including web-based applications)
            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. 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.


                                                                                                                1
]]></page><page Index="2"><![CDATA[



                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM


            Source: WA Admin. Code Sec. 182-531-1730.

            Live Video Reimbursement

            No reference found.                                Yes, for patients with fee-for-service coverage.

                                                               Eligible services:

                                                                   •   Consultations;
                                                                   •   Office or other outpatient visits;
                                                                   •   Psychiatric intake and assessment;
                                                                   •   Individual psychotherapy;
                                                                   •   Visit for drug monitoring

                                                               Eligible Providers at the Distant Site are:

                                                                   •   Physicians (including Psychiatrists); and
                                                                   •   Advanced Registered Nurse Practitioners

                                                               Source: WA State Health Care Authority, Medicaid Provider
                                                               Guide, Physician-Related Svcs./Health Care Professional Svcs., p.
                                                               47-48 (Jan. 1, 2015).

                                                               Patients must be present and participate in the visit.

                                                               For patients with managed care plan coverage,
                                                               telehealth services 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.

                                                               Source: WA State Health Care Authority, Medicaid Provider
                                                               Guide, Physician-Related Svcs./Health Care Professional Svcs., p.
                                                               46 (Jan. 1, 2015).

                                                               New Rule (Now Effective, Expires 4/31/15) – Applied
                                                               Behavioral Analysis
                                                               Telemedicine can be used to provide these services:
                                                                   •   Program supervision when the client is present;
                                                                       and
                                                                   •   Family training, which does not require the
                                                                       client’s presence.

                                                               Source: WA Admin. Code Sec. 182-531A-1200.
            Store and Forward Reimbursement
            No reference found.                                No reference found.

            Remote Patient Monitoring Reimbursement
            (see Medicaid column)                              Home health monitoring is not covered as telemedicine.

                                                               Source: WA State Health Care Authority, Medicaid Provider
                                                               Guide, Physician-Related Svcs./Health Care Professional Svcs., p.
                                                               45 (Jan. 1, 2015).

                                                               The Medicaid agency covers the delivery of home health
                                                               services through telemedicine.

                                                                                                                2
]]></page><page Index="3"><![CDATA[



                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM


                                                               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

                                                               Source: WA Admin. Code Sec. 182-551-2125 & WA State Health
                                                               Care Authority, Medicaid Provider Guide, Home Health Svcs.
                                                               (Acute Care Svcs.), p. 20-26  (Jul. 1, 2014).

                                                                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. 22  (Jul. 1, 2014).

            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. 63(Jan.
                                                               1, 2015).
            Online Prescribing
            The WA Medical Quality Assurance Commission has    No reference found.
            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

                                                                                                                3
]]></page><page Index="4"><![CDATA[



                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            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,
            Consent
            No reference found.                                No reference found.

            Location
            No reference found.                                Eligible originating sites:

                                                                   •   Practitioner offices;
                                                                   •   Hospitals;
                                                                   •   Critical Access Hospitals;
                                                                   •   Rural Health Clinics;
                                                                   •   Federally Qualified Health Centers.

                                                               Source: WA State Health Care Authority, Medicaid Provider
                                                               Guide, Physician-Related Svcs./Health Care Professional svcs., p.
                                                               46 (Jan. 1, 2015).
            Cross-State Licensing
            Out-of-state, licensed practitioners may deliver   No reference found.
            telemedicine or telehealth services, as long as they do
            not open an office or appoint a place of meeting patients
            or receive calls within the state.

            Source: Revised Code of WA Sec. 18.71.030 (2012).
            Private Payers
            No reference found.                                No reference found.
            Site/Transmission Fee

                                                               Facility fees for originating sites.

                                                               Source: WA State Health Care Authority, Medicaid Provider
                                                               Guide, Physician-Related Svcs./Health Care Professional Svcs., p.
                                                               46 (Jan. 1, 2015).
            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.

                                                                                                                4
]]></page><page Index="5"><![CDATA[



                                                                                 Center for Connected Health Policy


                         Comment:
                                       WA State requires a provider directory 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.











































































                                                                                                                5
]]></page></pages></Search>