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                                                                                 Center for Connected Health Policy

           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

            “The practice of telemedicine means the use of     “A tele-consultation is an interactive member encounter
            electronic information and communication technologies   that meets specific criteria. This service requires the use
            to provide health care when distance separates     of interactive telecommunications systems, defined as
            participants. It includes one or both of the following:   multimedia communication equipment that involves at
                                                               least audio and video equipment, and which permits
               1.  The diagnosis of a patient within this state by a   two-way consultation among the member, consultant
                   physician located outside this state, as a result   and referring provider.  Telephones, facsimile machines,
                   of the transmission of individual patient data,   and electronic mail systems do not qualify as interactive
                   specimens or other material by electronic or   telecommunication systems.”
                   other means from within this state to the
                   physician or his or her agent;              Source: WV Dept. of Health and Human Svcs., Medicaid Provider
                                                               Manual, Chapter–519 Covered Svcs., Limitations, And Exclusions
               2.  The rendering of treatment to a patient within   For Practitioner Svcs. – Including Physicians, Physician
                                                               Assistants, And Advanced Registered Nurse Practitioners, p. 25
                   this state by a physician located outside this   (Jan. 16, 2012).
                   State as a result of transmission of individual
                   patient data, specimens or other material by
                   electronic or other means from within this State
                   to the physician or his or her agent.”

            Source: WV Code Sec. 30-3-13.
            Live Video Reimbursement

            No reference found.                                West Virginia Medicaid reimburses for live video
                                                               consultations for medical services and nutrition and
                                                               exercise services.

                                                               Requirements:

                                                                   •   The consult must involve real-time consultation
                                                                       as appropriate for the member‘s medical needs,
                                                                       and as needed to provide information to and at
                                                                       the direction of the consulting physician;
                                                                   •   Coverage of consult is limited to members in
                                                                       non-metropolitan statistical professional
                                                                       shortage areas as defined by the Centers for
                                                                       Medicare & Medicaid Services. The referring
                                                                       provider must be located in the same non-


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                       metropolitan area;
                                                                   •   The referring provider may bill for an office,
                                                                       outpatient, or inpatient evaluation and
                                                                       management (E&M) service that precedes the
                                                                       consultation, and for other Medicaid-covered
                                                                       services the consultant orders, or for services
                                                                       unrelated to the medical problem for which the
                                                                       consult was requested. However, the referring
                                                                       provider may not bill for a second visit for
                                                                       activities provided during the consult;
                                                                   •   The consultant must be in control of the
                                                                       member‘s medical examination, with the
                                                                       referring provider participating, as needed. The
                                                                       patient must be present in real time, and
                                                                       telecommunication technology must allow the
                                                                       consultant to conduct a medical exam;
                                                                   •   The consultant must provide the referring
                                                                       physician with a written report;
                                                                   •   Separate payment is not made for the review
                                                                       and interpretation of medical records;
                                                                   •   Coverage is limited to professional
                                                                       consultations that meet the criteria.

                                                               Source: WV Dept. of Health and Human Svcs., Medicaid Provider
                                                               Manual, Chapter–519 Covered Svcs., Limitations, And Exclusions
                                                               For Practitioner Svcs. – Including Physicians, Physician
                                                               Assistants, And Advanced Registered Nurse Practitioners, p. 25
                                                               (Jan. 16, 2012).

                                                               Exercise and nutrition services may be delivered
                                                               through a single site, or between two sites, with a formal
                                                               agreement between the two parties.

                                                               Source: WV Dept. of Health and Human Svcs., Medicaid Provider
                                                               Manual, Chapter 527: Mountain Health Choices, p. 37 (Jan. 30,
                                                               2009).

                                                               For facility-based fitness centers/certified trainer
                                                               services, rural clinics may partner with a single-site
                                                               provider to utilize their professional services. Scheduled
                                                               appointments are then set up and video
                                                               teleconferencing is used to deliver services to the
                                                               member with at minimum a nurse present with the
                                                               member during the consultation.

                                                               Source: WV Dept. of Health and Human Svcs., Medicaid Provider
                                                               Manual, Chapter 527: Mountain Health Choices, p. 40 (Jan. 30,
                                                               2009).

                                                               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. 11 (Jan. 1,
                                                               2013).

                                                               WV Medicaid encourages providers to render services
                                                               via telehealth in the Behavioral Health Clinic Services

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               program.

                                                               Source: WV Dept. of Health and Human Svcs., Medicaid Provider
                                                               Manual, Chapter–502 Covered Svcs., Limitations, And Exclusions
                                                               For Behavioral Health Clinic Services, p. 14 (Jul. 4, 2014) &
                                                               Medicaid Provider Manual Chapter 503 Covered Svcs.,
                                                               Limitations, and Exclusions for Behavioral Health Rehabilitation
                                                               Services, p. 13 (Jul. 1, 2014).
            Store and Forward Reimbursement

            No reference found.                                No reimbursement, based upon definition of
                                                               teleconsultation, which describes it as using an
                                                               “interactive telecommunications system that allows a
                                                               “two-way consultation among the member, consultant
                                                               and referring provider”.

                                                               Source: WV Dept. of Health and Human Svcs., Medicaid Provider
                                                               Manual, Chapter–519 Covered Svcs., Limitations, And Exclusions
                                                               For Practitioner Svcs. – Including Physicians, Physician
                                                               Assistants, And Advanced Registered Nurse Practitioners, p. 25
                                                               (Jan. 16, 2012).
            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 Covered Svcs., Limitations, And Exclusions
                                                               For Practitioner Svcs. – Including Physicians, Physician
                                                               Assistants, And Advanced Registered Nurse Practitioners, p. 25
                                                               (Jan. 16, 2012).
            Online Prescribing
            A “valid patient-practitioner relationship” can be   No reference found.
            established through telemedicine in a manner approved
            by the appropriate board.

            Source: WV Code Sec. 30-5-4.

            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
            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.

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM


            Source: WV Code Sec. 11-1A-12.
            Consent

            No reference found.                                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. 14 (Jul. 4, 2014) &
                                                               Medicaid Provider Manual Chapter 503 Covered Svcs.,
                                                               Limitations, and Exclusions for Behavioral Health Rehabilitation
                                                               Services, p. 13 (Jul. 1, 2014).
            Location

            No reference found.                                Limited to members in CMS-defined non-metropolitan
                                                               statistical professional shortage areas.  The referring
                                                               provider must be located in the non-metropolitan area.

                                                               Source: WV Dept. of Health and Human Svcs., Medicaid Provider
                                                               Manual, Chapter–519 Covered Svcs., Limitations, And Exclusions
                                                               For Practitioner Svcs. – Including Physicians, Physician
                                                               Assistants, And Advanced Registered Nurse Practitioners, p. 25
                                                               (Jan. 16, 2012).
            Cross-State Licensing

            No reference found.                                No reference found.
            Private Payers
            No reference found.                                No reference found.

            Site/Transmission Fee
            No reference found.                                 No reimbursement.  Patients may not be billed for these
                                                                fees.

                                                                Source: WV Dept. of Health and Human Svcs, Medicaid Provider
                                                                Manual, Chapter–519 Covered Svcs., Limitations, And
                                                                Exclusions For Practitioner Svcs. – Including Physicians,
                                                                Physician Assistants, And Advanced Registered Nurse
                                                                Practitioners, p. 25 (Jan. 16, 2012).
            Miscellaneous
























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