Medicaid Telehealth Reimbursement
Summary
Virginia Medicaid reimburses for live video, store-and-forward, and remote patient monitoring under certain circumstances. Plans participating in the Medicare-Medicaid Demonstration Waiver are permitted to use store-and-forward and remote patient monitoring in rural and urban locations and to provide reimbursement for services.
Definitions
“Telemedicine is the real-time or near real-time two-way transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment.”
Live Video
Policy
Reimbursement is provided subject to coverage requirements.
Eligible Services/Specialties
See billing information for specific codes. Click to see list of eligible services.
Eligible Providers
Click to view list of eligible providers.
Eligible Sites
Click to view list of eligible originating sites.
Geographic Limits
Physicians may be physically located outside of VA but must be located within the continental US to deliver telemedicine services. Telemedicine out-of-state coverage does not include other out-of-state providers such as nurse practitioners.
Facility/Transmission Fee
Reimburses a facility fee.
Store-and-Forward
Policy
DMAS reimburses for diabetic retinopathy screening through telemedicine for Medicaid members with Type 1 or 2 diabetes. Radiology related procedures are also included under telemedicine coverage as well as certain codes for teledermatology.
Eligible Services/Specialties
Click to view services covered.
Geographic Limits
Physicians may be physically located outside of VA but must be located within the continental US to deliver telemedicine services. Telemedicine out-of-state coverage does not include other out-of-state providers such as nurse practitioners.
Transmission Fee
Reimburses a facility fee.
Remote Patient Monitoring
Policy
VA Medicaid reimburses for Continuous Glucose Monitoring.
Conditions
Used for patients with one or more chronic conditions.
Provider Limitations
No reference found.
Other Restrictions
No reference found.
Email/Phone/Fax
No reimbursement for email. No reimbursement for telephone. No reimbursement for FAX.
Consent
No reference found.
Out of State Providers
Newly enrolling out-of-state physicians who enter on their enrollment application a service address that is within 50 miles of the Virginia border may be enrolled as in-state providers.
Miscellaneous
Use of telemedicine must be noted in the service documentation of the patient record.
Private Payer Laws
Definitions
Telemedicine services means the use of electronic technology or media, including interactive audio or video for the purpose of diagnosing or treating a patient or consulting with other health care providers regarding a patient’s diagnosis or treatment. ‘Telemedicine services’ does not include an audio-only telephone, electronic mail message, facsimile transmission, or online questionnaire.
Requirements
An insurer shall not exclude a service for coverage solely because the service is provided through telemedicine services.
Parity
The treating provider or consulting provider must be reimbursed on the same basis that the insurer is responsible for coverage for the provision of services face-to-face.
Professional Regulation/Health & Safety
Definitions
Telemedicine services means the use of electronic technology or media, including interactive audio or video for the purpose of diagnosing or treating a patient or consulting with other health care providers regarding a patient’s diagnosis or treatment.
Consent
Informed consent must be obtained and maintained.
Online Prescribing
Effective until July 1, 2020: Practitioners prescribing controlled substances must have a “bona fide” relationship with the patient.
Cross State Licensing
VA adopted the Nurses Licensure Compact.
Miscellaneous
Click to see details on the telemedicine guidance released by the VA Medical Board.
Source: Center for Connected Health Policy
https://www.cchpca.org
What are the requirements for administering telehealth services in the state of Virginia?
In the Commonwealth of Virginia, the provision of telehealth services is primarily governed by the Virginia telehealth laws. These laws require that healthcare providers be licensed to practice within the state. Moreover, healthcare professionals delivering care through telehealth must comply with the same standard of care as in-person services. They should also consider patient consent, patient privacy, confidentiality, and getting malpractice liability insurance. Additionally, providers must establish a patient-provider relationship before delivering telehealth services. It’s always important to stay updated with the Virginia Department of Health for any changes in these laws.