Virginia Telehealth State Laws & Reimbursement Policies

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.

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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.”

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Live Video

Policy
Reimbursement is provided subject to coverage requirements.

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Eligible Services/Specialties
See billing information for specific codes. Click to see list of eligible services.

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Eligible Providers
Click to view list of eligible providers.

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Eligible Sites
Click to view list of eligible originating sites.

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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.

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Facility/Transmission 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.

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Eligible Services/Specialties
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.

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Transmission Fee

Remote Patient Monitoring

Policy
VA Medicaid reimburses for Continuous Glucose Monitoring.

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Conditions
Used for patients with one or more chronic conditions.

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Provider Limitations
Other Restrictions

Email/Phone/Fax

No reimbursement for email. No reimbursement for telephone. No reimbursement for FAX.

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Consent

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.

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Miscellaneous

Use of telemedicine must be noted in the service documentation of the patient record.

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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.

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Requirements

An insurer shall not exclude a service for coverage solely because the service is provided through telemedicine services.

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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.

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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.

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Consent

Informed consent must be obtained and maintained.

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Online Prescribing

Effective until July 1, 2020: Practitioners prescribing controlled substances must have a “bona fide” relationship with the patient.

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Cross State Licensing

VA adopted the Nurses Licensure Compact.

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Miscellaneous

Click to see details on the telemedicine guidance released by the VA Medical Board.

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Source: Center for Connected Health Policy
https://www.cchpca.org

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