Washington Telehealth State Laws & Reimbursement Policies

Medicaid Telehealth Reimbursement

Summary

Washington Medicaid (Apple Health) reimburses for live video, store-and-forward, and remote patient monitoring under some circumstances.

Read More

Definitions

“Telemedicine is when a health care practitioner uses HIPAA-compliant interactive real-time audio and video telecommunications (including web-based applications) or store-and-forward technology 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.”

Read More

Live Video

Policy
Live video is covered for patients with fee-for-service coverage when it is medically necessary. The referring provider is responsible for determining and documenting medical necessity.

Read More

Eligible Services/Specialties
Click to view eligible services for Applied Behavior Analysis (ABA) for Clients Age 20 and Younger, Behavioral Health and Teledentistry.

Read More

Eligible Providers
Rural Health Clinics (RHCs): RHCs are not authorized to serve as a distant site for telemedicine consultations.

Read More

Eligible Sites
Click to view list of eligible originating sites.

Read More

Geographic Limits
Originating sites may not distinguish between rural and urban originating sites.

Read More

Facility/Transmission Fee
Facility fees are available for originating sites, except inpatient hospitals, skilled nursing facilities, homes or other locations determined appropriate by the individual receiving service, but not specified as an eligible originating site.

Read More

Store-and-Forward

Policy
Washington Medicaid reimburses for some store-and-forward services.

Read More

Eligible Services/Specialties
WA Apple Health pays for store-and-forward for teledermatology. Teledermatology services via store-and-forward must be billed with GQ modifier and 02 POS Code from the distant site.

Read More

Geographic Limits
Transmission Fee
The originating site for store-and-forward is not eligible to receive an originating site fee.

Read More

Remote Patient Monitoring

Policy
The Medicaid agency covers the delivery of home health services through telemedicine for clients with a high risk of sudden change in medical condition which could compromise health outcomes and prescription drug monitoring.

Read More

Conditions

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.

Read More

Provider Limitations
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.

Read More

Other Restrictions

Email/Phone/Fax

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

Read More

Consent

Written consent must be obtained for store-and-forward.

Read More

Out of State Providers

Miscellaneous

“Use place of service (POS) 02 to indicate that a billed service was furnished as a telemedicine service from a distant site. Distant site practitioners billing for telemedicine services under Critical Access Hospital (CAH) optional payment method must use the GT modifier. Add modifier 95 if the distant site is designated as a nonfacility.”

Read More

Private Payer Laws

Definitions

“Telemedicine” means the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. For purposes of this section only, “telemedicine” does not include the use of audio-only telephone, facsimile, or email.

Read More

Requirements

Insurers (including employee health plans and Medicaid Managed Care) must reimburse a provider for services delivered through telemedicine or store-and-forward under certain circumstances.

Read More

Parity

Services must be considered an essential health benefit under the ACA and be determined to be safely and effectively provided through telemedicine or store-and-forward.

Read More

Professional Regulation/Health & Safety

Definitions

“Telemedicine means the delivery of health care (or behavioral health) services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment."

Read More

Consent

Patient consent should be obtained and documented prior to the telemedicine encounter.

Read More

Online Prescribing

The WA Medical Quality Assurance Commission has 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.

Read More

Cross State Licensing

Member of the following: Interstate Medical Licensure Compact, Physical Therapy Compact.

Read More

Miscellaneous

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.

Read More

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

Reach out to us for all your Telehealth needs

What best describes you?

Currently serving 47 states

with the ability to service all 50 states
Our telemedicine services can be applied to big cities as well as rural locations. We contract with the highest quality health professionals and partner with hospitals, clinics, and other healthcare facilities throughout the Nation.
Learn More About the States we Serve
AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY DC
linkedin facebook pinterest youtube rss twitter instagram facebook-blank rss-blank linkedin-blank pinterest youtube twitter instagram