West Virginia Telehealth Laws & Reimbursement Policies

West Virginia Telehealth Laws

Medicaid Telehealth Reimbursement

Summary

West Virginia Medicaid reimburses for live video under some circumstances. Reimbursement is only made for real time communications, therefore there is no reimbursement for store-and-forward or remote patient monitoring.

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Definitions

“Telehealth: The use of electronic information and telecommunications technologies to provide professional health care; is often used to connect practitioners and clinical experts in large hospitals or academic medical centers with patients in smaller hospitals or critical access hospitals which are typically located in more remote locations; and can assure that these remotely located patients enjoy the same access to potentially life-saving technologies and expertise that are available to patients in more populated parts of the country.”

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Live Video

Policy
West Virginia Medicaid reimburses for a limited number of telehealth services that are provided to enrolled members by enrolled practitioners via a telecommunication system. WV Medicaid utilizes CMS guidance on Telehealth Services.

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Eligible Services/Specialties
West Virginia Medicaid reimbursement of telehealth services is limited to certain CPT/HCPCS codes. See manual.

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Eligible Providers
Click to view authorized distant site providers.

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Eligible Sites
Click to view authorized originating sites.

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Geographic Limits
WV Medicaid does not limit telehealth services to members in non-metropolitan statistical professional shortage areas as defined by CMS telehealth guidance.

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Facility/Transmission Fee
An originating site can bill for a facility fee.

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Store-and-Forward

Policy
No reimbursement. WV Medicaid only reimburses for real time communications.

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Eligible Services/Specialties
Geographic Limits
Transmission Fee

Remote Patient Monitoring

Policy
No reimbursement. WV Medicaid only reimburses for real time communications.

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Conditions
Provider Limitations
Other Restrictions

Email/Phone/Fax

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

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Consent

Patient consent must be obtained.

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Out of State Providers

Miscellaneous

Additional instructions regarding telehealth standards and billing available in the following manuals: Licensed Behavioral Health Center Services (Ch. 503); Behavioral Health Outpatient Services (Ch. 521); School-Based Health Services (Ch. 538). Limited to specific CPT codes.

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Private Payer Laws

Definitions

Requirements

Parity

Professional Regulation/Health & Safety

Definitions

Practice of telemedicine means the practice of medicine using communication tools such as electronic communication, information technology or other means of interaction between a licensed health care professional in one location and a patient in another location, with or without an intervening health care provider, and typically involves secure real time audio/video conferencing or similar secure audio/video services, remote monitoring, interactive video and store-and-forward digital image or health data technology to provide or support health care delivery by replicating the interaction of a traditional in person encounter between a provider and a patient.

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Consent

Online Prescribing

A “valid patient-practitioner relationship” can be established through telemedicine in a manner approved by the appropriate board.

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Cross State Licensing

Member of the following: Nurse Licensure Compact, Physical Therapy Compact, and Compact of the Association of State and Provincial Psychology Boards.

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Miscellaneous

Professional Board Regulation: Board of Examiners for Speech-Language Pathology and Audiology

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

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