Washington State

House of Representatives

Office of Program Research



Health Care & Wellness Committee

SSB 5175

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Brief Description: Regarding telemedicine.

Sponsors: Senate Committee on Health Care (originally sponsored by Senators Becker, Frockt, Angel, Rivers, Cleveland, Dammeier, Keiser, Fain, Parlette, Darneille, Pedersen, Habib, Kohl-Welles and Mullet).

Brief Summary of Substitute Bill

  • Requires health carriers to reimburse for services provided via telemedicine.

  • Allows hospitals to rely on the privileging decisions of another hospital when services are being provided via telemedicine.

Hearing Date: 3/25/15

Staff: Jim Morishima (786-7191).


I. Reimbursement for Telemedicine.

Telemedicine is the use of electronic communications to provide health care services to a patient at a distance. Electronic communication is accomplished through audio-visual equipment permitting real-time, interactive interaction between the patient (at the "originating site") and the provider (at the "distant site"). Similar, but not identical, to telemedicine, "store and forward" technology consists of the storage of clinical information that is subsequently forwarded to a health care provider for diagnosis.

The Uniform Medical Plan covers telemedicine, but only in professional shortage areas as defined by the federal government. The state's Medicaid program also covers telemedicine in certain circumstances. For example, Medicaid reimburses home health agencies for skilled home health visits delivered via telemedicine. Private health carriers are currently not required to cover telemedicine services.

II. Physician Privileging.

Prior to granting privileges to a physician, a hospital must:

The MQAC must be advised within 30 days of the name of any physician denied staff privileges, association, or employment.

Under federal Medicare regulations, when health care services are provided by a physician through telemedicine, the originating site hospital may choose to rely on the privileging decisions made by the distant site hospital if:

Summary of Bill:

I. Reimbursement for Telemedicine.

A health plan offered by a health carrier, a health plan offered to state employees and their covered dependents, or a Medicaid managed care plan must reimburse a provider for a health care service delivered through telemedicine or store and forward technology if:

If the service is provided through store and forward technology, there must be an associated office visit between the covered person and the referring health care provider, which may be accomplished via telemedicine. Reimbursement for store and forward technology is available only for covered services that are specified in the negotiated agreement between the health plan and the health care provider.

A plan may not distinguish between originating sites that are rural and urban. An originating site for telemedicine includes a hospital, a rural health clinic, a federally qualified health center, a physician's or other provider's office, a community mental health center, a skilled nursing facility, and a renal dialysis center (other than an independent renal dialysis center).

An originating site may charge a facility fee for infrastructure and preparation of the patient. Reimbursement for the facility fee is subject to a negotiated agreement between the originating site and the plan. A site that is not an originating site, including a distant site, may not charge a facility fee. A plan may subject telemedicine or store and forward services to all terms and conditions of the plan applicable to in-person services, including utilization review, prior authorization, deductibles, copayments, or coinsurance. Reimbursement is not required for a health care service that is not a covered benefit, for providers who are not covered under the plan, or for professional fees to the originating site.

"Telemedicine" is defined as the use of interactive audio, video, or electronic media for the purpose of diagnosis, consultation, or treatment. The term does not include the use of audio-only telephone, facsimile, or electronic mail. "Store and forward technology" is defined as the use of an asynchronous transmission of a covered person's medical information from an originating site to the health care provider at a distant site, which results in the medical diagnosis and management of the covered person, and does not include the use of audio-only telephone, facsimile, or electronic mail. "Originating site" is defined as the physical location of a patient receiving health care services through telemedicine, which prepares the patient for the telemedicine services and provides the infrastructure for the telemedicine services to occur. "Distant site" is defined as the site at which a physician or other licensed provider is physically located at the time a service is delivered through telemedicine.

The Health Care Authority (HCA), using existing data and resources, must report on the impact on access for underserved communities and the costs to the state and the Medicaid managed health care system for reimbursement of telemedicine services. The HCA must submit the report to the Legislature no later than December 31, 2018.

II. Physician Privileging.

An originating site hospital may rely on a distant site hospital's decision to grant or renew the privileges or association of any physician providing telemedicine services if the originating site hospital has a written agreement with the distant site hospital that assures the following:

The Board of Osteopathic Medicine and Surgery must be advised within 30 days of the name of any physician denied staff privileges, association, or employment.

Appropriation: None.

Fiscal Note: Available on original bill.

Effective Date: This bill takes effect 90 days after adjournment of the session in which the bill is passed, except for section 2 relating to reimbursement for telemedicine and store and forward technology, which takes effect January 1, 2017.