Washington State

House of Representatives

Office of Program Research

BILL

ANALYSIS

Health Care & Wellness Committee

HB 1529

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.

Background:

Telemedicine and Telehealth

Telemedicine and telehealth are terms that encompass a range of evolving technologies capable of transmitting medical information between patients and health care practitioners as well as related applications that enable remote medical procedures or examinations. Telemedicine and telehealth are often used in an interchangeable fashion; for the purposes of Medicaid they refer to different health care applications.

Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient's health. Electronic communication refers to the use of interactive telecommunications equipment that includes audio and visual equipment permitting two-way, real time interactive communication between the patient, and the physician or practitioner at a distant site. For the purposes of the federal Medicaid statute, telemedicine is viewed as a cost-effective alternative to traditional face-to-face avenues of providing medical care that states may choose to cover. Telemedicine is not recognized by the statute as a distinct service.

Telehealth (or Telemonitoring) is the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, and information across distance. Telehealth includes technologies such as telephones, fax machines, electronic mail systems, and remote patient monitoring devices that are used to collect and transmit patient data for monitoring and interpretation. While they do not meet the Medicaid definition of telemedicine, they may nevertheless be covered and reimbursed as part of a Medicaid-coverable service under the federal Social Security Act as laboratory service, x-ray service, or physician service.

Applications

One growing area of telemedicine and telehealth focuses on the home care setting, enabling providers to communicate directly with a patient in his or her place of habitation. In this context, a site-based apparatus transmits information about vital signs and disease progression to an off-site provider. The content of the communication may include blood pressure measurements for hypertensive patients, blood sugar levels for diabetics, or weight checks for patients with cardiopulmonary disease. Devices designed to stay in a patient's home may prompt them to take medications or may require them to answer questions about their quality of sleep and intensity of pain. According to the Centers for Medicare and Medicaid Services, such arrangements augment the efficiency with which care is provided to homebound and chronically ill elderly persons by decreasing the need for providers to perform home visits. This efficiency aspect is especially true for patients living in rural areas where the geographic separation from providers often frustrates access to care.

Reimbursement for Telemedicine Services

State Medicaid will reimburse for physician consultations that use interactive video teleconferencing, but the patient must be present and participating in the telehealth visit. No reimbursement is available for home health monitoring. Additionally, only fee-for-service enrollees may be reimbursed for telehealth services. Reimbursement rates are the same as for services that are delivered face-to-face.

Summary of Bill:

Home health care services delivered through telemedicine are covered by and reimbursed under the state's Medicaid payment program. The Department of Social and Health Services is directed to establish reimbursement rates for telemedicine home health services that are comparable to rates paid for home health visits.

Home health services providers using telemedicine must provide written statements offering patients the option to refuse telemedical treatment, describing all confidentiality protections, and informing them of their right to access their telemedical records.

Telemedicine is defined as medical services or treatment, transfer of medical data, or education related to health services using audio, video, or data communication.