Telemedicine Reimbursement. A health plan offered by a health carrier, a health plan offered to school or state employees and their dependents, a Medicaid managed care plan, and a behavioral health administrative services organization—for covered persons under 18 years of age—must reimburse providers for health care services provided through telemedicine or store and forward technology if:
An originating site for telemedicine includes a hospital, rural health clinic, federally qualified health center, health care provider's office, community mental health center, skilled nursing center, renal dialysis center, or a home.
A health plan offered by a health carrier, a health plan offered to school or state employees, and a Medicaid managed care plan must reimburse a provider for a health care service provided through telemedicine at the same rate as if it was provided in person. Hospitals, hospital systems, telemedicine companies, and provider groups of 11 or more providers may negotiate a different reimbursement rate.
For these requirements, telemedicine does not include the use of audio-only telephone, facsimile, or e-mail.
Hospital Privileging. A hospital may grant privileges to physicians to treat patients in its facilities. When a patient is being treated through telemedicine, 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. The definition of telemedicine for this purpose does not include audio-only telephone, facsimile, or e-mail.
Telemedicine Collaborative. Hosted by the University of Washington, the Collaborative for the Advancement of Telemedicine (Collaborative) is a group convened to develop recommendations on telemedicine. Issues the Collaborative considers include reimbursement, access, best practices, and technical assistance. The Collaborative expires on December 31, 2021.
Telemedicine Reimbursement. A health plan offered by a health carrier, a health plan offered to school or state employees and their dependents, a Medicaid managed care plan, or a behavioral health administrative services organization—for covered persons under 18 years of age—must reimburse providers for health care services provided through audio-only telemedicine under the same conditions applicable to audio-video telemedicine.
If a provider intends to bill for audio-only telemedicine, they must first obtain the patient's consent to the billing prior to the service being delivered. A pattern of potential violations of the consent requirement must be reported to the provider's disciplining authority and the provider must be given the opportunity to cure or explain the violations. The disciplining authority may levy a fine or cost recovery and take any other action as permitted under its statutory authority. Upon completion of its review, the disciplining authority must notify the Insurance Commissioner or the Health Care Authority, as appropriate, the results of the review.
Beginning January 1, 2023, the audio-only telemedicine reimbursement requirement applies only if the covered person has an established relationship with the provider. An established relationship exists if the person has had at least one in-person appointment within the past year with the audio-only telemedicine provider or a provider in the same clinic, or the covered person was referred by another provider who had at least one in-person appointment with the person within the past year and gave relevant medical information to the audio-only telemedicine provider.
A health plan offered by a health carrier, a health plan offered to school or state employees, and a Medicaid managed care plan must reimburse a provider for a health care service provided through telemedicine the same amount of compensation that would have been paid to the provider if the service was provided in person. Medicaid managed care organizations must reimburse rural health clinics for audio-only telemedicine at the rural health clinic encounter rate. A hospital acting as an originating site may not charge a facility fee for audio-only telemedicine.
The Health Care Authority must adopt rules requiring Medicaid fee-for-service reimbursement for audio-only telemedicine services. The rules must establish a manner of reimbursement consistent with Medicaid managed care, except that rural health clinics must be reimbursed at the encounter rate.
For these requirements, "audio-only telemedicine" means the delivery of health care services through the use of audio-only technology, permitting real-time communication between the patient at the originating site and the provider for diagnosis, consultation, or treatment. Audio-only telemedicine does not include facsimile, electronic mail or the delivery of health care services that are customarily delivered by audio-only technology and not billed as separate services by the provider, such as sharing laboratory results.
The Insurance Commissioner may adopt any rules necessary to implement telemedicine requirements applicable to health carriers.
Hospital Privileging. The definition of telemedicine for hospital privileging is expanded to include audio-only telemedicine.
The Telemedicine Collaborative. The termination date for the Collaborative is extended from December 31, 2021, to December 31, 2023.
Insurance Commissioner Study. The Insurance Commissioner, in collaboration with the Washington State Telehealth Collaborative and the Health Care Authority, must complete a study by November 15, 2023 on: