WASHINGTON TELEMEDICINE LAW
Things are heating up for telemedicine in Washington! The state’s telemedicine parity law was enacted this year, and as of January 1, 2017, it will expand to cover even more different telehealth services.
Interstate licensing is still a distant reality in Washington state, but that’s alright–it just means telemedicine there still has room to grow!
Ready to find out more about Washington’s telemedicine policy? Keep on reading.
Parity Law
Washington’s parity law is very recent! Enacted in 2015, the law mandates telemedicine coverage equal to reimbursement for in-person care under private insurance, state employee health plans, and Medicaid managed care.
Type of Telemedicine Covered
As of January 1, 2017, all insurers will be required to cover live video and store-and-forward telemedicine, including private payers, employee health plans and Medicaid Managed Care. Currently, Washington Medicaid provides live video reimbursement for patients with fee-for-service coverage.
Covered Health Services
These services are eligible for reimbursement when performed via live video:
Consultations
Office or other outpatient visits
Psychiatric intake and assessment
Individual psychotherapy
Visit for drug monitoring
Medicaid also covers the delivery of home telehealth services for patients who have been diagnosed with an unstable condition, and who may be at risk for hospitalization or a more costly level of care.
Eligible services include:
Assessment and monitoring of clinical data (vital signs, pain levels, biometrics)
Assessment of response to previous changes in the plan of care
Detection of condition changes
Management plan
Billing Codes
Use these CPT codes to bill for telemedicine:
Consultations, 99241–99245 and 99251-99255
Office or other outpatient visits, 99201-99215
Psychiatric intake and assessment, 90791 or 90792
Individual psychotherapy, 90832, +90833; 90834, +90836; 90837, +90838
And don’t forget your GT modifier!
Eligible Healthcare Providers
Providers eligible for telemedicine reimbursement include physicians (including psychiatrists) and advanced registered nurse practitioners (ARNPs).
Online Prescriptions
These online prescribing guidelines, while not legal mandates, are considered to be the standard in Washington:
A documented patient evaluation, including history and physical evaluation adequate to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided, must be obtained prior to providing treatment, including issuing prescriptions, electronically or otherwise.
Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in in-person settings.
Treatment, including issuing a prescription, based solely on an online questionnaire or consultation does not constitute an acceptable standard of care.
Informed Patient Consent
Written informed consent is required for telemedicine.
Interstate Telemedicine Licensing
Out-of-state practitioners can practice in Washington with a full Washington medical license, provided they do not attempt to establish an office in the state or meet patients there.
Provider-Patient Relationship
Telemedicine may be used instead of an in-person visit to establish a patient-provider relationship.
Restrictions on Locations
Originating sites may include:
Hospital
Rural health clinic
Federally qualified health center
Physician’s or other health care provider’s office
Community mental health center
Skilled nursing facility
Renal dialysis center
It is not necessary to distinguish between rural and urban originating sites.
Reimbursement Rates
Reimbursement rates for a telemedicine service should be equivalent to the rates of the same service rendered in-person.
Helpful Resources