District of Columbia

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: No
  • Remote Patient Monitoring: No
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: IMLC, PSY, PTC
  • Consent Requirements: Yes

STATE RESOURCES

  1. Medicaid Program: District of Columbia Medicaid
  2. Administrator: District of Columbia Dept. of Health Care Finance
  3. Regional Telehealth Resource Center: Mid-Atlantic Telehealth Resource Center

Last updated 09/03/2022

Audio-Only Delivery

Medicaid: Final Rule Amending Section 910, Ch. 9, Title 29 of DC Regulations, permanently allow audio-only telehealth via Medicaid

STATUS: Permanent

Medicaid: Audio-Only Visits and HIPAA

STATUS: Varies, some sections only active during DC PHE.

Medicaid: Billing for Teledentistry Encounters

STATUS: Varies, some sections only active during DC PHE.

Medicaid: Coding for Telemedicine and COVID-19

STATUS: Varies, some sections only active during DC PHE.

DC Act 23-404: Amended the law on August 19, 2020, permanently allow audio-only telehealth via Medicaid.

STATUS: Permanent

Medicaid: Telemedicine Guide

STATUS: Varies, some sections only active during DC PHE.

Medicaid 1915(c) Waiver: Appendix K – Elderly and Persons with Physical Disabilities (EPD Waiver); Individuals with Intellectual and Developmental Disabilities (IDD Waiver)

STATUS: Active, extended through Addendum

Medicaid 1915(c) Waiver: Appendix K Addendum – Elderly and Persons with Physical Disabilities (EPD Waiver); Individuals with Intellectual and Developmental Disabilities (IDD Waiver)

STATUS: Active, expires Six (6) months after the conclusion of the national public health emergency.

Medicaid: Updates to ADHP rates and Temporary Enhanced Reimbursement Rates for ADHP Services Due to COVID-19

STATUS: Active

Last updated 09/03/2022

Cross-State Licensing

Department of Health: Director Second Amended Declaration – Allowing Temporary Licensure; Temporary Licensure

STATUS: Waiver Period Ended August 11, 2022

Medicaid: Coding for Telemedicine and COVID-19

STATUS: Varies

Health Regulation and Licensing Administration: Guidance on use of Telehealth in DC

STATUS: Active

DC Health Board of Medicine: Licensure 

STATUS: Active

DC Act A24-0245: Preserve Our Healthcare Workforce Congressional Review Emergency Amendment Act of 2021

STATUS: Expired March 27, 2022

DC Act A24-0240: Preserve Our Healthcare Workforce Temporary Amendment Act of 2021

STATUS: Expired August 10, 2022

Last updated 09/03/2022

Easing Prescribing Requirements

Health Regulation and Licensing Administration: Guidance on use of Telehealth in DC

STATUS: Active

Department of Health: Coronavirus (COVID-19) Online Consultation/Telemedicine (Medical Marijuana)

STATUS: Varies, some sections only active during DC PHE.

Last updated 09/03/2022

Miscellaneous

Medicaid: Temporary Allowance of Telephonic Signature on Long Term Care Applications

STATUS: Active, expires on the 60th day after the end of the National PHE.

Dept. of Health: Medical Marijuana Recommender/COVID-19 Online Consultations/Telemedicine

STATUS: Active

 

Last updated 09/03/2022

Originating Site

Medicaid: Telemedicine Guide

STATUS: Varies, some sections only active during DC Public Health Emergency.

Medicaid: Reimbursable Telemedicine Services

STATUS: Permanent

Medicaid: Billing for Telemedicine Encounters

STATUS: Permanent

Medicaid 1915(c) Waiver: Appendix K – Elderly and Persons with Physical Disabilities (EPD Waiver); Individuals with Intellectual and Developmental Disabilities (IDD Waiver)

STATUS: Active, expires six (6) months after the conclusion of the public health emergency (see below for extension).

Medicaid 1915(c) Waiver: Appendix K Addendum – Elderly and Persons with Physical Disabilities (EPD Waiver); Individuals with Intellectual and Developmental Disabilities (IDD Waiver)

STATUS: Active, expires six (6) months after the conclusion of the public health emergency.

Medicaid: Coding for Telemedicine and COVID-19

STATUS: Varies, some sections only active during DC Public Health Emergency.

Last updated 09/03/2022

Private Payer

Health Regulation and Licensing Administration: Guidance on use of Telehealth in DC

STATUS: Active

Department of Insurance: Order regarding carriers provide telehealth coverage

STATUS: Varies, some sections only active during DC PHE.

Last updated 09/03/2022

Provider Type

No Reference Found.

Last updated 09/03/2022

Service Expansion

Medicaid: Telemedicine Guide

STATUS: Varies, some sections only active during DC PHE.

Medicaid: Temporary Enhanced Reimbursement Rates for Adult Substance Abuse Rehabilitation Services

STATUS: Active

Medicaid: Reimbursable Telemedicine Services

STATUS: Permanent

Medicaid: Billing for Teledentistry Encounters

STATUS: Varies, some sections only active during DC PHE.

1135 Medicaid Waiver: Elderly and Persons with Physical Disabilities (EPD Waiver); Individuals with Intellectual and Developmental Disabilities (IDD Waiver)

STATUS: Expired March 10, 2021

Medicaid: Coding for Telemedicine and COVID-19

STATUS: Varies, some sections only active during DC PHE.

Medicaid: Delivering Psychosocial Rehabilitation Clubhouse Services via Telemedicine

STATUS: Varies, some sections only active during DC PHE.

Medicaid: Updates to ADHP rates and Temporary Enhanced Reimbursement Rates for ADHP Services Due to COVID-19

STATUS: Active

 

Last updated 09/03/2022

Definitions

“Telehealth” means the delivery of healthcare services through the use of interactive audio, video, or other electronic media used for the purpose of diagnosis, consultation, or treatment; provided, that services delivered through electronic mail messages, or facsimile transmissions are not included.

SOURCE: DC Code Sec. 31-3861. (Accessed Sept. 2022).

Last updated 09/03/2022

Parity

SERVICE PARITY

A health insurer offering a health benefits plan in the District may not deny coverage for a healthcare service on the basis that the service is provided through telehealth if the same service would be covered when delivered in person.

A health insurer must reimburse a provider for the diagnosis, consultation or treatment of the patient when the service is delivered by telehealth.

SOURCE: DC Code Sec. 31-3862. (Accessed Sept. 2022).


PAYMENT PARITY

No explicit payment parity.

Last updated 09/03/2022

Requirements

Health insurers are required to pay for telehealth services if the same service would be covered when delivered in-person.

A health insurer shall reimburse the provider for the diagnosis, consultation, or treatment of the insured when the service is delivered through telehealth.

A health insurer may require a deductible, copayment, or coinsurance that may not exceed the amount applicable to the same service delivered in-person.  A health insurer shall not impose any annual or lifetime dollar maximum on coverage for telehealth services other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services under the health benefits plan.

SOURCE: DC Code Sec. 31-3862. (Accessed Sept. 2022).

Last updated 09/03/2022

Definitions

Telemedicine is a service delivery model that delivers healthcare services through a two-way, real time interactive video-audio communication or audio-only communication for the purpose of evaluation, diagnosis, consultation, or treatment.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.2; Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 1. (Accessed Sept. 2022).

Telemedicine is a service delivery model that delivers healthcare services through a two-way, real time interactive video-audio communication for the purpose of evaluation, diagnosis, consultation, or treatment.

SOURCE: Physicians Billing Manual. DC Medicaid. (June 7, 2022) Sec. 15.10, P. 66; FQHC Billing Manual, 15.2.1, P. 49.; Clinic Billing Manual (Aug. 24, 2022) 15.2.1, P. 51.; Behavioral Health Billing Manual (July 28, 2022) 14.1, p. 67. (Accessed Sept. 2022).

“Telehealth” means the delivery of healthcare services through the use of interactive audio, video, or other electronic media used for the purpose of diagnosis, consultation, or treatment; provided, that services delivered through email messages or facsimile transmissions are not included.

SOURCE; DC Code Sec. 31-3861 & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 1,  (Accessed Sept. 2022).

“Telehealth” means the delivery of healthcare services through the use of interactive audio, video, or other electronic media used for the purpose of diagnosis, consultation, or treatment; provided, that services delivered through audio-only telephones, email messages or facsimile transmissions are not included.

SOURCE: Physicians Billing Manual, DC Medicaid (June 7, 2022). Section 15.10, p. 66.  Clinic Billing Manual (Aug. 24, 2022) 15.2, P. 50; Behavioral Health Billing Manual (July 28, 2022) 14, p. 67. (Accessed Sept. 2022).

For the purposes of coverage by the Department of Health Care Finance (DHCF), telehealth and telemedicine shall be deemed synonymous.

SOURCE: Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 1 & Physicians Billing Manual. DC Medicaid. (June 7, 2022) Sec. 15.10, P. 66; Behavioral Health Billing Manual (July 28, 2022) 14, p. 67. (Accessed Sept. 2022).

Last updated 09/03/2022

Email, Phone & Fax

Under recently effective final regulations, DHCF added audio-only communication as an allowable method of telemedicine services.

A telemedicine provider that utilizes audio-only communication methods is required to use audio equipment that ensures clear communication and includes echo cancellation.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.2. & 910.13 & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022. (Accessed Sept. 2022).

DC Medicaid does not reimburse for service delivery using e-mail messages or facsimile transmissions.

SOURCE: DC Code Sec. 31-3861 & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 1, (Accessed Sept. 2022).

The physician, clinic, and FQHC billing manuals still reference an audio-only exclusion in addition to e-mail messages or facsimile transmissions within the definition of telehealth.

SOURCE: Physicians Billing Manual. DC Medicaid. (June 7, 2022) Sec. 15.10, P. 66; FQHC Billing Manual, 15.2.1, P. 49.; Clinic Billing Manual (Aug. 24, 2022) 15.2.1, P. 51. (Accessed Sept. 2022).

Last updated 09/03/2022

Live Video

POLICY

DC Medicaid must reimburse for health care services through telehealth if the same service would be covered when delivered in person.

SOURCE: DC Code Sec. 31-3863 (Accessed Sept. 2022).

The DC Medical Assistance Program will reimburse telemedicine services, if the Medicaid beneficiary meets the following conditions:

  • Be enrolled in the DC Medicaid Program;
  • Be physically present at the originating site at the time the telemedicine service is rendered; and
  • Provide written or verbal consent to receive telemedicine services in lieu of in-person healthcare services, consistent with all applicable DC laws.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.5, Physicians Billing Manual. DC Medicaid. Jun. 7, 2022, Sec. 15.9.2. P. 66 & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 2 (Accessed Sept. 2022).


ELIGIBLE SERVICES/SPECIALTIES

Medicaid shall cover and reimburse for healthcare services appropriately delivered through telehealth if the same services would be covered when delivered in person.

SOURCE: DC Code Sec. 31-3863 (Accessed Sept. 2022)

Covered Services:

  • Evaluation and management
  • Consultation of an evaluation and management of a specific healthcare problem requested by an originating site provider
  • Behavioral healthcare services including, but not limited to, psychiatric evaluation and treatment, psychotherapies, and counseling
  • Rehabilitation services including speech therapy

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.11 & Physicians Billing Manual.  DC Medicaid.  (Jan. 10, 2022) Sec. 15.10.6. P. 68, Clinic Billing Manual, DC Medicaid (Aug. 24, 2022), Sec. 15.2.6, P. 52. FQHC Billing Manual, DC Medicaid 15.2.6, P. 51. (Aug. 24, 2022), & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 5, (Accessed Sept. 2022)

The provider shall determine if the service can reasonably be delivered at the standard of care via telemedicine.

SOURCE: Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 5. (Accessed Sept. 2022).

Distant site providers may only bill for the appropriate codes outlined (see manuals).

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.12, Physicians Billing Manual. DC Medicaid. (Jan. 10, 2022) Sec. 15.9.8. P. 67-68, Clinic Billing Manual, DC Medicaid (Aug. 24, 2022), Sec. 15.2.8, P. 52-53. & FQHC Billing Manual, DC Medicaid 15.2.8, P. 51-52. (Aug. 24, 2022). (Accessed Sept. 2022).

Education-Related Services

Office of the State Superintendent of Education shall only bill for distant site services that are allowable healthcare services to be delivered by the individual fee-for-service providers delivering DC EIP services under them and can be delivered at the standard of care via telemedicine.

The following reimbursement parameters apply for services delivered under the Office of the State Superintendent of Education through the Strong Start DC Early Intervention Program.

  • The LEA shall only bill for distant site services that are allowable healthcare services to be delivered at DCPS/DCPCS and can be delivered at the standard of care via telemedicine;
  • The LEA shall provide an appropriate primary support professional to attend the medical encounter with the member at the originating site. In instances where it is clinically indicated, an appropriate healthcare professional shall attend the encounter with the member at the originating site.

SOURCE: Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 5. (Accessed Sept. 2022).

Excluded Services

The Program will not reimburse telemedicine providers for the following:

  • Incomplete delivery of services via telemedicine, including technical interruptions that result in partial service delivery.
  • When a provider is only assisting the beneficiary with technology and not delivering a clinical service.
  • For a telemedicine transaction fee and/or facility fee.
  • For store and forward and remote patient monitoring

SOURCE: Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 5, Clinic Billing Manual, DC Medicaid (Aug. 24, 2022), Sec. 15.2.7, P. 52. FQHC Billing Manual, DC Medicaid 15.2.7, P. 51. (Aug. 24, 2022). & Physicians Billing Manual. DC Medicaid. (Jan. 10, 2022) Sec. 15.10.7. P. 68 (Accessed Sept. 2022).

Certain dental procedures require prior authorization.

Providers should consult the fee schedule to determine if the procedure code requires prior authorization.

Medical necessity or a medically necessary service is defined as medical, surgical or other services required for the prevention, diagnosis, cure, or treatment of a health related illness, condition or disability including services necessary to prevent a detrimental change in either medical, behavioral, mental or dental health status. Only supplies, equipment, appliances, and services that are determined as medically necessary by the Department of Health Care Finance or its contracted representative are covered. See manual for complete list to determine medical necessity.

SOURCE: Physicians Billing Manual. DC Medicaid. (Jun. 7, 2022) Sec. 15.10.9-10 P. 69 (Accessed Sept. 2022).


ELIGIBLE PROVIDERS

Telemedicine providers must comply with the following:

  • Be an enrolled Medicaid provider and comply with requirements including having a completed, signed Medicaid Provider Agreement
  • Comply with technical, programmatic and reporting requirements
  • Be licensed; and
  • Appropriately document the beneficiary’s written or verbal consent.
  • Comply with any other applicable consent requirements under District laws, including but not limited to Section 3026 of Title 5-E of the District of Columbia Municipal Regulations if providing telemedicine services at a District of Columbia Public School (DCPS) or District of Columbia Public Charter School (DCPCS).

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.6. (Accessed Sept. 2022)

D.C. Medicaid enrolled providers are eligible to deliver telemedicine services, using fee-for-service reimbursement, at the same rate as in-person consultations. All reimbursement rates for services delivered via telemedicine are consistent with the District’s Medical State Plan and implementing regulations.

The eligible distant site providers include but are not limited to the following:

  • Hospital
  • Nursing facility
  • Federally Qualified Health Center
  • Clinic
  • Physician Group/Office
  • Nurse Practitioner Group/Office
  • DCPS
  • DCPCS; and
  • MHRS provider, ASARS provider and ASTEP provider certified by DBH and eligible to provide behavioral health services set forth under the State Plan

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.7 & Physicians Billing Manual. DC Medicaid. Jun. 7, 2022, Sec. 15.10.3-4. P. 66-67 &Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 3-4., Clinic Billing Manual, DC Medicaid (Aug. 24, 2022), Sec. 15.2.3-4, P. 51-52.FQHC Billing Manual, DC Medicaid 15.2.3-4, P. 50. (Aug. 24, 2022). (Accessed Sept. 2022).

At the discretion of the rendering provider, personnel delivering telemedicine services may work remotely, as long as all other requirements in the rule are met. See sections on technology, documentation in medical records, and confidentiality in guidance document for further specifications.

SOURCE: Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 3, 5-7. (Accessed Sept. 2022).

When a beneficiary’s home is the originating site, the distant site provider shall ensure the technology in use meets the minimum requirements.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.30. (Accessed Sept. 2022).

Federally Qualified Health Center (FQHC) Reimbursement

In accordance with the District’s Prospective Payment System (PPS) or alternative payment methodology (APM) for FQHCs, the following reimbursement parameters apply:

  • Originating Site: An FQHC provider must deliver an FQHC-eligible service in order to be reimbursed the appropriate PPS, APM, or fee-for-service (FFS) rate at the originating site;
  • Distant Site: An FQHC provider must deliver an FQHC-eligible service that is listed in Appendix A in order to be reimbursed the appropriate PPS, APM, or FFS rate; and
  • Originating and Distant Site: If both the originating and the distant site are FQHCs, for both to receive reimbursement, each site must deliver a different PPS or APM service (e.g. medical or behavioral). If both sites submit a claim for the same PPS or APM service (e.g. medical), then only the distance site will be eligible to receive reimbursement.

SOURCE: Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 4., Clinic Billing Manual, DC Medicaid (Aug. 24, 2022), Sec. 15.2.5, P. 52. FQHC Billing Manual, DC Medicaid 15.2.5, P. 50-51. (Aug. 24, 2022). & Physicians Billing Manual. DC Medicaid. Jun. 7, 2022. Sec. 15.10.5. P. 67. (Accessed Sept. 2022).


ELIGIBLE SITES

Eligible services can be delivered via telemedicine when the beneficiary is at the originating site, while the eligible “distant” provider renders services via the audio/video or audio-only connection.

When clinically indicated, an originating site provider or its designee shall be in attendance during the patient’s medical encounter with the distant site professional. An originating site provider shall not be required to be in attendance when the beneficiary prefers to be unaccompanied because the beneficiary feels the subject is sensitive. An originating site provider shall note their attendance status in the patient’s medical record.

To receive reimbursement, originating site providers must deliver an eligible service, distinct from the service delivered at the distant site, in order to receive reimbursement.

Telemedicine providers will submit claims in the same manner the provider uses for in person services. When billing for services delivered via telemedicine, distant site providers shall enter the “GT” (via real-time interactive video-audio communication) procedure modifier on the claim. Additionally, the distant site provider must report the National Provider Identifier (NPI) of the originating site provider in the “referring provider” portion of the claim.

SOURCE: Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 3-4. (Accessed Sept. 2022).

The beneficiary’s home, or other settings authorized by DHCF, may serve as the originating site. When the originating site is the beneficiary’s home the distant site provider is responsible for ensuring that the technology in use meets the minimum requirements set forth in Subsection 910.13.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.7 & 910.30. (Accessed Sept. 2022).

Must be an approved telemedicine provider.  The following providers are considered an eligible originating site:

  • Hospital
  • Nursing facility
  • Federally Qualified Health Center
  • Clinic
  • Physician Group/Office
  • Nurse Practitioner Group/Office
  • District of Columbia Public Schools (DCPS)
  • District of Columbia Public Charter Schools (DCPCS)
  • Mental Health Rehabilitation Service (MHRS) provider, Adult Substance Abuse Rehabilitation Service (ASARS) provider, and Adolescent Substance Abuse Treatment Expansion Program (ASTEP) provider certified by the Department of Behavioral Health (DBH) and eligible to provide behavioral health services set forth under the District of Columbia Medicaid State Plan (State Plan).
  • The beneficiary’s home or other settings identified in guidance published on the DHCF website.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.7,  Physicians Billing Manual. DC Medicaid. Jun. 7, 2022. Sec. 15.10.3. P. 66-67, Clinic Billing Manual, DC Medicaid (Aug. 24, 2022), Sec. 15.2.3, P. 51. & FQHC Billing Manual, DC Medicaid 15.2.3, P. 49-50. (Aug. 24, 2022). & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 3. (Accessed Sept. 2022).

When a beneficiary’s home is the originating site, the distant site provider shall ensure the technology in use meets the minimum requirements set forth in Subsection 910.13.

In the event the beneficiary’s home is the originating site, the distant site provider must bill using the GT modifier and specify the place of service ‘02’.

SOURCE: Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 4., 6 (Accessed Sept. 2022).

When DCPS or DCPCS is the originating site provider, a primary support professional (an individual designated by the school) shall be in attendance during the patient’s medical encounter.

An originating site provider shall not be required to be in attendance when the beneficiary prefers to be unaccompanied because the beneficiary feels the subject is sensitive. Sensitive topics may include counseling related to abuse, or other psychiatric matters. An originating site provider shall note their attendance status in the patient’s medical record.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.16-17. (Accessed Sept. 2022).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No transaction or facility fee.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.28, Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 5, Clinic Billing Manual, DC Medicaid (Aug. 24, 2022), Sec. 15.2.7, P. 52. FQHC Billing Manual, DC Medicaid 15.2.7, P. 51. (Aug. 24, 2022). & Physicians Billing Manual. DC Medicaid. (Jan. 10, 2022) Sec. 15.10.7. P. 68 (Accessed Sept. 2022).

Last updated 09/03/2022

Miscellaneous

Where an FQHC provides an allowable healthcare service at the originating or distant site, the FQHC shall be reimbursed the applicable rate (PPS, APM or FFS).  If an FQHC is both the originating and distant site, and both sites render the same healthcare service, only the distant site will be reimbursed.

When DCPS or DCPCS provides any of the allowable healthcare services at the originating or distant site, the provider shall only be reimbursed for distant site healthcare services that are Medicaid eligible and are to be delivered in a licensed education agency.

When an originating site and a distant site are CSAs, and the same provider identification number is used for a service delivered via telemedicine, only the distant site provider shall be eligible for reimbursement of the allowable healthcare services described within this section.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.24, 25, 26 & 27. (Accessed Sept. 2022).

See Transmittal for documentation standards for services delivered via telemedicine in DC Medicaid.

SOURCE: DC Medicaid Department of Health Care Finance. Transmittal #20-42: Documentation Standards for Services Delivered Via Telemedicine. Nov. 30, 2020 (Accessed Sept. 2022).

Telemedicine section also appears in Provider Manuals on:

See regulation and telemedicine guidance for specific technology and medical record requirements.

A provider is required to develop a confidentiality compliance plan.

DHCF is required to send a Telemedicine Program Evaluation survey to providers.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.13, 14 & 15 & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 6-7. (Accessed Sept. 2022).

Required documents include prior authorization form, the letter of medical necessity, evaluation/assessment and plan of treatment.

SOURCE: Physicians Billing Manual. DC Medicaid. (June 7, 2022) Sec. 15.10.11. P. 69-70 (Accessed Sept. 2022).

Last updated 09/03/2022

Out of State Providers

Providers must be enrolled in the Program and licensed, by the applicable Board, to practice in the jurisdiction where services are rendered. For services rendered outside of the District, providers shall meet any licensure requirements of the jurisdiction where he/she is physically located and the jurisdiction where the patient is physically located.

When the provider and patient receiving healthcare services are located in the District of Columbia, all individual practitioners shall be licensed in the state. For healthcare services rendered outside of the District, the provider of the services shall meet any licensure requirements of the jurisdiction in which the patient is physically located.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.9. (Accessed Sept. 2022).

Providers whose practice address is located outside of the geographic boundaries of the District of Columbia are eligible to request consideration for participation in the DC Medicaid program if licensed in the state of the practice address.

SOURCE: FQHC Billing Manual. DC Medicaid. (Aug. 24, 2022) Sec. 5.3.2. P. 15, Physicians Billing Manual. DC Medicaid. (June 7, 2022) Sec. 5.3.2. P. 17, & Clinic Billing Manual, DC Medicaid (Aug. 24, 2022), Sec. 5.3.2, P. 17. (Accessed Sept. 2022).

 

Last updated 09/03/2022

Overview

Medicaid is required to cover healthcare services appropriately delivered through telehealth if the same services would be covered when delivered in person. Medicaid enrolled providers are eligible to deliver telemedicine services at the same rate as in-person consultations. Medicaid is also now covering audio-only telehealth. Medicaid continues to not cover asynchronous telehealth or remote patient monitoring, and billing manuals still reference an exclusion of audio-only in addition to e-mail and fax.

Source: DC Code 31-3863; DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.2. & 910.13.; Telemedicine Provider Guidance, Jan. 7, 2022. (Accessed Sept. 2022).

Last updated 09/03/2022

Remote Patient Monitoring

POLICY

There is no reimbursement for remote patient monitoring.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.29, Clinic Billing Manual, DC Medicaid (Aug. 24, 2022), Sec. 15.2.7, P. 52.; FQHC Billing Manual, DC Medicaid 15.2.7, P. 51. (Aug. 24, 2022); Physicians Billing Manual. DC Medicaid. June 7, 2022, Sec. 15.10.7. P. 68; & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 5. (Accessed Sept. 2022).


CONDITIONS

No Reference Found.


PROVIDER LIMITATIONS

No Reference Found.


OTHER RESTRICTIONS

No Reference Found.

Last updated 09/03/2022

Store and Forward

POLICY

No reimbursement for store-and-forward.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.29, Clinic Billing Manual, DC Medicaid (Aug. 24, 2022), Sec. 15.2.7, P. 52.; FQHC Billing Manual, DC Medicaid 15.2.7, P. 51. (Aug. 24, 2022); Physicians Billing Manual. DC Medicaid. June 7, 2022, Sec. 15.10.7. P. 68; & Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 5.  (Accessed Sept. 2022).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found.


GEOGRAPHIC LIMITS

No Reference Found.


TRANSMISSION FEE

No Reference Found.

Last updated 09/03/2022

Cross-State Licensing

Must have license to practice medicine in the District of Columbia.

For any services rendered outside the District of Columbia, the provider of the services shall meet any licensure requirement of the jurisdiction in which the patient is physically located.

A District of Columbia-licensed physician may rely on a patient evaluation performed by another District of Columbia-licensed physician if the former is providing coverage for the latter.

SOURCE: DC Regs. Sec. 17-4618.1 & .6. (Accessed Sept. 2022).

 

Last updated 09/03/2022

Definitions

Telemedicine – The practice of medicine by a licensed practitioner to provide patient care, treatment or services, between a licensee in one location and a patient in another location with or without an intervening healthcare provider, through the use of health information and technology communications, subject to the existing standards of care and conduct.

SOURCE: DC Regs. Sec. 17-4699., DC Department of Health Board of Medicine Policy No. 15-01 (Accessed Sept. 2022).

“Telehealth” means the delivery of healthcare services through interactive audio, video, or other electronic media used for the purpose of diagnosis, consultation, or treatment; provided, that services delivered through audio-only telephones, electronic mail messages, or facsimile transmissions are not included.

SOURCE: Code of the District of Columbia Sec. 7-3201(13). (Accessed Sept. 2022).

Last updated 09/03/2022

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. (Accessed Sept. 2022).

Member of Physical Therapy Compact

SOURCE: PT Compact, Compact Map (Accessed Sept. 2022).

Member of the Psychology Interjurisdictional Compact.

SOURCE: PSYPACT, Map, (Accessed Sept. 2022).

 

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 09/03/2022

Miscellaneous

No Reference Found.

Last updated 09/03/2022

Online Prescribing

A physician shall perform a patient evaluation to establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication for a patient utilizing the appropriate standards of care, except when performing interpretive services.

If a physician-patient relationship does not include a prior in-person interaction with a patient, the physician may use real-time telemedicine to allow a free exchange of protected health information between the patient and the physician to establish the physician-patient relationship and perform the patient evaluation.

SOURCE: DC Reg Sec. 17-4618.3 & 4 (Accessed Sept. 2022).

Last updated 09/03/2022

Professional Board Standards

Board of Medicine

SOURCE: DCMR Title 17, Ch. 46 Sec. 4618 (Accessed Feb. 2022).; Board of Medicine Policy No. 15-01 Telemedicine Policy. (Accessed Sept. 2022).