District of Columbia

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

District of Columbia Medicaid

Administrator

District of Columbia Dept. of Health Care Financing

Regional Telehealth Resource Center

Mid-Atlantic Telehealth Resource Center

Medicaid Reimbursement

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

Private Payer Law

Law Exists: Yes
Payment Parity: No

Professional Requirements

Licensure Compacts: IMLC, PSY
Consent Requirements: Yes

Last updated 02/28/2021

Audio-Only Delivery

Medicaid: Coding for Telemedicine and COVID-19

STATUS: Active, until end of DC PHE

Medicaid: Telemedicine Guide

STATUS: Varies, some sections only active during DC PHE

Medicaid:  Audio-Only Visits and HIPAA

STATUS: Active, until end of DC PHE

Medicaid: Billing for Teledentistry Encounters

STATUS: Active, until end of 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, expires March 10, 2021; 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 public health emergency

Last updated 02/28/2021

Cross-State Licensing

Medicaid: Coding for Telemedicine and COVID-19

STATUS: Active, until end of DC PHE

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

STATUS: Active

Last updated 02/28/2021

Easing Prescribing Requirements

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

STATUS: Active

Last updated 02/28/2021

Miscellaneous

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

STATUS: Active, until 60 days after termination of PHE

Council of DC:  Fund Telehealth Programs

STATUS: Active, expires 90 days after emergency acts expire

Last updated 02/28/2021

Originating Site

Medicaid: Coding for Telemedicine and COVID-19

STATUS: Active, until end of DC PHE

Medicaid: Telemedicine Guide

STATUS: Varies, some sections only active during DC PHE

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 March 10, 2021; 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 public health emergency

 

Last updated 02/28/2021

Private Payer

Department of Insurance: Order regarding carriers provide telehealth coverage

STATUS: Active, until end of DC PHE

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

STATUS: Active

Last updated 02/28/2021

Provider Type

No Reference Found

Last updated 02/28/2021

Service Expansion

Medicaid: Coding for Telemedicine and COVID-19

STATUS: Active, until end of DC PHE

Medicaid: Telemedicine Guide

STATUS: Varies, some sections only active during DC PHE

Medicaid: Reimbursable Telemedicine Services

STATUS: Permanent

Medicaid: Billing for Teledentistry Encounters

STATUS: Active, until end of DC PHE

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

STATUS: Active, expires March 10, 2021

Last updated 02/28/2021

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 Feb. 2021).

Telehealth is defined as 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, electronic mail messages, or facsimile transmissions are not included. For the purposes of coverage by the Department of Health Care Finance (DHCF), telehealth and telemedicine shall be deemed synonymous.

SOURCE: Physicians Billing Manual.  DC Medicaid.  (Jan. 13, 2021) Sec. 15.9. Pgs. 65 & Behavioral Health Billing Manual, pg. 66.  (Accessed Feb. 2021).

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: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.2. (Accessed Feb. 2021) & Physicians Billing Manual.  DC Medicaid.  (Jan. 13, 2021) Sec. 15.9.1. Pgs. 66.  (Accessed Feb., 2021).

Last updated 02/28/2021

Email, Phone & Fax

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

SOURCE: DC Code Sec. 31-3861 & Physicians Billing Manual.  DC Medicaid.  (Jan.13, 2021) Sec. 15.9 p. 66.  (Accessed Feb. 2021).

Last updated 02/28/2021

Live Video

POLICY

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

SOURCE: DC Code Sec. 31-3863 (Accessed Feb. 2021).

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 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. (Accessed Feb. 2021) & Physicians Billing Manual.  DC Medicaid.  Jan. 13, 2021) Sec. 15.9.3. P. 66.  (Accessed Feb. 2021).


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 Feb. 2021).

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. 13, 2021) Sec. 15.9.6. P. 67 (Accessed Feb. 2021).

Distant site providers may only bill for the appropriate codes outlined (see manual and guidance).

SOURCE: DC Dept. of Health Care Finance. Telemedicine Provider Guidance. P. 3. (Mar. 2020), DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.12 & Physicians Billing Manual.  DC Medicaid. (Jan. 2021) Sec. 15.9.8. P. 67-68. (Accessed Feb. 2021).

Education-Related Services

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 listed in Appendix A that are allowable healthcare services to be delivered at DCPS/DCPCS;
  • 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: DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 4 & 6 (Mar. 2020) (Accessed Feb. 2021).


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
  • Comply with any applicable consent requirements, including but not limited to providing telemedicine services at DC public schools or public charter schools.

SOURCE: DC Municipal Regulation. Emergency Regulation. Title 29, Ch. 9, Sec. 910.6. (Accessed Feb. 2021).

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.

SOURCE: Physicians Billing Manual. DC Medicaid.  (Jan. 13, 2021) Sec. 15.9.4. P. 66 & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 4  (Mar. 2020).  (Accessed Feb. 2021).

The following providers are considered an eligible distant site provider:

  • 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. 910.8 & Physicians Billing Manual.  DC Medicaid.  (Jan. 13, 2021) Sec. 15.9.3. P. 66 & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 3 (Mar. 2020) (Accessed Feb. 2021).

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 Feb. 2021).


ELIGIBLE SITES

Recently Adopted Rule

The beneficiary’s home 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 910.3.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910 & 910.30. (Accessed Feb. 2021).

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

  • 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 (Accessed Feb. 2021) & Physicians Billing Manual.  DC Medicaid.  (09/14/2020) Sec. 15.9.3. P. 68 & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 2 (Mar. 2020) (Accessed Feb. 2021).

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: DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 4 & 6 (Mar. 2020) (Accessed Feb. 2021).

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.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.17. (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

No transaction or facility fee.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.28. (Accessed Jan. 2021) & Physicians Billing Manual.  DC Medicaid.  (Jan. 13, 2021) Sec. 15.9.7. P. 67 & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 6 (Mar. 2020). (Accessed Feb. 2021).

Last updated 02/28/2021

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 serviced 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 Feb. 2021).

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 Feb. 2021).

Special reimbursement parameters for FQHCs:

  • When FQHC is originating site:  An FQHC provider must deliver an FQHC-eligible service in order to be reimbursed the appropriate PPS or fee for service (FFS) rate at the originating site;
  • When FQHC is distant site:  An FQHC provider must deliver an FQHC-eligible service* in order to be reimbursed the appropriate PPS or FFS rate; and
  • When FQHC is Originating and Distant Site: In instances where the originating site is an FQHC, the distant site is an FQHC, and both sites deliver a service eligible for the same clinic visit/encounter all-inclusive PPS code, only the distant site will be eligible to be reimbursed for the appropriate PPS rate for an FQHC-eligible service.

SOURCE: Physicians Billing Manual. DC Medicaid.  (Jan. 13, 2021) Sec. 15.9.5. Pg. 67 & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 4 (Feb. 2018) (Accessed Feb. 2021).

Telemedicine section also appears in Provider Manuals on:

See regulation and telemedicine guidance for specific technology requirements.

A provider is required to develop a confidentiality compliance plan.

DHCF is required to send a Telemedicine Program Evaluation survey to providers, effective Jan. 1, 2017.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.13, 14 & 15 & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 6-7 (Mar. 2020). (Accessed Feb. 2021).

Last updated 02/28/2021

Out of State Providers

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 Feb. 2021).

“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.”

SOURCE: Physicians Billing Manual.  DC Medicaid.  (Jan. 13, 2021) Sec. 15.9. P.65. (Accessed Feb. 2021).

Last updated 02/28/2021

Overview

Medicaid shall cover and reimburse for healthcare services appropriately delivered through telehealth if the same services would be covered when delivered in person.  Although this law was amended to expand reimbursement to store-and-forward and remote patient monitoring, it was not funded under an approved budget and financial plan and therefore did not go into effect.

Source: DC Code 31-3863. (Accessed Feb. 2021).

Last updated 02/28/2021

Remote Patient Monitoring

POLICY

There is no reimbursement for remote patient monitoring.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.29. (Accessed Feb. 2021) & Physicians Billing Manual.  DC Medicaid.  (Jan. 13, 2021) Sec. 15.9.7. P.67 & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 6 (Mar. 2020).  (Accessed Feb. 2021).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 02/28/2021

Store and Forward

POLICY

No reimbursement for store-and-forward.

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.29. (Accessed Feb. 2021) & Physicians Billing Manual.  DC Medicaid.  (Jan. 13, 2021) Sec. 15.9.7. P. 67. & DC Dept. of Healthcare Finance. Telehealth Provider Guidance. p. 6 (Mar. 2020). (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 02/28/2021

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 Feb. 2021).

Last updated 02/28/2021

Parity

SERVICE PARITY

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 Feb. 2021).


PAYMENT PARITY

No explicit payment parity.

Last updated 02/28/2021

Requirements

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

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 Feb. 2021).

Last updated 02/28/2021

Cross-State Licensing

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

SOURCE: DC Regs. Sec. 17-4618.1. (Accessed Feb. 2021).

Last updated 02/28/2021

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.  (Accessed Feb. 2021).

Last updated 02/28/2021

Licensure Compacts

Member of the Interstate Medical Licensure Compact. (Implementation delayed)

SOURCE: Interstate Medical Licensure Compact. (Accessed Feb. 2021).

Last updated 02/28/2021

Miscellaneous

No Reference Found

Last updated 02/28/2021

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.

A physician-patient relationship can be established through real-time telemedicine.

SOURCE: DC Code Sec. 17-4618.3 & 4 (Accessed Feb. 2021).

Last updated 02/28/2021

Professional Board Standards

Department of Health (applies to the Board of Medicine)

SOURCE: DCMR Title 17, Ch. 46 Sec. 4618 (Accessed Feb. 2021).