Virginia

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Virginia Medicaid

Administrator

State Dept. of Medical Assistance Services (DMAS)

Regional Telehealth Resource Center

Mid-Atlantic Telehealth Resource Center

Medicaid Reimbursement

Live Video: Yes
Store-and-Forward: Yes
Remote Patient Monitoring: Yes

Private Payer Law

Law Exists: Yes
Payment Parity: Yes

Professional Requirements

Licensure Compacts: PTC, NLC, PSY, EMS, AOTA
Consent Requirements: Yes

Last updated 05/31/2021

Audio-Only Delivery

Medicaid: Flexibilities Related to COVID-19 Update for Developmental Disabilities and Commonwealth Coordinate Care

STATUS: Telemedicine flexibilities expire Aug. 1, 2021

Medicaid: MCO Flexibilities Continuation

STATUS:  Active, until VA state of emergency ends

Medicaid: Provider Flexibilities Continuation

STATUS:  Expired 4/20/21, but extended to July 20, 2021 (see above)

Medicaid: Behavioral Health and ARTS Provider Flexibilities Related to COVID-19 (3/27)

STATUS:  Modified, see below.

Medicaid: New 1135 Waiver and Administrative Provider Flexibilities (5/26)

STATUS:  Active, until the end of the emergency declaration

Medicaid:  Home and Community Based Services Waivers (HCBS) COVID-19 Policy Continuation and Timeline

STATUS:  Varies

Medicaid: Delivery of Group Based Services in Behavioral Health and Addiction (ARTS) during COVID-19 (7/1)

STATUS:  Active during PHE.

Medicaid: Developmental Disabilities (DD) and Commonwealth Coordinated Care (CCC) Plus Waivers: Provider Flexibilities Related to COVID-19 (8/11)

STATUS:  Expired January 26, 2021

Medicaid: Provider Flexibilities Related to COVID-19 (DD and CCC Plus Waivers)

STATUS:  Expired March 12, 2021. See above for continuation.

Medicaid 1915(c) Waiver: Appendix K – Commonwealth Coordinated Care Plus, Family and Individuals Supports, Community Living, and Building Independence

STATUS:  Active, expires six months after end of PHE

Medicaid 1915(c) Waiver: Appendix K Addendum – Commonwealth Coordinated Care Plus, Family and Individuals Supports, Community Living, and Building Independence

STATUS:  Active, expires six months after end of PHE

Medicaid: Updates on COVID-19 Continuation and Timelines for Behavioral Health and Addiction and Recovery Treatment Services (10/2)

STATUS:  Expired March 12, 2021

House Bill 5046:  Requirement for Audio-Only & Telemedicine Service Coverage

STATUS: Expires July 1, 2021

Last updated 05/31/2021

Cross-State Licensing

Executive Order:  Licensing of Health Care Professionals

STATUS:  Active, for duration of emergency.

Executive Order: Extension of Certain Waivers

STATUS:  Active, for duration of state of emergency

Board of Psychology:  COVID-19 Information

STATUS:  Licensure flexibility expired September 8, 2020

Board of Medicine:  COVID-19 Announcements

STATUS:  Active, for duration of state of emergency

Last updated 05/31/2021

Easing Prescribing Requirements

Board of Medicine:  COVID-19 Announcements

STATUS:  Active, for duration of state of emergency

Last updated 05/31/2021

Miscellaneous

Medicaid: Flexibilities continued to July 20, 2021

STATUS:  Expires July 20, 2021

Medicaid 1915(c) Waiver: Appendix K Addendum – Extension

STATUS:  Extends Waivers out to six months after end of PHE.

Last updated 05/31/2021

Originating Site

Medicaid: Flexibilities Related to COVID-19 Update for Developmental Disabilities and Commonwealth Coordinate Care

STATUS: Telemedicine flexibilities expire Aug. 1, 2021

Medicaid: MCO Flexibilities Continuation

STATUS:  Active, until VA state of emergency ends

Medicaid: Provider Flexibilities Continuation

STATUS:  Expired 4/20/21, but extended to July 20, 2021 (see above)

Medicaid: Behavioral Health and ARTS Provider Flexibilities Related to COVID-19 (3/27)

STATUS:  Modified, see below.

Medicaid:  Home and Community Based Services Waivers (HCBS) COVID-19 Policy Continuation and Timeline

STATUS:  Varies

Medicaid: Developmental Disabilities (DD) and Commonwealth Coordinated Care (CCC) Plus Waivers: Provider Flexibilities Related to COVID-19 (8/11)

STATUS:  Expired January 26, 2021

Medicaid: Provider Flexibilities Related to COVID-19 (DD and CCC Plus Waivers)

STATUS:  Expired March 12, 2021. See above for continuation.

Medicaid: Updates on COVID-19 Continuation and Timelines for Behavioral Health and Addiction and Recovery Treatment Services (10/2)

STATUS:  Expired March 12, 2021

Last updated 05/31/2021

Private Payer

No Reference Found

Last updated 05/31/2021

Provider Type

Medicaid: Flexibilities Related to COVID-19 Update for Developmental Disabilities and Commonwealth Coordinate Care

STATUS: Telemedicine flexibilities expire Aug. 1, 2021

Medicaid: MCO Flexibilities Continuation

STATUS:  Active, until VA state of emergency ends

Medicaid: Provider Flexibilities Continuation

STATUS:  Expired 4/20/21, but extended to July 20, 2021 (see above)

Medicaid: Behavioral Health and ARTS Provider Flexibilities Related to COVID-19 (3/27)

STATUS:  Modified, see below.

Medicaid: New Administrative Provider Flexibilities (5/15)

STATUS:  Active, until VA state of emergency ends

Medicaid:  Home and Community Based Services Waivers (HCBS) COVID-19 Policy Continuation and Timeline

STATUS:  Varies

Medicaid: Developmental Disabilities (DD) and Commonwealth Coordinated Care (CCC) Plus Waivers: Provider Flexibilities Related to COVID-19 (8/11)

STATUS:  Expired January 26, 2021

Medicaid: Provider Flexibilities Related to COVID-19 (DD and CCC Plus Waivers)

STATUS:  Expired March 12, 2021. See above for continuation.

Medicaid: Updates on COVID-19 Continuation and Timelines for Behavioral Health and Addiction and Recovery Treatment Services (10/2)

STATUS:  Expired March 12, 2021

Last updated 05/31/2021

Service Expansion

Medicaid: Flexibilities Related to COVID-19 Update for Developmental Disabilities and Commonwealth Coordinate Care

STATUS: Telemedicine flexibilities expire Aug. 1, 2021

Medicaid: MCO Flexibilities Continuation

STATUS:  Active, until VA state of emergency ends

Medicaid: Provider Flexibilities Continuation

STATUS:  Expired 4/20/21, but extended to July 20, 2021 (see above)

Medicaid: Behavioral Health and ARTS Provider Flexibilities Related to COVID-19 (3/27)

STATUS:  Modified, see below.

Medicaid: New Administrative Provider Flexibilities (5/15)

STATUS:  Active, until VA state of emergency ends

Medicaid: New 1135 Waiver and Administrative Provider Flexibilities (5/26)

STATUS:  Active, until the end of the emergency declaration

Medicaid:  Home and Community Based Services Waivers (HCBS) COVID-19 Policy Continuation and Timeline

STATUS:  Varies

Medicaid: Delivery of Group Based Services in Behavioral Health and Addiction (ARTS) during COVID-19 (7/1)

STATUS:  Active during PHE.

Medicaid: Developmental Disabilities (DD) and Commonwealth Coordinated Care (CCC) Plus Waivers: Provider Flexibilities Related to COVID-19 (8/11)

STATUS:  Expired January 26, 2021

Medicaid: Provider Flexibilities Related to COVID-19 (DD and CCC Plus Waivers)

STATUS:  Expired March 12, 2021. See above for continuation.

Medicaid: Updates on COVID-19 Continuation and Timelines for Behavioral Health and Addiction and Recovery Treatment Services (10/2)

STATUS:  Expired March 12, 2021

House Bill 5046:  Requirement for Audio-Only & Telemedicine Service Coverage

STATUS: Expires July 1, 2021

Last updated 06/01/2021

Definitions

“Telemedicine is the real-time or near real-time two-way transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment.”

SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and Limitations. p. 16 (Mar. 2020). (Accessed May 2021).

“Telemedicine is the real-time or near real-time exchange of information for the purposes of diagnosis and treatment.”

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Psychiatric Services Provider Manual, Covered Svcs. and Limitations. p. 17 (Aug. 2018) (Accessed May 2021).

Telehealth is defined as “the real-time or near real-time transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment.”

SOURCE: VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual, Home Health Manual, Covered Services and Limitations. p. 5 (Aug. 2020). (Accessed May 2021).

Medicaid-Medicare Waiver

“Telehealth” means the real-time or near real-time two-way transfer of data and information using an interactive audio and video connection for the purposes of medical diagnosis and treatment.

SOURCE: VA Reg Text 12VAC30-121-70(7(b)). (Accessed May 2021).

Last updated 05/31/2021

Live Video

POLICY

All coverage requirements described in the DMAS Provider Manuals apply when the service is delivered via telemedicine. The use of telemedicine must be noted in the service documentation of the patient record.

SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and Limitations, p. 16 (Mar. 2020) (Accessed May 2021).


ELIGIBLE SERVICES/SPECIALTIES

The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services.  Such plan shall include:

  • A provision for the payment of medical assistance for medically necessary health care services provided through telemedicine services regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. No health care provider who provides health care services through telemedicine services shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.

“Originating site” means any location where the patient is located, including any medical care facility or office of a health care provider, the home of the patient, the patient’s place of employment, or any public or private primary or secondary school or postsecondary institution of higher education at which the person to whom telemedicine services are provided is located.

SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).

Telemedicine is available for selected services and limited provider types.

SOURCE: VA Dept. of Medical Assistance Svcs.  General Information.  All Manuals, pg. 7, Jan. 2021, (Accessed Feb. 2021).

All coverage requirements described in the DMAS Provider Manuals apply when the service is delivered via telemedicine. The use of telemedicine must be noted in the service documentation of the patient record.  Eligible telemedicine codes are listed in the manual in two tables.

See manual for non-covered services.

SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and Limitations, p. 16-18 (Mar. 2020) & Billing Instructions, pg. 20 (5/1/17), (Accessed May 2021).

See billing information for specific codes.

Eligible services include:

  • Evaluation and management
  • Psychiatric care
  • Specialty medical procedures such as echocardiography and obstetric ultrasound
  • Speech therapy
  • Radiology procedures

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 3. (May. 2014). (Accessed May 2021).

DMAS permits the delivery of covered speech-language therapy services by a DMAS qualified SLP provider through the use of audio and video conferencing to a child at a school-based site located remotely from the qualified provider.  The presence of an aide with the student at the time of the encounter is optional, however, an aide must be present if the LEA intends to bill for the “originating site fee”.

SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Local Education Agency Provider Manual, Covered Svcs. and Limitations, p. 11 (Mar. 2021). (Accessed May 2021).

Community Mental Health Rehabilitative Services

A Comprehensive Needs Assessment meeting DMAS telemedicine standards is allowed for:

  • Psychosocial rehabilitation
  • Partial hospitalization
  • Intensive Community Treatment
  • Crisis intervention

SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Community Mental Health Rehabilitative Services, Covered Svcs. and Limitations, p. 18 (May. 2019). (Accessed May 2021).

Telemedicine is reimbursable for psychiatric evaluation in crisis stabilization services when coordinated with an outpatient provider and billed as physician or outpatient psychiatric services, however telemedicine is not allowed for services billed under Crisis Stabilization.

SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Community Mental Health Rehabilitative Services, Covered Svcs. and Limitations, p. 49-50 (May. 2019). (Accessed May 2021).

Durable Medical Equipment (DME) and Supplies

The face-to-face encounter to qualify for DME may occur through telehealth.

SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Durable Medical Equipment and Supplies Manual, Covered Svcs. and Limitations, p. 8 (10/20/20). (Accessed May 2021).

Opioid Treatment Services

Services can be provided face-to-face or by telemedicine according to DMAS policy regarding telemedicine.  MCO contracted providers should consult with the contracted MCOs for their specific policies and requirements for telemedicine.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Addiction and Recovery Treatment Services, Covered Svcs and Limitations p. 7 & 34. (Dec. 2017). (Accessed May 2021).

MAT for Opioid Use Disorder

Prescribing controlled substances for the treatment of addiction delivered via telemedicine must include a qualified provider and a telepresenter located at the originating site, as well as a qualified prescribing provider located at the remote site. Psychotherapy and SUD counseling may also be provided via telemedicine by a qualified provider who is a credentialed addiction treatment professional as defined in this memorandum and DMAS ARTS Provider Manual.  See manual for eligible MAT codes.

SOURCE:  Medicaid Bulletin:  Clarification of DMAS Requirements Related to the Use of Telemedicine in Providing MAT for OUD. Oct. 23, 2019, p. 3-4. (Accessed May 2021). 

Residential Treatment Service

An assessment for residential referrals can be completed face-to-face or through telemedicine.  See Medicaid manual for DMAS policy.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Residential Treatment Services, Covered Services and Limitations, p. 5 & 33 (1/9/21), (Accessed May 2021).

Vision Manual

CPT codes that are recognized by DMAS are listed.  Codes include:

  • Consultations
  • Office visits
  • Individual psychotherapy
  • Psychiatric diagnostic interview examination
  • Pharmacologic management
  • Colostomy
  • Obstetric ultrasound
  • Echocardiography, fetal
  • Cardiography interpretation and report only
  • Echocardiography

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Vision Manual, Billing Instructions, p. 23 (Jul. 2015), (Accessed May 2021).


ELIGIBLE PROVIDERS

Eligible providers:

  • Physicians
  • Nurse practitioners
  • Nurse midwives
  • Psychiatrist
  • Clinical psychologist
  • Clinical nurse specialists
  • Clinical social worker
  • Professional counselor
  • Psychiatric clinical nurse specialist
  • Psychiatric nurse practitioner
  • Marriage and family therapist/counselor
  • School psychologist
  • Substance abuse treatment practitioner
  • Local Education Agency (billing speech therapy)
  • Federally Qualified Health Center Providers
  • Appropriately licensed behavioral health and developmental services providers enrolled with Magellan.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Federally Qualified Health Centers Coverage of Telemedicine. (Mar. 2019) & Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 4. (May. 2014) (Accessed May 2021).

Medication Assisted Treatment

The Member is located at an approved originating site with the Medicaid enrolled telepresenter. The originating site provider cannot bill an originating site fee unless the Member is assisted by a Medicaid enrolled telepresenter at the originating site.

SOURCE:  Medicaid Bulletin:  Clarification of DMAS Requirements Related to the Use of Telemedicine in Providing MAT for OUD. Oct. 23, 2019, p.4. (Accessed May 2021). 


ELIGIBLE SITES

Eligible originating sites locations:

  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Hospitals
  • Nursing Facilities
  • Health Department Clinics
  • Renal Units (dialysis centers)
  • Community Services Boards (mental health-intellectual disability provider)
  • Residential Treatment Centers

All listed providers are considered eligible originating site providers.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Federally Qualified Health Centers Coverage of Telemedicine, p. 1 (Mar. 2019) & Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 6. (May 2014) (Accessed May 2021).

The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services.  Such plan shall include:

  • A provision for the payment of medical assistance for medically necessary health care services provided through telemedicine services regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. No health care provider who provides health care services through telemedicine services shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.

“Originating site” means any location where the patient is located, including any medical care facility or office of a health care provider, the home of the patient, the patient’s place of employment, or any public or private primary or secondary school or postsecondary institution of higher education at which the person to whom telemedicine services are provided is located.

SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).


GEOGRAPHIC LIMITS

Physicians may be physically located outside of VA but must be located within the continental US to deliver telemedicine services.  Telemedicine out-of-state coverage does not include other out-of-state providers such as nurse practitioners.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 2. (May. 2014) (Accessed May 2021).


FACILITY/TRANSMISSION FEE

Reimburses a facility fee.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 4. (May. 2014) & VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Billing Instructions, p. 22 (May 2017); Vision Manual, Billing Instructions, p. 24 (Jul. 2015). (Accessed May 2021).

DMAS permits the delivery of covered speech-language therapy services by a DMAS qualified SLP provider through the use of audio and video conferencing to a child at a school-based site located remotely from the qualified provider.  The presence of an aide with the student at the time of the encounter is optional, however, an aide must be present if the LEA intends to bill for the “originating site fee”.  See Billing Instructions for proper billing of originating site fee.

SOURCE: VA Dept. of Medical Assistant Svcs. Medicaid Provider Manual, Local Education Agency Provider Manual, Covered Svcs. and Limitations, p. 11 (Mar. 2021) & Billing Instructions, (Mar. 2021), (Accessed May 2021).

Medication Assisted Treatment

The originating site provider cannot bill an originating site fee unless the Member is assisted by a Medicaid enrolled telepresenter at the originating site.

SOURCE:  Medicaid Bulletin:  Clarification of DMAS Requirements Related to the Use of Telemedicine in Providing MAT for OUD. Oct. 23, 2019, p.4. (Accessed May 2021).

Last updated 05/31/2021

Miscellaneous

The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services.  Such plan shall include:

  • A provision for payment of medical assistance services delivered to Medicaid-eligible students when such services qualify for reimbursement by the Virginia Medicaid program and may be provided by school divisions, regardless of whether the student receiving care has an individualized education program or whether the health care service is included in a student’s individualized education program. Such services shall include those covered under the state plan for medical assistance services or by the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), and shall include a provision for payment of medical assistance for health care services provided through telemedicine services. No health care provider who provides health care services through telemedicine shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.
  • A provision for the payment of medical assistance for medically necessary health care services provided through telemedicine services regardless of the originating site or whether the patient is accompanied by a health care provider at the time such services are provided. No health care provider who provides health care services through telemedicine services shall be required to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.
  • A provision for payment of medical assistance for remote patient monitoring services provided via telemedicine for:
    • High-risk pregnant persons;
    • Medically complex infants and children; Transplant patients;
    • Patients who have undergone surgery, for up to three months following the date of such surgery; and
    • Patients with a chronic health condition who have had two or more hospitalizations or emergency department visits related to such chronic health condition in the previous 12 months.

“Originating site” means any location where the patient is located, including any medical care facility or office of a health care provider, the home of the patient, the patient’s place of employment, or any public or private primary or secondary school or postsecondary institution of higher education at which the person to whom telemedicine services are provided is located.

“Remote patient monitoring services” means the use of digital technologies to collect medical and other forms of health data from patients in one location and electronically transmit that information securely to health care providers in a different location for analysis, interpretation, and recommendations, and management of the patient. “Remote patient monitoring services” includes monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other patient physiological data, treatment adherence monitoring, and interactive videoconferencing with or without digital image upload.

SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 1987, SB 1307, HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).

Use of telemedicine must be noted in the service documentation of the patient record.

The originating site provider or designee must attend the encounter with the member, unless the encounter documentation in the patient record notes the reason staff was not present.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 3-4. (May 2014) & Dept. of Medical Assistance Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. And Limitations, p. 16-17 (Mar. 2020); Psychiatric Services Provider Manual, Covered Svcs, And Limitations pg. 17, (Aug. 2018), (Accessed May 2021).

Telemedicine also available for limited screening under the Governor’s Access Plan for the Seriously Mentally Ill (GAP).

SOURCE: VA Dept. of Medical Assistant Svcs., GAP Manual, p. 3 & 6 (Feb. 2019). (Accessed May 2021).

See Psychiatric Services Provider Manual for requirements around equipment, professional protocols, and confidentiality.

SOURCE: VA Dept. of Medical Assistance Svcs.  Psychiatric Services Provider Manual, Covered Services, pg. 17, (Aug. 2018), (Accessed May 2021).

Dual Eligibles (Medicare and Medicaid)

DMAS established the Commonwealth Coordinated Care program and allows participating plans to reimburse for telehealth for Medicare and Medicaid services as an innovative way to reduce hospital readmissions, reduce ED visits, etc.  Participating plans shall encourage the use of telehealth to promote community living and improve behavioral health services.  Plans shall be permitted to use telehealth in rural and urban settings and reimburse for store-and-forward.  Plans shall also have the ability to cover remote patient monitoring.

SOURCE: 12VAC30-121-70 (B(7)). (Accessed May 2021).

Last updated 05/31/2021

Out of State Providers

Newly enrolling out-of-state physicians who enter on their enrollment application a service address that is within 50 miles of the Virginia border may be enrolled as in-state providers.

SOURCE:  VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 2-3. (May. 2014) (Accessed May 2021).

Out-of-state physicians must enroll with DMAS contractors to utilize telemedicine in the Medicaid program.

All providers utilizing telemedicine and billing for services must be enrolled with DMAS. All coverage requirements described in the DMAS provider manuals apply when the service is delivered via telemedicine.

Physicians may be physically located outside of VA but must be located within the continental US to deliver telemedicine services.  Telemedicine out-of-state coverage does not include other out-of-state providers such as nurse practitioners.

SOURCE:  VA Dept. of Medical Assistance Svcs. Medicaid Bulletin.Updates to Telemedicine Coverage. P. 2-3. (May. 2014) & VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and Limitations, p. 16-17 (Mar. 2020) (Accessed May 2021).

Providers must have the appropriate required license from the Department of Behavioral Health and Developmental Services (http://www.dbhds.virginia.gov/) and enrolled with Magellan. These providers are considered as remote providers.

SOURCE:  VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 6. (May. 2014), (Accessed May 2021).

Last updated 05/31/2021

Overview

Virginia Medicaid reimburses for live video, store-and-forward, and remote patient monitoring under certain circumstances. Plans participating in the Medicare-Medicaid Demonstration Waiver are permitted to use store-and-forward and remote patient monitoring in rural and urban locations and to provide reimbursement for services.

Last updated 05/31/2021

Remote Patient Monitoring

POLICY

Face-to-face encounters for home health services may occur through telehealth.

SOURCE: VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual, Home Health Manual, Covered Services and Limitations. p. 5 (Aug. 2020). (Accessed May 2021).

VA Medicaid reimburses for Continuous Glucose Monitoring.

SOURCE: VA Department of Medical Assistance Services. Medicaid Memo. Clarification of Existing Medicaid Coverage of Continuous Glucose Monitoring for Members in Medicaid/FAMIS/FAMIS MOMS Fee-for-Service Programs. (Oct. 2016) (Accessed May 2021).

Medicare-Medicaid Demonstration Waiver:

Participating plans shall also have the ability to cover remote patient monitoring.

SOURCE: VA Reg. Text 12VAC30-121-70(7). (Accessed May 2021).

The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services.  Such plan shall include a provision for payment of medical assistance for remote patient monitoring services provided via telemedicine for specific conditions (see section below).

 

“Remote patient monitoring services” means the use of digital technologies to collect medical and other forms of health data from patients in one location and electronically transmit that information securely to health care providers in a different location for analysis, interpretation, and recommendations, and management of the patient. “Remote patient monitoring services” includes monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other patient physiological data, treatment adherence monitoring, and interactive videoconferencing with or without digital image upload.

SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 1987, SB 1307, HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).


CONDITIONS

The Board, subject to the approval of the Governor, is authorized to prepare, amend from time to time, and submit to the U.S. Secretary of Health and Human Services a state plan for medical assistance services.  Such plan shall include:

  • A provision for payment of medical assistance for remote patient monitoring services provided via telemedicine for:
    • High-risk pregnant persons;
    • Medically complex infants and children; Transplant patients;
    • Patients who have undergone surgery, for up to three months following the date of such surgery; and
    • Patients with a chronic health condition who have had two or more hospitalizations or emergency department visits related to such chronic health condition in the previous 12 months.

“Remote patient monitoring services” means the use of digital technologies to collect medical and other forms of health data from patients in one location and electronically transmit that information securely to health care providers in a different location for analysis, interpretation, and recommendations, and management of the patient. “Remote patient monitoring services” includes monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other patient physiological data, treatment adherence monitoring, and interactive videoconferencing with or without digital image upload.

SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 1987, SB 1307, HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).

Used for patients with one or more chronic conditions, such as:

  • congestive heart failure
  • cardiac arrhythmias
  • diabetes
  • pulmonary diseases
  • anticoagulation treatment

Enrollee must agree to use of remote patient monitoring.

SOURCE: VA Reg. Text 12VAC30-121-20. (Accessed May 2021).

Coverage Continuous Glucose Monitoring is limited to members with:

  • Type 1 diabetes
  • Type 2 diabetes (when over 16 years old)
  • Pregnant women who are injecting insulin with either Type 1 or 2.

Service authorization is required. Additional requirements apply.

SOURCE: VA Department of Medical Assistance Services. Medicaid Memo. Clarification of Existing Medicaid Coverage of Continuous Glucose Monitoring for Members in Medicaid/FAMIS/FAMIS MOMS Fee-for-Service Programs. (Nov. 2016) (Accessed May 2021).


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

“Remote patient monitoring services” means the use of digital technologies to collect medical and other forms of health data from patients in one location and electronically transmit that information securely to health care providers in a different location for analysis, interpretation, and recommendations, and management of the patient. “Remote patient monitoring services” includes monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other patient physiological data, treatment adherence monitoring, and interactive videoconferencing with or without digital image upload.

SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 1987, SB 1307, HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).

Last updated 05/31/2021

Store and Forward

POLICY

DMAS reimburses for diabetic retinopathy screening through telemedicine for Medicaid members with Type 1 or 2 diabetes.  Radiology related procedures are also included under telemedicine coverage as well as certain codes for teledermatology.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 5-6. (May. 2014) & Dept. of Medical Assistance Svcs., Medicaid Provider Manual Physician/Practitioner Manual, Billing Instructions, p. 21 (May 2017). (Accessed May 2021).

Medicare-Medicaid Demonstration Waiver:

Participating plans shall be permitted to use telehealth in rural and urban settings and reimburse for store-and-forward applications.

SOURCE: VA Reg. Text 12VAC30-121-70-B-7. (Accessed May 2021).


ELIGIBLE SERVICES/SPECIALTIES

Refer to the manual for a full list of CPT and HCPCS codes reimbursable by Virginia Medicaid.

Services covered include:

  • Radiology and radiology procedures
  • Diabetic retinopathy (regardless of the number of fields viewed for all Medicaid Members with Type 1 or Type 2 diabetes)
  • Outpatient teledermatology

SOURCE: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner. Billing Instructions, p. 20-24 (May 2017) & VA Medicaid Memo. Clarification of Medicaid Coverage of Diabetic Retinopathy Screening via Telemedicine.  Nov. 9, 2016.   (Accessed May 2021).


GEOGRAPHIC LIMITS

Physicians may be physically located outside of VA but must be located within the continental US to deliver telemedicine services.  Telemedicine out-of-state coverage does not include other out-of-state providers such as nurse practitioners.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 2. (May 2014) (Accessed May 2021).  


TRANSMISSION FEE

Reimburses a facility fee.

SOURCE:  VA Dept. of Medical Assistance Svcs. Medicaid Bulletin. Updates to Telemedicine Coverage. P. 4. (May 2014) & VA Dept. of Medical Assistant Svcs, Medicaid Provider Manual, Physician/Practitioner-Manual. Covered Services and Limitations, p. 17 (Mar. 2020) (Accessed May 2021).

Last updated 05/31/2021

Definitions

Telemedicine services means  the use of electronic technology or media, including interactive audio or video, for the purpose of diagnosing or treating a patient, providing remote patient monitoring services, or consulting with other health care providers regarding a patient’s diagnosis or treatment, regardless of the originating site and whether the patient is accompanied by a health care provider at the time such services are provided. “Telemedicine services” does not include an audio-only telephone, electronic mail message, facsimile transmission, or online questionnaire. Nothing in this section shall preclude coverage for a service that is not a telemedicine service, including services delivered through real-time audio-only telephone.

SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).

Last updated 05/31/2021

Parity

SERVICE PARITY

An insurer shall not be required to reimburse the treating provider or the consulting provider for technical fees or costs for the provision of telemedicine services; however they shall reimburse the treating provider or the consulting provider for the diagnosis, consultation, or treatment of the insured delivered through telemedicine services on the same basis that the insurer  is responsible for coverage for the provision of the same service through face-to-face consultation or contact.

SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).


PAYMENT PARITY

No explicit payment parity.

Last updated 05/31/2021

Requirements

An insurer shall not exclude a service for coverage solely because the service is provided through telemedicine services and is not provided through face-to-face consultation or contact between a health care provider and a patient for services appropriately provided through telemedicine services.

No insurer, corporation, or health maintenance organization shall require a provider to use proprietary technology or applications in order to be reimbursed for providing telemedicine services.

Requirements on the coverage of telemedicine services include medically necessary remote patient monitoring services to the full extent that these services are available.

Prescribing of controlled substances via telemedicine shall comply with the requirements of § 54.1-3303 and all applicable federal law.

SOURCE: VA Code Annotated Sec. 38.2-3418.16, as amended by HB 5046 & SB 5080 (2020-2021 Session). (Accessed May 2021).

Last updated 05/31/2021

Cross State Licensing

No Reference Found

Last updated 05/31/2021

Definitions

Telemedicine services means the use of electronic technology or media, including interactive audio or video for the purpose of diagnosing or treating a patient, providing remote patient monitoring services, or consulting with other health care providers regarding a patient’s diagnosis or treatment. ‘Telemedicine services’ does not include an audio-only telephone, electronic mail message, facsimile transmission, or online questionnaire.

SOURCE: VA Code Annotated Sec. 38.2-3418.16, (Accessed May 2021).

“Teledentistry” means the delivery of dentistry between a patient and a dentist who holds a license to practice dentistry issued by the board through the use of telehealth systems and electronic technologies or media, including interactive, two-way audio or video.

SOURCE: VA Code Annotated Sec. 54.1-2700 (Accessed May 2021).

Statewide Telehealth Plan

“Telehealth services” means the use of telecommunications and information technology to provide access to health assessments, diagnosis, intervention, consultation, supervision, and information across distance. “Telehealth services” includes the use of such technologies as telephones, facsimile machines, electronic mail systems, store-and-forward technologies, and remote patient monitoring devices that are used to collect and transmit patient data for monitoring and interpretation.

SOURCE: VA Statute 32.1-122.03:1 (HB 1332 – 2020 Session). (Accessed May 2021).

Last updated 05/31/2021

Licensure Compacts

Member of the Nurses Licensure Compact.

SOURCE:  Nurse Licensure Compact (Accessed May 2021).

Member of the Physical Therapy Compact.

SOURCE: Compact Map. Physical Therapy Compact. (Accessed May 2021).

Member of the Emergency Medical Services Personnel Licensure Compact.

SOURCE: EMS Compact (Accessed May 2021).

Member of the Psychology Interjurisdictional Compact

SOURCE: PSYPACT (Accessed May 2021).

Member of Occupational Therapy Interjurisdictional Licensure Compact

SOURCE: Senate Bill 1189 (2020-2021 Session), (Accessed May 2021).

Last updated 05/31/2021

Miscellaneous

Telemedicine Guidance from VA Medical Board

  • Prescribing via telemedicine is at the discretion of the prescribing practitioner.
  • Informed consent must be obtained and maintained.
  • See guidance for additional requirements.

SOURCE: VA Board of Medicine. Telemedicine Guidance Document: 85-12. p. 3-4 (Oct. 2018). (Accessed May 2021).

Virginia requires the Commonwealth Broadband Chief Advisor to advocate for and facilitate the development and deployment of applications, programs, and services, including but not limited to telework, telemedicine, and e-learning, that will bolster the usage of and demand for broadband level telecommunications, among other things.

SOURCE: VA SB 877 (2020 Session) (Accessed May 2021).

By Jan. 1. 2021, Virginia requires the Board of Health to develop and implement a Statewide Telehealth plan to promote an integrated approach to the introduction and use of telehealth services and telemedicine services. The bill requires the Statewide Telehealth Plan to promote:

  • the use of remote patient monitoring services and store-and-forward technologies, including in cases involving patients with chronic illness;
  • the leveraging of telehealth and telemedicine technologies to streamline general practice and nonemergency triage services;
  • rapid patient access to emergency medicine providers through telehealth services and telemedicine services;
  • such other telehealth services and telemedicine services and technologies as the Board of Health deems appropriate

SOURCE: VA Code Annotated Sec. 32.1-122.03 (C(1)) (HB 1332) (Accessed May 2021).

Last updated 05/31/2021

Online Prescribing

Effective until July 1, 2021:

Practitioners prescribing controlled substances must have a “bona fide” relationship with the patient. Requirements include:

  1. Obtained or caused to be obtained a medical or drug history of the patient;
  2. Provided information to the patient about the benefits and risks of the drug being prescribed;
  3. Performed or caused to be performed an appropriate examination of the patient, either physically or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically; and
  4. Initiated additional interventions and follow-up care, if necessary, especially if a prescribed drug may have serious side effects.

Except in cases involving a medical emergency, the examination required shall be performed by the practitioner prescribing the controlled substance, a practitioner who practices in the same group as the practitioner prescribing the controlled substance, or a consulting practitioner.

A practitioner who has established a bona fide practitioner-patient relationship with a patient in accordance with the provisions of this subsection may prescribe Schedule II through VI controlled substances to that patient, provided that, in cases in which the practitioner has performed the examination required pursuant to clause (iii) by use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically, the prescribing of such Schedule II through V controlled substance is in compliance with federal requirements for the practice of telemedicine.

For the purpose of prescribing a Schedule VI controlled substance to a patient via telemedicine services, a prescriber may establish a bona fide practitioner-patient relationship by an examination through face-to-face interactive, two-way, real-time communications services or store-and-forward technologies when all of the following conditions are met:

  • The patient has provided a medical history that is available for review by the prescriber
  • The prescriber obtains an updated medical history at the time of prescribing
  • The prescriber makes a diagnosis at the time of prescribing
  • The prescriber conforms to the standard of care expected of in-person care as appropriate to the patient’s age and presenting condition, including when the standard of care requires the use of diagnostic testing and performance of a physical examination, which may be carried out through the use of peripheral devices appropriate to the patient’s condition
  • The prescriber is actively licensed in the Commonwealth and authorized to prescribe
  • If the patient is a member or enrollee of a health plan or carrier, the prescriber has been credentialed by the health plan or carrier as a participating provider and the diagnosing and prescribing meets the qualifications for reimbursement by the health plan or carrier; and
  • Upon request, the prescriber provides patient records in a timely manner and all other state and federal laws and regulations.

Nothing in this paragraph shall permit a prescriber to establish a bona fide practitioner-patient relationship for the purpose of prescribing a Schedule VI controlled substance when the standard of care dictates that an in-person physical examination is necessary for diagnosis. Nothing in this paragraph shall apply to:

  • A prescriber providing on-call coverage per an agreement with another prescriber or his prescriber’s professional entity or employer;
  • A prescriber consulting with another prescriber regarding a patient’s care; or
  • Orders of prescribers for hospital out-patients or in-patients.

An examination is not required in cases in which the practitioner is an employee or contracted by the Department of Health or local health department and is providing expedited partner therapy.  Cases in which the practitioner is an employee of or contracted by the Department of Health or a local health department, a “bona-fide” practitioner-patient relationship is not required for purposes of prescribing Schedule VI antibiotics and antiviral agents.

SOURCE:  VA Code Annotated Sec. 54.1-3303, (Accessed May 2021).

Newly Passed (Effective July 1, 2021)

A practitioner who has established a bona fide practitioner-patient relationship with a patient in accordance with the provisions of this subsection may prescribe Schedule II through VI controlled substances to that patient via telemedicine if such prescribing is in compliance with federal requirements for the practice of telemedicine and, in the case of the prescribing of a Schedule II through V controlled substance the prescriber maintains a practice at a physical location in the Commonwealth or is able to make appropriate referral of patients to a licensed practitioner located in the Commonwealth in order to ensure an in-person examination of the patient when required by the standard of care.

Adds to the conditions a prescriber must meet for a bona fide practitioner-patient relationship for the purpose of prescribing Schedule II through VI controlled substances by an examination through face-to-face interactive, two-way, real-time communications services or store-and-forward technologies. Includes:

  • The establishment of a bona fide practitioner-patient relationship via telemedicine is consistent with the standard of care, and the standard of care does not require an in-person examination for the purpose of diagnosis; and
  • The establishment of a bona fide practitioner patient relationship via telemedicine is consistent with federal law and regulations and any waiver thereof.

SOURCE:  House Bill 1987 (2020-2021 Session), (Accessed May 2021).

Prescribing controlled substances requires the establishment of a bona fide practitioner-patient relationship in accordance with § 54.1-3303 (A) of the Code of Virginia. Prescribing controlled substances, in-person or via telemedicine services, is at the professional discretion of the
prescribing practitioner. The indication, appropriateness, and safety considerations for each prescription provided via telemedicine services must be evaluated by the practitioner in accordance with applicable law and current standards of practice and consequently carries the same professional accountability as prescriptions delivered during an in-person encounter.

Prescriptions must comply with the requirements set out in Virginia Code § 54.1-3408.01 and § 54.1-3303(A). Prescribing controlled substances in Schedule II through V via telemedicine also requires compliance with federal rules for the practice of telemedicine. Practitioners issuing prescriptions as part of telemedicine services should include direct contact for the prescriber or the prescriber’s agent on the prescription. This direct contact information ensures ease of access by pharmacists to clarify prescription orders, and further facilitates the prescriber-patient-pharmacist relationship.

SOURCE:  VA Board of Medicine. Telemedicine Guidance Document: 85-12. p. 4 (Oct. 2018), (Accessed May 2021).

Teledentistry

No person shall practice dentistry unless a bona fide dentist-patient relationship is established in person or through teledentistry. A bona fide dentist-patient relationship shall exist if the dentist has:

  • Obtained or caused to be obtained a health and dental history of the patient;
  • Performed or caused to be performed an appropriate examination of the patient, either physically, through use of instrumentation and diagnostic equipment through which digital scans, photographs, images, and dental records are able to be transmitted electronically, or through use of face-to-face interactive two-way real-time communications services or store-and-forward technologies;
  • Provided information to the patient about the services to be performed; and
  • Initiated additional diagnostic tests or referrals as needed. In cases in which a dentist is providing teledentistry, the examination required by clause (ii) shall not be required if the patient has been examined in person by a dentist licensed by the Board within the six months prior to the initiation of teledentistry and the patient’s dental records of such examination have been reviewed by the dentist providing teledentistry.

SOURCE: VA Statute 54.1-2711.  (Accessed May 2021).

Certification for use of cannabis oil for treatment.

The practitioner shall use his professional judgement to determine the manner and frequency of patient care and evaluation and may employ the use of telemedicine consistent with federal requirements for the prescribing of Schedule II through V controlled substances.

SOURCE: VA Code Annotated Sec. 54.1-3408.3. (Accessed May 2021).

The practitioner shall use his professional judgment to determine the manner and frequency of patient care and evaluation, which may include the use of telemedicine. Such telemedicine use shall be consistent with federal requirements for the prescribing of Schedules II through V controlled substances.

SOURCE: 18VAC110-60-30(C). (Accessed May 2021).

Last updated 05/31/2021

Professional Board Standards

See rules for the practice of teledentistry specifically.

SOURCE: VA Statute 54.1-2711 (SB 122 – 2020 Session).  (Accessed May 2021).