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: No

Professional Requirements

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

Last updated 09/20/2021

Audio-Only Delivery

Medicaid: Continuing COVID flexibilities based on federal authority

STATUS: Active

Medicaid: Policies remaining in effect

STATUS: Active

Medicaid: Policies expired prior to June 30, 2021

STATUS:  Expired

Medicaid: Emergency Waivers Policies ending June 30, 2021

STATUS: Expired

Medicaid: Policies expiring June 30, 2021 with a 60-day grace period

STATUS: Expired

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

STATUS: Expired

Medicaid: MCO Flexibilities Continuation

STATUS:  Expired

Medicaid: Provider Flexibilities Continuation

STATUS:  Expired

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

STATUS:  Expired

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:  Expired

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

STATUS:  Expired

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 09/21/2021

Cross-State Licensing

Executive Order:  Licensing of Health Care Professionals

STATUS:  Expired

Executive Order: Extension of Certain Waivers

STATUS:  Expired

Board of Psychology:  COVID-19 Information

STATUS:  Licensure flexibility expired September 8, 2020

Board of Medicine:  COVID-19 Announcements

STATUS: Expired

Last updated 09/20/2021

Easing Prescribing Requirements

Board of Medicine:  COVID-19 Announcements

STATUS:  Varies. Some expired with State of Emergency expiration.

Last updated 09/21/2021

Miscellaneous

Medicaid: Flexibilities continued to July 20, 2021

STATUS:  Expired

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

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

Last updated 09/21/2021

Private Payer

No Reference Found

Last updated 09/20/2021

Service Expansion

Medicaid: Continuing COVID flexibilities based on federal authority

STATUS: Active

Medicaid: Policies remaining in effect

STATUS: Active

Medicaid: Policies expired prior to June 30, 2021

STATUS:  Expired

Medicaid: Emergency Waivers Policies ending June 30, 2021

STATUS: Expired

Medicaid: Policies expiring June 30, 2021 with a 60-day grace period

STATUS: Expired

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

STATUS: Expired

Medicaid: MCO Flexibilities Continuation

STATUS:  Expired

Medicaid: Provider Flexibilities Continuation

STATUS:  Expired

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

STATUS:  Expired

Medicaid: New Administrative Provider Flexibilities (5/15)

STATUS:  Expired

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 09/16/2021

Definitions

“Telemedicine is a means of providing services through the use of two-way, real time interactive electronic communication between the member and the Provider located at a site distant from the member. This electronic communication must include, at a minimum, the use of audio and video equipment. Telemedicine does not include an audio-only telephone.”

Telehealth means the use of telecommunications and information technology to provide access to medical and behavioral health assessment, diagnosis, intervention, consultation, supervision, and information across distance. Telehealth encompasses telemedicine as well as a broader umbrella of services that includes the use of such technologies as telephones, interactive and secure medical tablets, remote patient monitoring devices, and store-and-forward devices. Telehealth includes services delivered in the dental health setting (i.e., teledentistry), and telehealth policies for dentistry are covered in the dental manuals.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list),  (July 2021) (Accessed Sept. 2021).

Last updated 09/20/2021

Email, Phone & Fax

Telehealth encompasses telemedicine as well as a broader umbrella of services that includes the use of such technologies as telephones, interactive and secure medical tablets, remote patient monitoring devices, and store-and-forward devices.

This electronic communication must include, at a minimum, the use of audio and video equipment. Telemedicine does not include an audio-only telephone.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 1  (July 2021) (Accessed Sept. 2021).

Last updated 09/20/2021

Live Video

POLICY

Services delivered via telehealth will be eligible for reimbursement when all of the following conditions are met:

  • The Provider at the distant site deems that the service being provided is clinically appropriate to be delivered via telehealth;
  • The service delivered via telehealth meets the procedural definition and components of the CPT or HCPCS code, as defined by the American Medical Association (AMA);
  • The service provided via telehealth meets all state and federal laws regarding confidentiality of health care information and a patient’s right to his or her medical information; and
  • Services delivered via telehealth meet all applicable state laws, regulations and licensure requirements on the practice of telehealth; and
  • DMAS deems the service eligible for delivery via telehealth.

In order to be reimbursed for services using telehealth that are provided to MCO-enrolled individuals, Providers must follow their respective contract with the MCO.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 2  (July 2021) (Accessed Sept. 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. 32.1-325, (Accessed Sept. 2021).

Telemedicine is available for selected services.

SOURCE: VA Dept. of Medical Assistance Svcs.  General Information.  All Manuals, pg. 10, Jun. 2021, (Accessed Sept. 2021).

Attachment A in the Telehealth Supplement lists covered services that may be reimbursed when provided via telehealth.

Certain types of services that would not be expected to be appropriately delivered via telemedicine include, but are not limited to, those that:

  • are performed in an operating room or while the patient is under anesthesia;
  • require direct visualization or instrumentation of bodily structures;
  • involve sampling of tissue or insertion/removal of medical devices; and/or
  • otherwise require the in-person presence of the patient for any reason

If, after initiating a telemedicine visit, the telemedicine modality is found to be medically and/or clinically inappropriate, or otherwise can no longer meet the requirements stipulated in the “Reimbursable Telehealth Services” section, the Provider shall provide or arrange, in a timely manner, an alternative to meet the needs of the individual (e.g., services delivered in-person; services delivered via telemedicine when conditions allow telemedicine to meet requirements stipulated in the “Reimbursable Telehealth Services” section). In this circumstance, the Provider shall be reimbursed only for services successfully delivered.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 2  (July 2021) (Accessed Sept. 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. 8 (Mar. 2021). (Accessed Sept. 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 (Jun. 2021). (Accessed Sept. 2021).

Opioid Treatment Services

Services can be provided face-to-face or by telemedicine according to DMAS policy regarding telemedicine.

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

Residential Treatment Service

DMAS reimburses for telemedicine services under limited circumstances. Telemedicine is the real-time or near real-time exchange of information for diagnosing and treating medical conditions. Telemedicine utilizes audio/video connections linking medical practitioners in one locality with medical practitioners in another locality. DMAS recognizes telemedicine as a means for delivering some covered Medicaid services.

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


ELIGIBLE PROVIDERS

The term “Provider” refers to the billing provider – either a qualified, licensed practitioner of the healing arts or a facility – who is enrolled with DMAS.

Telehealth services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the Commonwealth. If approved, these facilities may serve as the Provider site and bill under the encounter rate. When an FQHC or RHC serves as the originating site, the originating site fee is paid separately from the center or clinic all-inclusive rate.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 1 & 4, (July 2021) (Accessed Sept. 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 Sept. 2021). 

Preferred OBOT services must be provided by a buprenorphine-waivered practitioner and a co- located Credentialed Addiction Treatment Professional and may be provided in a variety of practice settings including primary care clinics, outpatient health system clinics, psychiatry clinics, Federally-Qualified Health Centers (FQHCs), Community Service Boards (CSBs), local health department clinics, and physicians’/physician extenders’ offices. DMAS expects Preferred OBOT services to be primarily delivered in-person/on site and utilize telehealth as an option to increase access to services as needed. DMAS does not support Preferred OBOTs services to be delivered solely or primarily through telehealth. The practitioners must be credentialed by DMAS, the DMAS fee-for-service contractor or MCOs to perform Preferred OBOT services. Preferred OBOT providers do not require a separate DBHDS license.

Thus Preferred OBOT services may be provided via telehealth based on the individualized needs of the member and must have supporting documentation of why the in-person interactions are not meeting the member’s specific needs. The primary means of services delivery shall be in-person for the Preferred OBOT model with the exception of telehealth for specific member circumstances (such as transportation issues, childcare, employment, co-morbidities, distance, etc.) that impede their access to treatment. Providers delivering services using telemedicine shall bill according to the requirements in the DMAS Telehealth Services Supplemental Manual.

SOURCE: VA Dept. of Medical Assistance Svcs. Medicaid Provider Manual, Addiction and Recovery Treatment Services, Opioid Treatment Services/Medication Assisted Treatment, p. 15 & 19 &  (Jul. 2021), (Accessed Sept. 2021).


ELIGIBLE SITES

The originating site is the location of the member at the time the service is rendered, or the site where the asynchronous store-and-forward service originates (i.e., where the data are collected). Examples of originating sites include: medical care facility; Provider’s outpatient office; the member’s residence or school; or other community location (e.g., place of employment).

Telehealth services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the Commonwealth. If approved, these facilities may serve as the Provider site and bill under the encounter rate. When an FQHC or RHC serves as the originating site, the originating site fee is paid separately from the center or clinic all-inclusive rate.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 4 (July 2021) (Accessed Sept. 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. 32.1-325, (Accessed Sept. 2021).


GEOGRAPHIC LIMITS

No reference found.


FACILITY/TRANSMISSION FEE

In the event it is medically necessary for a Provider to be present at the originating site at the time a synchronous telehealth service is delivered, said Provider may bill an originating site fee (via procedure code Q3014) when the following conditions are met:

  • The Medicaid member is located at a provider office or other location where services are delivered on an in-person basis (this does not include the member’s residence);
  • The member and distant site Provider are not located in the same location;
  • The distant site Provider providing the service also does not provide services on an in-person basis at the same location of the entity billing the Originating Site Fee; and
  • The Provider (or the Provider’s designee), is affiliated with the provider office or other location where the Medicaid member is located and attends the encounter with the member. The Provider or designee may be present to assist with initiation of the visit but the presence of the Provider or designee in the actual visit shall be determined by a balance of clinical need and member preference or desire for confidentiality.

Telehealth services may be included in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC), or Indian Health Center (IHC) scope of practice, as approved by HRSA and the Commonwealth. If approved, these facilities may serve as the Provider site and bill under the encounter rate. When an FQHC or RHC serves as the originating site, the originating site fee is paid separately from the center or clinic all-inclusive rate.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 4  (July 2021) (Accessed Sept. 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. 8 (Mar. 2021) & Billing Instructions, pg 9 (Jul. 2021), (Accessed Sept. 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 Sept. 2021).

Last updated 09/20/2021

Miscellaneous

See Telehealth Supplement for Documentation and Equipment/Technology Requirements.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 5  (July 2021) (Accessed Sept. 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 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. 32.1-325, (Accessed Sept. 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 Sept. 2021).

Last updated 09/20/2021

Out of State Providers

Providers must maintain a practice at a physical location in the Commonwealth or be able to make appropriate referral of patients to a Provider located in the Commonwealth in order to ensure an in-person examination of the patient when required by the standard of care.

Providers must meet state licensure, registration or certification requirements per their regulatory board with the Virginia Department of Health Professions to provide services to Virginia residents via telemedicine. Providers shall contact DMAS Provider Enrollment (888-829-5373) or the Medicaid MCOs for more information.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 5  (July 2021) (Accessed Sept. 2021).

Last updated 09/21/2021

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.

VA Medicaid recently moved the telehealth-specific content they had in their individual provider manuals into a ‘telehealth supplement’.  Manuals that formerly included telehealth content now direct providers towards the telehealth supplement.  Provider manuals that incorporate the supplement include:

  • Addiction and Recovery Treatment Services (ARTS)
  • Mental Health Services
  • Early Intervention Services
  • Physician/Practitioner
  • Home Health
  • Psychiatric Services
  • Residential Treatment Services

See the Provider Manual home page to access all manuals.

Last updated 09/20/2021

Remote Patient Monitoring

POLICY

Face-to-face encounters may occur through telemedicine, which is defined as the two-way, real time interactive electronic communication between the member and the Provider located at a site distant from the member. This electronic communication must include, at a minimum, the use of audio and video equipment. Telemedicine shall not include by telephone or email.

SOURCE: VA Dept. of Medical Assistance Svcs., Medicaid Provider Manual, Home Health Manual, Covered Services and Limitations. p. 5 (July 2021). (Accessed Sept. 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 Sept. 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. 32.1-325 (Accessed Sept. 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. 32.1-325 (Accessed Sept. 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 Sept. 2021).


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No reference found.

Last updated 09/20/2021

Store and Forward

POLICY

Store-and-forward means the asynchronous transmission of a member’s medical information from an originating site to a health care Provider located at a distant site. A member’s medical information may include, but is not limited to, video clips, still images, x-rays, laboratory results, audio clips, and text. The information is reviewed at the Distant Site without the patient present with interpretation or results relayed by the distant site Provider via synchronous or asynchronous communications.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 2 (July 2021) (Accessed Sept. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Refer to the telehealth supplement and billing manual for a full list of CPT and HCPCS codes reimbursable by Virginia Medicaid, including those through store and forward.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 7-13  (July 2021) & VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner. Billing Instructions, p. 20-25 (July 2021) (Accessed Sept. 2021).


GEOGRAPHIC LIMITS

The originating site is the location of the member at the time the service is rendered, or the site where the asynchronous store-and-forward service originates (i.e., where the data are collected). Examples of originating sites include: medical care facility; Provider’s outpatient office; the member’s residence or school; or other community location (e.g., place of employment).

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 2 (July 2021) (Accessed Sept. 2021).


TRANSMISSION FEE

Facility fee is only available for synchronous telehealth services.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 4  (July 2021) (Accessed Sept. 2021).

Last updated 09/20/2021

Definitions

“Telemedicine services” as it pertains to the delivery of health care 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 (Accessed Sept. 2021).

Last updated 09/20/2021

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 (Accessed Sept. 2021).


PAYMENT PARITY

No explicit payment parity.

Last updated 09/20/2021

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, (Accessed Sept. 2021).

Last updated 09/20/2021

Cross State Licensing

The practice of medicine occurs where the patient is located at the time telemedicine services are used, and insurers may issue reimbursements based on where the practitioner is located. Therefore, a practitioner must be licensed by, or under the jurisdiction of, the regulatory board of the state where the patient is located and the state where the practitioner is located. Practitioners who treat or prescribe through online service sites must possess appropriate licensure in all jurisdictions where patients receive care. To ensure appropriate insurance coverage, practitioners must make certain that they are compliant with federal and state laws and policies regarding reimbursements.

The first is the “consultant exemption” found in § 54.1-2901 which lists Exceptions and Exemptions Generally to licensure. Subsection (A)(15) reads as follows: “Any legally qualified out-of-state or foreign practitioner from meeting in consultation with legally licensed practitioners in this Commonwealth.” This statute is intended to have a Virginia practitioner involved in the care of the patient when a practitioner in another state/country consults with the Virginia practitioner or the patient. It provides an opportunity for Virginia residents to benefit
from the expertise of practitioners known for specializing in certain conditions. There must be regular communication between the consultant and the Virginia practitioner while the consultation/care is being provided.

The second section of the Code of Virginia pertinent to telemedicine is § 38.2-3418.16 of the Code of Virginia, which provides the definition of telemedicine in the Insurance Title. The section enumerates what does and what does not constitute telemedicine. Section 38.2-3418.16 defines telemedicine as “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.” To practice telemedicine into Virginia requires a license from the Board of Medicine. The Board notes that § 38.2-3418.16 states “Telemedicine services” does not include an audio-only telephone, electronic mail message, facsimile transmission, or online questionnaire. The Board believes that these communications do not constitute telemedicine, and therefore do not require licensure, when used in the follow-up care of a Virginia resident with whom a bona fide practitioner-patient relationship has been previously established. The establishment of a new practitioner-patient relationship requires a Virginia license and must comport with the requirements for telemedicine found in § 54.1-3303 of the Code of Virginia.

SOURCE: Telemedicine Guidance. Doc. # 85-12. VA Board of Medicine. P. 2 & 4-5 (Aug. 19, 2021). (Accessed Sept. 2021).

Last updated 09/20/2021

Definitions

For the purpose of prescribing Schedule VI controlled substances, “telemedicine services” is defined as it is in § 38.2-3418.16 of the Code of Virginia. Under that definition, “telemedicine services,” as it pertains to the delivery of health care services, means the use of electronic technology or media, including interactive audio or video, for the purpose of diagnosing or treating a patient 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: Telemedicine Guidance. Doc. # 85-12. VA Board of Medicine. P. 4 (Aug. 19, 2021). (Accessed Sept. 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 Sept. 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 Sept. 2021).

Last updated 09/20/2021

Licensure Compacts

Member of the Nurses Licensure Compact.

SOURCE:  Nurse Licensure Compact (Accessed Sept. 2021).

Member of the Physical Therapy Compact.

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

Member of the Emergency Medical Services Personnel Licensure Compact.

SOURCE: EMS Compact (Accessed Sept. 2021).

Member of the Psychology Interjurisdictional Compact

SOURCE: PSYPACT (Accessed Sept. 2021).

Member of Occupational Therapy Interjurisdictional Licensure Compact

SOURCE: Senate Bill 1189 (2020-2021 Session), &Occupational Therapy Compact Map (Accessed Sept. 2021).

Last updated 09/20/2021

Miscellaneous

Telemedicine Guidance from VA Medical Board includes:

  • Establishing the practitioner-patient relationship
  • Guidelines for appropriate use of telemedicine services
  • Prescribing
  • Electronic medical services that do not require licensure

See guidance for details and statutory references.

SOURCE: Telemedicine Guidance. Doc. # 85-12. VA Board of Medicine. (Aug. 19, 2021). (Accessed Sept. 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), (Accessed Sept. 2021).

Last updated 09/20/2021

Online Prescribing

The practitioner-patient relationship is fundamental to the provision of acceptable medical care. It is the expectation of the Board that practitioners recognize the obligations, responsibilities, and patient rights associated with establishing and maintaining a practitioner-patient relationship. Where an existing practitioner-patient relationship is not present, a practitioner must take appropriate steps to establish a practitioner-patient relationship consistent with the guidelines identified in this document, with Virginia law, and with any other applicable law.  While each circumstance is unique, such practitioner-patient relationships may be established using telemedicine services provided the standard of care is met.

A practitioner is discouraged from rendering medical advice and/or care using telemedicine services without (1) fully verifying and authenticating the location and, to the extent possible, confirming the identity of the requesting patient; (2) disclosing and validating the practitioner’s identity and applicable credential(s); and (3) obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding the use of telemedicine services. An appropriate practitioner-patient relationship has not been established when the identity of the practitioner may be unknown to the patient.

A documented medical evaluation and collection of relevant clinical history commensurate with the presentation of the patient to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided must be obtained prior to providing treatment, which treatment includes the issuance of prescriptions, electronically or otherwise. Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional, in-person encounters. Treatment, including issuing a prescription based solely on an online questionnaire, does not constitute an acceptable standard of care.

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. Where such measures are upheld, and the appropriate clinical consideration is carried out and documented, the practitioner may exercise their judgment and prescribe controlled substances as part of telemedicine encounters in accordance with applicable state and federal law.

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: Telemedicine Guidance. Doc. # 85-12. VA Board of Medicine. P. 1-4 (Aug. 19, 2021). (Accessed Sept. 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: VA Code Annotated 54.1-3303, (Accessed Sept. 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 Sept. 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 provided that the use of telemedicine includes the delivery of patient care through real-time interactive audio-visual technology. Such telemedicine use shall be consistent with federal requirements for the prescribing of Schedule II through V controlled substances.

SOURCE: VA Code Annotated Sec. 54.1-3408.3. (Accessed Sept. 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, provided that the use of telemedicine:

  • Includes the delivery of patient care through real-time interactive audio-visual technology;
  • Conforms to the standard of care expected for in-person care; and
  • Transmits information in a manner that protects patient confidentiality.

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 Sept. 2021).

Last updated 09/20/2021

Professional Board Standards

See rules for the practice of teledentistry specifically.

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