Washington

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

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

STATE RESOURCES

  1. Medicaid Program: Washington Apple Health
  2. Administrator: Washington State Health Care Authority
  3. Regional Telehealth Resource Center: Northwest Regional Telehealth Resource Center

Last updated 04/11/2022

Audio-Only Delivery

Medicaid: Telemedicine and Telehealth Brief

STATUS: Expired. Effective January 1, 2022 see Clinical policy and billing

Medicaid: Clinical Policy and Billing FAQ

STATUS: Effective February 1, 2022

Medicaid: Apple Health (Medicaid) Applied Behavior Analysis (ABA) policy and billing during the COVID-19 pandemic

STATUS: Active

Medicaid: Behavioral Health Policy and Billing FAQ

STATUS: Active

STATUS: Active

STATUS: Active

Medicaid: Home Health FAQ

STATUS: Active

STATUS: Active

Medicaid 1915(c) Waiver: Basic Plus

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: Core

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: Community Protection

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: Individual and Family Services

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: Children’s Intensive In Home Behavior Support

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: Basic Plus; Individual and Family Services, Core, Community Protection, Children’s Intensive In home Behavior Support

STATUS: Active, Expires 6 months following the end of the federal PHE. Extends waivers shown above.

Medicaid: 1115 Waiver Summary – Telephone and Telehealth Options

STATUS: Active during the PHE.

Medicaid 1915(c) Waiver: New Freedom

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: Residential Support Waiver

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: COPES Waiver; Residential Support Waiver; New Freedom Waiver

STATUS: Active, extends the end date of current waivers shown above until 6 months following the end of the Federal PHE

Medicaid 1135 Waiver: Telehealth Summary

STATUS: Active

Medicaid: Provider Bulletin Expanding Telemedicine to include Audio-Only

STATUS: Effective July 1, 2022

Medicaid: Telehealth Audio-Only Codes

STATUS: Effective July 1, 2022

Last updated 04/11/2022

Cross-State Licensing

Department of Health: Health Care Professions with Authority to Provide Telehealth Services

STATUS: Active

Department of Health: Dietitians

STATUS: Active

Department of Health: Chiropractors

STATUS: Active

Washington Medical Commission: FAQ on Telemedicine and Licensing

STATUS: Active

Medicaid: Behavioral Health Policy and Billing FAQ

STATUS: Active

STATUS: Active

Last updated 04/11/2022

Easing Prescribing Requirements

Medicaid: COVID-19 and Opioid Treatment Programs FAQ

STATUS: Active

Medicaid: Relaxations regarding signed prescriptions for scheduled substances during COVID-19 emergency

STATUS: Active

Last updated 04/11/2022

Miscellaneous

Medicaid: No Cost Zoom Licenses

STATUS: Reached license capacity

Medicaid 1915(c) Waiver: COPES Waiver; Residential Support Waiver; New Freedom Waiver

STATUS: Active, extends the end date of current waivers listed until 6 months following the end of the Federal PHE

Medicaid 1915(c) Waiver: Basic Plus; Individual and Family Services, Core, Community Protection, Children’s Intensive In home Behavior Support

STATUS: Active, extends the end date of current waivers listed until 6 months following the end of the Federal PHE

Emergency Rule: Home health and hospice supervision 

STATUS: Expired

Emergency Rule:Home health and hospice supervision; updated telemedicine definition

STATUS: Effective December 1, 2021

Last updated 04/11/2022

Private Payer

Office of the Governor: Proclamation on Telemedicine Payment Parity

STATUS: Active, until WA State of Emergency ends

Department of Insurance: Partial Emergency Order on Telemedicine Extension

STATUS: Expired May 30, 2021

Office of the Governor: Proclamation on Telemedicine

STATUS: Expired

Last updated 04/11/2022

Service Expansion

Medicaid: Telehealth Guidance for Apple Health Clients – Available in 36 languages

STATUS: Active

Medicaid: Telemedicine and Telehealth Brief

STATUS: Expired. Effective January 1, 2022 see Clinical policy and billing

Medicaid: Clinical Policy and Billing FAQ

STATUS: Effective February 1, 2022

Medicaid: COVID-19 and Opioid Treatment Programs FAQ

STATUS: Active

Medicaid: Apple Health (Medicaid) Applied Behavior Analysis (ABA) policy and billing during the COVID-19 pandemic

STATUS: Active

Medicaid: Behavioral Health Policy and Billing FAQ

STATUS: Active

STATUS: Active

STATUS: Active

Medicaid: Home Health FAQ

STATUS: Active

STATUS: Active

STATUS: Active

Department of Social and Health Services: Developmental Disabilities Distance-Based Observation

STATUS: Active

Medicaid: Sex Offenders Access of Telehealth

STATUS: Active

Medicaid: Emergency Rule on Alien Emergency Medical Program (AEM)

STATUS: Active

Medicaid: Apple Health (Medicaid) dental emergency coverage related to COVID-19 pandemic

STATUS: Active

Medicaid 1915(c) Waiver: Basic Plus

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: Core

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: Community Protection

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: Individual and Family Services

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: Children’s Intensive In Home Behavior Support

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: Basic Plus; Individual and Family Services, Core, Community Protection, Children’s Intensive In home Behavior Support

STATUS: Active, extends the end date of current waivers listed until 6 months following the end of the Federal PHE

Medicaid: 1115 Waiver Summary – Telephone and Telehealth Options

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: COPES

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: New Freedom

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: Residential Support Waiver

STATUS: Active, Expires 6 months following the end of the federal PHE.

Medicaid 1915(c) Waiver: COPES Waiver, Residential Support Waiver, New Freedom Waiver

STATUS: Active, extends previously approved Appendix K waivers above

Medicaid 1135 Waiver: Telehealth Summary

STATUS: Active

Last updated 04/11/2022

Definitions

“Telemedicine is when health care practitioners use HIPAA-compliant interactive real-time audio and video telecommunications (including web-based applications) or store-and-forward technology to deliver covered services that are within his or her scope of practice to a client at a site other than the site where the provider is located.”

SOURCE: WA Admin. Code Sec. 182-531-1730 & WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 88 (Apr. 2022);   (Accessed Apr. 2022).

Telemedicine is when a health care provider uses HIPAA-compliant, interactive, real-time audio and video telecommunications (including web-based applications) to deliver covered services that are within the provider’s scope of practice to a student at a site other than the site where the provider is located.  The HCA does not cover the following services provided through telemedicine for School-Based Health Care Services:

  • Email, telephone, and facsimile transmissions
  • Installation or maintenance of any telecommunication devices or systems
  • Purchase, rental, or repair of telemedicine equipment
  • Home health monitoring (in ABA manual only)

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based Health Care Services, p. 35 (Oct. 2021); Applied Behavior Analysis (ABA) Program, p. 32 (Apr. 2022); Maternity Support Services and Infant Case Management, p. 26 (Jan. 2021), (Accessed Apr. 2022).

Manuals for Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Maternity Support Services, Mental Health Services, Medical Nutrition Therapy, Neurodevelopmental Centers, Habilitative Services, Outpatient Hospital Services, Outpatient Rehabilitation Respiratory Care, and Substance Use Disorder refer to agency’s telemedicine coverage policy in the Physician-related services manual.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide. Federally Qualified Health Centers Manual, p. 63, Apr. 2022; Rural Health Clinics, p. 45,  Apr. 2022; Mental Health Services, p. 19 (Apr. 2022);  Medical Nutrition Therapy Manual, Oct. 1, 2020, pg. 15; Neurodevelopmental Centers, (July 2021), p. 14, Habilitative Services, pg. 14, (Jan. 2022); Outpatient Rehabilitation, (Jan. 2022), pg. 15; Outpatient Hospital Services Manual, Apr. 2022 pg. 28; Respiratory Care, Oct. 2021, pg. 22; Substance Use Disorder, (Apr. 2021), pg. 23 (Accessed Apr. 2022).

“Telemedicine” means the delivery of health care or behavioral health services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. For purposes of this section only, “telemedicine” includes audio-only telemedicine, but does not include facsimile, or email.

SOURCE: RCW 74.09.325(9)(k) & RCW 71.24.335(9)(i). (Accessed Apr. 2022).

Last updated 04/11/2022

Email, Phone & Fax

The authority shall adopt rules regarding medicaid fee-for-service reimbursement for services delivered through audio-only telemedicine.  The rules must establish a manner of reimbursement for audio-only telemedicine that is consistent with RCW 74.09.325. The rules shall require rural health clinics to be reimbursed for audio-only telemedicine at the rural health clinic encounter rate.

“Audio-only telemedicine” means the delivery of health care services through the use of audio-only technology, permitting real-time communication between a patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.  It does not include:

  • The use of facsimile or email; or
  • The delivery of health care services that are customarily delivered by audio-only technology and customarily not billed as separate services by the provider, such as the sharing of laboratory results.

SOURCE: RCW 74.09.327 (Accessed Apr. 2022).

Managed Care & Behavioral Health Administrative Services Organizations

“Audio-only telemedicine” means the delivery of health care services through the use of audio-only technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.  It does not include:

  • The use of facsimile or email; or
  • The delivery of health care services that are customarily delivered by audio-only technology and customarily not billed as separate services by the provider, such as the sharing of laboratory results.

Upon initiation or renewal of a contract with the Washington state health care authority to administer a medicaid managed care plan, a managed health care system shall reimburse a provider for a health care service provided to a covered person through telemedicine or store and forward technology if … Beginning January 1, 2023, for audio-only telemedicine, the covered person has an established relationship with the provider.

“Established relationship” means the covered person has had at least one in-person appointment within the past year with the provider providing audio-only telemedicine or with a provider employed at the same clinic as the provider providing audio-only telemedicine or the covered person was referred to the provider providing audio-only telemedicine by another provider who has had at least one in-person appointment with the covered person within the past year and has provided relevant medical information to the provider providing audio-only telemedicine.

A rural health clinic shall be reimbursed for audio-only telemedicine at the rural health clinic encounter rate.

If a provider intends to bill a patient or a managed health care system for an audio-only telemedicine service, the provider must obtain patient consent for the billing in advance of the service being delivered. The authority may submit information on any potential violations of this subsection to the appropriate disciplining authority, as defined in RCW 18.130.020.

Effective June 9, 2022: Established relationship means the provider providing audio-only telemedicine has access to sufficient health records to ensure safe, effective, and appropriate care services and:

  • For health care services included in the essential health benefits category of mental health and substance use disorder services, including behavioral health treatment:
  • The covered person has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the provider providing audio-only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system operated by a carrier licensed under chapter 48.44 or 48.46 RCW as the provider providing audio-only telemedicine; or
  • The covered person was referred to the provider providing audio-only telemedicine by another provider who has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the covered person and has provided relevant medical information to the provider providing audio-only telemedicine.

SOURCE: Revised Code of Washington 74.09.325 & 71.24.335, as amended by HB 1821 (2022 Legislative Session). (Accessed Apr. 2022).

Effective June 9, 2022: For any other health care service:

  • The covered person has had, within the past two years, at least one in-person appointment with the provider providing audio-only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system operated by a carrier licensed under chapter 48.44 or 48.46 RCW as the provider providing audio-only telemedicine; or
  • The covered person was referred to the provider providing audio-only telemedicine by another provider who has had, within the past two years, at least one in-person appointment with the covered person and has provided relevant medical information to the provider providing audio-only telemedicine.

SOURCE: Revised Code of Washington 74.09.325, as amended by HB 1821 (2022 Legislative Session). (Accessed Apr. 2022).

No reimbursement for email.

No reimbursement for telephone.

No reimbursement for FAX.

Teledermatology does not include single-mode consultations by telephone calls, images transmitted via facsimile machines, or electronic mail.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 89 & 93 (Apr. 2022), School-Based Health Care Services, p. 35 (Oct. 2021); Applied Behavioral Analysis (ABA) Program, p. 33 (Apr. 2022), (Accessed Apr. 2022).

HCA pays for telephone services when used by a physician to report and bill for episodes of care initiated by an established patient (i.e., someone who has received a face-to-face service from you or another physician of the same specialty in your group in the past three years) or by the patient’s guardian. See manual for codes and additional requirements.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 50 (Apr. 2022). (Accessed Apr. 2022).

The agency does not cover email or facsimile transmissions as teledentistry services.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Dental-Related Services, p. 73, Apr. 2022, (Accessed Apr. 2022).

Last updated 04/11/2022

Live Video

POLICY

Fee-for-service clients are eligible for medically necessary covered health care services delivered via telemedicine. The referring provider is responsible for determining and documenting that telemedicine is medically necessary. The referring provider is responsible for determining and documenting medical necessity.

As a condition of payment, the client must be present and participating in the telemedicine visit.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 89 (Apr. 2022). (Accessed Apr. 2022).

Newly Passed Legislation – Managed Care & Behavioral Health Administrative Organizations

Upon initiation or renewal of a contract with the Washington state health care authority to administer a Medicaid managed care plan, a managed health care system shall reimburse a provider for a health care service provided to a covered person through telemedicine at the same rate as if:

  • The medicaid managed care plan in which the covered person is enrolled provides coverage of the health care service when provided in person by the provider;
  • The health care service is medically necessary;
  • The health care service is a service recognized as an essential health benefit under section 1302(b) of the federal patient protection and affordable care act in effect on January 1, 2015;
  • The health care service is determined to be safely and effectively provided through telemedicine or store and forward technology according to generally accepted health care practices and standards, and the technology used to provide the health care service meets the standards required by state and federal laws governing the privacy and security of protected health information; and
  • Beginning January 1, 2023, for audio-only telemedicine, the covered person has an established relationship with the provider.

A managed health care system shall reimburse a provider for a health care service provided to a covered person through telemedicine the same amount of compensation the managed health care system would pay the provider if the health care service was provided in person by the provider.

Hospitals, hospital systems, telemedicine companies, and provider groups consisting of eleven or more providers may elect to negotiate an amount of compensation for telemedicine services that differs from the amount of compensation for in-person services.

A managed health care system may subject coverage of a telemedicine or store and forward technology health service to all terms and conditions of the plan in which the covered person is enrolled including, but not limited to, utilization review, prior authorization, deductible, copayment, or coinsurance requirements that are applicable to coverage of a comparable health care service provided in person.

SOURCE: RCW 74.09.325 & 71.24.335. (Accessed Apr. 2022).

If the service is provided through store and forward technology there must be an associated visit between the covered person and the referring provider. Nothing in this section prohibits the use of telemedicine for the associated office visit.

SOURCE: RCW 71.24.335 (Accessed Apr. 2022).


ELIGIBLE SERVICES/SPECIALTIES

Physician-Related Services

WA Medicaid covers telemedicine when it is a substitute for an in-person face-to-face hands-on encounter for only those services specifically listed in the telemedicine section of the manual.

The agency reimburses medically necessary covered services through telemedicine when the service is provided by a Washington Apple Health (Medicaid) provider and is within their scope of practice.  Place of service 02 to indicate the service was furnished as a telemedicine service from the distant site.

Effective for dates of service on and after April 4, 2022, providers must use the following coding guidance when billing with place of service (POS) 02 or 10. Providers whose systems are ready to bill using new POS 10 before April 4, 2022, may begin to do so effective with dates of service on and after January 1, 2022. See manual for POS descriptions.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 89 & 91-92 (Apr. 2022).  (Accessed Apr. 2022).

School Based Services

HCA covers telemedicine when it is used to substitute for an in-person, face-to-face, hands-on encounter for only those services specifically listed in this billing guide. In order for a school district to receive reimbursement for telemedicine, the provider furnishing services through telemedicine must be enrolled as a servicing provider under the school district’s ProviderOne account. Services provided by nonlicensed school staff must be billed under the supervising provider’s NPI in ProviderOne.

To indicate that the billed service was provided through telemedicine, school districts must submit claims for telemedicine services using place of service (POS) 02. School districts must enter modifier 95 on any claims for services provided through telemedicine. When billing for telemedicine through the SBHS program, the school district always submits a claim on behalf of both the originating and distant site.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School-Based Health Services, p. 35-36 (Oct. 2021). (Accessed Apr. 2022).

Applied Behavior Analysis (ABA) for Clients Age 20 and Younger

Eligible telemedicine services:

  • Program supervision when the child is present
  • Family training, which does not require the child’s presence
  • Speech language pathologist services during day treatment (only in ABA Medical Provider Guide).

The LBA may use telemedicine to supervise the CBT’s delivery of ABA services to the client, the family, or both. LBAs who use telemedicine are responsible for determining if telemedicine can be performed without compromising the quality of the parent training, or the outcome of the ABA therapy treatment plan.

See ABA Treatment fee schedule for telemedicine billing instructions.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Applied Behavior Analysis for Clients 20 and Younger, p. 32 (Apr. 2022) & WAC 182-531A-1200. (Accessed Apr. 2022).

Teledentistry

Teledentistry can be delivered through a synchronous or asynchronous method.  The agency covers teledentistry as a substitute for an in-person, face-to-face, hands-on encounter when medically necessary, within the scope of practice of the performing agency-contracted providers, and Department of Health teledentistry guidelines.

A dentist or authorized dental provider may delegate allowable tasks to Washington State Registered Dental Hygienists and Expanded Function Dental Assistants through teledentistry.  Delegation of tasks must be under general supervision. Teledentistry does not meet the definition of close supervision.

See manual for acceptable CPT codes.

SOURCE: WA State Health Care Authority, Medicaid Provider. Dental-Related Services, p. 72-73. (Apr. 2022). (Accessed Apr. 2022).

Mental Health Services

Drug monitoring must be provided during a face-to-face visit with the client, unless it is part of a qualified telemedicine visit.

SOURCE: WA State Health Care Authority, Medicaid Provider. Mental Health Services, p. 47. (Apr. 2022), (Accessed Apr. 2022).

Abortion

Medical abortion services provided via telemedicine to a client who does not receive ultrasound(s) and laboratory studies from the medical abortion provider are not eligible for the HCPCS S0199 bundled payment.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 218 (Apr. 2022). (Accessed Apr. 2022).

Home Health Services

The face-to-face encounter requirements of this section may be met using telemedicine or telehealth services.

SOURCE: WA Admin Code 182-551-2040. (Accessed Apr. 2022).

Maternal Support Services (MSS)

Certain MMS services covered are if certain conditions are met including if they are provided in a face-to-face encounter, including telemedicine.

SOURCE: WA State Health Care Authority, Maternity Support Services and Infant Case Management Billing Guide, p 23 (Jan. 1, 2021). (Accessed Apr. 2022).

Federally Qualified Health Center (FQHCs)

A face-to-face or telehealth visit between a client and a qualified FQHC provider (e.g., a physician, physician assistant, or advanced registered nurse practitioner) who exercises independent judgment when providing services that qualify for an encounter rate.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Rural Health Clinics, p. 9, (Apr. 2022); Federally Qualified Health Centers, p. 10. (Apr. 2022), (Accessed Apr. 2022).


ELIGIBLE PROVIDERS

Rural Health Clinics (RHCs) & FQHCs

RHCs & FQHCs are authorized to serve as an originating site for telemedicine services. RHCs and FQHCs may receive the encounter rate when billing as a distant site provider if the service being billed is encounter eligible. Clients enrolled in an agency-contracted MCO must contact the MCO regarding whether or not the plan will authorize telemedicine coverage.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Rural Health Clinics, p. 45-46, (Apr. 2022); Federally Qualified Health Centers, p. 63. (Apr. 2022), (Accessed Apr. 2022).

School Based Health Care Services

Under the SBHS program, HCA pays for services provided through telemedicine as outlined in this billing guide. Licensed providers, licensed assistants, compact license holders, interim permit holders, and non-licensed school staff practicing under the supervision of a licensed provider may provide SBHS through telemedicine.

In order for a school district to receive reimbursement for telemedicine, the provider furnishing services through telemedicine must be enrolled as a servicing provider under the school district’s ProviderOne account. Services provided by nonlicensed school staff must be billed under the supervising provider’s NPI in ProviderOne.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School-Based Health Services, p. 34-35, 38-39 (Oct. 2021). (Accessed Apr. 2022).

Tribal Health Program

An encounter can be conducted face-to-face or via real-time telemedicine.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Tribal Health Program, p. 19, (Jan. 2022), (Accessed Apr. 2022).


ELIGIBLE SITES

Approved Originating Sites

  • Clinics;
  • Community mental health center/chemical dependency settings;
  • Dental offices;
  • Federally qualified health center;
  • Home or any location determined appropriate by the individual receiving the service;
  • Hospitals—inpatient or outpatient;
  • Neurodevelopmental centers;
  • Physician’s or other health professional’s office;
  • Renal dialysis centers, except an independent renal dialysis center;
  • Rural health clinic;
  • Schools; or
  • Skilled nursing facility

Originating site (referring) providers are responsible for determining and documenting that telemedicine is medically necessary.

SOURCE: WAC 182-531-1730.(3) & WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 89-90 (Apr. 2022). (Accessed Apr. 2022).

Managed Care

The following are eligible originating sites.

  1. Hospital;
  2. Rural health clinic;
  3. Federally qualified health center;
  4. Physician’s or other health care provider’s office;
  5. Licensed or certified behavioral health agency;
  6. Skilled nursing facility;
  7. Home or any location determined by the individual receiving the service; or
  8. Renal dialysis center, except an independent renal dialysis center.

SOURCE: RCW 74.09.325. (Accessed Apr. 2022).

School-Based Health Care Services (SBHS)

When the originating site is a school, the school district must submit a claim on behalf of both the originating and distant site.  The location of the student and provider must be documented.  The SBHS program allows the following approved originating sites:

  • The school
  • The home, daycare, or any location determined appropriate by the students or parents

See manual for specific scenarios and appropriate modifiers.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based Health Care Services, p. 35-36 (Oct. 2021), (Accessed Apr. 2022).


GEOGRAPHIC LIMITS

A managed health care system may not distinguish between originating sites that are rural and urban in providing the coverage required in subsection (1) of this section.

SOURCE: RCW 74.09.325 (Accessed Apr. 2022).


FACILITY/TRANSMISSION FEE

Facility fees are available for originating sites, except inpatient hospitals, skilled nursing facilities, homes or other locations determined appropriate by the individual receiving service. Eligible originating sites explicitly listed for the facility fee include:

  • Hospital outpatient
  • Critical access hospitals
  • FQHCs and RHCs
  • Physicians or other health professional office
  • Other settings, when approved as an originating site

See manual for specific billing instructions for each.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 90-91 (Apr. 2022). (Accessed Apr. 2022).

Newly Passed Legislation – Managed Care

The following eligible originating sites (besides #7) can charge a facility fee for infrastructure and preparation of the patient. Reimbursement for a facility fee must be subject to a negotiated agreement between the originating site and the managed health care system.

  1. Hospital;
  2. Rural health clinic;
  3. Federally qualified health center;
  4.  Physician’s or other health care provider’s office;
  5. Licensed or certified behavioral health agency;
  6. Skilled nursing facility;
  7. Home or any location determined by the individual receiving the service; or
  8. Renal dialysis center, except an independent renal dialysis center.

Reimbursement for a facility fee must be subject to a negotiated agreement between the originating site and the managed health care system. A distant site, a hospital that is an originating site for audio-only telemedicine, or any other site not identified in subsection (3) of this section may not charge a facility fee.

SOURCE: RCW 74.09.325. (Accessed Apr. 2022).

FQHCs/RHCs

FQHCs and Rural Health Clinics that serve as an originating site for telemedicine services are paid an originating site facility fee. Charges for the originating site facility fee may be included on a claim, but the originating site facility fee may not be included on the cost report.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide Rural Health Clinics, p. 45-46, (Apr. 2022) & Federally Qualified Health Centers, p. 63 (Apr. 2022). (Accessed Apr. 2022).

School-Based Health Care Services (SBHS)

When the originating site is a school, the school district will receive a telemedicine fee per completed telemedicine transmission.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based Health Care Services, p. 35 (Oct. 2021), (Accessed Apr. 2022).

Dental Related Services

The facility fee is included in the CDT code.  There is no separate facility fee for teledentistry.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Dental Services, p. 74 (Apr. 2022). (Accessed Apr. 2022).

Abortion

When telemedicine is used to provide HCPCS S0199 bundled services, HCA does not pay any additional originating facility fees.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 217 (Apr. 2022). (Accessed Apr. 2022).

Tribal Health

The telemedicine facility fee (HCPCS code Q3014) is not included in the encounter rate, but it is payable separately from the encounter rate at the applicable rate in the fee schedule. The telemedicine facility fee must be billed on a separate claim from the encounter claim to avoid including the item in the encounter payment.

SOURCE: WA State Health Care Authority, Tribal Health Billing Guide, p. 21 (Jan. 2022). (Accessed Apr. 2022).

Last updated 04/11/2022

Miscellaneous

The documentation requirements are the same as those listed in Evaluation and management documentation and billing, in addition to the following:

  • Specification of the telehealth modality that was used (e.g., visit was conducted via HIPAA-compliant real-time audio/visual)
  • Verification that telemedicine was clinically appropriate for this service
  • Whether any assistive technologies were used
  • The location of the client
  • The names and credentials (MD, ARNP, RN, PA, CNA, etc.) of all provider personnel involved in the telemedicine visit
  • Consent for care via the modality that was used

Use place of service (POS) 02 to indicate that a billed service was furnished as a telemedicine service from a distant site. Distant site practitioners billing for telemedicine services under Critical Access Hospital (CAH) optional payment method must use the GT modifier. Add modifier 95 if the distant site is designated as a nonfacility.

Effective for dates of service on and after April 4, 2022, providers must use the following coding guidance when billing with place of service (POS) 02 or 10. Providers whose systems are ready to bill using new POS 10 before April 4, 2022, may begin to do so effective with dates of service on and after January 1, 2022. See manual for code descriptions.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 89, 91-92. (Apr. 2022). (Accessed Apr. 2022).

“If a provider from the originating site performs a separately identifiable service for the client on the same day as telemedicine, documentation for both services must be clearly and separately identified in the client’s medical record.”

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 91 (Apr. 2022). (Accessed Apr. 2022).

Last updated 04/11/2022

Out of State Providers

No Reference Found

Last updated 04/11/2022

Overview

Washington Medicaid (Apple Health) reimburses for live video, limited store-and-forward, and remote patient monitoring under some circumstances.

Client must be present and participating in telemedicine visit.  Clients under the Family Planning Only – Pregnancy Related program, Family Planning Only program (formerly TAKE CHARGE), First Steps, and School Based Health Care Service program are eligible for telemedicine through fee-for-service.

MCO’s cover the delivery of care via telemedicine. Follow the MCO’s policy and billing requirements.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 89, 92 (Apr. 2022); (Accessed Apr. 2022).

Telemedicine is covered by the Department.

SOURCE: WA Admin. Code Sec. 182-531-0100. (Accessed Apr. 2022).

Effective July 1, 2022, the Department plans to begin covering audio-only services under the definition of telemedicine.

SOURCE: WA State Health Care Authority, Medicaid Provider Bulletin, Audio-Only Telemedicine (Apr. 2022). (Accessed Apr. 2022).

Last updated 04/11/2022

Remote Patient Monitoring

POLICY

Home Health Services

“Telemedicine means the use of tele-monitoring to enhance the delivery of certain home health skilled nursing services through:

  • The collection of clinical data and the transmission of such data between a patient at a distant location and the home health provider through electronic processing technologies. Objective clinical data that may be transmitted includes, but is not limited to, weight, blood pressure, pulse, respirations, blood glucose, and pulse oximetry; or
  • The provision of certain education related to health care services using audio, video, or data communication instead of a face-to-face visit.”

SOURCE: WA Admin. Code Sec. 182-551-2010. (Accessed Apr. 2022).

HCA covers the delivery of home health services through telemedicine for clients who have been diagnosed with an unstable condition who may be at risk for hospitalization or a more costly level of care.

SOURCE: Washington Apply Health Medicaid Home Health Billing Guide, pg. 28, (Apr. 2022), (Accessed Apr. 2022).


CONDITIONS

Home Health Services

The client must have a diagnosis or diagnoses where there is a high risk of sudden change in medical condition which could compromise health outcomes. See manual for specific does to bill.

SOURCE: Washington Apply Health Medicaid Home Health Billing Guide, pg. 28, (Apr. 2022), (Accessed Apr. 2022).


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

Home Health Services

HCA pays for one telemedicine interaction, per eligible client, per day, based on the ordering licensed practitioner’s home health plan of care.

To receive payment for the delivery of home health services through telemedicine, the services must involve:

  • A documented assessment, identified problem, and evaluation, which includes:
    • Assessment and monitoring of clinical data including, but not limited to, vital signs, pain levels and other biometric measures specified in the plan of care. Also included is an assessment of response to previous changes in the plan of care.
    • Detection of condition changes based on the telemedicine encounter that may indicate the need for a change in the plan of care
  • Implementation of a documented management plan through one or
    more of the following:

    • Education regarding medication management as appropriate, based on the findings from the telemedicine encounter
    • Education regarding other interventions as appropriate to both the patient and the caregiver
    • Management and evaluation of the plan of care, including changes in visit frequency or the addition of other skilled services
    • Coordination of care with the ordering licensed provider regarding findings from the telemedicine encounter
    • Coordination and referral to other medical providers as needed
    • Referral to the emergency room as needed

HCA does not pay for the purchase, rental, repair, or maintenance of telemedicine equipment and associated costs of operation of telemedicine equipment.

HCA does not require prior authorization for the delivery of home health services through telemedicine.

SOURCE: Washington Apply Health Medicaid Home Health Billing Guide, pg. 28-29, (Apr. 2022), (Accessed Apr. 2022).

Home health monitoring is not covered in Applied Behavior Analysis Program for clients Age 20 or younger.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Applied Behavior Analysis for Clients 20 and Younger, p. 33 (Apr. 2022). (Accessed Apr. 2022).

Last updated 04/11/2022

Store and Forward

POLICY

Managed Care

“Store and forward technology” means use of an asynchronous transmission of a covered person’s medical information from an originating site to the health care provider at a distant site which results in medical diagnosis and management of the covered person, and does not include the use of audio-only telephone, facsimile, or email.

Upon initiation or renewal of a contract with the Washington state health care authority to administer a Medicaid managed care plan, a managed health care system shall reimburse a provider for a health care service provided to a covered person through telemedicine at the same rate as if:

  • The medicaid managed care plan in which the covered person is enrolled provides coverage of the health care service when provided in person by the provider;
  • The health care service is medically necessary;
  • The health care service is a service recognized as an essential health benefit under section 1302(b) of the federal patient protection and affordable care act in effect on January 1, 2015;
  • The health care service is determined to be safely and effectively provided through telemedicine or store and forward technology according to generally accepted health care practices and standards, and the technology used to provide the health care service meets the standards required by state and federal laws governing the privacy and security of protected health information; and
  • Beginning January 1, 2023, for audio-only telemedicine, the covered person has an established relationship with the provider.

A managed health care system shall reimburse a provider for a health care service provided to a covered person through telemedicine the same amount of compensation the managed health care system would pay the provider if the health care service was provided in person by the provider.  For purposes of this section, reimbursement of store and forward technology is available only for those services specified in the negotiated agreement between the managed health care system and health care provider.

Hospitals, hospital systems, telemedicine companies, and provider groups consisting of eleven or more providers may elect to negotiate an amount of compensation for telemedicine services that differs from the amount of compensation for in-person services.

A managed health care system may subject coverage of a telemedicine or store and forward technology health service to all terms and conditions of the plan in which the covered person is enrolled including, but not limited to, utilization review, prior authorization, deductible, copayment, or coinsurance requirements that are applicable to coverage of a comparable health care service provided in person.

SOURCE: RCW 74.09.325 (Accessed Apr. 2022).

Newly Passed Legislation – Behavioral Health Administrative Services Organizations and Managed Care Organizations

If the service is provided through store and forward technology there must be an associated visit between the covered person and the referring provider. Nothing in this section prohibits the use of telemedicine for the associated office visit.

Reimbursement of store and forward technology is available only for those services specified in the negotiated agreement between the behavioral health administrative services organization, or managed care organization, and the provider.

SOURCE: RCW 71.24.335 (Accessed Apr. 2022).

Store and Forward is the transmission of medical information to be reviewed later by a physician or practitioner at a distant site. A client’s medical information may include, but is not limited to, video clips, still images, x-rays, laboratory results, audio clips, and text. The physician or practitioner at the distant site reviews the case without the client present.  WA Medicaid pays for store-and-forward for teledermatology or when all of the following conditions are met:

  • There is an associated office visit that can be done either in-person or via asynchronous telemedicine and include one or more of the following types of information: video clips, still images, x-rays, MRIs, electrocardiograms and electroencephalograms, laboratory results, audio clips, and text. The visit results in a documented care plan that is communicated back to the referring provider.
  • The transmission of protected health information is HIPAA compliant.
  • Written informed consent is obtained that store and forward technology will be used and who the consulting provider is.

If the consultation results in a face-to-face visit in-person or via telemedicine with the specialist within 60 days of the store-and-forward consult, the agency does not pay for the consult.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 92-93 (Apr. 2022). (Accessed Apr. 2022).

WA Medicaid covers asynchronous teledentistry when the client’s dental clinical information is gathered at the originating site the information is sent via store-and-forward technology to a dentist or authorized dental provider (distant site) for review and subsequent intervention at a later point in time.

SOURCE:  WA State Health Care Authority, Medicaid Provider. Dental-Related Services, p. 73. (Apr. 2022), (Accessed Apr. 2022).


ELIGIBLE SERVICES/SPECIALTIES

WA Apple Health pays for store-and-forward for teledermatology.  Teledermatology services via store-and-forward must be billed with GQ modifier and 02 POS Code from the distant site.  The sending provider bills as usual with the E&M code and no modifier.

See manual for acceptable CPT/HCPCS codes.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 92-93. (Apr. 2022). (Accessed Apr. 2022).

Health departments may use a recorded video submitted by the client in place of the in-home visit or office visit. HCPCS code G2010 may be billed when this modality is used and the requirements of the code are met. HCPCS code G2010 is not Federally Qualified Health Center (FQHC) encounter-eligible

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 72 (Apr. 2022). (Accessed Apr. 2022).

Teledentistry

Teledentistry can be delivered through a synchronous or asynchronous method.  The agency covers teledentistry as a substitute for an in-person, face-to-face, hands-on encounter when medically necessary.  For asynchronous teledentistry, the client’s dental clinical information is sent via store-and-forward technology from the originating site to a dentist or authorized dental provider (distant site) for review and subsequent intervention at a later point in time.

See manual for acceptable CPT codes.

SOURCE: WA State Health Care Authority, Medicaid Provider. Dental-Related Services, p. 73-74. (Apr. 2022). (Accessed Apr. 2022).

Behavioral Health Organizations

Reimbursement of store and forward technology is available only for those services specified in the negotiated agreement between the behavioral health administrative services organization, or managed care organization, and the provider.

SOURCE: RCW 71.24.335. (Accessed Apr. 2022).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

The originating site for store-and-forward is not eligible to receive an originating site fee.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 93 (Apr. 2022). (Accessed Apr. 2022).

 

Last updated 04/11/2022

Definition

“Telemedicine” means the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. For purposes of this section only, “telemedicine” includes audio-only telemedicine, but does not include facsimile or email.

“Audio-only telemedicine” means the delivery of health care services through the use of audio-only technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.
For purposes of this section only, “audio-only telemedicine” does not include:
  • The use of facsimile or email; or
  • The delivery of health care services that are customarily delivered by audio-only technology and customarily not billed as separate services by the provider, such as the sharing of laboratory results.

SOURCE: WA Rev. Code Sec. 48.43.735 & Sec. 41.05.700. (Accessed Apr. 2022).

“Telemedicine” means the delivery of health care services through the use of interactive audio and video technology or audio-only technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. For purposes of this chapter, “telemedicine” does not include facsimile, email, or text messaging, unless the use of text-like messaging is necessary to ensure effective communication with individuals who have a hearing, speech, or other disability.

“Audio-only telemedicine” means the delivery of health care services through the use of audio-only technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. “Audio-only telemedicine” does not include:

  • The use of facsimile, email, or text messages, unless the use of text-like messaging is necessary to ensure effective communication with individuals who have a hearing, speech, or other disability; or
  • The delivery of health care services that are customarily delivered by audio-only technology and customarily not billed as separate services by the provider, such as the sharing of laboratory results.

Last updated 04/11/2022

Parity

SERVICE PARITY

Services must be considered an essential health benefit under the ACA and be determined to be safely and effectively provided through telemedicine or store-and-forward.

Reimbursement of store and forward technology is available only for those covered services specified in the negotiated agreement between the health carrier and the health care provider.

SOURCE: RCW 48.43.735 & Sec. 41.05.700 & WAC 284-170-433. (Accessed Apr. 2022).


PAYMENT PARITY

A health carrier shall reimburse a provider for a health care service provided to a covered person through telemedicine the same amount of compensation the carrier would pay the provider if the health care service was provided in person by the provider.

Hospitals, hospital systems, telemedicine companies, and provider groups consisting of eleven or more providers may elect to negotiate an amount of compensation for telemedicine services that differs from the amount of compensation for in-person services.

SOURCE: RCW 48.43.735 & Sec. 41.05.700 & WAC 284-170-433. (Accessed Apr. 2022).

“Same amount of compensation” means providers are reimbursed by a carrier using the same allowed amount for telemedicine services as they would if the service had been provided in-person unless negotiation has been undertaken. Where consumer cost-sharing applies to telemedicine services, the consumer’s payment combined with the carrier’s payment must be the same amount of compensation, or allowed amount, as the carrier would pay the provider if the telemedicine service had been provided in person. Where an alternative payment methodology other than fee-for-service payment would apply to an in-person service, “same amount of compensation” means providers are reimbursed by a carrier using the same alternative payment methodology that would be used for the same service if provided in-person, unless negotiation has been undertaken.

SOURCE: WA Rev. Code Sec. 284-170-130, as amended by Insurance Commissioner Permanent Rule. (Accessed Apr. 2022).

Last updated 04/11/2022

Requirements

Insurers (including employee health plans and Medicaid Managed Care) must reimburse a provider for services delivered through telemedicine or store-and-forward if:

  • The plan provides coverage when provided in-person;
  • The health care service is medically necessary;
  • The health care service is a service recognized as an essential health benefit under section 1302(b) of the federal patient protection and affordable care act (ACA);
  • The health care service is determined to be safely and effectively provided through telemedicine or store-and-forward technology according to generally accepted health care practices and standards, and the technology used to provide the health care service meets the standards required by state and federal laws governing the privacy and security of protected health information; and
  • Beginning January 1, 2023, for audio-only telemedicine, the covered person has an established relationship with the provider.

SOURCE: RCW 48.43.735 & Sec. 41.05.700, & WAC 284-170-433. (Accessed Apr. 2022).

“Established relationship” means the covered person has had at least one in-person appointment within the past year with the provider providing audio-only telemedicine or with a provider employed at the same clinic as the provider providing audio-only telemedicine or the covered person was referred to the provider providing audio-only telemedicine by another provider who has had at least one in-person appointment with the covered person within the past year and has provided relevant medical information to the provider providing audio-only telemedicine.

SOURCE: RCW 48.43.735 & Sec. 41.05.700, (Accessed Apr. 2022).

“Established relationship” means: The covered person has had at least one in-person appointment within the past year with the provider providing audio-only telemedicine, with a provider employed at the same clinic as the provider providing audio-only telemedicine, or with a locum tenens or other provider who is the designated back up or substitute provider for the provider providing audio-only telemedicine who is on leave and is not associated with an established clinic; or The covered person was referred to the provider providing audio-only telemedicine by another provider who has had at least one in-person appointment with the covered person within the past year and has provided relevant medical information to the provider providing audio-only telemedicine. A referral includes circumstances in which the provider who has had at least one in-person appointment with the covered person participates in the audio-only telemedicine encounter with the provider to whom the covered person has been referred.

SOURCE: WA Rev. Code Sec. 284-170-130, as amended by Insurance Commissioner Permanent Rule. (Accessed Apr. 2022).

Effective June 9, 2022:

“Established relationship” means the provider providing audio-only telemedicine has access to sufficient health records to ensure safe, effective, and appropriate care services and:

  • For health care services included in the essential health benefits category of mental health and substance use disorder services, including behavioral health treatment:
    • The covered person has had, within the past three years, at least one in-person appointment or at least one real-time interactive appointment using both audio and video technology, with the provider providing audio-only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system operated by a carrier licensed under chapter 48.44 or 48.46 RCW as the provider providing audio-only telemedicine; or
    • The covered person was referred to the provider providing audio-only telemedicine by another provider who has had, within the past three years, at least one in-person appointment, or at least one real-time interactive appointment using both audio and video technology, with the covered person and has provided relevant medical information to the provider providing audio-only telemedicine;
  • For any other health care service:
    • The covered person has had, within the past two years, at least one in-person appointment with the provider providing audio-only telemedicine or with a provider employed at the same medical group, at the same clinic, or by the same integrated delivery system operated by a carrier licensed under chapter 48.44 or 48.46 RCW as the provider providing audio-only telemedicine; or
    • The covered person was referred to the provider providing audio-only telemedicine by another provider who has had, within the past two years, at least one in-person appointment with the covered person and has provided relevant medical information to the provider providing audio-only telemedicine;

SOURCE: RCW 48.43.735 & Sec. 41.05.700, as amended by HB 1821 (2022 Legislative Session). (Accessed Apr. 2022).

Eligible Originating Sites:

  1. Hospital
  2. Rural health clinic
  3. Federally qualified health center
  4. Physician’s or other health care provider’s office
  5. Licensed or certified behavioral health agency
  6. Skilled nursing facility
  7. Home or any location determined appropriate by the individual receiving the service
  8. Renal dialysis center, except an independent renal dialysis center

Any originating site (other than #7 above) may charge a facility fee for infrastructure and preparation of the patient. Reimbursement for a facility fee must be subject to a negotiated agreement between the originating site and the health plan. A distant site, a hospital that is an originating site for audio-only telemedicine, or any other site not identified in the list above may not charge a facility fee.

The plan may not distinguish between originating sites that are rural and urban.

SOURCE: RCW 48.43.735 & Sec. 41.05.700 & WAC 284-170-433, (Accessed Apr. 2022).

An originating site that is a home or location determined appropriate by the individual receiving the service includes, but is not limited to: a pharmacy or a school-based health center. If the site chosen by the individual receiving service is in a state other than the state of Washington, a provider’s ability to conduct a telemedicine encounter in that state is determined by the licensure status of the provider and the provider licensure laws of the other state.

SOURCE: WAC 284-170-433, as added by Permanent Rule. (Accessed Apr. 2022).

Insurers offering a plan shall ensure that their benefits and services provided through electronic and information technology, including telehealth, are accessible to individuals with disabilities, unless doing so would result in undue financial and administrative burdens or a fundamental alteration in the nature of the health programs or activities. When undue financial and administrative burdens or a fundamental alteration exist, the issuer shall provide information in a format other than an electronic format that would not result in such undue financial and administrative burdens or a fundamental alteration but would ensure, to the maximum extent possible, that individuals with disabilities receive the benefits or services of the plan that are provided through electronic and information technology.

SOURCE:  WAC 284-43-5965 (Accessed Apr. 2022).

Language assistance services required under subsection (1) of this section must be provided free of charge, be accurate and timely, and protect the privacy and independence of the individual with limited-English proficiency, regardless of whether an associated health service is provided in person or through telehealth.

SOURCE:  WAC 284-43-5960 (Accessed Apr. 2022).

Printed and online provider directories must include information about any available telemedicine services, including any audio-only telemedicine services that are available, and specifically describe the services and how to access those services.

SOURCE: WAC 284-170-260, as amended by Insurance Commissioner Permanent Rule. (Accessed Apr. 2022).

Every participating provider contract must, for health plans issued or renewed on or after July 25, 2021, and by July 1, 2022, ensure that access to telemedicine services is inclusive for those patients who may have disabilities or limited-English proficiency and for whom the use of telemedicine technology may be more challenging.

A health carrier is not required to reimburse:

  • An originating site for professional fees;
  • A provider for a health care service that is not a covered benefit under the plan; or
  • An originating site or provider when the site or provider is not a participating provider under the plan.

A health carrier may subject coverage of a telemedicine or store and forward technology health service under subsection (1) of this section to all terms and conditions of the plan in which the covered person is enrolled including, but not limited to, utilization review, prior authorization, deductible, copayment, or coinsurance requirements that are applicable to coverage of a comparable health care service provided in person.

A carrier may not deny, reduce, terminate or fail to make payment for the delivery of health care services using audio and visual technology solely because the communication between the patient and provider during the encounter shifted to audio-only due to unanticipated circumstances. In these instances, a carrier may not require a provider to obtain consent from the patient to continue the communication.

A carrier has no obligation to reimburse a provider for both an audio-visual and an audio-only encounter when both means of communication have been used during the encounter due to unforeseen circumstances.

Every participating provider contract must, effective July 25, 2021, provide that if a provider intends to bill a covered person or the covered person’s health plan for an audio-only telemedicine service, the provider must obtain patient consent from the covered person for the billing in advance of the service being delivered, consistent with the requirements of this subsection and state and federal laws applicable to obtaining patient consent.

A covered person’s consent must be obtained prior to initiation of the first audio-only encounter with a provider and may constitute consent to such encounters for a period of up to 12 months. If audio-only encounters continue beyond an initial 12-month period, consent must be obtained from the covered person for each prospective 12-month period.

Consent to be billed for audio-only telemedicine services must be obtained by the provider or auxiliary personnel under the general supervision of the provider.

A covered person may consent to a provider billing them or their health plan in writing or verbally. Consent to billing for an audio-only telemedicine encounter may be obtained and documented by the provider or auxiliary personnel under the general supervision of the provider as part of the process of making an appointment for an audio-only telemedicine encounter, recorded verbally as part of the audio-only telemedicine encounter record or otherwise documented in the patient record. Consent must be documented and retained by the provider for a minimum of five years. As needed, a carrier also may request documentation of the covered person’s consent as a condition of claim payment.

A patient may revoke consent granted under this subsection. Revocation of the patient’s consent must be communicated by the patient or their authorized representative to the provider or auxiliary personnel under the general supervision of the provider verbally or in writing and must be documented and retained by the provider for a minimum of five years. Once consent is revoked, the revocation must operate prospectively.

SOURCE: WAC 284-170-433, as added by Permanent Rule. (Accessed Apr. 2022).

Last updated 04/12/2022

Cross State Licensing

There is no prohibition against the consultation through telemedicine by a practitioner, licensed by another state or territory in which he or she resides, with a practitioner licensed in WA who has responsibility for the diagnosis and treatment of the patient within WA.

SOURCE: RCW 18.71.030(6) and RCW 18.57.040.  (Accessed Apr. 2022).

Last updated 04/12/2022

Definitions

“Telemedicine means the delivery of health care (or behavioral health) services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.   ‘Telemedicine’ includes audio-only telemedicine, but does not include facsimile, or email.”

“Audio-only telemedicine” means the delivery of health care services through the use of audio-only technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.
“Audio-only telemedicine” does not include:
  • The use of facsimile or email; or
  • The delivery of health care services that are customarily delivered by audio-only technology and customarily not billed as separate services by the provider, such as the sharing of laboratory results.

SOURCE: RCW 70.41.020, (Accessed Apr. 2022).

Hospice and Home Health

“Telehealth” means a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technology. Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services.

“Telemedicine” means the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. Telemedicine does not include the use of audio-only telephone, facsimile, or electronic mail.

SOURCE: WAC 246-335-610 (20) & (21).. WAC 246-335-510 (21) & (22). (Accessed Apr. 2022).

Physical and Occupational Therapy

“Telehealth means providing physical therapy [or occupational therapy] via electronic communication where the physical [occupational] therapist or physical [or occupational] therapist assistant and the patient are not at the same physical location.”

SOURCE: WAC 246-915-187(3(a)) & 246-847-176.(1) (Accessed Apr. 2022).

Last updated 04/12/2022

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: The IMLC. (Accessed Apr. 2022).

Member of Physical Therapy Compact.

SOURCE:  PT Compact. Compact Map. (Accessed Apr. 2022).

Enacted Occupational Therapy Licensure Compact (Effective June 9, 2022):

SOURCE: SB 5518 (2022 Legislative Session). OT Compact. (Accessed Apr. 2022).

Member of the Psychology Interjurisdictional Compact.

SOURCE: Psychology Interjurisdictional Compact. (Accessed Apr. 2022).

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

Last updated 04/12/2022

Miscellaneous

Beginning Jan. 1, 2021, a health care professional who provides clinical services through telemedicine, other than a physician licensed under chapter 18.71 RCW or an osteopathic physician licensed under chapter 18.57 RCW, shall complete a telemedicine training. By January 1, 2020, the telemedicine collaborative shall make a telemedicine training available on its web site for use by health care professionals who use telemedicine technology. If a health care professional completes the training, the health care professional shall sign and retain an attestation. The training:

  • Must include information on current state and federal law, liability, informed consent, and other criteria established by the collaborative for the advancement of telemedicine, in collaboration with the department and the Washington state medical quality assurance commission;
  • Must include a question and answer methodology to demonstrate accrual of knowledge; and
  • May be made available in electronic format and completed over the internet.

A health care professional is deemed to have met the requirements of subsection (2) of this section if the health care professional:

  • Completes an alternative telemedicine training; and
  • Signs and retains an attestation that he or she completed the alternative telemedicine training.

SOURCE: RCW 43.70.495 (WA SB 6061 – 2020). (Accessed Apr. 2022).

Collaborative for the advancement of telemedicine was created to develop recommendations on improving reimbursement and access to care, and review the concept of telemedicine payment parity.  They were required to submit policy reports with recommendations in December 2017, 2018, and December 2021.  Recent legislation requires the collaborative to study store and forward technology with an emphasis on utilization, whether it should be paid for at parity, the potential for store and forward to improve rural health outcomes and ocular services.

SOURCE:  RCW 48.43.735  & RCW 28B.20.830. (Accessed Apr. 2022).

The insurance commissioner, in collaboration with the Washington state telehealth collaborative and the health care authority, shall study and make recommendations for audio-only telemedicine, among other items.

SOURCE: HB 1196 (2021 Session), (Accessed Apr. 2022).

During a telemedicine visit, supervision over a medical assistant assisting a health care practitioner with the telemedicine visit may be provided through interactive audio and video telemedicine technology.

SOURCE: Revised Code of Washington Sec. 18.360.010. (Accessed Apr. 2022).

Last updated 04/12/2022

Online Prescribing

The WA Medical Quality Assurance Commission has issued guidelines on the use of the Internet in medical practices.  A guideline does not have the force of law, but can be considered by the Commission to be the standard of practice in the state.

Prior to providing treatment, including issuing prescriptions, a practitioner who uses telemedicine should interview the patient to collect the relevant medical history and perform a physical examination, when medically necessary, sufficient for the diagnosis and treatment of the patient. A practitioner may not delegate an appropriate history and physical examination to an unlicensed person or to a licensed individual for whom that function would be out of the scope of the license.

Once a practitioner has obtained a relevant medical history and performed a physical examination, it is within the practitioner’s judgment to determine whether it is medically necessary to obtain a history or perform a physical examination at subsequent encounters. The technology used in a telemedicine encounter must be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed inperson by the practitioner. An on-line questionnaire does not constitute an acceptable medical interview for the provision of treatment, including issuance of prescriptions, by a practitioner. The standard of care requires direct interaction with a licensed practitioner.

SOURCE: Washington Medical Commission, Defining and Providing Guidance on Telemedicine Usage, p. 4 (November 19, 2021).  (Accessed Apr. 2022).

For purposes of authorizing the medical use of marijuana, a physician must complete an in-person physical exam or a remote physical exam when certain conditions are met.  Following an in-person physical examination to authorize the use of marijuana for medical purposes, the health care professional may determine and note in the patient’s medical record that subsequent physical examinations for the purposes of renewing an authorization may occur through the use of telemedicine technology if the health care professional determines that requiring the qualifying patient to attend a physical examination in person to renew an authorization would likely result in severe hardship to the qualifying patient because of the qualifying patient’s physical or emotional condition.

SOURCE:  Revised Code Washington Sec. 69.51A.030. (Accessed Apr. 2022).

Last updated 04/12/2022

Professional Boards Standards

Washington Medical Commission

SOURCE: Defining and providing guidance on Telemedicine usage (Accessed Apr. 2022).

Physical Therapy Practice Board

SOURCE: WAC 246-915-187 (Accessed Apr. 2022).

Occupational Therapy Practice Board

SOURCE: WAC 246-847-176 (Accessed Apr. 2022).