Washington

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Washington Apple Health

Administrator

Washington State Health Care Authority

Regional Telehealth Resource Center

Northwest Regional Telehealth Resource Center

Medicaid Reimbursement

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

Private Payer Law

Law Exists: Yes
Payment Parity: No

Professional Requirements

Licensure Compacts: IMLC, PTC
Consent Requirements: Yes

Audio-Only Delivery

Medicaid:  Telemedicine Coverage Brief

STATUS: Active

Medicaid: FAQ for Physical, Occupational and Speech Therapy

STATUS: Active

Medicaid: Long Term Care Facilities/SNF

STATUS: Active

Medicaid: Clinical Policy and Billing FAQ

STATUS: Active

Medicaid: Applied Behavior Analysis  FAQ

STATUS: Active

Medicaid: Home Health FAQ

STATUS: Active

Medicaid: School-Based Health Services FAQs

STATUS: Active

Medicaid 1915(c) Waiver: Appendix K – Basic Plus

STATUS: Expired February 28, 2021

Medicaid 1915(c) Waiver: Appendix K – Core

STATUS: Expired February 28, 2021

Medicaid 1915(c) Waiver: Appendix K – Community Protection

STATUS: Expired February 28, 2021

Medicaid 1915(c) Waiver: Appendix K – Individual and Family Services

STATUS: Expired February 28, 2021

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

STATUS: Expired February 28, 2021

Medicaid: 1115 Waiver Summary – Telephone and Telehealth Options

STATUS: Active, Expires 3/31/21

Medicaid 1915(c) Waiver: Appendix K – COPES

STATUS: Expired January 31, 2021

Medicaid 1915(c) Waiver: Appendix K – New Freedom

STATUS: Expired January 31, 2021

Medicaid 1915(c) Waiver: Appendix K – Residential Support Waiver

STATUS: Expired January 31, 2021

Medicaid 1915(c) Waiver: Appendix K Extension – 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 1135 Waiver: Telehealth Summary

STATUS: Active

Last updated 02/28/2021

Cross-State Licensing

No Reference Found

Last updated 02/28/2021

Easing Prescribing Requirements

No Reference Found

Last updated 02/28/2021

Miscellaneous

Medicaid: No Cost Zoom Licenses

STATUS: Active, limited supply

Medicaid:  Security in Telehealth Technology

STATUS: Active

Department of Health: Guidance on HIPAA

STATUS: Active, until end of PHE

Department of Health: Sex Offender Treatment Program

STATUS: Expired

Last updated 02/28/2021

Originating Site

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

STATUS: Active

Medicaid: FAQ for Physical, Occupational and Speech Therapy

STATUS: Active

Medicaid: Clinical Policy and Billing FAQ

STATUS: Active

Last updated 02/28/2021

Private Payer

Department of Insurance: Emergency Order on Telemedicine Extension

STATUS: Expired September 15, 2020

Department of Insurance: Emergency Order on Telemedicine

STATUS: Expired September 15, 2020

Department of Insurance: Partial Extending of Emergency Order

STATUS: Active, expires May 2, 2021

Office of the Governor: Proclamation on Telemedicine

STATUS: Expired August 1, 2020

Office of the Governor: Proclamation on Telemedicine Payment Parity

STATUS: Active, until WA State of Emergency ends

Last updated 02/28/2021

Provider Type

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

STATUS: Active

Medicaid: Clinical Policy and Billing FAQ

STATUS: Active

Medicaid: Applied Behavior Analysis  FAQ

STATUS: Active

Medicaid: Home Health FAQ

STATUS: Active

Last updated 02/28/2021

Service Expansion

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

STATUS: Active

Medicaid:  Telemedicine Coverage Brief

STATUS: Active

Medicaid: FAQ for Physical, Occupational and Speech Therapy

STATUS: Active

Medicaid: Long Term Care Facilities/SNF

STATUS: Active

Medicaid: Clinical Policy and Billing FAQ

STATUS: Active

Medicaid: Applied Behavior Analysis  FAQ

STATUS: Active

Medicaid: Home Health FAQ

STATUS: Active

Medicaid: School-Based Health Services FAQs

STATUS: Active

Medicaid: Emergency Rule on face-to-face requirement

STATUS: Expired

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

STATUS: Expired

Medicaid 1915(c) Waiver: Appendix K – Basic Plus

STATUS: Expired February 28, 2021

Medicaid 1915(c) Waiver: Appendix K – Core

STATUS: Expired February 28, 2021

Medicaid 1915(c) Waiver: Appendix K – Community Protection

STATUS: Expired February 28, 2021

Medicaid 1915(c) Waiver: Appendix K – Individual and Family Services

STATUS: Expired February 28, 2021

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

STATUS: Expired February 28, 2021

Medicaid 1115 Waiver Summary – Telephone and Telehealth Options

STATUS: Active, Expires 3/31/21

Medicaid 1915(c) Waiver: Appendix K – COPES

STATUS: Expired January 31, 2021

Medicaid 1915(c) Waiver: Appendix K – New Freedom

STATUS: Expired January 31, 2021

Medicaid 1915(c) Waiver: Appendix K – Residential Support Waiver

STATUS: Expired January 31, 2021

Medicaid 1915(c) Waiver: Appendix K Extension – 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 1135 Waiver: Telehealth Summary

STATUS: Active

Last updated 02/28/2021

Definitions

“Telemedicine is when a health care practitioner uses 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. 84 (Feb. 2021); Accessed Feb. 2021).

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:

  • Email, audio only telephone, and facsimile transmissions
  • Installation or maintenance of any telecommunication devices or systems
  • Purchase, rental, or repair of telemedicine equipment

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based Health Care Services, p. 33 (Oct. 2020); Applied Behavior Analysis (ABA) Program, p. 33 (Dec. 2020); Maternity Support Services and Infant Case Management, p. 26 (Jan. 2021), (Accessed Feb. 2021).

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. 64 Jan. 2021; Rural Health Clinics, p. 44,  Jan. 2021; Mental Health Services, p. 20 (Jan. 2021); Maternity Support Services Manual, Jan. 2021, pg. 26; Medical Nutrition Therapy Manual, Oct. 1, 2020, pg. 15; Neurodevelopmental Centers, (Jan. 2021), Habilitative Services, pg. 14, (Jan. 2021); Outpatient Rehabilitation, (Jan. 2021), pg. 13; Outpatient Hospital Services Manual, Jan. 2021 pg. 27; Respiratory Care, Oct. 2020, pg. 23; Substance Use Disorder, (Jan. 2021), pg. 24 (Accessed Feb. 2021).

Last updated 02/28/2021

Email, Phone & Fax

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. 88 (Jan. 2021), School-Based Health Care Services, p. 33 (Oct. 2020); Applied Behavioral Analysis (ABA) Program, p. 34, (Accessed Feb. 2021).

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. 48 (Feb. 2021), (Accessed Feb. 2021).

Effective for dates of service on and after March 1, 2021, the agency will no longer reimburse CDT code D9992 for triage and care coordination over the telephone.

The agency does not cover email, audio only telephone, and facsimile transmissions as teledentistry services.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Dental-Related Services, p. 68, Mar. 2021, (Accessed Feb. 2021). 

Last updated 02/28/2021

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. 85 (Feb. 2021).  (Accessed Feb. 2021).


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.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 85 & 87 (Feb. 2021).  (Accessed Feb. 2021).

School Based Services

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. 33 (Oct. 2020).  (Accessed Feb. 2021).

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

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. 33 (Feb. 2021) & WAC 182-531A-1200. (Accessed Feb. 2021).

Behavioral Health

Behavioral health administrative services organizations and managed care organizations who have a contract with the department shall reimburse a provider for behavioral health services provided to a covered person who is under 18 years old through telemedicine or store-and-forward if:

  • The behavioral health administrative services organization or managed care organization provides coverage for behavioral health services when provided in-person; and
  • The service is medically necessary

SOURCE: Revised Code of WA Sec. 71.24.335(1). (Accessed Feb. 2021).

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. 67-68. (Mar. 2021). (Accessed Feb. 2021).

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. Jan. 2021, (Accessed Feb. 2021).

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. 213 (Feb. 2021).  (Accessed Feb. 2021).


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. 44, Jan. 2021; Federally Qualified Health Centers, p. 64. (Accessed Feb. 2021).

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.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, School Based-Health Care Services, p. 32, Oct. 2020. (Accessed Feb. 2021). 

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. 17, Jan. 2021, (Accessed Feb. 2021).


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. 86 (Feb. 2021). (Accessed Feb. 2021). 

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. 33-34 (Oct. 2020), (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


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

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 86-87 (Feb. 2021). (Accessed Feb. 2021).

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. 44, Jan. 2021 & Federally Qualified Health Centers, p. 64 (Jan. 2021))  (Accessed Feb. 2021).

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. 33 (Oct. 2020), (Accessed Feb. 2021).

Dental Related Services

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

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Dental Services, p. 67 (Mar. 2021).  (Accessed Feb. 2021).

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. 213 (Feb. 2021).  (Accessed Feb. 2021).

Last updated 02/28/2021

Miscellaneous

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.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 87-88 (Feb. 2021). (Accessed Feb. 2021).

Additional Documentation Requirements for Telemedicine:

  • 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

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 85-86 (Feb. 2021). (Accessed Feb. 2021).

“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., 87 (Feb. 2021). (Accessed Feb. 2021).

Last updated 02/28/2021

Out of State Providers

No Reference Found

Last updated 02/28/2021

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. 84-85 (Feb. 2021); (Accessed Feb. 2021).

Telemedicine is covered by the Department.

SOURCE: WA Admin. Code Sec. 182-531-0100. (Accessed Feb. 2021).

Last updated 02/28/2021

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 Feb. 2021).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

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. 34 (Feb. 2021). (Accessed Feb. 2021).

Last updated 02/28/2021

Store and Forward

POLICY

Newly Passed Legislation (Effective Now)

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 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 a reimbursement rate for telemedicine services that differs from the reimbursement rate for in-person services.

SOURCE: RCW 74.09.325 (SB 5385 – 2020 Session), (Accessed Feb. 2021).

Washington Medicaid reimburses for some store-and-forward services under certain circumstances.  If the service is provided through store-and-forward technology, there must be an associated office visit between the client and the referring health care provider.

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. 84-85 (Feb. 2021) (Accessed Feb. 2021).

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. 68. (Mar. 2021), (Accessed Feb. 2021).

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 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. 88 (Feb. 2021). (Accessed Feb. 2021).


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. 88 (Feb. 2021). (Accessed Feb. 2021).

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. 68  (Mar. 2021) (Accessed Feb. 2021).

Behavioral Health Organizations

Store-and-forward reimbursable only for covered services specified in the negotiated agreement between the behavioral health administrative services organization and health care provider.

SOURCE: RCW 71.24.335(2(b)), (Accessed Feb. 2021).


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. 88 (Feb. 2021). (Accessed Feb. 2021). 

 

Last updated 02/28/2021

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” does not include the use of audio-only telephone, facsimile, or email.

SOURCE: WA Rev. Code Sec. 48.43.735.(8(g)) & Sec. 41.05.700((8(g). (Accessed Feb. 2021).

Last updated 02/28/2021

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.

SOURCE: RCW 48.43.735.(1(iii)) & Sec. 41.05.700.(1(iii)). (Accessed Feb. 2021).,


PAYMENT PARITY

Recently Passed Legislation (Now Effective)

Health plans issued or renewed on or after January 1, 2021 shall reimburse a provider for a health care service provided to a covered person through telemedicine at the same rate as 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 a reimbursement rate for telemedicine services that differs from the reimbursement rate for in-person services.

SOURCE: RCW 41.05.700; 48.43.735 (WA SB 5385 – 2020 Session), (Accessed Feb. 2021)

Last updated 02/28/2021

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); and
  • 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.

SOURCE: RCW 48.43.735.(1) & Sec. 41.05.700.(1), (Accessed Feb. 2021).

Eligible Originating Sites

  • Hospital
  • Rural health clinic
  • Federally qualified health center
  • Physician’s or other health care provider’s office
  • Community mental health center
  • Skilled nursing facility
  • Renal dialysis center, except an independent renal dialysis center
  • Home or any location determined appropriate by the individual receiving the service

Originating sites may not distinguish between rural and urban originating sites

SOURCE: RCW 48.43.735.(3) & Sec. 41.05.700.(3), (Accessed Feb. 2021).

An originating site (other than a home) can charge a facility fee, but it is subject to a negotiated agreement between the originating site and the health carrier.

SOURCE: RCW 48.43.735.(4) & .Sec. 41.05.700.(4), (Accessed Feb. 2021).

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

SOURCE: Revised Code of WA Sec. 41.05700(5) (Accessed Feb. 2021).

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 Feb. 2021).

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 Feb. 2021).

Last updated 02/28/2021

Cross State Licensing

No Reference Found

Last updated 02/28/2021

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.  For purposes of this section only, ‘telemedicine’ does not include the use of audio-only telephone, facsimile, or email.”

SOURCE: RCW 70.41.020(13) & WAC 246-335-610.(21) (Accessed Feb. 2021).

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 Feb. 2021).

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 Feb. 2021).

Last updated 02/28/2021

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: The IMLC. (Accessed Feb. 2021).

Member of Physical Therapy Compact.

SOURCE:  PT Compact. Compact Map.  (Accessed Feb. 2021).

Last updated 02/28/2021

Miscellaneous

Recently Passed Legislation (Now Effective)

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 Feb. 2021).

WA State requires a provider directory to be updated monthly.  For each health plan, the associated provider directory must include information about available telemedicine services and specifically described.

SOURCE: WAC 284-107-260. (Accessed Feb. 2021).

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, and 2018, and are required to issue another in 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:  SB 6163 – 2018 & SB 5385 (2020 Session).  (Accessed Feb. 2021).

Last updated 02/28/2021

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.

An appropriate history and evaluation of the patient must precede the rendering of any care, including provision of prescriptions.

Patient completion of a questionnaire does not, by itself, establish a practitioner-patient relationship, and therefore treatment, including prescriptions, based solely on a questionnaire does not constitute an acceptable standard of care.

Careful consideration should apply before prescribing DEA-controlled substances, and compliance with all laws and regulations pertaining to such prescriptions is expected.

Treatment, including issuing a prescription, based solely on an online questionnaire or consultation does not constitute an acceptable standard of care.

SOURCE: Washington Medical Quality Assurance Commission, Guidelines for Appropriate Use of the Internet in Medical Practice, p. 3-4, Oct. 3, 2014, (Accessed Feb. 2021).

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 Feb. 2021).

Last updated 02/28/2021

Professional Boards Standards

Physical Therapy Practice Board

SOURCE: WAC 246-915-187 (Accessed Feb. 2021).

Occupational Therapy Practice Board

SOURCE: WAC 246-847-176 (Accessed Feb. 2021).