West Virginia

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

West Virginia Medicaid

Administrator

Bureau for Medical Services, under the West Virginia Dept. of Health and Human Resources

Regional Telehealth Resource Center

Mid-Atlantic 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, NLC, ASLP-IC, EMS
Consent Requirements: Yes

Last updated 02/28/2021

Audio-Only Delivery

Medicaid:  Non-emergent E&M for FQHCs/RHCs (revised)

STATUS: Active

Medicaid:  Non-Emergent E&M Services via Telehealth

STATUS: Revised, see above source

Medicaid: Telehealth Modality for Physical, Occupational or Speech Therapy

STATUS: Active

Medicaid: Telehealth Modality

STATUS: Active

Medicaid 1915(c) Waiver: Appendix K – Intellectual/Developmental Disability Waiver

STATUS: Expired June 30, 2020; extension approved

Medicaid 1915(c) Waiver: Appendix K – Aged and Disabled Disability Waiver

STATUS: Expired June 30, 2020; extension approved

Medicaid 1915(c) Waiver: Appendix K – Traumatic Brain Injury Disability Waiver

STATUS: Expired June 30, 2020; extension approved

Medicaid 1915(c) Waiver: Appendix K – Children with Serious Emotional Disorder

STATUS: Expired June 30, 2020; extension approved

Medicaid 1915(c) Waiver: Children with Serious Emotional Disorders 1915 C Waiver

STATUS: Expired March 31, 2021

Medicaid 1915(c) Waiver: Appendix K Extension – Combined Waivers

STATUS: Expired March 31, 2021

Last updated 02/28/2021

Cross State Licensing

Board of Medicine:  Emergency Registration to Practice

STATUS: Active, until WV state of emergency ends

Last updated 02/28/2021

Easing Prescribing Requirements

Board of Medicine:  Audio-only Telemedicine Technologies

STATUS: Active, until WV state of emergency ends

HB 2016: Waiving Standards of Care for Patient-Provider relationship

STATUS: Pending

Last updated 02/28/2021

Miscellaneous

Board of Speech Language Pathology and Audiology: Telepractice Rule Suspension

STATUS: Active, until WV state of emergency ends

Last updated 02/28/2021

Originating Site

Medicaid: Telehealth Educational Handout

STATUS: Active

Medicaid:  Non-emergent E&M for FQHCs/RHCs (revised)

STATUS: Active

Medicaid:  Non-Emergent E&M Services via Telehealth

STATUS: Revised, see above source

Medicaid: Teledentistry

STATUS: Active, until the end of the federal PHE declaration or until further notice

Medicaid: Telehealth Modality for Physical, Occupational or Speech Therapy

STATUS: Active

Medicaid: Telehealth Modality

STATUS: Active

Last updated 02/28/2021

Private Payer

Office of Insurance Commissioner: Coverage of Telehealth Services and Coronavirus (COVID-19)

STATUS: Superseded by HB 4003

Office of Insurance Commissioner: Modified Coverage of Telehealth Services and Coronavirus (COVID-19)

STATUS: Varies

Last updated 02/28/2021

Provider Type

Medicaid:  Non-emergent E&M for FQHCs/RHCs (revised)

STATUS: Active

Medicaid:  Non-Emergent E&M Services via Telehealth

STATUS: Revised, see above source

Medicaid: Teledentistry

STATUS: Active

Last updated 02/28/2021

Service Expansion

Medicaid: Psychological Testing and Evaluation Services

STATUS: Active, until the end of the federal PHE declaration or until further notice

Medicaid: Telehealth Educational Handout

STATUS: Active

Medicaid:  Non-emergent E&M for FQHCs/RHCs (revised)

STATUS: Active

Medicaid:  Non-Emergent E&M Services via Telehealth

STATUS: Revised, see above source

Medicaid: Teledentistry

STATUS: Active, until the end of the federal PHE declaration or until further notice

Medicaid: Telehealth Modality for Physical, Occupational or Speech Therapy

STATUS: Active

Medicaid: Telehealth Modality

STATUS: Active

Last updated 02/28/2021

Definitions

“Telehealth: The use of electronic information and telecommunications technologies to provide professional health care; often used to connect practitioners and clinical experts in large hospitals or academic medical centers with patients in smaller hospitals or critical access hospitals which are typically located in more remote locations; and can assure that these remotely located patients enjoy the same access to potentially life-saving technologies and expertise that are available to patients in more populated parts of the country.”

“A telecommunication system is defined as an interactive audio and video system that permits real time communication between the member at the originating site and the practitioner at the distant site.  The telecommunication technology must allow the treating practitioner at the distant site to perform a medical examination of the member that substitutes for an in-person encounter.”

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed Feb. 2021).

Telehealth – for purposes of Medicaid, telemedicine seeks to improve a patient’s health by permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–200 Definitions and Acronyms.  (Nov. 1, 2016) (Accessed Feb. 2021).

“Telehealth Services: Health care services provided through advanced telecommunications technology from one location to another. Medical information is exchanged in real-time communication from an Originating Site, where the participant is located, to a Distant Site, where the provider is located, allowing them to interact as if they are having a face-to-face, “hands-on” session.”

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter 522 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 17. (Jul. 1, 2019) (Accessed Feb. 2021).

Last updated 02/28/2021

Live Video

POLICY

To utilize Telehealth, providers must document that the service was rendered under that modality. When filing a claim, the provider must bill the service code with Place of Service code 02. West Virginia Medicaid covers and reimburses Telehealth services that are identified in designated polices as appropriate to be rendered through this modality.

West Virginia Medicaid does not limit Telehealth services to members in non-metropolitan statistical professional shortage areas as defined by the Centers for Medicare and Medicaid Services (CMS) Telehealth guidance.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Revised Mar. 1 ,2020.) (Accessed Feb. 2021).

Federally Qualified Health Center and Rural Health Clinic Services:

The member must be able to see and interact with the off-site provider at the time services are provided via telehealth.  Services provided via videophone or webcam are not covered.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter 522.8 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 9. (July 1, 2019.) (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

See the applicable chapters of the WV BMS Policy Manual for more detail on specific services, including whether telehealth is an accepted modality to render the service. If not indicated as available, telehealth should be considered a non-covered modality to render the service.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. Revised Mar. 1, 2020.  (Accessed Feb. 2021).

School-based health services manual refers to the Telehealth Chapter (519.17) of the practitioner manual, and lists under each code in the manual whether or not it is eligible for telehealth.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–538 School-Based Health Services. Revised Aug. 1, 2019 (Accessed Feb. 2021).

Targeted case management can be conducted through telemedicine with the exception of the required 90 day face-to-face encounter with the targeted case manager.

SOURCE: WV Dept. of Health and Human Svcs., Medicaid Provider Manual, Chapter 523: Targeted Case Management, p. 13 (Jul. 1, 2016), (Accessed Feb. 2021).

WV Medicaid encourages providers to render services via telehealth in the Behavioral Health Clinic Services program and for substance use disorder (SUD) waiver services.  Under each code in the manuals, it lists whether or not the service is eligible for telehealth.

SOURCE: WV Dept. of Health and Human Service Medicaid Provider Manual, Chapter—503.12 Licensed Behavioral Health Center Services (Jul. 15, 2018); 504.10 Substance Use Disorder Services (Jul. 1, 2019); 521.9 Behavioral Health Outpatient Services (Jan. 15, 2018). (Accessed Feb. 2021).


ELIGIBLE PROVIDERS

Authorized distant site providers include:

  • Physicians;
  • Physician Assistants (PA);
  • Advanced Practice Registered Nurses (APRN)/Nurse Practitioners (NP)
  • Certified Nurse Midwife (CNM);
  • Clinical Nurse Specialists (CNS);
  • Community Mental Health Center (CMHC);
  • Licensed Behavioral Health Center (LBHC);
  • Licensed Psychologists (LP) and Supervised Psychologist (SP);
  • Licensed Independent Clinical Social Worker (LICSW); and
  • Licensed Professional Counselor (LPC)

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.1 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed Feb. 2021).

FQHC and RHC may only serve as a distant site for Telehealth services provided by a psychiatrist or psychologist and are reimbursed at the encounter rate.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.1 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) & WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter 522 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 9. (Jul. 1, 2019) (Accessed Feb. 2021).


ELIGIBLE SITES

Authorized originating sites:

  • Offices of physicians or practitioners;
  • Hospitals;
  • Critical Access Hospitals (CAH);
  • Rural Health Clinics (RHCs);
  • Federally Qualified Health Centers (FQHCs);
  • Hospital-based or CAH-based Renal Dialysis Centers (including satellites);
  • Skilled Nursing Facilities (SNF);
  • Licensed behavioral health centers
  • Community Mental Health Centers (CMHC);
  • School-Based Health Service sites; and
  • Homes of members who are receiving treatment of substance abuse and/or mental health disorders via telehealth as identified in Chapters 503, 504, 521, 522, and 538 of the WV BMS Policy Manual.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.1 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

WV Medicaid does not limit telehealth services to members in non-metropolitan statistical professional shortage areas as defined by CMS telehealth guidance.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.1 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed Feb. 2021).


FACILITY/TRANSMISSION FEE

An originating site must bill the appropriate telehealth originating site code (Q3014) unless the originating site is the home of the member. , However facility fees are not covered.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. Revised Mar. 1, 2020 (Accessed Feb. 2021).

Last updated 02/28/2021

Miscellaneous

See manual for equipment standards and requirements.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.2 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed Feb. 2021).

Additional instructions regarding telehealth standards and billing available in the following manuals:  Licensed Behavioral Health Center Services (Ch. 503); Substance Use Disorder Services (Ch. 504); Behavioral Health Outpatient Services (Ch. 521); Targeted Case Management (Ch. 523). Limited to specific CPT codes.

SOURCE: WV Dept. of Health and Human Service Medicaid Provider Manual, Chapter—503.12 Licensed Behavioral Health Center Services (Jul. 15, 2018); 504.10 Substance Use Disorder Services (Jul. 1, 2019); 521.9 Behavioral Health Outpatient Services (Jan. 15, 2018); 523.3 Targeted Case Management (Revised Jul. 1, 2016) (Accessed Feb. 2021).

Last updated 02/28/2021

Out of State Providers

No Reference Found

Last updated 02/28/2021

Overview

West Virginia Medicaid reimburses for live video under some circumstances. Reimbursement is only made for real-time communications, therefore there is no reimbursement for store-and-forward or remote patient monitoring.

Last updated 02/28/2021

Remote Patient Monitoring

POLICY

No reimbursement. WV Medicaid only reimburses for real time communications.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed Feb. 2021).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 02/28/2021

Store and Forward

POLICY

Store and forward means the asynchronous computer-based communication of medical data or images from an originating location to a health care provider at another site for the purpose of diagnostic or therapeutic assistance.

Store and Forward telehealth services may only be utilized for specific codes for the Optometrist provider type only.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed Feb. 2021).


ELIGIBLE SERVICES/SPECIALTIES

Only available for optometrist providers for two specific codes.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 02/28/2021

Definitions

Newly Passed Legislation (Now Effective)

“Telehealth services” means the use of synchronous or asynchronous telecommunications technology by a health care practitioner to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term does not include audio-only telephone calls, e-mail messages, or facsimile transmissions.

SOURCE: WV Statute Sec. 5-16-7b & 33-53-1 (HB 4003 – 2020 session). (Accessed Feb. 2021).

Network Adequacy: “Telemedicine” or “Telehealth” means health care services provided through telecommunications technology by a health care professional who is at a location other than where the covered person is located.

SOURCE: WV Code Sec. 33-53-1 (HB 4061 – 2020 Session), & 33-55-1. (Accessed Feb. 2021).

Last updated 02/28/2021

Parity

SERVICE PARITY

The insurer shall provide coverage of health care services provided through telehealth services if those same services are covered through face-to-face consultation by the policy.

SOURCE: WV Statute Sec. 5-16-7b & 33-53-1 (HB 4003 – 2020 session). (Accessed Feb. 2021).


PAYMENT PARITY

The insurer shall provide reimbursement for a telehealth service at a rate negotiated between the provider and the insurance company.

SOURCE: WV Statute Sec. 5-16-7b & 33-53-1 (HB 4003 – 2020 session). (Accessed Feb. 2021).

Last updated 02/28/2021

Requirements

Newly Passed Legislation (Now Effective)

An insurer shall provide coverage of health care services provided through telehealth services if those same services are covered through face-to-face consultation by the policy.  The insurer may not exclude a service for coverage solely because the service is provided through telehealth services.

An originating site may charge an insurer a site fee.

The coverage required by this section shall include the use of telehealth technologies as it pertains to medically necessary remote patient monitoring services to the full extent that those services are available.

SOURCE: WV Statute Sec. 5-16-7b & 33-53-1 (HB 4003 – 2020 session). (Accessed Feb. 2021).

Health carriers providing a network plan are required to maintain a network that is sufficient in numbers and appropriate types of providers. The commissioner shall determine sufficiency in accordance with the requirements of this section, and may establish sufficiency by reference to any reasonable criteria, which may include telemedicine or telehealth, among other components.

SOURCE: WV Code Sec. 33-53-3 (HB 4061 – 2020 Session), (Accessed Feb. 2021).

Last updated 02/28/2021

Cross State Licensing

Must hold active unexpired WV license.

SOURCE: WV Code Sec. 30-3-13 & 30-14-12d. (Accessed Feb. 2021).

Last updated 02/28/2021

Definitions

Recently Passed Legislation (Now Effective)

“Telehealth services” means the use of synchronous or asynchronous telecommunications technology by a health care practitioner to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration. The term does not include audio-only telephone calls, e-mail messages, or facsimile transmissions.

SOURCE: WV Statute Sec. 30-1025 (HB 4003 – 2020 session). (Accessed Feb. 2021). 

“Practice of telemedicine means the practice of medicine using communication tools such as electronic communication, information technology or other means of interaction between a licensed health care professional in one location and a patient in another location, with or without an intervening health care provider, and typically involves secure real-time audio/video conferencing or similar secure audio/video services, remote monitoring, interactive video and store-and-forward digital image or health data technology to provide or support health care delivery by replicating the interaction of a traditional in-person encounter between a provider and a patient. The practice of telemedicine occurs in this state when the patient receiving health care services through a telemedicine encounter is physically located in this state.”

SOURCE: WV Code Sec. 30-3-13.(b) (Accessed Sep. 2020). (Accesed Feb. 2021).

“Telemedicine” means the practice of medicine using tools such as electronic communication, information technology, store and forward telecommunication or other means of interaction between a physician in one location and a patient in another location, with or without an intervening health care provider.

“Telemedicine technologies” means technologies and devices which enable secure electronic communications and information exchange in the practice of telemedicine, and typically involve the application of secure real-time audio/video conferencing or similar secure video services, remote monitoring, or store-and-forward digital image technology to provide or support healthcare delivery by replicating the interaction of a traditional in-person encounter between a physician or podiatrist and a patient.

SOURCE: WV Code 30-14-12d.(a(4)) & (a(5)); WV Code, 30-3-13a.(a(4)) & (a(5)). (Accessed Feb. 2021).

“Telehealth” means the application of telecommunication, audio-visual, or other technologies that meets the applicable standard of care to deliver audiology or speech-language pathology services at a distance for assessment, intervention, or consultation.

SOURCE: WV Code Sec. 30-32A-2. (Accessed Feb. 2021).

Medication Assisted Treatment Program

“Telehealth” means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site.

SOURCE: WV Code Sec. 16-5Y-2. (Accessed Feb. 2021).

“Telehealth” means the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.

SOURCE: WV Code, Ch. 16, Article 2D, Sec. 16-2D-2.(45) (Accessed Feb. 2021).

Last updated 02/28/2021

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

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

Member of the Audiology & Speech-Language Pathology Interstate Compact.

SOURCE: ASLP Compact. (Accessed Feb. 2021).

Member of the Physical Therapist Licensure Compact

SOURCE: PT Compact (Accessed Feb. 2021).

Member of the Emergency Medical Services Personnel Licensure Compact

SOURCE: EMS Compact (Accessed Feb. 2021).

Member of the Nurse Licensure Compact

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

Last updated 02/28/2021

Miscellaneous

Recently Passed Legislation (Now Effective)

WV Statute requires each health care board to propose a rule for legislative approval to regulate telehealth practice that includes certain elements (see statute).

SOURCE: WV Statute Sec. 30-1-25 (HB 4003 – 2020 session). (Accessed  Feb. 2021).

Last updated 02/28/2021

Online Prescribing

A “valid patient-practitioner relationship” can be established through telemedicine in a manner approved by the appropriate board.

SOURCE: WV Code Sec. 30-5-4.(67) (Accessed Feb. 2021).

A physician-patient relationship cannot be established through audio only communication, text communications or any combination thereof.

A physician-patient relationship can be established through the use of telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing or similar secure video services during the initial physician-patient encounter; or for the practice of pathology and radiology, a physician-patient relationship may be established through store and forward telemedicine or other similar technologies.

A physician or podiatrist may not prescribe any pain-relieving controlled substance listed in Schedules II through V of the Uniform Controlled Substance Act as part of a course of treatment for chronic nonmalignant pain solely based upon a telemedicine encounter.

A physician or podiatrist who practices medicine to a patient solely through the utilization of telemedicine technologies may not prescribe to that patient any controlled substances listed in Schedule II of the Uniform Controlled Substances Act.  Certain exceptions apply.

A physician or health care provider may not prescribe any drug with the intent of causing an abortion.

SOURCE: WV Code 30-14-12d. (Accessed Feb. 2021).

Prohibits providers from issuing prescriptions, via electronic or other means, for persons without establishing an ongoing physician-patient relationship, wherein the physician has obtained information adequate to support the prescription.

Exceptions:

  • Documented emergencies;
  • On-call or cross-coverage situations;
  • Where patient care is rendered in consultation with another physician who has an ongoing relationship with the patient; and who has agreed to supervise the patient’s treatment, including use of any prescribed medications.

SOURCE: WV Code of State Rules Sec. 11-1A-12.2(k) (Accessed Feb. 2021).

A practitioner providing medication-assisted treatment may perform certain aspects of telehealth if permitted under his or her scope of practice.

SOURCE:  WV Code Sec. 16-5Y-5(r) (SB 273 – 2018).  (Accessed Feb. 2021).

 

Last updated 02/28/2021

Professional Board Standards

Board of Examiners for Speech-Language Pathology and Audiology

SOURCE: WV Admin. Law Sec. 29-1-15, (Accessed Feb. 2021).