West Virginia

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes* (CMS RPM Codes)
  • Audio Only: No

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: ASLP-IC, CC, EMS, IMLC, NLC, OT, PSY, PTC
  • Consent Requirements: Yes

FQHCs

  • Originating sites explicitly allowed for Live Video: Yes
  • Distant sites explicitly allowed for Live Video: Yes
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: No
  • Allowed to collect PPS rate for telehealth: Yes

STATE RESOURCES

  1. Medicaid Program: West Virginia Medicaid
  2. Administrator: Bureau for Medical Services, under the West Virginia Dept. of Health and Human Resources
  3. Regional Telehealth Resource Center: Mid-Atlantic Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 08/31/2022

Audio-Only Delivery

Medicaid: Telehealth Modality for Physical, Occupational or Speech Therapy

STATUS: Active

Medicaid: Telehealth Modality

STATUS: Active

Medicaid: Teledentistry

STATUS: Active

Medicaid: Telehealth Educational Handout

STATUS: Active

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

STATUS: Active, see waiver below for extension to six months following end of PHE.

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

STATUS: Active, see waiver below for extension to six months following end of PHE.

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

STATUS: Active, see waiver below for extension to six months following end of PHE.

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

STATUS: Active, see waiver below for extension to six months following end of PHE.

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

STATUS: Active, see waiver below for extension to six months following end of PHE.

Medicaid 1915(c) Waiver: Extension for waivers combined

STATUS:  Active, extended six months following end of PHE.

Last updated 08/31/2022

Cross State Licensing

Board of Medicine: Emergency Registration to Practice

STATUS: Active, until WV state of emergency ends

Office of Governor: Executive Order 7-20 – Suspends Licensing Requirements

STATUS: Active (EO 12-21 Clarified still in effect until terminated by subsequent EO)

Board of Speech Language Pathology and Audiology: Interstate Telepractice

STATUS: Active, expires on July 1, 2030.

Board of Speech Language Pathology and Audiology: Interstate Telepractice & Telepractice Rule Suspension

STATUS: Expired 6/8/2021, due to passage of HB 2024 which provided for cross-state licensee registration.  See more information HERE.

Last updated 08/31/2022

Easing Prescribing Requirements

Office of the Governor: Executive Order 17-20 – Waived In-Person Prescribing Requirements in Certain Instances

STATUS: Active (EO 12-21 Clarified still in effect until terminated by subsequent EO)

Board of Medicine: COVID-19 Information

STATUS: Active

Last updated 08/31/2022

Miscellaneous

Medicaid 1915(c) Waiver: Extension for waivers combined

STATUS: Active, extended six months following end of PHE.

Last updated 08/31/2022

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: Active

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

Medicaid: Provider Newsletter with updated place of service code billing guidance

STATUS: Active

Last updated 08/31/2022

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 08/31/2022

Provider Type

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

STATUS: Active

Medicaid:  Non-Emergent E&M Services via Telehealth

STATUS: Active

Medicaid: Teledentistry

STATUS: Active

Medicaid: Telehealth Educational Handout

STATUS: Active

Last updated 08/31/2022

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 09/02/2022

Definitions

“Telehealth services” means the use of synchronous or asynchronous telecommunications technology or audio only telephone calls 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 e-mail messages or facsimile transmissions.

“Virtual telehealth” means a new patient or follow-up patient for acute care that does not require chronic management or scheduled medications.

SOURCE: WV Statute Sec. 5-16-7b & 33-57-1. (Accessed Sept. 2022).

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. 33-55-1 & WV Admin. Law Sec. 114-100. (Accessed Sept. 2022).

Last updated 09/02/2022

Parity

SERVICE PARITY

A plan 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 plan may not exclude a service for coverage solely because the service is provided through telehealth services.

An insurer that issues, renews, amends, or adjusts a plan, policy, contract, or agreement on or after July 1, 2021, shall provide reimbursement for a telehealth service at a rate negotiated between the provider and the insurance company for the virtual telehealth encounter.  They shall also provide reimbursement for a telehealth service for an established patient, or care rendered on a consulting basis to a patient located in an acute care facility whether inpatient or outpatient on the same basis and at the same rate under a contract, plan, agreement, or policy as if the service is provided through an in-person encounter rather than provided via telehealth.  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 & 33-57-1. (Accessed Sept. 2022).


PAYMENT PARITY

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

The insurer shall provide reimbursement for a telehealth service for an established patient, or care rendered on a consulting basis to a patient located in an acute care facility whether inpatient or outpatient, on the same basis and at the same rate as if the service is provided through an in-person encounter rather than provided via telehealth.

SOURCE: WV Statute Sec. 5-16-7b & 33-57-1. (Accessed Sept. 2022).

Last updated 09/02/2022

Requirements

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 & 33-57-1. (Accessed Sept. 2022).

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. 33-55-3. (Accessed Sept. 2022).

Health carriers must create an access plan that addresses how they use telemedicine or telehealth or other technology to meet network access standards.

SOURCE: WV Admin Law Sec. 114-100. (Accessed Sept. 2022).

Last updated 09/02/2022

Definitions

“Telehealth” is the use of digital information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include video conferencing, the internet, store and forward imaging, streaming media, landline and wireless communications.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services, p. 5 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

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), p. 19-20 & Ch. 502 Children with Serious Emotional Disorder Waiver, 7/1/21, Pg. 67-68. (Accessed Sept. 2022).

“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 Sept. 2022).

Medication-Assisted Treatment Program Licensing Act

“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 Section 16-5Y-2. (Accessed Sept. 2022).

Certificate of Need

“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 Section 16-2D-2(45). (Accessed Sept. 2022).

Last updated 09/02/2022

Email, Phone & Fax

No reimbursement for FAX.

No reimbursement for email.

The Jan. 1, 2022 update to the WV Medicaid Provider Manual on Telehealth Services removed the reference to telephones under Non-Covered Services.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.2 Practitioner Services: Telehealth Services. p. 4, 6 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

FQHCs/RHCs, Behavioral Health Outpatient Services & Licensed Behavioral Health Centers

No reimbursement for telephone.

No reimbursement for FAX.

No reimbursement for email.

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). WV Dept. of Health and Human Svcs, Behavioral Health Outpatient Services Chapter 521, p. 9 (Jan. 15, 2018). WV Dept. of Health and Human Svcs, Licensed Behavioral Health Centers, Chapter 503, p. 9 (July 15, 2018). (Accessed Sept. 2022).

Substance Use Disorder

Reimbursement is not available for a telephone conversation, electronic mail message (e-mail), or facsimile transmission (fax) between a provider and a member except for targeted case management services.

SOURCE: WV Dept. Health and Human Svcs., Substance Use Disorder, Chapter 504, p. 10 (October 1, 2020). (Accessed Sept. 2022).

Children with Serious Emotional Disorder Waiver

Reimbursement is not available for a telephone conversation, electronic mail message (email), or facsimile transmission (fax) between a provider and a member except for wraparound facilitation services.

In extenuating circumstances, plan of care members may participate by teleconferencing (i.e., telephone).

SOURCE: WV Dept. of Health and Human Svcs, Children with Serious Emotional Disorder Waiver, Chapter 502, p. 14, 33 (July 1, 2021). (Accessed Sept. 2022).

Diabetes Self-Management Programs

Diabetes self-management programs may offer telehealth education when resources are limited, and may otherwise communicate by telephone when patients lack access to broadband internet.

Last updated 09/02/2022

Live Video

POLICY

The Medicaid plan, which issues, renews, amends, or adjusts a plan, policy, contract, or agreement on or after July 1, 2021, shall provide reimbursement for a telehealth service at a rate negotiated between the provider and the insurance company for virtual telehealth encounters. The Medicaid plan, which issues, renews, amends, or adjusts a plan, policy, contract, or agreement on or after July 1, 2021, shall provide reimbursement for a telehealth service for an established patient, or care rendered on a consulting basis to a patient located in an acute care facility whether inpatient or outpatient on the same basis and at the same rate under a contract, plan, agreement, or policy as if the service is provided through an in-person encounter rather than provided via telehealth.

SOURCE: WV Statute Sec. 9-5-28. (Accessed Sept. 2022).

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 or 10. West Virginia Medicaid covers and reimburses Telehealth services that are identified in designated policies 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., p. 2 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

Effective January 1, 2022, the CMS added place of service 10 – telehealth provided in a patient’s home. This is a location other than a hospital or other facility where the patient receives care in a private residence. The patient is in their home when receiving health services or health related services through telecommunication technology. Place of service 02 will still be utilized for telehealth provided other than in the patient’s home.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Newsletter, Qtr. 1 2022, p. 6. (Accessed Sept. 2022).

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 Sept. 2022).


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., p. 3 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

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, p. 9. (Accessed Sept. 2022).

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 Sept. 2022).

Manual on Children with Serious Emotional Disorder Waiver 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.

Many services, including Child and Family Team (CFT) meetings, can be provided via telehealth (i.e., video conferencing). This delivery method is reimbursable, for the wraparound facilitator, as it is considered a face-to-face meeting. In extenuating circumstances, plan of care (POC) members may participate by teleconferencing (i.e., telephone). Team members may not bill for the time spent in the POC, and the wraparound facilitator must note on the signature sheet that they attended by phone. The wraparound facilitator must obtain signatures within 10 days for any POC member who attended the meeting via telehealth or teleconference and must forward copies of the POC to all participating CFT members and the managed care organization (MCO) Care Manager within 14 days of the meeting. If the clinical record does not include a valid signature page with required signatures, in ink or in an electronic documentation system, the service plan will be invalid, and subsequently, no services provided under its auspices will be billable. Please see Chapter 519.17, Telehealth Services for more information on telehealth requirements.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Ch. 502 Children with Serious Emotional Disorder Waiver, 7/1/21, Pg. 33. (Accessed Sept. 2022).

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 (Oct. 1, 2020); 521.9 Behavioral Health Outpatient Services (Jan. 15, 2018); Children with Serious Emotional Disorder Waiver (July 1, 2021). (Accessed Sept. 2022).

Diabetes self-management programs may offer telehealth education when resources are limited, and may otherwise communicate by telephone when patients lack access to broadband internet.

SOURCE: WV Rule Sec. 64-115-1, (Accessed Sept. 2022).


ELIGIBLE PROVIDERS

Authorized distant site providers include:

  • Physicians;
  • Podiatrists;
  • 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. (Effective Jan. 1, 2022) p. 2-3. (Accessed Sept. 2022).

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.

The distant-site practitioner must bill the appropriate Current Procedural Technology/Healthcare Common Procedure Coding System (CPT/HCPCS) code with the appropriate Place of Service (02). The GT modifier is no longer required to be billed with the service code. Effective January 1, 2022, Telehealth provided in a patient’s home will require the appropriate Place of Service code 10.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services., p. 3 (Effective Jan. 1, 2022); 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 Sept. 2022).


ELIGIBLE SITES

Authorized originating sites:

  • Offices of physicians or practitioners;
  • Hospitals;
  • Critical Access Hospitals (CAH);
  • Rural Health Clinics (RHCs);
  • Federally Qualified Health Centers (FQHCs);
  • Renal Dialysis Facilities including Hospital-Based or CAH-Based Renal Dialysis Centers and satellites;
  • Skilled Nursing Facilities (SNF);
  • Licensed behavioral health centers;
  • Community Mental Health Centers (CMHC);
  • School-Based Health Centers;
  • University-Based Health Centers;
  • A patient’s home; and
  • Work location of a patient

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services., p. 2 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

The originating site may bill for an office, outpatient, or inpatient evaluation and management (E&M) service in addition to the Telehealth service and for other Medicaid-covered services the distant site orders, or for services unrelated to the medical problem for which the Telehealth service was requested.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services., p. 3 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

Effective January 1, 2022, the CMS added place of service 10 – telehealth provided in a patient’s home. This is a location other than a hospital or other facility where the patient receives care in a private residence. The patient is in their home when receiving health services or health related services through telecommunication technology. Place of service 02 will still be utilized for telehealth provided other than in the patient’s home.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Newsletter. Qtr. 1 2022. (Accessed Sept. 2022).


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 Practitioner Services: Telehealth Services., p. 2 (Effective Jan. 1, 2022). (Accessed Sept. 2022).


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., p. 3-4 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

Last updated 09/02/2022

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. p. 3 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

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 (Oct. 1, 2020); 521.9 Behavioral Health Outpatient Services (Jan. 15, 2018); 523.3 Targeted Case Management (Jul. 1, 2016). (Accessed Sept. 2022).

Last updated 09/02/2022

Out of State Providers

All interstate telehealth practitioners must be registered with the appropriate board in West Virginia.

Interstate: The provision of telehealth services to a patient located in West Virginia by a healthcare practitioner located in any other state or commonwealth of the United States. The practitioner must be licensed and in good standing in the state they reside and not currently under investigation or subject to an administrative complaint. The provider must register as an interstate telehealth practitioner with the appropriate board in West Virginia and will be subject to the laws and requirements set forth by the registering board. The practitioner must also enroll with the current Medicaid fiscal agent(s) as an Interstate Provider. A practitioner currently licensed to practice in West Virginia is not subject to registration.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.2 Practitioner Services: Telehealth Services. p. 3, 5 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

Last updated 09/02/2022

Overview

West Virginia Medicaid reimburses for live video under some circumstances. Reimbursement is largely limited to real-time communications, however store-and-forward services may be billed by ophthalmologists and optometrists with certain restrictions. Specific remote patient monitoring codes are also eligible for reimbursement.

Last updated 09/02/2022

Remote Patient Monitoring

POLICY

According to the WV Medicaid Telehealth Services Manual, only real-time communications are reimbursed. However, a WV Medicaid Provider Newsletter announced additions to the 2022 CPT code set, including five new codes to report therapeutic remote monitoring, expanding on remote physiologic monitoring codes created in 2020.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. p. 2 (Effective Jan. 1, 2022); WV Dept. of Health and Human Svcs. Medicaid Provider Newsletter, Qtr. 1 2022, p. 6. (Accessed Sept. 2022).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 09/02/2022

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.

Ophthalmologists and Optometrists may bill store and forward telehealth services (92227 and 92228) in combination with certain diagnosis restrictions.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Effective Jan. 1, 2022) p. 3, 5. (Accessed Sept. 2022).


ELIGIBLE SERVICES/SPECIALTIES

Only available for ophthalmologist and optometrist providers for two specific codes.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Effective Jan. 1, 2022) p. 3. (Accessed Sept. 2022).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 08/31/2022

Cross State Licensing

A state licensing board shall issue an occupational license or other authorization to practice to a person upon application if they hold a valid license or authorization in another state, are in good standing with the board in every other state, and have established residency as a West Virginia resident. Additional requirements and applicable fees apply, see statute for further information.

SOURCE: WV Code Sec. 21-17-3, as added by HB 4634 (2022 Session). (Accessed Aug. 2022).

A registration issued pursuant to the provisions of or the requirements of this section does not authorize a health care professional to practice from a physical location within this state without first obtaining appropriate licensure.

By registering to provide interstate telehealth services to patients in this state, a health care practitioner is subject to:

  • The laws regarding the profession in this state, including the state judicial system and all professional conduct rules and standards incorporated into the health care practitioner’s practice act and the legislative rules of registering board; and
  • The jurisdiction of the board with which he or she registers to provide interstate telehealth services, including such board’s complaint, investigation, and hearing process.

A health care professional who registers to provide interstate telehealth services pursuant to the provisions of or the requirements of this section shall immediately notify the board where he or she is registered in West Virginia and of any restrictions placed on the individual’s license to practice in any state or jurisdiction.

SOURCE; WV Code Sec. 30-1-26. (Accessed Aug. 2022).

The practice of medicine occurs where the patient is located at the time the telemedicine technologies are used.

A physician or podiatrist who practices telemedicine must be licensed as provided in this article or registered as provided in §30-1-1 et seq. of this code.

This does not apply to:

  • An informal consultation or second opinion, at the request of a physician or podiatrist who is licensed to practice medicine or podiatry in this state:  Provided, that the physician or podiatrist requesting the opinion retains authority and responsibility for the patient’s care; and
  • Furnishing of medical assistance by a physician or podiatrist in case of an emergency or disaster, if no charge is made for the medical assistance.

SOURCE: WV Code Sec. 30-3-13a & 30-14-12d. (Accessed Aug. 2022).

Veterinarians

To provide veterinary care in the State of West Virginia via interstate telehealth services, an individual not otherwise licensed by the board must first apply for and obtain registration with the board. See statute for complete details.

SOURCE: WV Statute Sec. 30-10-24, as added by HB 4570 (2022 Session). (Accessed Aug. 2022).

Final Rule (Effective until August 1, 2030) – Speech Language Pathology and Audiology

See emergency rule for interstate telepractice requirements, including qualifications, fees and renewal protocols.

SOURCE: WV Rule 29-01-16. (Accessed Aug. 2022).

Final Rule (Effective until August 1st, 2027) – Medical Board

A health care practitioner who is not licensed in West Virginia may provide interstate telehealth services to patients located at an originating site in West Virginia, within the practitioner’s scope of practice, if the practitioner holds an interstate telehealth registration issued by the Board or pursuant to 11 CSR 14 during a declared state of emergency.

Health care practitioners who are not licensed in West Virginia may only provide telehealth services pursuant to this rule if the practitioner is eligible for an interstate telehealth registration.   See rule for complete details about the process of obtaining registration, fees, and renewal terms.

SOURCE: WV Admin Law 11-15-3 (Accessed Aug. 2022).

Final Rule (Effective until August 1st, 2027) – Dentistry

A dentist or dental hygienist desiring to provide teledentistry services in this state via interstate telehealth services, shall make application for a registration on a form prescribed by the Board.

See rule for more details about fees and renewal information.

SOURCE: WV Admin Law 5-16-3 (Accessed Aug. 2022).

Final Rule (Effective until August 1st, 2027) – Chiropractic Examiners & Osteopathic Medicine

A (profession) is eligible for registration as an interstate telehealth practitioner.  See rule for associated requirements.

SOURCE: WV Admin Law 4-9-2, p. 2. & WV Admin Law 24-10-3, p. 6. (Accessed Aug. 2022).

Final Rule (Effective until August 1, 2030) – Social Workers

A licensee shall only provide telehealth services in accordance with the respective scope of practice commensurate with his/her level of licensure.

Clinical social work services provided by individuals outside of the state may only be provided by a practitioner licensed at the clinical level.

All licensees of the Board providing telehealth services to clients outside the state of West Virginia shall comply with the laws and rules of that jurisdiction.

Social works eligible for out-of-state telehealth practitioner registration under certain circumstances.  See regulation for details.

SOURCE: WV Admin Law 25-1-5,6. (Accessed Aug. 2022).

Final Rule (Effective until August 1, 2027) – Nurses

A registered nurse or advanced practice registered nurse who are not licensed in West Virginia or practicing on a multistate Registered Nurse practice privilege many only provide telehealth services pursuant to this rule if the nurse is eligible for an interstate telehealth registration.  See regulation for additional requirements.

SOURCE: WV Admin Law 19-16-4. (Accessed Aug. 2022).

Emergency Rule (Effective until August 1st, 2027) – Professional Counselors & Marriage and Family Therapists 

A professional counselor and marriage and family therapist who is not licensed in West Virginia may provide interstate Telehealth Services to clients located in West Virginia, within scope of practice, if holding an interstate telehealth registration issued by the Board. See regulation for additional requirements.

SOURCE: WV Admin Law 27-14-3. (Accessed Aug. 2022).

Last updated 08/31/2022

Definitions

“Telehealth services” means the use of synchronous or asynchronous telecommunications technology or audio only telephone calls 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 internet questionnaires, e-mail messages, or facsimile transmissions.

SOURCE: WV Statute Sec. 30-1-26. (Accessed Aug. 2022).

“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 Aug. 2022).

“Telemedicine” means the practice of medicine using tools such as electronic communication, information technology, store and forward telecommunication, audio only telephone calls, or other means of interaction between a physician or podiatrist 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 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, or audio only telephone calls to provide or support health care delivery by replicating the interaction of a traditional in-person encounter between a physician or podiatrist and a patient.

SOURCE: WV Statute Sec. 30-3-13a & 30-14-12d. (Accessed Aug. 2022).

Veterinarians

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

SOURCE: WV Statute Sec. 30-10-24, as added by HB 4570 (2022 Session). (Accessed Aug. 2022).

Speech-Language Pathologists and Audiologists Compact

“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 Aug. 2022).

Dentistry (Final Rule, Expires August 1, 2027)

“Teledentistry” or “Teledentistry services” means the use of synchronous or asynchronous telecommunications technology or audio only telephone calls by a dentist or dental hygienist to provide health care services, within their scope of practice, 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 internet questionnaires, e-mail messages, or facsimile transmissions.

SOURCE: WV Admin Law 5-16-2. (Accessed Aug. 2022).

Board of Nursing, Board of Osteopathic Medicine, Board of Medicine (Final Rule, Expires Aug. 1, 2027)

“Telehealth services” means the use of synchronous or asynchronous telecommunications technology or audio only telephone calls by (profession) 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 internet questionnaires, e-mail messages, or facsimile transmissions.

“Telemedicine technologies” means technologies and devices which enable secure 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, or audio only telephone calls to provide or support health care delivery by replicating the interaction of a traditional in-person provider and a patient.

SOURCE: WV Admin Law 19-16-2. (Nursing). WV Admin Law 24-10-2. (Osteopathic Medicine). WV Admin Law 11-15-2. (Medicine). (Accessed Aug. 2022).

Board of Social Work (Final Rule, Expires August 1, 2030)

“Telehealth services” means the use of synchronous or asynchronous telecommunications technology or audio only telephone calls 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 internet questionnaires, e-mail messages, or facsimile transmissions.

SOURCE: WV Admin Law 25-1-2.(Accessed Aug. 2022).

Board of Counseling Examiners (Emergency Rule, Expires Aug. 1, 2027)

“Telehealth services” means the use of synchronous or asynchronous telecommunications technology or audio only telephone calls by a licensed professional counselor or licensed marriage and family therapist to provide services, including. but not limited to, assessment, diagnosis, consultation and treatment.  The term does not include internet questionnaires, email messages, or facsimile transmissions.

“Telemedicine technologies” means technologies and devices which enable secure 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, or audio only telephone calls to provide or support health care delivery by replicating the interaction of a traditional in-person counseling session.

SOURCE: WV Admin Law 27-14-2. (Accessed Aug. 2022).

Board of Nursing (Final Rule, Expires Aug. 1, 2027)

“Virtual telehealth” means a new patient or follow-up patient for acute care that does not require chronic management or scheduled medications.

SOURCE: WV Admin Law 19-16-2. (Accessed Aug. 2022).

Board of Chiropractic Examiners (Final Rule, Expires Aug. 1, 2027)

“Telehealth services” means the use of synchronous or asynchronous telecommunications technology or audio only telephone calls by a health care practitioner to provide chiropractic services for assessment, intervention and/or consultation.  The term does not include internet questionnaires, email messages, or facsimile transmissions, nor does it include promoting or soliciting patients.

SOURCE: WV Admin Law 4-9-2. (Accessed Aug. 2022).

Speech Language Pathology and Audiology (Final Rule, Expires August 1, 2030)

“Telepractice Services” is defined as the application of telecommunication technology to deliver speech-language pathology and/or audiology services at a distance for assessment, intervention and/or consultation.

SOURCE: WV Rule 29-01-2. (Accessed Aug. 2022).

Last updated 08/31/2022

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. The IMLC. (Accessed Aug. 2022).

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

SOURCE: ASLP Compact. (Accessed Aug. 2022).

Member of the Physical Therapist Licensure Compact

SOURCE: PT Compact (Accessed Aug. 2022).

Member of the Emergency Medical Services Personnel Licensure Compact

SOURCE: EMS Compact (Accessed Aug. 2022).

Member of the Nurse Licensure Compact

SOURCE: Nurse Licensure Compact (Accessed Aug. 2022).

Member of the Psychology Interjurisdictional Compact.

SOURCE: PSYPACT Map (Accessed Aug. 2022).

Member of the Occupational Therapy Licensure Compact.

SOURCE: Occupational Therapy Licensure Compact. (Accessed Aug. 2022). 

Member of the Counseling Compact.

SOURCE: Counseling Compact Map. (Accessed Aug. 2022).

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

Last updated 09/02/2022

Miscellaneous

Final Rule (Effective until August 1, 2030) – Social Workers

A social worker shall maintain current competence in the use of telehealth and technology through relevant continuing education or consultation.

SOURCE: WV Admin Law 25-1-5. (Accessed Sept. 2022).

Final Rule (Effective until August 1. 2032) – Teledentistry

A dentist registered to provide teledentistry services shall complete continuing education as required by the State her or she is licensed in, but shall complete 3 hours of drug diversion as set forth in subdivision 3.5.4. of this rule every two years.5.2. A dental hygienist registered to provide teledentistry services shall complete continuing education as required by the State her or she is licensed in.

SOURCE: WV Admin Law 5-11-5. (Accessed Sept. 2022)

HB 4333 (2022 Session) – Speech-Language Pathology and Audiology & Hearing-Aid Dealers and Fitters

The Board of Examiners for Speech-Language Pathology and Audiology is required to propose rules including guidelines for telepractice that also apply to hearing aid fitters.

SOURCE: WV Statute Sec. 30-32-7 and 30-26-21, as amended by HB 4333 (2022 Session). (Accessed Sept. 2022).

Last updated 08/31/2022

Online Prescribing

Each health care board is required to propose an emergency rule for telehealth regulation. The rule must include a prohibition of prescribing any controlled substance listed in Schedule II of the Uniform Controlled Substance Act, unless authorized by another section: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an established patient.

The standard of care shall require that with respect to the established patient, the patient shall visit an in-person health care practitioner within 12 months of using the initial telemedicine service or the telemedicine service shall no longer be available to the patient until an in-person visit is obtained. This requirement may be suspended, in the discretion of the health care practitioner, on a case-by-case basis, and it does not apply to the following services: acute inpatient care, post-operative follow-up checks, behavioral medicine, addiction medicine, or palliative care.

SOURCE: WV Statute Sec. 30-1-26. (Accessed Aug. 2022).

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

SOURCE: WV Code Sec. 30-5-4. (Accessed Aug. 2022).

A physician-patient relationship may not be established through:

  • Text-based communications such as e-mail, Internet questionnaires, text-based messaging, or other written forms of communication.
If an existing physician-patient relationship is not present prior to the utilization to telemedicine technologies, or if services are rendered solely through telemedicine technologies, a physician-patient relationship may only 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;
  • For the practice of pathology and radiology, a physician-patient relationship may be established through store and forward telemedicine or other similar technologies; or
  • Through the use of audio-only calls or conversations that occur in real time. Patient communication though audio-visual communication is preferable, if available or possible. Audio-only calls or conversations that occur in real time may be used to establish the physician-patient relationship.

Once a physician-patient relationship has been established, either through an in-person encounter or in accordance with the above, the physician may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.

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: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an established patient.

The prescribing limitations do not apply when a physician is providing treatment to patients who are minors, or if 18 years of age or older, who are enrolled in a primary or secondary education program and are diagnosed with intellectual or developmental disabilities, neurological disease, Attention Deficit Disorder, Autism, or a traumatic brain injury in accordance with guidelines as set forth by organizations such as the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, or the American Academy of Pediatrics. The physician must maintain records supporting the diagnosis and the continued need of treatment.

The prescribing limitations do not apply to a hospital, excluding the emergency department, when a physician submits an order to dispense a controlled substance, listed in Schedule II of the Uniform Controlled Substances Act, to a hospital patient for immediate administration in a hospital.

A physician or podiatrist may not prescribe any pain-relieving controlled substance listed in Schedule II of the Uniform Controlled Substance Act as part of a course of treatment for chronic nonmalignant pain solely based upon a telemedicine encounter: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an established patient.

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

These provisions do not prohibit the use of audio-only or text-based communications by a physician who is:

  • Responding to a call for patients with whom a physician-patient relationship has been established through an in-person encounter by the physician;
  • Providing cross coverage for a physician who has established a physician-patient or relationship with the patient through an in-person encounter; or
  • Providing medical assistance in the event of an emergency.

SOURCE: WV Statute Sec. 30-14-12d & 30-3-13a, (Accessed Aug. 2022).

“Dishonorable, unethical or unprofessional conduct of a character likely to deceive, defraud or harm the public or any member thereof” includes practice of providing treatment recommendations relating to issuing prescriptions, via electronic or other means, for persons without establishing an on-going physician-patient relationship wherein the physician has obtained information adequate to support the prescription: Provided, That this definition does not apply: in a documented emergency; or in an on-call or cross coverage situation; or 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) p. 19. (Accessed Aug. 2022).

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). (Accessed Aug. 2022).

Veterinarians

A veterinarian-client-patient relationship is required for providing veterinary care in the State of West Virginia via telehealth services. The veterinary care professional shall perform an in person exam within the 12 months prior, and at least every 12 months thereafter, or the telehealth service shall no longer be available to the patient. Such relationship exists when:

  • A veterinarian assumes responsibility for medical judgments regarding the health of an animal and the client who is the owner or owner’s advocate of the animal consents to the veterinarian’s treatment plan; and 
  • A veterinarian, through personal examination of an animal or a representative sample of a herd or flock, obtains sufficient information to make at least a general or preliminary diagnosis of the medical condition of the animal, herd or flock, which diagnosis is expanded through medically appropriate visits to the premises where the animal, herd or flock is kept,
  • In the event of an imminent, life-threatening emergency veterinary care may be provided in this State via telehealth services without an existing veterinarian-client-patient relationship or an in-person visit within 12 months.

A registrant shall not prescribe any controlled substance listed in Schedule II of the Uniform Controlled Substance Act via interstate telehealth services.

SOURCE: WV Statute Sec. 30-10-24, as added by HB 4570 (2022 Session). (Accessed Aug. 2022).

Final Rule (Effective until August 1st, 2027) – Dentistry

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

  • obtained or caused to be obtained a health and dental history of the patient
  • performed or caused to be performed an appropriate examination of the patient, either physically, through use of instrumentation and diagnostic equipment by which digital scans, photographs, images, and dental records are able to be transmitted electronically, or through use of face-to-face interactive two-way real-time communications services or store-and-forward technologies
  • provided information to the patient about the services to be performed
  • initiated additional diagnostic tests or referrals as needed; or
  • through audio only calls or conversations that occur in real time

In cases in which a dentist is providing teledentistry, the examination required shall not be required if the patient has been examined in person by a dentist licensed by the board within the twelve months prior to the initiation of teledentistry and the patient’s dental records of such examination have been reviewed by the practitioner providing teledentistry.

SOURCE: WV Admin Law 5-16-4. (Accessed Aug. 2022).

Final Rule (Effective until August 1st, 2027) – Medical Board

Among other ways, a provider-patient relationship is formed when a provider serves a patient’s medical needs, examines, diagnoses or treats a patient, or agrees to examine, diagnose or treat a patient.

A provider-patient relationship may be established through:

  • An in-person patient encounter;
  • Store and forward telemedicine or other similar technologies for the practice of pathology and radiology;
  • Telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial provider-patient encounter; or
  • Audio-only calls or conversations that occur in real time.

While real-time audio-only communications may be utilized to establish the provider-patient relationship, patient communication though audio-visual communication is preferable, if available or possible.  Real-time audio-only communications may not be utilized when its use does not conform to the standard of care.

The provider-patient relationship may not be established through text-based communications such as email, internet questionnaires, text-based messaging, or other written forms of communication.

A telehealth provider’s selection of telemedicine technologies for a patient encounter must permit the provider to meet the standard of care for the patient’s particular health issue and presentation.  Treatment, including issuing a prescription, based solely on an online questionnaire, does not conform to the standard of care.

When prescribing to a patient via telemedicine, a telehealth provider shall prescribe within the prescriptive authority of the provider’s profession in West Virginia.

A telehealth provider who provides health care to a patient solely through the use of telemedicine technologies is prohibited from prescribing a controlled substance listed in Schedule II of the Uniform Controlled Substance Act except under the following circumstances:

  • The patient is an established patient of the prescribing telehealth provider’s group practice;
  • The provider submits an order to dispense a Schedule II controlled substance to a hospital patient, other than in the emergency department, for immediate administration in a hospital
  • The telehealth provider is treating patients who are minors, or if 18 years of age or older, who are emolled in a primary or secondary education program and are diagnosed with intellectual or developmental disabilities, neurological disease, Attention Deficit Disorder, Autism, or a traumatic brain injury in accordance with guidelines as set forth by organizations such as the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, or the American Academy of Pediatrics. The provider must maintain records supporting the diagnosis and the continued need of treatment.

See rule for additional requirements for prescribing controlled substances.

A telehealth provider may not, based solely upon a telemedicine encounter, prescribe any drug with the intent of causing an abortion.

SOURCE: WV Admin Law 11-15-6, 7 & 8. (Accessed Aug. 2022).

Final Rule (Effective until August 1st, 2027) – Board of Nursing

A practitioner-patient relationship may be established through:

  • An in-person patient encounter;
  • Telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial provider-patient encounter; or
  • Audio-only calls or conversations that occur in real time.

While real-time audio-only communications may be utilized to establish the practitioner-patient relationship, patient communication through audio-visual communication is preferable, if available or possible.  Real-time audio-only communications may not be utilized when its use does not conform to the standard of care.

The practitioner-patient relationship may not be established through text-based communications such as email, internet questionnaires, text-based messaging, or other written forms of communication.

After a practitioner-patient relationship has been established, a practitioner may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.

A telehealth provider’s selection of telemedicine technologies for a patient encounter must permit the provider to meet the standard of care for the patient’s particular health issue and presentation.  Treatment, including issuing a prescription if the nurse has prescriptive authority, based solely on an online questionnaire, does not conform to the standard of care.

The standard of care requires a telehealth provider to verify that a patient has visited an in-person health care practitioner within twelve months of an initial telehealth service by the provider or the provider’s telehealth service or company. Continued treatment of a patient solely through telemedicine technologies after an initial telehealth encounter, with no intervening in-person health services, violates the standard of care. The provisions of this subsection do not apply to acute inpatient care, post-operative follow-up checks, behavioral medicine, addiction medicine, or palliative care; and may be suspended, in the discretion of the telehealth provider, on a case-by-case basis. If suspended, the telehealth provider must document the reason for suspending the in-person visit requirement in the patient medical record.

APRNs:  When prescribing to a patient via telemedicine, a telehealth provider shall prescribe within the prescriptive authority of the provider’s profession in the state of West Virginia pursuant to qualified advanced practice registered nurses to prescribe prescription drugs in accordance with the provisions of W. Va. Code § 60A-9-5a and the requirements set forth in §30-7-15a, 15b, and 15c and 19 CSR 08.

See rule for requirements for controlled substances.

SOURCE: WV Admin Law 19-16-6, 7, 8 (Accessed Aug. 2022).

Final Rule (Effective until August 1st, 2027) – Board of Osteopathic Medicine

A provider-patient relationship may be established through:

  • An in-person patient encounter;
  • Store and forward telemedicine or other similar technologies for the practice of pathology and radiology;
  • Telemedicine technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial provider-patient encounter; or
  • Audio-only calls or conversations that occur in real time.

The provider-patient relationship may not be established through text-based communications such as email, internet questionnaires, text-based messaging, or other written forms of communication. After a provider-patient relationship has been established, a provider may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.

It is the standard of care in this state for health care practitioners to complete an appropriate controlled substance prescribing course prior to prescribing controlled substances to patients located in West Virginia.  The Board maintains a list of Board-approved courses in drug diversion training and best practice prescribing controlled substances training on its website.  Registrants may comply with the standard of care by completing a Board-approved course or a controlled substance continuing education course required by the registrant’s state of licensure.

When prescribing to a patient via telemedicine, a telehealth provider shall prescribe within the prescriptive authority of the provider’s profession in this state.

A telehealth provider who provides health care to a patient solely through the use of telemedicine technologies is prohibited from prescribing a controlled substance listed in Schedule II of the Uniform Controlled Substance Act except under the following circumstances:

  • The patient is an established patient of the prescribing telehealth provider’s group practice;
  • The provider submits an order to dispense a Schedule II controlled substance to a hospital patient, other than in the emergency department, for immediate administration in a hospital; or
  • The telehealth provider is treating patients who are minors, or if 18 years of age or older, who are enrolled in a primary or secondary education program and are diagnosed with intellectual or developmental disabilities, neurological disease, Attention Deficit Disorder, Autism, or a traumatic brain injury in accordance with guidelines as set forth by organizations such as the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, or the American Academy of Pediatrics. The provider must maintain records supporting the diagnosis and the continued need of treatment.

See additional requirements for providers who prescribe controlled substances.

A telehealth provider may not, based solely upon a telemedicine encounter, prescribe any drug with the intent of causing an abortion.

SOURCE: WV Admin Law 24-10-6, 7, 8 (Accessed Aug. 2022).

Final Rule (Effective until August 1, 2030) – Social Workers

The practitioner-client relationship is established at the time informed consent is obtained.

SOURCE: WV Admin Law 25-1-5. (Accessed Aug. 2022).

Final Rule (Effective until August 1, 2030) – Speech Language Pathology and Audiology

Established patient means a patient who has, within the last three years, received professional services, face-to-face, from the physician, qualified health care professional, or another physician or qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice.

The standard of care requires that with respect to the established patient, the patient shall visit an in-person health care practitioner within 12 months of using the initial telepractice service or the telepractice service shall no longer be available to the patient until an in-person visit is obtained. This requirement may be suspended, in the discretion of the health care practitioner, on a case-by-case basis, but it does not apply to the following services: acute inpatient care, post-operative follow-up checks, behavioral medicine, addiction medicine, or palliative care.

SOURCE: WV Rule 29-01-16. (Accessed Aug. 2022).

Last updated 08/31/2022

Professional Board Standards

Board of Examiners for Speech-Language Pathology and Audiology

SOURCE: WV Admin. Law Sec. 29-1-17 (Accessed Aug. 2022).

Board of Physical Therapy

SOURCE: WV Admin Law Sec. 16-01 & 05 (Accessed Aug. 2022).

Board of Occupational Therapy

SOURCE: WV Admin. Law Sec. 13-09 (Accessed Aug. 2022).

Veterinarians

SOURCE: WV Statute Sec. 30-10-24, as added by HB 4570 (2022 Session). (Accessed Aug. 2022).

Dentistry (Final Rule, Expires Aug. 1, 2027)

SOURCE: WV Admin Law 5-16 (Accessed Aug. 2022).

Board of Nursing (Final Rule, Expires Aug. 1, 2027)

SOURCE: WV Admin Law 19-16. (Accessed Aug. 2022).

Board of Osteopathic Medicine (Final Rule, Expires Aug. 1, 2027)

SOURCE:WV Admin Law 24-10 (Accessed Aug. 2022).

Board of Social Work (Final Rule, Expires Aug. 1, 2030)

SOURCE: WV Admin Law 25-1. (Accessed Aug. 2022).

Board of Medicine (Final Rule, Expires Aug. 1, 2027)

SOURCE: WV Admin Law 11-15 (Accessed Aug. 2022).

Board of Examiners in Counseling (Emergency Rule, Expires Aug. 1, 2027)

SOURCE: WV Admin Law 27-14 (Accessed Aug. 2022).

A health care board shall propose an emergency rule for legislative approval to regulate telehealth practice by a telehealth practitioner. The proposed rule shall consist of the following:

  1. The practice of the health care service occurs where the patient is located at the time the telehealth services are provided;
  2. The health care practitioner who practices telehealth shall be:
    1. Licensed in good standing in all states in which he or she is licensed and not currently under investigation or subject to an administrative complaint; and
    2. Registered as an interstate telehealth practitioner with the appropriate board in West Virginia;
  3. When the health care practitioner-patient relationship is established.
  4. The standard of care for the provision of telehealth services.  The standard of care shall require that with respect to the established patient, the patient shall visit an in-person health care practitioner within 12 months of using the initial telemedicine service or the telemedicine service shall no longer be available to the patient until an in-person visit is obtained.  This requirement may be suspended, in the discretion of the health care practitioner, on a case-by-case basis, and it does not to the following services: acute inpatient care, post-operative follow-up checks, behavioral medicine, addiction medicine, or palliative care.
  5. A prohibition of prescribing any controlled substance listed in Schedule II of the Uniform Controlled Substance Act, unless authorized by another section: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an established patient.
  6. Establish the conduct of a registrant for which discipline may be imposed by the board of registration.
  7. Establish a fee, not to exceed the amount to be paid by a licensee, to be paid by the interstate telehealth practitioner registered in the state.
  8. A reference to the Board’s discipline process.

SOURCE: WV Statute Sec. 30-1-26. (Accessed Aug. 2022).

Statutes include requirements for telemedicine practice standards for the physicians and osteopathic physicians and surgeons.

SOURCE: WV Statute Sec. 30-14-12d & 30-3-13a. (Accessed Apr. 2022).

Last updated 09/02/2022

Definition of Visit

A billable encounter is defined as a face-to-face visit between an eligible practitioner and a patient where the practitioner is exercising independent professional judgment consistent within the scope of their license.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual. Chapter 522.8 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 16. (July 1, 2019). (Accessed Sept. 2022).

Last updated 09/02/2022

Eligible Distant Site

FQHCs may now serve as a distant site for Telehealth consultations by a psychiatrist or psychologist only and be reimbursed at the encounter rate. The distant-site practitioner must bill the appropriate Current Procedural Technology/Healthcare Common Procedure Coding System (CPT/HCPCS) code with the appropriate Place of Service on a HCFA1500 form.

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); WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services., p. 3 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

Last updated 09/02/2022

Eligible Originating Site

Yes, FQHCs are listed as eligible originating medical facility sites.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services., p. 2 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

FQHCs or RHCs may serve as an originating site for Telehealth services, which is the location of the Medicaid member at the time the service is provided through a telecommunications system.

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 Sept. 2022).

Last updated 09/02/2022

Facility Fee

Enrolled FQHCs or RHCs that serve as an originating site for Telehealth services are paid an originating site facility fee.

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 Sept. 2022).

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., p. 2 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

Last updated 09/02/2022

Home Eligible

An FQHC or RHC encounter can also be a visit between a homebound patient and a Registered Nurse (RN), Licensed Practical Nurse (LPN), or Licensed Vocational Nurse (LVN) under certain conditions.

Homebound is an individual who is permanently or temporarily confined to his or her place of residence because of a medical or health condition. This individual may be considered homebound if he or she leaves their place of residence infrequently. “Place of Residence” does not include a hospital or long-term care facility. The member is provided with nursing care on a part-time or intermittent basis by an RN, LPN, or LVN that is employed by or receives compensation for the services from the facility. 42 CFR §405.2416

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual. Chapter 522.8 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 6, 8. (July 1, 2019). (Accessed Sept. 2022).

Generally, an authorized originating site may include the home.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services., p. 2 (Effective Jan. 1, 2022). (Accessed Sept. 2022).

Last updated 09/02/2022

Modalities Allowed

Live Video

WV Medicaid reimburses live video telehealth services. The member must be able to see and interact with the off-site provider at the time services (“real-time not delayed”) are provided through Telehealth. Services provided through 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 Sept. 2022).

See: WV Medicaid Live Video


Store and Forward

WV Medicaid does not explicitly cover store-and-forward for FQHCs.

See: WV Medicaid Store-and-Forward


Remote Patient Monitoring

WV Medicaid does not explicitly cover RPM for FQHCs.

See: WV Medicaid RPM


Audio-Only

Telehealth is not a telephone conversation, email, or faxed transmission between a healthcare provider and a member, or a consultation between two healthcare providers.

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 Sept. 2022).

See: WV Email, Phone & Fax

Last updated 09/02/2022

Patient-Provider Relationship

No explicit FQHC reference found.

For general information about forming a patient-provider relationship see: WV Professional Requirements Online Prescribing

Last updated 09/02/2022

PPS Rate

FQHCs or RHCs may now serve as a distant site for Telehealth consultations by a psychiatrist or psychologist only and be reimbursed at the encounter rate. The distant-site practitioner must bill the appropriate Current Procedural Technology/Healthcare Common Procedure Coding System (CPT/HCPCS) code with the appropriate Place of Service on a HCFA1500 form.

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 Sept. 2022).

Last updated 09/02/2022

Same Day Encounters

An FQHC may bill for up to three separate encounters per member occurring in one day:

  1. One medical encounter;
  2. One behavioral health encounter; and
  3. One dental encounter

Encounters with more than one health professional and multiple encounters with the same health professionals which take place on the same day and at a single location constitute a single visit, except when one of the following conditions exist:

  • After the first medical encounter, the patient suffers from an illness or injury requiring an additional diagnosis or treatment; or
  • The patient has a behavioral health visit with an LP, LICSW, LCSW, LGSW under the supervision of the LICSW or LCSW, LPC; or
  • The patient has a dental visit with the dentist. An Initial Preventive Physical Examination (IPPE) or an Annual Wellness Visit (AWV) is considered an FQHC or RHC encounter. However, if it is provided in conjunction with another service, it may not be billed separately.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual. Chapter 522.8 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 6. (July 1, 2019). (Accessed Sept. 2022).