West virginia

MASTER MEDICAID TELEHEALTH LAWS
WITH THE HELP FROM GD

Summary

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

Definitions

Telehealth: The use of electronic information and telecommunications technologies to provide professional health care; is 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.
“The 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 Jan. 15, 2016) (Accessed Apr. 2019).

 

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 Apr. 2019).

 

“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. 19. (Revised Dec. 1, 2015) (Accessed Apr. 2019).

Live Video

Policy

West Virginia Medicaid reimburses for a limited number of telehealth services that are provided to enrolled members by enrolled practitioners via a telecommunication system. WV Medicaid utilizes CMS guidance on Telehealth Services.

Source: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Revised Jan. 15, 2016) (Accessed Apr. 2019).
Eligible Services / Specialties

West Virginia Medicaid reimbursement of telehealth services is limited to certain CPT/HCPCS codes. See manual.

Source: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. Revised Jan. 15, 2016 (Accessed Apr. 2019).

 

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 Apr. 2019).

 

WV Medicaid encourages providers to render services via telehealth in the Behavioral Health Clinic Services program.

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, 2018); 521.9 Behavioral Health Outpatient Services (Jan. 15, 2018); 538.9 School-Based Health Services (Aug. 1, 2017). (Accessed Apr. 2019).
Eligible Providers

Authorized distant site providers include:
• Physicians;
• Physician Assistants (PA);
• Advanced Practice Registered Nurses (APRN)/Nurse Practitioners (NP);
• APRN/Certified Nurse Midwife (CNM);
• APRN/Clinical Nurse Specialists (CNS);
• Licensed Psychologists (LP); and
• Licensed Independent Clinical Social Worker (LICSW).

Source: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.1 Practitioner Services: Telehealth Services. (Revised Jan. 15, 2016) (Accessed Apr. 2019).

 

RHCs and FQHCs are not authorized to serve as distant sites for telehealth consultations, which is the location of the practitioner, and may not bill or include the cost of a visit on the cost report.

Source: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.1 Practitioner Services: Telehealth Services. (Revised Jan. 15, 2016) & WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter 522 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 10. (Revised Dec. 1, 2015) (Accessed Apr. 2019).
Eligible Sites

Authorized originating sites:
• Offices of physicians or practitioners;
• Private Psychological Practices;
• 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); and
• Community Mental Health Centers (CMHC).
Independent Renal Dialysis Facilities are not eligible originating sites.

Source: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.1 Practitioner Services: Telehealth Services. (Revised Jan. 15, 2016) (Accessed Apr. 2019).
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 Jan. 15, 2016) (Accessed Apr. 2019)
Facility/Transmission Fee

An originating site can bill for an originating site fee, 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 Jan. 15, 2016 (Accessed Apr. 2019).

Store-and-Forward

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 Jan. 19, 2016) (Accessed Apr. 2019).
Email / Phone / Fax

No reimbursement for email.
No reimbursement for telephone.
No reimbursement for FAX.

 

Source: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.2 Non-Covered Services: Telehealth Services. (Revised Jan. 15, 2016) & WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter 522.8 Federally Qualified Health Center and Rural Health Clinic Svcs. P. 10. (Revised Dec. 1, 2015) (Accessed Apr. 2019).
Consent

Provider must obtain patient’s (or legal guardian’s) written and verbal consent. The patient has the right to withdraw from telehealth services at any point for an alternative service.

Source: WV Dept. of Health and Human Svcs., Medicaid Provider Manual, Chapter 523: Targeted Case Management, p. 7 (Jul.1, 2016); 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, 2018); 521.9 Behavioral Health Outpatient Services. P. 9-10.(Jan. 15, 2018); 538.9 School-Based Health Services (Aug. 1, 2017). (Accessed Apr. 2019).
Miscellaneous

Additional instructions regarding telehealth standards and billing available in the following manuals:
Licensed Behavioral Health Center Services (Ch. 503); Behavioral Health Outpatient Services (Ch.521); School-Based Health Services (Ch. 538). 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); 521.9 Behavioral Health Outpatient Services (Jan. 15, 2018); 538.9 School-Based Health Services (Aug. 1, 2017). (Accessed Apr. 2019).

Professional Regulation /
Health & Safety

Definitions

“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 Apr. 2019).

 

“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(4) & (5) (SB 47 – 2016). (Accessed Apr. 2019).

 

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 (SB 454—2016). (Accessed Apr. 2019).
Consent

Must obtain consent.

Source: WV Code Sec. 30-14-12D.(d(6)) (SB 47 – 2016). (Accessed Apr. 2019).
Online Prescribing

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 real time video conferencing or storeand-forward (for pathology and radiology).
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.

Source: WV Code 30-14-12d (SB 47 – 2016). (Accessed Apr. 2019).

 

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 Apr. 2019).

 

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 Apr. 2019).
Cross-State Licensing

Member of the Interstate Medical Licensure Compact.

Source: Interstate Medical Licensure Compact. The IMLC. (Accessed Apr. 2019).

 

Member of the Physical Therapist Licensure Compact

Source: PT Compact (Accessed Apr. 2019).

 

Member of the Nurse Licensure Compact

Source: Nurse Licensure Compact (Accessed Apr. 2019).

 

Must hold active unexpired WV license.

Source: WV Code Sec. 30-3-13 & 30-14-12d (SB 47 – 2016). (Accessed Apr. 2019).
Miscellaneous

Professional Board Regulation:
• Board of Examiners for Speech-Language Pathology and Audiology

 

Source: WV Admin. Law Sec. 29-1-15) (Accessed Apr. 2019).

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