Last month, Washington state enacted legislation requiring coverage of medical services delivered through telehealth technology, making it the latest State to join the growing consensus that telehealth is an important component of efficiently delivering health care.
Under Washington’s telehealth parity law, health plans will be required to cover a service delivered through “telemedicine” or “store and forward technology,” if the plan covers the service when delivered in person; the service is medically necessary; and the service is “recognized as an essential health benefit” under the Affordable Care Act.
The legislation defines “telemedicine and “store and forward technology” as follows:
“Telemedicine” means the delivery of health care services through the use of interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. . . . “[T]elemedicine” does not include the use of audio-only telephone, facsimile, or email.
“Store and forward technology” means use of an asynchronous transmission of a covered person’s medical information from an originating site to the health care provider at a distant site which results in medical diagnosis and management of the covered person, and does not include the use of audio-only telephone, facsimile, or email.
As these definitions indicate, the legislation requires that the patient be located at an “originating site” – i.e., a medical facility such as a hospital or a physician’s office – for reimbursement for services provided through “store and forward technology.” No such requirement exists for coverage of “telemedicine.” In addition, the legislation specifies that services delivered through store and forward technology must involve “an associated office visit between the covered person and the referring health care provider,” though that visit can occur using telemedicine.
The legislation imposes similar requirements on Medicaid managed care organizations. That is, Medicaid managed care entities will be required to cover medically necessary state plan services delivered through telemedicine or store and forward technology, subject to the same conditions that apply in the commercial market.
Finally, the legislation specifies that hospitals with patients receiving telemedicine services can “rely on a distant site hospital’s decision to grant or renew clinical privileges or association of the physician,” if certain conditions are met. One of these conditions is that “[a]ny physician providing telemedicine services will hold and maintain a valid license to perform such services issued or recognized by the state of Washington.” It is notable that even Washington, a State that now requires coverage for telemedicine, did not extend telemedicine parity to health care providers licensed in other States.