| To: | Chief Executive Officers, Chief Financial Officers and Government Affairs staff |
| Please forward to staff involved in telemedicine and billing | |
| From: | Shirley Prasad, JD | Policy Director, Government Affairs |
| ShirleyP@wsha.org | (206) 216-2550 | |
|
Subject: |
New telemedicine payment parity law and training requirements and temporary telemedicine changes as a result of the coronavirus (COVID-19) pandemic |
Purpose
This bulletin is to inform hospitals and health systems about recent legislation enacted in the 2020 legislative session requiring telemedicine payment parity and changes to the coverage of use of store-and-forward technology in Senate Bill 5385, and new telemedicine training requirements in Senate Bill 6061. This bulletin also includes useful information and resources regarding recent temporary changes to telemedicine billing practices in Medicaid, Medicare and commercial health plans as a result of the COVID-19 pandemic.
Applicability/Scope
- Telemedicine payment parity and changes to store-and-forward technology: this will be of interest to hospitals and health systems utilizing telemedicine to deliver care to patients enrolled in commercial health plans, health plans offered by the Public Employees Benefits Board (PEBB) or the School Employees Benefits Board (SEBB), or Medicaid.
- Telemedicine training: this will be of interest to all providers (except physicians, who are exempt from this new training requirement) who provide telemedicine services.
- Temporary billing changes to telemedicine as a result of the COVID-19 pandemic: this will be of interest to anyone providing and billing Medicaid, Medicare or commercial health plans for telemedicine services.
Recommendation
Review this bulletin and share with staff as appropriate.
Overview
Legislative Changes to Telemedicine
For several years, WSHA has been an active and vocal advocate for telemedicine. This legislative session, we worked to ensure that new laws provide appropriate flexibility for providers, while recognizing the Legislature’s desire to advance the use of telemedicine in Washington State.
Senate Bill 5385, Telemedicine Payment Parity: After seven years of WSHA’s advocacy, Washington State now joins 11 other states that have adopted telemedicine payment parity legislation. The bill’s passage is well-timed as hospitals and health systems look for ways to expand no-touch patient contact during the COVID-19 pandemic.
In Washington State, telemedicine is defined as “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 purposes of diagnosis, consultation, or treatment….it does not include the use of audio-only telephone, facsimile, or email.” RCW 48.43.735 (8)(g), RCW 41.05.700(8)(g), and RCW 74.09.325(8)(h).
Payment is to a provider who delivers health care services to a patient through telemedicine or store-and-forward technology if it is:
- A covered service;
- Medically necessary;
- An essential health service (as defined in the Affordable Care Act, sec. 1302(b), as of January 1, 2015); and
- Safety and effectively provided through telemedicine or store-and-forward technology.
RCW 48.43.735 (1), RCW 41.05.700(1), and RCW 74.09.325(1).
A distant site is defined as “the site at which a physician or other licensed provider, delivering a professional service, is physically located at the time the service is provided through telemedicine.” RCW 48.43.735 (8)(a), RCW 41.05.700(8)(a), and RCW 74.09.325(8)(a).
An originating site is defined as a “hospital, rural health clinic, federally qualified health center, health care provider’s office, community mental health center, skilled nursing facility, home or any location where the individual receives service, or renal dialysis center (except independent rental dialysis center).” RCW 48.43.735 (3)(a)-(h), RCW 41.05.700(3)(a)-(h), and RCW 74.09.325(3)(a)-(h).
Key provisions of the telemedicine payment parity legislation include:
Commercial health plans and health plans offered by PEBB and SEBB
- Commercial health plans and health plans offered by PEBB and SEBB shall pay health care providers for telemedicine services at the same rate as if the service was provided in person.
- The legislation also provides hospitals and providers flexibility with payment parity. Hospitals, health systems and provider groups of 11 or more providers may choose to negotiate payment rates for telemedicine services that are different from in-person visit rates. It is not intended for health plans to initiate this effort.
- This provision is to be permanently in effect as of January 1, 2021. However, there are temporary changes to the effective date due to the public health emergency.
-
- Commercial health plans: As a result of the COVID-19 pandemic, Governor Inslee issued a proclamation to temporarily enact this provision for commercial health plans, beginning on March 25, 2020.
The Governor’s initial proclamation expired within 30 days. After which, the Democratic and Republican leadership in both the Senate and House, collectively, has the authority to extend this, which they have done four times. The most current proclamation extension expires on July 1, 2020. WSHA anticipates this proclamation will continue to be extended throughout the public health emergency – subsequent extensions, if issued, may be found on the Governor’s website.
-
- PEBB and SEBB: The Uniform Health Plan (UMP) and the commercial health plans offered by PEBB and SEBB have temporarily allowed payment parity during the public health emergency. Please see the COVID-19 section below for resources from these health plans.
Medicaid managed care organizations (MCOs)
- Beginning March 19, 2020, MCOs shall pay health care providers for telemedicine services at the same rate as if the services were provided in-person.
Store-and-forward technology
- Beginning March 19, 2020, the need for a patient to have an in-person visit with the referring provider before the use of store-and-forward technology may be reimbursed is eliminated.
- Store-and-forward technology is defined as the “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…” RCW 48.43.735 (8)(f), RCW 41.05.700(8)(f), and RCW 74.09.325(8)(g).
Senate Bill 6061, Telemedicine Training: Beginning January 1, 2021, telemedicine providers (those who provide clinical services through telemedicine, other than a physician licensed under chapter 18.57 RCW or chapter 18.71 RCW) must complete a telemedicine training. The training may be provided by the Telemedicine Collaborative, hospitals and other health care facilities, continuing education courses, or health care professional boards or commissions.
A health care professional who completes the training must sign and retain an attestation. The legislation does not address any penalties a health care provider may encounter if the training is not completed or if a signed attestation is not retained.
Temporary Telemedicine Changes Due to the COVID-19 Pandemic
The COVID-19 pandemic has led to a significant increase in the use of telemedicine to deliver care to patients that minimizes personal contact. To recognize this and the fact that not all providers and patients have access to reliable internet services, the Center for Medicare & Medicaid Services (CMS), through federal waiver authority, has relaxed certain restrictions on telemedicine. The Health Care Authority (HCA) and commercial health plans have taken similar actions.
Medicaid
For Medicaid (fee-for-service and managed care), the HCA has temporarily allowed several changes in its telemedicine billing practices. Most notably, allowing the temporary use of non-HIPAA compliant audio-video technologies (FaceTime, Skype), audio-only (telephone calls), e-consults to deliver telemedicine services. This will be allowed for the duration of the public health emergency.
The HCA has published telemedicine guidance on the following topics:
- Telemedicine and telehealth brief
- Clinical policy and billing for COVID-19 (includes information on telemedicine/telehealth billing E/M, CPT and HCPC codes, and telemedicine/telehealth in RHC settings)
- Physical, occupational and speech therapy during COVID-19
- Family planning only program billing guide
- Long-term care facilities and skilled nursing facilities during COVID-19
OneHealthtPort has also compiled information on telemedicine billing policies during the public health emergency. Please see Section C: Telehealth.
Medicare
CMS has issued guidance on the temporary changes to its Medicare telehealth payment policies as a result of the public health emergency. OneHealthPort (with assistance from WSHA) has compiled some helpful information. Please see Medicare and Federal Billing and Payment FAQ, Telehealth for Medicare and RHCs.
Commercial health plans, PEBB and SEBB
For commercial health plans regulated by the Office of the Insurance Commissioner, OneHealthPort has compiled information about their telemedicine billing policies during the public health emergency. Please see Section C: Telehealth.
For temporary changes to telemedicine policies for health plans offered by PEBB and SEBB, please see:
- UMP (administered by Regence)
- Premera Blue Cross
- Kaiser Permanente
WSHA’s 2020 New Law Implementation Guide
Please visit WSHA’s 2020 implementation guide online, where you will find a list of the high priority laws that WSHA is preparing resources and information on to help members implement the new laws, as well as links to resources such as this bulletin. In addition, you will find the Government Affairs team’s schedule for release of upcoming resources on other laws and additional resources for implementation.
