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Telemedicine Regulations in Virginia

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Leading the Way to Increased Telemedicine Adoption

In order to serve the needs of Virginia’s diverse and distributed population, state leaders have been out in front of the new healthcare delivery options made possible by telemedicine. In 2010, Virginia became just the 10th state to require private payer parity for telehealth visits.

History of telemedicine regulations in Virginia

Senate Bill 675, Health insurance; mandated coverage for telemedicine services (2010)

On March 2, the Virginia Legislature unanimously approved a bill (SB 675) that would require private health insurers, health care subscription plans and HMOs to cover for the cost of health care services provided through telemedicine technology.

SB 1227 Telemedicine services; provision of health care services. (2015)

Enacted on February 26th, 2015, SB 1227, expanded access to care for minor illnesses by amending Virginia law to clarify that a prescriber licensed in Virginia may prescribe Schedule VI controlled substances via telemedicine, provided the prescriber conforms to the same standard of care expected of an in-person visit.

Getting Reimbursed for Telemedicine in Virginia

Private payer reimbursement for telemedicine in Virginia

 

Virginia can be considered a leader in achieving private payer reimbursement parity for telehealth.  In 2010, they became just the 10th state to mandate reimbursement for this important method of patient care.

Definition

The law defines telemedicine services as, “The use of electronic technology or media, including interactive audio or video, for the purpose of diagnosing or treating a patient or consulting with other health care providers regarding a patient’s diagnosis or treatment.”

Exclusions

Reimbursement is not required for the following:

  • An audio-only telephone conversation
  • An electronic mail message
  • A facsimile transmission

Policies Included

The law applies to all insurance policies, contracts, and plans delivered, issued for delivery, reissued, or extended on and after January 1, 2011, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made.

It does not apply to short-term travel, accident-only, or limited or specified disease policies or contracts, nor to policies or contracts designed for people eligible for Medicare, or any other similar coverage under state or federal governmental plans.

Parity

Insurers must reimburse treating providers for the diagnosis, consultation, or treatment of the insured delivered through telemedicine “on the same basis” that insurer is responsible for coverage for the provision of the same service through face-to-face contact.

Copayments and Maximums

An insurer may offer a health plan containing a deductible, copayment, or coinsurance requirement for a health care service provided through telemedicine as long as it does not exceed the deductible, copayment, or coinsurance applicable if the same services were provided face-to-face. Insurers may not impose any annual or lifetime dollar maximum on coverage for telemedicine services other one that applies to all items and services covered under the policy.

Patient Site Requirements

A policy can not distinguish between patients in rural or urban locations.

Virginia Department of Medical Assistance (Medicaid)

Legacy Reimbursement Approach

Although the private payer reimbursement and the code of physicians in Virginia are innovative, the Medicaid program is less so, reflecting the legacy approach taken by Medicare.

Hub-and-Spoke Model

The Virginia Department of Medical Assistance reimburses approved health care providers for services delivered via telemedicine using a “hub-and-spoke” model. The “hub”, or “distant site”, is the location of the medical specialist, who provides consultation services to the “spoke”, or “originating site”, where both provider and participant (patient) are located. Communication between the originating and distant sites involves real-time interaction via a secure, two-way audio and video telecommunication system.

Code of Virginia Physician Regulations

Virginia’s State Medical Board

Telemedicine Definition

For the purpose of regulating physician practices in Virginia “telemedicine services,” as it pertains to the delivery of health care services, means the use of electronic technology or media, including interactive audio or video, for the purpose of diagnosing or treating a patient or consulting with other health care providers regarding a patient’s diagnosis or treatment. “Telemedicine services” does not include an audio-only telephone, electronic mail message, facsimile transmission, or online questionnaire.”

 

Practitioner-Patient Relationship

Practitioners recognize the obligations, responsibilities, and patient rights associated with establishing and maintaining a practitioner-patient relationship. Where an existing practitioner-patient relationship is not present, a practitioner must take appropriate steps to establish a this relationship. Relationships may be established using telemedicine services provided the standard of care is met.

 

Identity and Consent

A practitioner is discouraged from rendering medical advice and/or care using telemedicine services without (1) fully verifying and authenticating the location and, to the extent possible, confirming the identity of the requesting patient; (2) disclosing and validating the practitioner’s identity and applicable credential(s); and (3) obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding the use of telemedicine services.

 

Documentation

Evidence documenting appropriate patient informed consent for the use of telemedicine services must be obtained and maintained.

The medical record should include, if applicable, copies of all patient-related electronic communications, including patient-practitioner communication, prescriptions, laboratory and test results, evaluations and consultations, records of past care, and instructions obtained or produced in connection with the utilization of telemedicine services.

 

Prescriptions

Prescribing medications, in-person or via telemedicine services, is at the professional discretion of the prescribing practitioner.

Frequently Asked Questions (FAQ)

Yes. A prior in-person, face-to-face interaction is not required. However, where an existing practitioner-patient relationship is not present, a practitioner must take appropriate steps to establish a relationship consistent with the standard of care.

Yes. A prescriber licensed in Virginia may prescribe Schedule VI controlled substances via telemedicine, provided the prescriber conforms to the same standard of care expected of an in-person visit.

Neither the Code of Physicians nor the private payer reimbursement regulations address this.

Yes. As are the standards related to medical records documentation and confidentiality.

Unfortunately, not at this time. Virginia Medicare uses a hub and spoke model for telemedicine requiring that the patient be at an originating site in the presence of another care provider. (This is not true for private payer reimbursement.)

Telehealth terms to know

Telemedicine

The practice of medicine from a distance in which intervention and treatment decisions and recommendations are based on clinical data, documents, and information transmitted through telecommunications systems.

Telepresence

The use of a set of technologies that allows individuals to feel as if they were present, to give the appearance of being present, or to have an effect at a place other than their true location. Telepresence generally means the use of means HD quality audio/video.

Hub and Spoke

This model, used for Medicaid by Virginia, is designed to incorporate the services of a specialist via telemedicine with the patient and another provider participating together from the same location.

Remote Monitoring

Type of ambulatory healthcare where patients use mobile medical devices to perform a routine test and send the test data to a healthcare professional in real-time. Remote monitoring includes devices such as glucose meters for patients with diabetes and heart or blood pressure monitors for patients receiving cardiac care.

Centers for Medicare & Medicaid Services (CMS)

A federal agency within the United States Department of Health and Human Services (DHHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children’s Health Insurance Program (SCHIP), and Health Insurance Portability and Accountability Act (HIPAA) standards.

Store and Forward Technology

The transmission of medical images or other media captured by the originating site provider and sent electronically to a distant site provider, who does not physically interact with the patient located at the originating site.

Join the thousands of Virginia physicians offering telemedicine

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