Getting Reimbursed for Telemedicine in Virginia


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.

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.

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)

Claudia Téllez

Author Claudia Téllez

Executive Director, Health Care Futurist

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