It is official. The Washington State Legislature appears to have bought into the promise of telemedicine. For the second year in a row, the Legislature has passed a bill (Senate Bill 6519) that helps reduce the barriers to patient access to remote healthcare.
Senate Bill 6519 builds on the 2015 telemedicine bill in the following ways:
- It establishes a collaborative that is tasked with determining the best course for telemedicine in Washington; and
- It requires health insurers to pay providers for telemedicine services provided to a patient who is located at his or her home.
The bill creates a telemedicine collaborative, to be convened by July 1, 2016, whose purpose is to “enhance the understanding and use of health services provided to telemedicine and other similar models in Washington State.”
The members of the collaborative will include representatives from the Washington State House and Senate, academic community, hospitals, clinics, health care providers, insurers, and other interested parties.
The collaborative will focus on developing recommendations on improving telemedicine reimbursement and access to services. It will also determine best practices for telemedicine, including billing and fraud and abuse compliance, and explore other priorities identified by the members.
One specific item that the collaborative must consider is the creation of a “technical assistance center” to support providers in implementing or expanding telemedicine services. The bill does not specify how such a center would be funded.
The collaborative must submit an initial progress report on its activities by December 1, 2016, and follow-up reports by December 1, 2017, and December 1, 2018.
Reimbursement for Home-Based Telemedicine Services
One key requirement in the 2015 telemedicine bill was that insurers must reimburse providers for telemedicine services if:
- The insurer provides coverage of the health care service when provided in person by the provider;
- The health care service is medically necessary; and
- The health care service is a service recognized as an essential health benefit under the Patient Protection and Affordable Care Act.
Also, the bill only required an insurer to pay a provider if the patient receiving telemedicine services was located in a healthcare facility that met the definition of “originating site.”
Under the 2015 bill, if a patient receiving telemedicine services was located in his or her home, the insurer had no obligation to reimburse the provider for the services. This was a major limitation for many healthcare professionals, including mental health providers, who desired to provide telemedicine services to patients in the security and privacy of their home.
The new bill does away with this limitation. A patient’s “home” is now listed as an “originating site.” Therefore, an insurer is required to reimburse a provider for telemedicine services that are provided to a patient located in his or her home.
However, presumably to make the “home” change palatable to insurers, the bill also includes new requirements on telemedicine services, including the following:
- The health care service must be determined to be safely and effectively provided;
- The health care service must be provided according to generally accepted health care practices and standards, and
- The technology used to provide the health care service must meet the standards required by state and federal privacy and security laws (e.g. HIPAA).
These standards are relatively vague and could allow an insurer to deny reimbursement for a service if it determines that the service did not meet professional standards or HIPAA requirements.
For example, if a patient who is located at his or her home utilizes a video conferencing system to speak with a provider, the provider needs to ensure that the system meets HIPAA standards for the transmission of electronic health information.
The 2016 Washington telemedicine bill is a step in the right direction for remote healthcare in Washington. With that said, the true success of the bill is dependent on the ability of the collaborative to understand and address the current barriers to telemedicine in Washington.
The bill’s option for patients to receive telemedicine services at home could help to remove some of these barriers; however, the usefulness of this change is dependent on how insurers interpret the increased standards that require services to be provided according to “accepted practices” and in accordance with “privacy and security laws.”
For more information about telemedicine, please contact Casey Moriarty.