|To:||Chief Executive Officers, Chief Financial Officers, Hospital HR Leaders, Government Affairs Staff
Please forward to staff managing telemedicine programs
|From:||David Streeter, MPA, Policy Director- Clinical and Data
DavidS@wsha.org | (206) 216-2508
|Subject:||Telemedicine Payment Parity Law and Training Requirement Now in Effect|
Change of Law :Hospital Action Required
The purpose of this bulletin is to inform hospitals about two important changes to Washington State’s telemedicine laws.
- Washington State’s telemedicine payment parity law is in full effect as of January 1, 2021.
- Washington State’s mandatory telemedicine training for most health care professionals is now available and must be completed by June 30, 2021.
Payment Parity Law
The payment parity law applies to state-regulated commercial health insurance plans, Medicaid managed care organizations’ (MCO’s) health plans, Public Employees Benefits Board (PEBB) health plans, and School Employees Benefits Board (SEBB) health plans. With the COVID-19 state of emergency, this law was put into effect early. However, WSHA is letting our members know the law is now in full effect. WSHA advocated strongly for this law during the 2020 legislative session.
Training Law Applicability
The telemedicine training requirement applies to all health care professionals who provide services through telemedicine, as defined in RCW 70.41.020. However, physicians licensed under chapter 18.71 RCW and osteopathic physicians licensed under chapter 18.57 RCW are specifically exempt from the training requirement.
The Department of Health (DOH) interprets the training requirement as applicable to the professions that are listed in RCW 18.130.040 or overseen by the boards and commissions listed in the same RCW. This includes nurses, pharmacists, mental health counselors, and many other professionals who provide patient care through telemedicine. Additionally, the Washington Nursing Care Quality Assurance Commission (NCQAC) recommends that any nurse involved in a telemedicine visit should also complete the training. Specific questions about applicability should be directed to the relevant boards and commissions overseeing health care professions.
- Review this bulletin to understand the payment parity law and the training requirement.
- Share this information with relevant staff.
New Payment Parity Law and Changes for Services Provided through Store and Forward
In 2020, the Washington State Legislature passed SB 5385, which requires commercial insurance, Medicaid MCO’s, PEBB, and SEBB health plans to reimburse for telemedicine services at parity to in-person services. The payment parity provisions for commercial insurance, PEBB, and SEBB became effective January 1, 2021.
Payment parity applies to telemedicine, which the relevant RCW sections below define as:
[T]he 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. For purposes of this section only, “telemedicine” does not include the use of audio-only telephone, facsimile, or email.
For commercial insurance plans: RCW 48.43.735 (b)(i) states, “for health plans issued or renewed on or after January 1, 2021, a health carrier shall reimburse a provider for a health care service provided to a covered person through telemedicine at the same rate as if the health care service was provided in person by the provider.” Subsection (b)(ii) gives hospitals and hospital systems the ability to negotiate a different reimbursement rate with insurance companies, if appropriate.
For PEBB and SEBB: RCW 41.05.700 (b)(i) states, “a health plan offered to employees, school employees, and their covered dependents under this chapter issued or renewed on or after January 1, 2021, shall reimburse a provider for a health care service provided to a covered person through telemedicine at the same rate as if the health care service was provided in person by the provider.” Subsection (b)(ii) gives hospitals and hospital systems the ability to negotiate a different reimbursement rate with insurance companies, if appropriate.
For Medicaid MCO’s: The payment parity provision for Medicaid MCO’s in RCW 74.09.325 took effect March 19, 2020 and remains in full effect.
SB 5385 also made an important change concerning store and forward technology. The bill removed the requirement that a patient have an in-person office visit with a referring provider before store and forward services may be reimbursed. Store and forward technology is defined as:
[U]se 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; and
The store and forward technology provision took effect permanently on March 19, 2020 in the same RCW sections referenced above.
New Telemedicine Training Requirement
SB 6061 (2020) created a new mandatory training requirement for telemedicine providers who are not licensed physicians or osteopathic physicians. The training’s purpose is to inform professionals of telemedicine definitions, regulations, and best practices. The training covers current state and federal telemedicine laws, liability, informed consent, and other relevant topics. The Washington State Telehealth Collaborative developed the training and maintains a resource page about the training on WSHA’s website.
DOH announced telemedicine providers must complete the training between January 1, 2021 and June 30, 2021. There are two free publicly available training options:
- The medical professional telemedicine training developed by the Telehealth Collaborative.
- The behavioral health professional telemedicine training developed by the Behavioral Health Institute. (This training contains 6 parts. Part 1 satisfies the statutory training requirement. Parts 2-6 are optional.)
Hospitals and health systems may also develop their own internal trainings that follow the guidelines established by the Telehealth Collaborative. The guidelines cover the minimum content that must be covered, which allows hospitals and health systems to add their own policies into the training. The Telehealth Collaborative published a reference copy (PowerPoint file) of their telemedicine training that can be used as the basis for an in-house training.
All professionals who complete the training are required to sign and retain an attestation document for their personal records. If an employer chooses to collect attestation documents, then it is the employer’s responsibility to develop an internal collection process for attestation documents. The two publicly available trainings listed above provide participants with a certificate of completion that satisfies the attestation requirement. If a hospital or health system develops an in-house training for its employees, then it must also develop an attestation document.
Please see the Telemedicine Training resource page for more information about the training requirement and options.
- Determine if your hospital or health system will require telemedicine providers to complete the public training or an in-house training.
- Develop an internal policy for collecting attestations from providers who complete the telemedicine training.
- Inform your telemedicine providers about the training requirement, the training that your hospital or health system will require, and the attestation collection policy.
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.
WSHA has been an active and vocal advocate for telemedicine. After seven years of WSHA’s advocacy, Washington State joined 11 other states by passing its telemedicine payment parity law. This law will help ensure the continued growth of telemedicine services in Washington State.
In March 2020, the Office of the Insurance Commissioner implemented the parity law’s commercial insurance provision before its’ effective date as part of Governor Jay Inslee’s COVID-19 emergency proclamation. The Uniform Health Plan and the commercial health plans offered by PEBB and SEBB also allowed payment parity during the public health emergency.
The telemedicine training requirement passed the legislature as SB 6061. The bill required the Telehealth Collaborative to develop and post the training online. The Telehealth Collaborative consists of a group of twenty-two statewide experts on telehealth, and four state legislators. The Collaborative was created in 2016 after the passage of legislation that tasked the collaborative to provide guidance, research, and recommendations for the advancement of telemedicine.
In 2021, WSHA will work to ensure that new laws impacting telemedicine provide appropriate flexibility and requirements for providers as the Legislature continues its work to expand access to telemedicine.
SB 5385 (2020) – Concerning telemedicine payment parity.
RCW 48.43.735 – Reimbursement of health care services provided through telemedicine or store and forward technology.
RCW 41.05.700 – Reimbursement of health care services provided through telemedicine or store and forward technology.
RCW 74.09.325 – Reimbursement of a health care service provided through telemedicine or store and forward technology—Report to the legislature.
SB 6061 (2020) – Requiring training standards in providing telemedicine services.
RCW 43.70.495 – Telemedicine training for health care professionals.
RCW 18.130.040 – Application to certain professions—Authority of secretary—Grant or denial of licenses—Procedural rules.
Washington Telehealth Training Information and FAQ
DOH Telemedicine Training Requirement Interpretive Statement. December 16, 2020
Alternative Telemedicine Training Guidelines
Reference Copy of Telemedicine Training (PowerPoint file)
WSHA Bulletin – “New telemedicine payment parity law and training requirements and temporary telemedicine changes as a result of the coronavirus (COVID-19) pandemic.” June 23, 2020.