Washington

Washington

Washington state has developed an important model that allows for both remote data monitoring and interactive video conferencing. Policymakers have adopted a cost-effective alternative to in person care with minimal barriers. They permit the use of telemedicine in lieu of a skilled nursing in-person home health visit and impose no restrictions on the types of technology that can be used during a remote visit. Interactive video conferencing and remote vital sign monitoring are both reimbursable services under their Medicaid program. There are no geographic restrictions placed on the delivery of telemedicine services in the home. “Telemedicine” – For the purposes of WAC 388-551-2000 through 388-551-2220, means the use of monitoring to enhance the delivery of certain home health skilled nursing services through:

  1. The collection of clinical data and the transmission of such data between a patient at a distant location and the home health provider through electronic processing technologies. Objective clinical data that may be transmitted includes, but is not limited to, weight, blood pressure, pulse, respirations, blood glucose, and pulse oximetry; or
  2. The provision of certain education related to health care services using audio, video, or data communication instead of a face-to-face visit. Washington does not require in-person contact or prior authorization from a physician for home health services that are delivered via telemedicine. The state pays for one telemedicine interaction per eligible client, per day, based on the ordering licensed practitioner’s home health plan of care. Despite the authorization of this robust home telehealth policy, there is a lack of parity in the reimbursement for telemedicine versus face-to-face visits. The reimbursement rate for home health telemedicine services is $77 per visit as compared to the $87 rate for an in-person visit. Equipment costs and costs associated with the operation of telemedicine equipment are not reimbursable expenses. Reimbursement is impacted by specific patient criteria.Home health agencies may be reimbursed for telemedicine encounters specifically involving patients diagnosed with an unstable condition, and at risk of hospitalization or transition to a costlier level of care: Home health services–Delivered through telemedicine. (1) The department covers the delivery of home health services through telemedicine for clients who have been diagnosed with an unstable condition who may be at risk for hospitalization or a more costly level of care. The client must have a diagnosis(es) where there is a high risk of sudden change in clinical status which could compromise health outcomes.
  3. To receive payment for the delivery of home health services through telemedicine, the services must involve:
    • An assessment, problem identification, and evaluation which includes: (i) Assessment and monitoring of clinical data including, but not limited to, vital signs, pain levels and other biometric measures specified in the plan of care. Also includes assessment of response to previous changes in the plan of care; and (ii) Detection of condition changes based on the telemedicine encounter that may indicate the need for a change in the plan of care; and
    • Implementation of a management plan through one or more of the following: (i) Teaching regarding medication management as appropriate based on the telemedicine findings for that encounter; (ii) Teaching regarding other interventions as appropriate to both the patient and the caregiver; (iii) Management and evaluation of the plan of care including changes in visit frequency or addition of other skilled services; (iv) Coordination of care with the ordering licensed practitioner regarding telemedicine findings; (v) Coordination and referral to other medical providers as needed; and (vi) Referral to the emergency room as needed.

Source: 4 States Lead the Way on Reimbursement for Remote Monitoring

Home Health Services (Acute Care Services)

Does the agency cover home health services through telemedicine?

The medicaid agency covers the delivery of home health services through telemedicine for clients who have been diagnosed with an unstable condition who may be at risk for hospitalization or a more costly level of care. The client must have a diagnosis (es) where there is a high risk of sudden change in medical condition which could compromise health outcomes.

When billing the Medicaid agency for home health services delivered through telemedicine, use the following codes:

Revenue Code HCPCS Code Short Description Limitation
0780 T1030 RN home care per diem One per client per day
0780 T1031 LPN home care per diem One per client per day

Payment

The Medicaid agency pays for one telemedicine interaction, per eligible client, per day based on the ordering licensed practitioner’s home health plan of care.

Payment requirements

To receive payment for the delivery of home health services through telemedicine, the services must involve:

  • A documented assessment, identified problem, and evaluation which includes:
    • Assessment and monitoring of clinical data including, but not limited to, vital signs, pain levels and other biometric measures specified in the plan of care. Also includes assessment of response to previous changes in the plan of care.
    • Detection of condition changes based on the telemedicine encounter that may indicate the need for change in the plan of care.
  • Implementation of a documented management plan through one or more of the following:
    • Education regarding medication management as appropriate, based on the findings from the telemedicine encounter.
    • Education regarding other interventions as appropriate to both the patient and the caregiver.
    • Management and evaluation of the plan of care including changes in visit frequency of the addition of other skilled services.
    • Coordination of care with the ordering licensed provider regarding findings from the telemedicine encounter.
    • Coordination and referral to other providers as needed.
      Referral to the emergency room as needed.

Telemedicine-related costs

The Medicaid agency does not pay for the purchase, rental, repair, or maintenance of telemedicine equipment and associated costs of operation of telemedicine equipment.

Prior Authorization

The Medicaid agency does not require prior authorization for the delivery of home health services through telemedicine.

Additional Resources

* Reference pages 20-22 of this document
Home Health Services (Acute Care Services)