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New Sections in West Virginia Code Relating to Telehealth

Alert by David Givens

West Virginia House Bill 4003 passed on March 7, 2020, adding new sections to the West Virginia Code relating to telehealth. These sections require health insurance coverage for certain telehealth services provided after July 1, 2020, and direct health care boards to promulgate additional rules to regulate telehealth practice.

Sections 5-16-7B and 33-53-3 require the public employees insurance plan and private health insurance plans to provide coverage for telehealth services “if those same services are covered through face-to-face consultation” by the policy. These sections also provide that healthcare services may not be excluded solely because the service is provided through telehealth. These sections do not, however, require that telehealth services be reimbursed at the same rate as in-person services. Rather, reimbursement for telehealth services shall be “at a rate negotiated between the provider and the insurance company.“ Annual and lifetime dollar maximums on coverage for telehealth services may not be imposed (except to the extent that they apply in the aggregate to all items and covered services). Copayments, coinsurance, and deductible amounts, and any durational benefit limitation or maximum for benefits or services are also prohibited unless equally imposed on all covered terms and services. These sections also provide that an originating site for the telehealth service may charge a fee. Finally, these sections require coverage for “medically necessary remote patient monitoring services to the full extent that those services are available.”

Section 31–1–25 defines “Telehealth services” as the use of synchronous or asynchronous telecommunications technology to provide health care services, including, but not limited to “assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration.” The term expressly does not include “audio-only telephone calls, e-mail messaging, or facsimile transmissions.“ The section also provides that health care boards shall propose a rule for legislative approval to regulate telehealth practice, which shall provide (1) that the practice of healthcare occurs where the patient is located at the time the telehealth technologies are used; (2) that the healthcare practitioner who practices telehealth must be licensed; (3) “When the health care practitioner-patient relationship is established”; (4) “The standard of care”; (5) A prohibition of prescribing schedule II drugs, unless otherwise authorized; and (6) “Implement the provisions of this section while ensuring competency, protecting the citizens of this state from harm, and addressing issues specific to each profession.

 

Disclaimer – This article was prepared as an educational document and is not intended as legal advice. The information provided is only a general overview and is not intended to take the place of either the written law or regulations. Readers are encouraged to review the specific statutes, regulations and other interpretive materials for a full understanding of their contents.