Bill Text: WV SB1 | 2021 | Regular Session | Engrossed
Bill Title: Providing for parity of payment for telehealth services between service in-person and service provided through telehealth platform
Spectrum: Bipartisan Bill
Status: (Engrossed - Dead) 2021-02-24 - To House Health and Human Resources [SB1 Detail]
Download: West_Virginia-2021-SB1-Engrossed.html
WEST virginia legislature
2021 regular session
Engrossed
Committee Substitute
for
Senate Bill 1
By Senators Takubo, Weld, Baldwin, Plymale, Stollings, Jeffries, Woelfel, Roberts, Maroney, Nelson, Romano, Grady, Woodrum, and Lindsay
[Originating in the Committee on Health and Human Resources; reported on February 18, 2021]
A BILL to amend and reenact §5-16-7b of the Code of West Virginia, 1931, as amended; to amend said code by adding thereto a new section, designated §9-5-28; to amend and reenact §30-1-26 of said code; to amend and reenact §30-3-13a of said code; to amend and reenact §30-14-12d of said code; and to amend and reenact §33-57-1 of said code, all relating to telehealth services; defining terms; requiring the Public Employees Insurance Agency, Medicaid, and specified insurance plans to reimburse for telehealth services at a negotiated rate for virtual telehealth encounters; requiring the Public Employees Insurance Agency, Medicaid, and specified insurance plans to provide reimbursement for a telehealth service on the same basis and at the same rate as if the service is provided in-person for established patients; requiring the Department of Health and Human Resources to file a Medicaid waiver; establishing a registration; permitting health care practitioners licensed in other states, in good standing, to practice in West Virginia using telehealth services and providing rule-making authority and emergency rule-making authority; setting forth requirements for registration; permitting a fee for registration; placing a cap on the fee; permitting physician-patient relationship to begin with an audio-only call or conversation in real time; providing restrictions and exceptions on prescriptive authority; adding criteria to the standard of care related to telehealth services; and providing exceptions.
Be it enacted by the Legislature of West Virginia:
Article 16. west virginia public employees insurance act.
§5-16-7b. Coverage for telehealth services.
(a) The following terms are defined:
(1) “Distant site” means the telehealth site where the health care practitioner is seeing the patient at a distance or consulting with a patient’s health care practitioner.
(2) “Established patient” means a patient who has received professional services, face-to-face, from the physician, qualified health care professional, or another physician or qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.
(2) (3) “Health care practitioner” means a person
licensed under §30-1-1 et seq. of this code who provides health care
services.
(3) (4)“Originating site” means the location where
the patient is located, whether or not accompanied by a health care
practitioner, at the time services are provided by a health care practitioner
through telehealth, including, but not limited to, a health care practitioner’s
office, hospital, critical access hospital, rural health clinic, federally
qualified health center, a patient’s home, and other nonmedical environments
such as school-based health centers, university-based health centers, or the
work location of a patient.
(4) (5) “Remote patient monitoring services” means
the delivery of home health services using telecommunications technology to
enhance the delivery of home health care, including monitoring of clinical
patient data such as weight, blood pressure, pulse, pulse oximetry, blood
glucose, and other condition-specific data; medication adherence monitoring;
and interactive video conferencing with or without digital image upload.
(5) (6) “Telehealth services” means the use of
synchronous or asynchronous telecommunications technology by a health care
practitioner 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 does not include audio-only
telephone calls, e-mail messages, or facsimile transmissions.
(7) “Virtual telehealth” means a new patient or follow-up patient for acute care that does not require chronic management or scheduled medications.
(b) After July 1, 2020, the plan shall provide coverage of health care services provided through telehealth services if those same services are covered through face-to-face consultation by the policy.
(c) After July 1, 2020, the plan may not exclude a service for coverage solely because the service is provided through telehealth services.
(d) The plan shall provide reimbursement for a telehealth service at a rate negotiated between the provider and the insurance company for virtual telehealth encounters after July 1, 2021. The plan shall provide reimbursement for a telehealth service for an established patient on the same basis and at the same rate under a contract, plan, agreement, or policy as if the service is provided through an in-person encounter rather than provided via telehealth after July 1, 2021.
(e) The plan may not impose any annual or lifetime dollar maximum on coverage for telehealth services other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy, or impose upon any person receiving benefits pursuant to this section any copayment, coinsurance, or deductible amounts, or any policy year, calendar year, lifetime, or other durational benefit limitation or maximum for benefits or services, that is not equally imposed upon all terms and services covered under the policy, contract, or plan.
(f) An originating site may charge the plan a site fee.
(g) The coverage required by this section shall include the use of telehealth technologies as it pertains to medically necessary remote patient monitoring services to the full extent that those services are available.
CHAPTER 9. HUMAN SERVICES.
ARTICLE 5. MISCELLANEOUS PROVISIONS.
§9-5-28. Requirement for telehealth rates.
The Medicaid plan shall provide reimbursement for a telehealth service at a rate negotiated between the provider and the insurance company for virtual telehealth encounters after July 1, 2021. The plan shall provide reimbursement for a telehealth service for an established patient on the same basis and at the same rate under a contract, plan, agreement, or policy as if the service is provided through an in-person encounter rather than provided via telehealth after July 1, 2021.
Chapter 30. Professions and occupations.
§30-1-26. Telehealth practice.
(a) For the purposes of this section:
“Health care practitioner” means a person licensed under §30-1-1 et seq. who provides health care services.
“Interstate telehealth services” means the provision of telehealth services to a patient located in West Virginia by a health care practitioner located in any other state or commonwealth of the United States.
“Registration” means an authorization to practice a health profession regulated by this chapter for the limited purpose of providing interstate telehealth services within the registrant’s scope of practice.
“Telehealth services” means
the use of synchronous or asynchronous telecommunications technology by a
health care practitioner 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 does not
include audio-only telephone calls internet questionnaires, e-mail
messages, or facsimile transmissions.
(b) Unless already provided for by statute or legislative rule, a health care board, referred to in this chapter, shall propose a rule for legislative approval in accordance with the provisions of §29A-3-1 et seq. to regulate telehealth practice by a telehealth practitioner. The proposed rule shall consist of the following:
(1) The practice of the health care service occurs where the patient is located at the time the telehealth technologies are used;
(2) The health care
practitioner who practices telehealth must be licensed as provided in this
chapter shall be:
(A) Licensed in the state in which he or she is located when rendering the services to patients in West Virginia; and
(B) Registered as an interstate telehealth practitioner with the appropriate board in West Virginia;
(3) The qualifications and requirements for eligibility to register as an interstate telehealth practitioner shall include, but not be limited to, verification that:
(A) The health care practitioner is licensed without restriction and is in good standing in all jurisdictions where he or she holds or held professional practitioner licensure;
(B) The health care practitioner has not had a license or other authorization to practice a health care profession revoked or restricted in any jurisdiction;
(C) The health care practitioner has not surrendered licensure in any jurisdiction while under or to avoid investigation or professional discipline; and
(D) The health care practitioner is not currently under investigation or the subject of an administrative complaint by a professional licensing board;
(4) The process and requirements to apply for registration shall include, but not be limited to, the provision of:
(A) Verification of out-of-state licenses;
(B) Contact and practice information;
(C) Information concerning the applicant’s education and professional training, where appropriate to the profession;
(D) Any adverse or negative licensing actions previously taken against a registration applicant in any other jurisdiction; and
(E) Other information requested by the board;
(5) The length of the initial registration period and a registration renewal process;
(6) Any requirements for continuing education;
(3) (7) When the health care practitioner-patient
relationship is established;
(4) (8) The standard of care for the provision
of telehealth services: Provided, That the standard of care shall
require that with respect to the established patient, the patient shall visit
an in-person health care practitioner within 12 months of using the initial
telemedicine service or the telemedicine service shall no longer be available
to the patient until an in-person visit is obtained: Provided, however,
That the requirements in this section may be suspended in the event the
Governor declares a state of emergency that impacts the public health: Provided
further, That the requirements of this section do not apply to the
following services: acute inpatient care, post-operative follow-up checks,
behavioral medicine, or addiction medicine;
(5) (9) A prohibition of prescribing: schedule
II drugs, unless authorized by another section; and
(A) any controlled substances listed in Schedule II of the Uniform Controlled Substances Act, unless authorized by another section; and
(B) Any controlled substance listed in Schedules III through V of the Uniform Controlled Substances Act, even if the health care practitioner is authorized to prescribe these drugs by another section, if the duly registered health care professional practices medicine to a patient solely through the utilization of audio-only telehealth services: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an existing physician-patient relationship of at least one year;
(10) Establish the conduct of a registrant for which discipline may be imposed by the board of registration;
(6) (11) Implement the provisions of this section
while ensuring competency, protecting the citizens of this state from harm, and
addressing issues specific to each profession.; and
(12) Establish a fee, not to exceed the amount to be paid by a licensee, to be paid by the interstate telehealth practitioner registered in the state.
(c) A registration issued pursuant to this section does not authorize a health care professional to practice from a physical location within this state without first obtaining appropriate licensure.
(d) By accepting a registration to provide interstate telehealth services to patients in this state, a health care practitioner is subject to:
(1) The laws regarding the profession in this state, including the state judicial system and all professional conduct rules and standards incorporated into the health care practitioner’s practice act and the legislative rules of registering board; and
(2) The jurisdiction of the board with which he or she registers to provide interstate telehealth services, including such board’s complaint, investigation, and hearing process.
(e) A health care professional who registers to provide interstate telehealth services pursuant to this section shall immediately notify the board where he or she is registered in West Virginia and of any restrictions placed on the individual’s license to practice in any state or jurisdiction.
(f) The Board of registration shall suspend a health care practitioner’s registration to provide interstate telehealth services without further hearing or process when presented with:
(1) A certified copy of an order from a licensing authority that revokes or suspends the license of a health care practitioner who holds a registration issued pursuant to this section; or
(2) A certified order or other evidence from the registrant or a licensing authority that a registrant surrendered licensure in another jurisdiction while under, or to avoid, an investigation.
A health care practitioner whose registration has been suspended pursuant to this subsection may seek reregistration only if the license or licenses which were subject to revocation, suspension, and/or license surrender are restored and in good standing.
(g) A health care practitioner who receives a registration pursuant to this section shall comply with the requirements of §16-29-1 et seq. of this code.
(h) A patient record of the telemedicine encounter shall be transmitted to the patient’s primary care physician, and if no primary care physician is identified, then no obligation exists to send a record.
ARTICLE 3. WEST VIRGINIA MEDICAL PRACTICE ACT.
§30-3-13a. Telemedicine practice; requirements; exceptions; definitions; rule-making.
(a) Definitions. — For the purposes of this section:
(1) “Chronic nonmalignant pain” means pain that has persisted after reasonable medical efforts have been made to relieve the pain or cure its cause and that has continued, either continuously or episodically, for longer than three continuous months. “Chronic nonmalignant pain” does not include pain associated with a terminal condition or illness or with a progressive disease that, in the normal course of progression, may reasonably be expected to result in a terminal condition or illness.
(2) “Physician” means a person licensed or registered by the West Virginia Board of Medicine to practice allopathic medicine in West Virginia.
(3) “Store and forward telemedicine” means the asynchronous computer-based communication of medical data or images from an originating location to a physician or podiatrist at another site for the purpose of diagnostic or therapeutic assistance.
(4) “Telemedicine” means the practice of medicine using tools such as electronic communication, information technology, store and forward telecommunication, or other means of interaction between a physician or podiatrist in one location and a patient in another location, with or without an intervening health care provider.
(5) “Telemedicine technologies” means technologies and devices which enable secure electronic communications and information exchange in the practice of telemedicine, and typically involve the application of secure real-time audio/video conferencing or similar secure video services, remote monitoring or store and forward digital image technology to provide or support health care delivery by replicating the interaction of a traditional in-person encounter between a physician or podiatrist and a patient.
(b) Licensure or registration. —
(1) The practice of medicine occurs where the patient is located at the time the telemedicine technologies are used.
(2) A physician or podiatrist who practices telemedicine must be licensed as provided in this article or registered as provided in §30-1-1 et seq. of this code.
(3) This section does not apply to:
(A) An informal consultation or second opinion, at the request of a physician or podiatrist who is licensed to practice medicine or podiatry in this state, provided that the physician or podiatrist requesting the opinion retains authority and responsibility for the patient’s care; and
(B) Furnishing of medical assistance by a physician or podiatrist in case of an emergency or disaster, if no charge is made for the medical assistance.
(c) Physician-patient or podiatrist-patient relationship through telemedicine encounter. —
(1) A physician-patient or podiatrist-patient relationship may not be established through:
(A) Audio-only
communication;
(B) Text-based communications such as e-mail, Internet
questionnaires, text-based messaging, or other written forms of communication;
or.
(C) Any combination
thereof.
(2) If an existing physician-patient or podiatrist-patient relationship does not exist prior to the utilization to telemedicine technologies, or if services are rendered solely through telemedicine technologies, a physician-patient or podiatrist-patient relationship may only be established:
(A) Through the use of
telemedicine technologies which incorporate interactive audio using store and
forward technology, real-time videoconferencing or similar secure video
services during the initial physician-patient or podiatrist-patient encounter; or
(B) For the practice of
pathology and radiology, a physician-patient relationship may be established
through store and forward telemedicine or other similar technologies.;
or
(C) Through the use of audio-only calls or conversations that occur in real time. Patient communication though audio-visual communication is preferable, if available or possible. However, audio-only calls or conversations that occur in real time may be used to establish the physician-patient relationship.
(3) Once a physician-patient or podiatrist-patient relationship has been established, either through an in-person encounter or in accordance with subdivision (2) of this subsection, the physician or podiatrist may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.
(d) Telemedicine practice. —
A physician or podiatrist using telemedicine technologies to practice medicine or podiatry shall:
(1) Verify the identity and location of the patient;
(2) Provide the patient with confirmation of the identity and qualifications of the physician or podiatrist;
(3) Provide the patient with the physical location and contact information of the physician;
(4) Establish or maintain a physician-patient or podiatrist-patient relationship that conforms to the standard of care;
(5) Determine whether telemedicine technologies are appropriate for the patient presentation for which the practice of medicine or podiatry is to be rendered;
(6) Obtain from the patient appropriate consent for the use of telemedicine technologies;
(7) Conduct all appropriate evaluations and history of the patient consistent with traditional standards of care for the patient presentation;
(8) Create and maintain health care records for the patient which justify the course of treatment and which verify compliance with the requirements of this section; and
(9) The requirements of subdivisions (1) through (8), inclusive, of this subsection do not apply to the practice of pathology or radiology medicine through store and forward telemedicine.
(e) Standard of care. —
The practice of medicine or podiatry provided via telemedicine technologies, including the establishment of a physician-patient or podiatrist-patient relationship and issuing a prescription via electronic means as part of a telemedicine encounter, are subject to the same standard of care, professional practice requirements and scope of practice limitations as traditional in-person physician-patient or podiatrist-patient encounters. Treatment, including issuing a prescription, based solely on an online questionnaire, does not constitute an acceptable standard of care.
(f) Patient records. —
The patient record established during the use of telemedicine technologies shall be accessible and documented for both the physician or podiatrist and the patient, consistent with the laws and legislative rules governing patient health care records. All laws governing the confidentiality of health care information and governing patient access to medical records shall apply to records of practice of medicine or podiatry provided through telemedicine technologies. A physician or podiatrist solely providing services using telemedicine technologies shall make documentation of the encounter easily available to the patient, and subject to the patient’s consent, to any identified care provider of the patient. A patient record of the telemedicine encounter shall be transmitted to the patient’s primary care physician, and if no primary care physician is identified then no obligation exists to send a record.
(g) Prescribing limitations. —
(1) A physician or podiatrist who practices medicine to a patient solely through the utilization of telemedicine technologies may not prescribe to that patient any controlled substances listed in Schedule II of the Uniform Controlled Substances Act.
(2) A physician or podiatrist who practices medicine to a patient solely through the utilization of audio-only telemedicine may not prescribe to that patient any controlled substances listed in Schedules III though V of the Uniform Controlled Substances Act until such time as the physician has evaluated the patient in-person or pursuant to the provisions of §30-3-13a(c)(2)(A) of this code: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an existing physician-patient relationship of at least one year.
(2) (3) The prescribing limitations in this
subsection do not apply when a physician is providing treatment to patients who
are minors, or if 18 years of age or older, who are enrolled in a primary or
secondary education program and are diagnosed with intellectual or
developmental disabilities, neurological disease, Attention Deficit Disorder,
Autism, or a traumatic brain injury in accordance with guidelines as set forth
by organizations such as the American Psychiatric Association, the American
Academy of Child and Adolescent Psychiatry, or the American Academy of
Pediatrics. The physician must maintain records supporting the diagnosis and
the continued need of treatment.
(3) (4) The prescribing limitations in this
subsection do not apply to a hospital, excluding the emergency department, when
a physician submits an order to dispense a controlled substance, listed in
Schedule II of the Uniform Controlled Substances Act, to a hospital patient for
immediate administration in a hospital.
(4) (5) A physician or podiatrist may not
prescribe any pain-relieving controlled substance listed in Schedules II
through V of the Uniform Controlled Substance Act as part of a course of
treatment for chronic nonmalignant pain solely based upon a telemedicine
encounter.
(5) (6) A physician or health care provider may
not prescribe any drug with the intent of causing an abortion. The term
“abortion” has the same meaning ascribed to it in §16-2F-2 of this code.
(h) Exceptions. —
This article does not prohibit the use of audio-only or text-based communications by a physician or podiatrist who is:
(1) Responding to a call for patients with whom a physician-patient or podiatrist-patient relationship has been established through an in-person encounter by the physician or podiatrist;
(2) Providing cross coverage for a physician or podiatrist who has established a physician-patient or podiatrist-patient relationship with the patient through an in-person encounter; or
(3) Providing medical assistance in the event of an emergency.
(i) Rulemaking. —
The West Virginia Board of
Medicine and West Virginia Board of Osteopathic Medicine may propose joint
rules for legislative approval in accordance with §29A-3-1 et seq.,
of this code to implement standards for and limitations upon the utilization of
telemedicine technologies in the practice of medicine and podiatry in this
state.
(j) Preserving traditional physician-patient or podiatrist-patient relationship. —
Nothing in this section changes the rights, duties, privileges, responsibilities and liabilities incident to the physician-patient or podiatrist-patient relationship, nor is it meant or intended to change in any way the personal character of the physician-patient or podiatrist-patient relationship. This section does not alter the scope of practice of any health care provider or authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law.
ARTICLE 14. OSTEOPATHIC PHYSICIANS AND SURGEONS.
§30-14-12d. Telemedicine practice; requirements; exceptions; definitions; rulemaking.
(a) Definitions. — For the purposes of this section:
(1) “Chronic nonmalignant pain” means pain that has persisted after reasonable medical efforts have been made to relieve the pain or cure its cause and that has continued, either continuously or episodically, for longer than three continuous months. “Chronic nonmalignant pain” does not include pain associated with a terminal condition or illness or with a progressive disease that, in the normal course of progression, may reasonably be expected to result in a terminal condition or illness.
(2) “Physician” means a person licensed or registered by the West Virginia Board of Osteopathic Medicine to practice osteopathic medicine in West Virginia.
(3) “Store and forward telemedicine” means the asynchronous computer-based communication of medical data or images from an originating location to a physician at another site for the purpose of diagnostic or therapeutic assistance.
(4) “Telemedicine” means the practice of medicine using tools such as electronic communication, information technology, store and forward telecommunication or other means of interaction between a physician in one location and a patient in another location, with or without an intervening health care provider.
(5) “Telemedicine technologies” means technologies and devices which enable secure electronic communications and information exchange in the practice of telemedicine, and typically involve the application of secure real-time audio/video conferencing or similar secure video services, remote monitoring or store and forward digital image technology to provide or support health care delivery by replicating the interaction of a traditional in-person encounter between a physician and a patient.
(b) Licensure or registration. —
(1) The practice of medicine occurs where the patient is located at the time the telemedicine technologies are used.
(2) A physician who practices telemedicine must be licensed as provided in this article or registered as provided in §30-1-1 et seq. of this code.
(3) This section does not apply to:
(A) An informal consultation or second opinion, at the request of a physician who is licensed to practice medicine in this state, provided that the physician requesting the opinion retains authority and responsibility for the patient’s care; and
(B) Furnishing of medical assistance by a physician in case of an emergency or disaster if no charge is made for the medical assistance.
(c) Physician-patient relationship through telemedicine encounter. —
(1) A physician-patient relationship may not be established through:
(A) Audio-only
communication;
(B) Text-based communications such as e-mail, Internet
questionnaires, text-based messaging, or other written forms of communication;
or.
(C) Any combination
thereof.
(2) If an existing physician-patient relationship is not present prior to the utilization to telemedicine technologies, or if services are rendered solely through telemedicine technologies, a physician-patient relationship may only be established:
(A) Through the use of telemedicine
technologies which incorporate interactive audio using store and forward
technology, real-time videoconferencing, or similar secure video services
during the initial physician-patient encounter; or
(B) For the practice of pathology and radiology, a physician-patient relationship may be established through store and forward telemedicine or other similar technologies; or
(C) Through the use of audio-only calls or conversations that occur in real time. Patient communication though audio-visual communication is preferable, if available or possible. However, audio-only calls or conversations that occur in real time may be used to establish the physician-patient relationship.
(3) Once a physician-patient relationship has been established, either through an in-person encounter or in accordance with subdivision (2) of this subsection, the physician may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.
(d) Telemedicine practice. — A physician using telemedicine technologies to practice medicine shall:
(1) Verify the identity and location of the patient;
(2) Provide the patient with confirmation of the identity and qualifications of the physician;
(3) Provide the patient with the physical location and contact information of the physician;
(4) Establish or maintain a physician-patient relationship which conforms to the standard of care;
(5) Determine whether telemedicine technologies are appropriate for the patient presentation for which the practice of medicine is to be rendered;
(6) Obtain from the patient appropriate consent for the use of telemedicine technologies;
(7) Conduct all appropriate evaluations and history of the patient consistent with traditional standards of care for the patient presentation;
(8) Create and maintain health care records for the patient which justify the course of treatment and which verify compliance with the requirements of this section; and
(9) The requirements of subdivisions (1) through (8), inclusive, of this subsection do not apply to the practice of pathology or radiology medicine through store and forward telemedicine.
(e) Standard of care. —
The practice of medicine provided via telemedicine technologies, including the establishment of a physician-patient relationship and issuing a prescription via electronic means as part of a telemedicine encounter, are subject to the same standard of care, professional practice requirements and scope of practice limitations as traditional in-person physician-patient encounters. Treatment, including issuing a prescription, based solely on an online questionnaire does not constitute an acceptable standard of care.
(f) Patient records. —
The patient record established during the use of telemedicine technologies shall be accessible and documented for both the physician and the patient, consistent with the laws and legislative rules governing patient health care records. All laws governing the confidentiality of health care information and governing patient access to medical records shall apply to records of practice of medicine provided through telemedicine technologies. A physician solely providing services using telemedicine technologies shall make documentation of the encounter easily available to the patient, and subject to the patient’s consent, to any identified care provider of the patient. A patient record of the telemedicine encounter shall be transmitted to the patient’s primary care physician, and if no primary care physician is identified then no obligation exists to send a record.
(g) Prescribing limitations. —
(1) A physician or podiatrist who practices medicine to a patient solely through the utilization of telemedicine technologies may not prescribe to that patient any controlled substances listed in Schedule II of the Uniform Controlled Substances Act.
(2) A physician or
podiatrist who practices medicine to a patient solely through the utilization
of audio-only telemedicine may not prescribe to that patient any controlled
substances listed in Schedules III though V of the Uniform Controlled
Substances Act until such time as the physician has evaluated the patient
in-person or pursuant to the provisions of §30-3-13a(c)(2)(A) §30-14-12d(c)(2)(A)
of this code: Provided, That the prescribing limitations contained in
this section do not apply to a physician or a member of the same group practice
with an existing physician-patient relationship of at least one year.
(2) (3)The prescribing limitations in this
subsection do not apply when a physician is providing treatment to patients who
are minors, or if 18 years of age or older, who are enrolled in a primary or
secondary education program and are diagnosed with intellectual or
developmental disabilities, neurological disease, Attention Deficit Disorder,
Autism, or a traumatic brain injury in accordance with guidelines as set forth
by organizations such as the American Psychiatric Association, the American
Academy of Child and Adolescent Psychiatry, or the American Academy of Pediatrics.
The physician must maintain records supporting the diagnosis and the continued
need of treatment.
(3) (4) The prescribing limitations in this
subsection do not apply to a hospital, excluding the emergency department, when
a physician submits an order to dispense a controlled substance, listed in
Schedule II of the Uniform Controlled Substances Act, to a hospital patient for
immediate administration in a hospital.
(4) (5) A physician or podiatrist may not
prescribe any pain-relieving controlled substance listed in Schedules II
through V of the Uniform Controlled Substance Act as part of a course of
treatment for chronic nonmalignant pain solely based upon a telemedicine
encounter.
(5) (6) A physician or health care provider may
not prescribe any drug with the intent of causing an abortion. The term
“abortion” has the same meaning ascribed to it in §16-2F-2 of this code.
(h) Exceptions. —
This section does not prohibit the use of audio-only or text-based communications by a physician who is:
(1) Responding to a call for patients with whom a physician-patient relationship has been established through an in-person encounter by the physician;
(2) Providing cross coverage for a physician who has established a physician-patient or relationship with the patient through an in-person encounter; or
(3) Providing medical assistance in the event of an emergency.
(i) Rulemaking. —
The West Virginia Board of
Medicine and West Virginia Board of Osteopathic Medicine may propose joint
rules for legislative approval in accordance with §29A-3-1 et seq.,
of this code to implement standards for and limitations upon the utilization of
telemedicine technologies in the practice of medicine in this state. The
West Virginia Board of Medicine and the West Virginia Board of Osteopathic
Medicine may promulgate emergency rules pursuant to the provisions of §29A-3-15
of this code to implement the provisions of the bill passed during the regular
session of the Legislature, 2021.
(j) Preservation of the traditional physician-patient relationship. —
Nothing in this section changes the rights, duties, privileges, responsibilities, and liabilities incident to the physician-patient relationship, nor is it meant or intended to change in any way the personal character of the physician-patient relationship. This section does not alter the scope of practice of any health care provider or authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law.
Chapter 33. insurance.
Article 57. required coverage for health insurance.
§33-57-1. Coverage of telehealth services.
(a) The following terms are defined:
(1) “Distant site” means the telehealth site where the health care practitioner is seeing the patient at a distance or consulting with a patient’s health care practitioner.
(2) “Established patient” means a patient who has received professional services, face-to-face, from the physician, qualified health care professional, or another physician or qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice, within the past three years.
(2) (3) “Health care practitioner” means a person
licensed under §30-1-1 et seq. of this code who provides health care
services.
(3) (4) “Originating site” means the location
where the patient is located, whether or not accompanied by a health care
practitioner, at the time services are provided by a health care practitioner
through telehealth, including, but not limited to, a health care practitioner’s
office, hospital, critical access hospital, rural health clinic, federally
qualified health center, a patient’s home, and other nonmedical environments
such as school-based health centers, university-based health centers, or the
work location of a patient.
(4) (5) “Remote
patient monitoring services” means the delivery of home health services using
telecommunications technology to enhance the delivery of home health care,
including monitoring of clinical patient data such as weight, blood pressure,
pulse, pulse oximetry, blood glucose, and other condition-specific data;
medication adherence monitoring; and interactive video conferencing with or
without digital image upload.
(5) (6) “Telehealth services” means the use of
synchronous or asynchronous telecommunications technology by a health care
practitioner 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 does not include audio-only
telephone calls e-mail messages or facsimile transmissions.
(7) “Virtual telehealth” means a new patient or follow up patient for acute care that does not require chronic management or scheduled medications.
(b) Notwithstanding the provisions of §33-1-1 et seq. of this code, an insurer subject to §33-15-1 et seq., §33-16-1 et seq., §33-24-1 et seq., §33-25-1 et seq., and §33-25A-1 et seq. of this code which issues or renews a health insurance policy on or after July 1, 2020, shall provide coverage of health care services provided through telehealth services if those same services are covered through face-to-face consultation by the policy.
(c) An insurer subject to §33-15-1 et seq., §33-16-1 et seq., §33-24-1 et seq., §33-25-1 et seq., and §33-25A-1 et seq. of this code which issues or renews a health insurance policy on or after July 1, 2020, may not exclude a service for coverage solely because the service is provided through telehealth services.
(d) An insurer subject to §33-15-1 et seq., §33-16-1 et seq., §33-24-1 et seq., §33-25-1 et seq., and §33-25A-1 et seq. of this code which issues, renews, amends, or adjusts a plane, policy, contract, or agreement after July 1, 2021, shall provide reimbursement for a telehealth service at a rate negotiated between the provider and the insurance company for the virtual telehealth encounter. An insurer subject to §33-15-1 et seq., §33-16-1 et seq., §33-24-1 et seq., §33-25-1 et seq., and §33-25A-1 et seq. of this code which issues, renews, amends, or adjusts a plane, policy, contract, or agreement after July 1, 2021, shall provide reimbursement for a telehealth service for an established patient on the same basis and at the same rate under a contract, plan, agreement, or policy as if the service is provided through an in-person encounter rather than provided via telehealth.
(e) An insurer subject to §33-15-1 et seq., §33-16-1 et seq., §33-24-1 et seq., §33-25-1 et seq., and §33-25A-1 et seq. of this code may not impose any annual or lifetime dollar maximum on coverage for telehealth services other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy, or impose upon any person receiving benefits pursuant to this section any copayment, coinsurance, or deductible amounts, or any policy year, calendar year, lifetime, or other durational benefit limitation or maximum for benefits or services, that is not equally imposed upon all terms and services covered under the policy, contract, or plan.
(f) An originating site may charge an insurer subject to §33-15-1 et seq., §33-16-1 et seq., §33-24-1 et seq., §33-25-1 et seq., and §33-25A-1 et seq. of this code a site fee.
(g) The coverage required by this section shall include the use of telehealth technologies as it pertains to medically necessary remote patient monitoring services to the full extent that those services are available.
