Washington State Solidifies Audio-Only Telehealth Regulations
The Office of the Insurance Commissioner has finalized regulations to implement the state's audio-only telehealth law, including rules surrounding patient consent and coverage denial.
Washington state's Office of the Insurance Commissioner has finalized regulations to implement the audio-only telehealth law that was passed in May.
The law requires payers to reimburse providers for audio-only telemedicine services at the same rate as in-person care. Starting Jan. 1, 2023, the payer is required to ensure telehealth payment parity only if the provider and patient have established a relationship through an in-person exam within the past year.
The law imposes rules on providers as well, prohibiting a hospital from charging payers a facility fee if the hospital serves as the originating site for audio-only telemedicine.
It also requires providers to obtain patient consent to be billed for telehealth delivered via audio technology alone.
Per the finalized regulations, patient consent must be documented in their medical record and may be obtained in the following two ways: as part of the process for making the audio-only telemedicine appointment or verbally as part of the audio-based telemedicine encounter record.
The patient's initial consent is valid for one year, after which it must be obtained again for the following year. The documentation of the consent must be retained for a minimum of five years and made available to payers as needed for claims payment.
But the new regulations also authorize patients to revoke their consent for billing either verbally or in writing. If consent is revoked, it must also be documented in the patient's medical record and retained for five years at minimum.
Not only do the regulations codify patient consent requirements, but also payer obligations.
An insurer cannot deny coverage or reduce or refuse payment for telehealth-based care delivery only because the communication between the patient and provider during the encounter shifted to audio-only due to unanticipated circumstances. In this case, the insurer also cannot require a provider to obtain consent from the patient to continue the communication.
But the payer is not required to reimburse a provider for both audio-visual and audio-only encounters when both means of communication have been used during the visit due to unforeseen circumstances.
The finalized regulations come as states across the country consider the telehealth flexibilities they enacted to address the COVID-19 pandemic and decide which ones to make permanent.
Public policy research organization R Street Institute made the case for permanent audio-only telehealth reimbursement, arguing that the modality boosted access, particularly for behavioral healthcare.
In 2021, as executive orders and temporary rules expired, 18 states enacted permanent audio-only allowances.
Research backs up the notion that audio-only telehealth expanded access, especially for underserved communities during the pandemic.
During the first week after the stay-at-home order in March 2020, telehealth visits accounted for nearly 40 percent of all visits at 36 community health centers in New York, according to a recent study. By mid-April last year, more than 60 percent of visits were conducted via telehealth.
There is also a federal push to ensure the continued availability of audio-only telehealth. The Centers for Medicare and Medicaid Services' final 2022 Physician Fee Schedule includes Medicare coverage for audio-only telemental health services provided by rural health clinics and federally qualified health centers beyond the public health emergency.