Appropriate Use of Telemedicine (GUI2014-03) (PDF)
Washington Medical Commission Addresses telemedicine licensure and standards of care; and informed consent.
Telemedicine & Continuity of Care (POL2018-01) (PDF)
The Washington Medical Commission addresses:
- the role of telemedicine to promote and facilitate continuity of care;
- the permit, under certain circ*mstances, of non-Washington-licensed practitioners to use telemedicine to provide follow-up care to established patients in Washington; and
- the allowance for Washington-licensed practitioners to use telemedicine to consult with non-Washington-licensed practitioners in other states.
Telemedicine guidance: consent-to-treat
Appropriate use of Telemedicine GUI2014-03) (PDF)
Recommends practitioners obtain and document informed consent for telemedicine encounters, including:
- reasonable understanding by all parties of the enabling technologies utilized,
- their capabilities and limitations, and
- a mutual agreement that they are appropriate for the circ*mstances;
- provider credentials.
Physician-Related Services -- Health Care Professional Services Billing Guide (PDF)
Requires written informed consent from clients when using store-and-forward technology. The consulting provider must also be identified. See page 90. Physician-Related Services -- Health Care Professional Services Billing Guide (PDF),
Behavioral-health-policy-and-billing-COVID-19 (PDF)
Requires clients to be informed when using a non-HIPAA compliant technology (allowed during the COVID-19 pandemic). Addresses using mail to obtain written consent, use of electronic signatures, and verbal consent.
COVID-19 Public Health Emergency Response and 42 CFR Part 2 Guidance (PDF)
Addresses providing Substance Use Disorder (SUD services via telemedicine/telehealth technologies and compliance with 42 CFR part 2. Washington Health Care Authority encourages providers to use email and scan, the mail, or electronic signature functionality to obtain written consent for the release of records.
Telemedicine guidance: prescribing
Relaxations regarding signed prescriptions for scheduled substances during COVID-19 emergency) (PDF)
On April 21, 2020, the Pharmacy Quality Assurance Commission temporarily eased regulations on practitioners who prescribe Schedule II substances due to the COVID-19 public health emergency The Commission increased the amount of time practitioners have to deliver signed prescriptions when authorizing an emergency prescription of a Schedule II substance to the pharmacy. Also allowed the "signed prescription" requirement via paper, electronic transmission, facsimile, photograph, or scanned copy.
Telemedicine and authorizing medical cannabis
Addresses the use of telemedicine following an in-person physical examination to authorize the use of cannabis for medical purposes, and for subsequent physical examinations for the purposes of renewing an authorization.
Appropriate use of Telemedicine GUI2014-03 (PDF)
The Washington Medical Commission addresses standards for using telemedicine for treatment, including issuing a prescription, and prescribing DEA-controlled substances.
Drug Monitoring in the context of Mental Health Services (PDF)
Addresses drug monitoring as part of a qualified telemedicine visit.
Telemedicine guidance: health professions
Washington State Department of Health Professions webpage
Telehealth Resources: Washington State Department of Health
Includes definitions, appropriate use of telemedicine/telehealth, and licensure guidance.
Health Professions with Authority to Provide Telehealth Services (PDF)
Requires a Washington state license to provide health care to patients in Washington unless:
- the provider is operating under the Uniform Emergency Volunteer Health Practitioners Act under chapter 70.15, or
- an interstate compact that allows practice in Washington with a Washington compact privilege.
Provides general information for health care professionals authorized to provide telehealth services. Note: Does not apply to providers in a Direct Indian Health Service Clinic, Tribal Clinic, or Tribal Federally Qualified Health Center (FQHC). These providers may be licensed in any state per federal law.
Note: Washington is a member of the Interstate Medical Licensure Compact and the Physical Therapy Compact.
Licensure related to telemedicine/telehealth during COVID-19 pandemic
- FAQ on telemedicine and licensing during the COVID-19 pandemic
- Federation of State Medical Boards document regarding states' licensure requirements during the COVID-19 pandemic (PDF)
Beginning Jan. 1, 2021 health care professionals providing clinical services through telemedicine need to complete a telemedicine training. Exceptions to this requirement are provided for physicians and osteopathic physicians.
Telemedicine guidance: health profession-specific information
Advanced Practice Nursing
Department of Health Nurse Care Quality Assurance Commission Advisory Opinion (draft) (PDF)
Addresses advanced registered nurse practitioner (ARNP) performance of telehealth services, license/credential requirements to provide telehealth services to individuals/patients located in Washington, and outside of Washington. (See information re Nursing Telehealth practice below).
Applied Behavior Analysis
WAC 182-531A-1200 Defines services provided via telemedicine.
Chiropractors
COVID-19 Message Telemedicine Policy and Temporary Continuing Education (PDF)
Describes how teledentistry is defined, supervised, regulated and disciplined by the Dental Commission and provides general technology principles.
Dentists
WAC 182-535-1050 Defines teledentistry.
Apple Health (Medicaid) dental emergency coverage related to COVID-19 pandemic (PDF)
Dieticians
Dietitians Providing Telehealth for Established Patients During the COVID-19 Declared Emergency (PDF)
Addresses dietitians licensed in Oregon or Idaho providing treatment to Washington residents using telehealth.
Hearing and Speech
Board of Hearing and Speech Telepractice Guidelines (PDF)
Addresses definitions of telehealth and standards of care.
Home Health Program – Medicaid.
WAC 182-551-2010: Definitions.
WAC 182-551-2040: Face-to-face encounter requirements.
WAC 182-551-2125: Delivered through telemedicine.
Hospice
WAC 246-335-610: Defines telemedicine, telehealth in the hospice context.
Naturopathic Medicine
Board of Naturopathy Appropriate Use of Telemedicine (PDF)
Clarifies the appropriate use of telemedicine in naturopathic practice and outline the Board of Naturopathy's expectations of naturopathic physicians when using telemedicine technologies.
Nursing Telehealth Practice
Department of Health Nurse Care Quality Assurance Commission Advisory Opinion (PDF)
Allows appropriately trained and competent registered nurses, licensed practical nurses, nursing technicians, and nursing assistants-certified/nursing assisted-registered to perform telehealth nursing care using telehealth technologies within their legal scope of practice, regulatory requirements, and practice standards. Addresses credentialing and cross-state telehealth practice requirements.
See above for information for Advance Practice Nurses
Occupational Therapists and Occupational Therapy Assistants
WAC 246-847-176: Telehealth.
Specifies that a Washington license is required to deliver occupational therapy via telehealth.
Optometry
Board of Optometry Telehealth Guideline (PDF)
Clarifies the appropriate use of telehealth in optometric practice, and to outline the Board of Optometry's expectations of optometric physicians when using telehealth technology.
Pharmacists and Pharmacy Interns
Pharmacists can provide pharmacy services via telehealth as long as the services provided fit within an element of the practice of pharmacy as defined in RCW 18.64.011(28) and the pharmacist complies with Pharmacy Commission rules in Chapter 246-945 WAC.
of a pharmacist to perform the monthly self-inspection requirement for pharmacies that store, dispense, and deliver drugs without a pharmacist on-site.
Requires the intern to practice under the immediate supervision of a pharmacist.
Physical Therapists
Use of telehealth in the practice of physical therapy WAC 246-915-187.
A Guide to Providing Treatment Via Telehealth for PTs and PTAs in Washington
Washington is a member of the Physical Therapy Compact.
Physicians
Washington State Medical Association website: COVID-19 and Telehealth
Medicaid scope of coverage for physician-related and health care professional services: WAC 182-531-0100.
Washington is a member of the Interstate Medical Licensure Compact.
FAQ on telemedicine and licensing during COVID | Washington Medical Commission
Federation of State Medical Boards regarding licensure during the COVID-19 pandemic (PDF)
Check the Washington Medical Commission web site for possible new guidance.
The Washington Medical Commission (WMC) will consider rulemaking to address the practice of physicians and physician assistants engaging in telemedicine with Washington patients, possibly including requirements for licensure; recordkeeping requirements; establishing a patient-practitioner relationship; prescribing issues; and standard of care. For more information see the WMC update Spring 2021.
Sex Offender Treatment Providers
WAC 246-930-010: General definitions.
Speech Language Pathologists
Board of Hearing and Speech Telepractice Guidelines (PDF).
Substance Use Disorder Professionals (SUDP)
SUDP employer/facility rules may restrict telehealth. For example, a significant number of SUDPs work in licensed behavioral health agencies (BHA). BHAs are subject to rules requiring “in-person” or “face-to-face” interactions with clients. WAC 246-341-0610(1)(a), WAC 246-341-0200, WAC 246-341-0712(3), WAC 246-341- 0820(2)(a), WAC 246-341-0910, WAC 246-341-0915, and WAC 246-341-1110(2)(b). These rules are currently waived in response to the COVID-19 pandemic. WSR 20- 07-0105.
Veterinarians
WAC 246-933-200: Veterinary-client-patient relationship.
Addresses use of veterinary telemedicine during the COVID-19 pandemic. (PDF)
Location and Practice Specific Guides
Location Specific Guides
Federally Qualified Health Center (FQHC) Billing Guide (PDF)
FQHCs are authorized to serve as an originating site for telemedicine services and are paid an originating site facility fee, or as a distant site. Provides further specifics regarding billing and claims.
Rural Health Clinic (RHC) Billing Guide (PDF)
RHCs are authorized to serve as an originating site for telemedicine services and are paid an originating site facility fee, or as a distant site. Provides further specifics regarding billing and claims.
School-Based Health Care Services (SBHS) (PDF)
Under the SBHS program, the Washington Health Care Authority pays for services provided through telemedicine as outlined in this billing guide. Addresses provider eligibility and requirements, originating site requirements, and billing information. Also see WAC 182-531-1730. For updated information regarding how to bill for SBHS during COVID-related school closures and/or distance learning models, see the SBHS COVID-19 FAQ (PDF), also available on the SBHS webpage.
Tribal Health Billing Guide (PDF)
Allows eligible encounters to be conducted via real-time telemedicine. Refers to WAC 182-531-1730 for telemedicine information.
Practice Specific Guides
Applied Behavioral Analysis (ABA) Billing Guide (PDF)
Defines “telemedicine,” “originating site,” and “distant site,” as it applies to ABA, and how telemedicine may be used for program supervision, family training, and reimbursem*nt eligibility as well as associated billing instructions. For more information see Provider billing guides and fee schedules; and WAC 182-531A-1200.
Behavioral Health
RCW 71.24.335: Reimbursem*nt for behavioral health services provided through telemedicine or store and forward technology—Coverage requirements
Addresses reimbursem*nt for behavioral health services provided through telemedicine or store-and-forward technology to persons under 18 years old - coverage requirements.
Aligns with SB5385.
See also Behavioral Health Policy and Billing-COVID-19 (PDF) - see detailed telehealth eligibility and billing guidance within this document.
Drug Monitoring in the context of Mental Health Services (PDF). Addresses drug monitoring as part of a qualified telemedicine visit.
Teledentistry
Dental Related Services Program Billing Guide (PDF)
Washington Apple Health clients are eligible for medically necessary covered dental services delivered through teledentistry. References the following.
Dental Quality Assurance Commission Tele Dentistry Guideline (PDF)
Defines “teledentistry” (and associated terms) as the variety of technologies and tactics used to deliver HIPAA-compliant, interactive, real-time audio and video telecommunications (including web-based applications) or store-and-forward technology to deliver covered services within dental care provider's scope of practice to a client at a site other than the site where the provider is located. Also notes that a dentist or authorized dental provider may delegate allowable tasks to Washington State Registered Dental Hygienists (RDHs) and Expanded Function Dental Assistants (EFDAs) through teledentistry, referencing WAC 246-817-525 and WAC 246-817-550. See also Apple Health (Medicaid) dental emergency coverage related to COVID-19 pandemic (PDF).
Apple Health Medicaid
Telehealth Guidance for Apple Health Clients during COVID-19 pandemic
Telehealth guidance for Apple Health clients during COVID-19 FAQ (English version); Available in additional languages here, (search “telehealth”).
Apple Health clinical policy and billing for COVID-19 (
Provides detailed information regarding Apple Health telehealth-specific policy during the COVID-19 pandemic, eligible telehealth services, and billing and coding guidance including use of appropriate telemedicine/telehealth modifiers. Includes defining “telemedicine” as HIPAA-compliant, synchronous/real-time, audio-video interaction; description of payment parity for “telemedicine” and “telehealth;” COVID-19 pandemic “relaxed regulations” allowing non-HIPAA-compliant non-public-facing telehealth platforms; additional non-“telemedicine” modalities, such as eConsults (asynchronous provider-to-provider consultation), online digital exchange through patient portals, texting and email.
Electronic signature guidance during the COVID-19 outbreak
Physician-Related Services - Health Care Professional Services Billing Guide
Provides updated telemedicine/telehealth guidance published on Washington Health Care Authority's webpage found under “Providers, billers, and partners” and then under “Physical health providers.”
Provider billing guides and fee schedules | Washington State Health Care Authority
Telemedicine & Telehealth brief for COVID-19
Provides an overview of the Washington Health Care Authority telemedicine and telehealth policies; billing guidance; best practices; privacy and HIPAA compliance information; considerations for Substance Use Disorder services; and a resource list.
Health Professional-specific Guidance pertaining to COVID-19 Pandemic
Behavioral Health Policy and Billing during COVID-19 pandemic - see detailed telehealth eligibility and billing guidance within this document.
Chiropractors
COVID-19 Message Telemedicine Policy and Temporary Continuing Education
Dental
Apple Health (Medicaid) dental emergency coverage related to COVID-19 pandemic
Dieticians
Dietitians Providing Telehealth for Established Patients During the COVID-19 Declared Emergency
Physicians
Washington State Medical Association “COVID-19 and Telehealth”
FAQ on telemedicine and licensing during COVID | Washington Medical Commission
Federation of State Medical Boards regarding licensure during the COVID-19 pandemic
School-Based-Health-Care-Services-COVID-19 for updated information regarding how to bill for SBHS during COVID
Veterinarians
Veterinary-Client-Patient Relationship Requirements During the COVID-19 Response.
Licensure during COVID-19 Pandemic:
FAQ on telemedicine and licensing during COVID | Washington Medical Commission
Federation of State Medical Boards regarding licensure during the COVID-19 pandemic
Prescribing over Telehealth - Guidance
Relaxations regarding signed prescriptions for scheduled substances during COVID-19 emergency (full text)
On April 21, 2020), the Pharmacy Quality Assurance Commission temporarily eased the regulations on practitioners who prescribe Schedule II substances due to the COVID-19 public health emergency, increasing the amount of time a practitioner has to deliver a signed prescription when authorizing an emergency prescription of a Schedule II substance to the pharmacy. Also allows the "signed prescription" requirement via paper, electronic transmission, facsimile, photograph, or scanned copy.
COVID-19 and Opioid Treatment Programs FAQ
Addresses the use of telemedicine or telephonic services to provide medically necessary services and/or psychosocial counseling services for the continuity of care for OTP clients, and starting a new, not yet admitted opioid use disorder diagnosed individual onto buprenorphine or methadone during the COVID-19 public health emergency.
Washington State Department of Labor and Industries
Temporary Record Review & Telehealth Independent Medical Exams (IME) Policy
Temporary Telehealth Policy When the Worker's Home is the Originating Site
