The State of Washington is enacting a new law regarding audio-only telehealth, SB 5036 Audio-Only Telemedicine – Reimbursement Conditions.

The law goes into effect July 23, 2023.

Background

Health coverage offered by a health carrier, the Public Employees Benefits Board, the School Employees Benefits Board, a Medicaid managed care plan, or a behavioral health administrative services organization must reimburse providers for health care services provided through telemedicine or store-and-forward technology if:

• the services are covered services;
• the services are medically necessary;
• the services are essential health benefits under the federal Patient Protection and Affordable Care Act;
• the services are determined to be safely and effectively provided through telemedicine or store-and-forward technology according to generally accepted health care practices and standards; and
• the technology meets state and federal standards governing the privacy and security of protected health information.

Additional requirements apply for audio-only telemedicine, including that the provider have an established relationship with the patient.

To help you navigate the requirements for offering audio-only telehealth for normally billable services, i.e., not simply sharing lab results, AAPPN has developed an interactive roadmap.

Please note that this online tool is intended as a reference only. AAPPN does not intend to provide legal advice. If you have any concerns about how your practice meets the law, be sure to contact the Washington State Department of Health or an attorney.