Telehealth care takes place where the patient is located at the time of the appointment. This means that practice laws and requirements in the patient's location regulate healthcare professionals' practice. Washington state has passed laws related to telehealth and telemedicine, addressing definitions; regulations; scope of practice; licensing, credentialing, and privileging requirements; consent; prescribing; privacy and security; billing and reimbursement; and documentation and coding. These laws are codified into one or more Revised Code of Washington (RCW), which new legislation can amend. The Washington Administrative Code (WAC) may provide additional guidance.
This page provides information on telehealth-related Washington state legislation, RCWs, and WACs. It includes links to guiding documents and standards of practice for various health care professionals. It also provides information on payer policies; telehealth and telemedicine billing and reimbursement; and COVID-19 pandemic-related guidance, waiver, and temporary changes.
Please refer to the original source documents for current information. Do not regard the information provided here as legal advice. It is for informational purposes only. Always consult with legal counsel when addressing legal and regulatory considerations.
- Establishes key definitions
- Requires coverage parity under specified conditions
- Specifies eligible patient locations
- Allows originating sites to charge a facility fee
- Discusses credentialing
- Adds home as an originating site
- Establishes the WA State Telehealth Collaborative (WSTC)
- Sets standards for the safety and effectiveness of services
- Makes store and forward technology eligible for "credential by proxy."
- Defines home as any location determined by the person receiving the services.
- Moves telemedicine training effective date to January 1, 2021.
- Makes the training required and adds an exemption for MDs and DOs.
- Outlines training topics and clarifies definitions.
- Requires reimbursement for telemedicine services at the same rate as in-person services, with some exceptions.
- Immediately effective due to the public health emergency.
- Directs WSTC to study store-and-forward technology and specifies foci of the study.
- Requires behavioral health administrative services organizations and managed care organizations to reimburse providers for behavioral health services provided via telemedicine or store-and-forward technology under specified conditions.
- Allows practitioners licensed by other states or territories to hold consultations via telemedicine with practitioners licensed in Washington with responsibility to diagnosis and treat patients in Washington.
- Defines and allows audio-only telemedicine services with established patients who have had at least one in-person visit in the last year. Takes effect January 1, 2023.
- Describes possible violations that would result in disciplinary actions.
More about Telehealth in Washington State
- Washington state telehealth legislation and laws
Revised Code of Washington (RCWs) that pertain to telehealth and telemedicine
RCW 74.09.658: Home health—Reimbursement—Telemedicine. : Medicaid managed care plans.
RCW 18.130.180: Unprofessional conduct.: Unprofessional Conduct.
Washington Administrative Codes (WACs) related to telehealth and telemedicine
WAC 182-531-1730 – Telemedicine
WAC 182-531-0100 - Scope of coverage for physician-related and health care professional services—General and administrative
WAC 182-535-1050 – Teledentistry
WAC 182-551-2010 - Within the context of Medicaid's home health program
WAC 182-551-2125 - Delivery of home health services through telemedicine
WAC 182-551-2040 - Medicaid Home Health Services Face-to-Face Encounter Requirements
See also WAC 182-551-2125
WAC 246-335-610 – Hospice
WAC 246-847-176 - Telehealth (Occupational Therapy)
WAC 246-915-187 - Use of telehealth in the practice of physical therapy
WAC 284-170-260 - Provider directory information about telemedicine services
- Guidance documents for healthcare professionals credentialed in Washington
Washington Medical Commission Addresses telemedicine licensure and standards of care; and informed consent.
The Washington Medical Commission addresses:
- the role of telemedicine to promote and facilitate continuity of care;
- the permit, under certain circumstances, 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
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 circumstances;
- provider credentials.
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),
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.
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
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.
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.
The Washington Medical Commission addresses standards for using telemedicine for treatment, including issuing a prescription, and prescribing DEA-controlled substances.
Addresses drug monitoring as part of a qualified telemedicine visit.
Telemedicine guidance: health professions
Telehealth Resources: Washington State Department of Health
Includes definitions, appropriate use of telemedicine/telehealth, and licensure guidance.
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.
Licensure related to telemedicine/telehealth during COVID-19 pandemic
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
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.
Describes how teledentistry is defined, supervised, regulated and disciplined by the Dental Commission and provides general technology principles.
WAC 182-535-1050 Defines teledentistry.
Addresses dietitians licensed in Oregon or Idaho providing treatment to Washington residents using telehealth.
Hearing and Speech
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.
WAC 246-335-610: Defines telemedicine, telehealth in the hospice context.
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
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.
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.
Use of telehealth in the practice of physical therapy WAC 246-915-187.
Washington is a member of the Physical Therapy Compact.
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.
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
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.
WAC 246-933-200: Veterinary-client-patient relationship.
Location and Practice Specific Guides
Location Specific Guides
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.
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.
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.
Allows eligible encounters to be conducted via real-time telemedicine. Refers to WAC 182-531-1730 for telemedicine information.
Practice Specific Guides
Defines “telemedicine,” “originating site,” and “distant site,” as it applies to ABA, and how telemedicine may be used for program supervision, family training, and reimbursement eligibility as well as associated billing instructions. For more information see Provider billing guides and fee schedules; and WAC 182-531A-1200.
RCW 71.24.335: Reimbursement for behavioral health services provided through telemedicine or store and forward technology—Coverage requirements
Addresses reimbursement 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.
Washington Apple Health clients are eligible for medically necessary covered dental services delivered through teledentistry. References the following.
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).
- Payer policies
Washington Medicaid/Apple Health
Provides an overview of the 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.
Telehealth Guidance for Apple Health Clients during COVID-19 pandemic (English version); available in additional languages (PDF)here, (search “telehealth”).
Defines “telemedicine,” including HIPAA-compliant, interactive, real-time audio and video telecommunications (including web-based applications) or store and forward technology, and associated requirements; and notes that the Health Care Authority does not cover the following services as telemedicine:
- Email, audio only telephone, and facsimile transmissions
- Installation or maintenance of any telecommunication devices or systems
- Purchase, rental, or repair of telemedicine equipment
Addresses eligibility requirements and provider responsibilities. MCOs cover the delivery of care via telemedicine: follow the MCO policy and billing requirements.
For updated telemedicine/telehealth guidance, see Information about novel coronavirus (COVID-19) | Washington State Health Care Authority found under "Providers, billers, and partners” and then under “Physical health providers
For telehealth policy, billing, or coding questions, contact via email.
Telehealth Information Provided by Healthcare Exchange Plans
Washington State Office of the Insurance Commissioner
Premera Blue Cross
Asuris Northwest Health
Community Health Network of Washington
Coordinated Care Washington
Alliance Northwest Health Plan
Kaiser Foundation Health Plan of the Northwest
Lifewise Health Plan of Washington
Molina Healthcare of Washington
PacificSource Health Plans
Providence Health Plans
Regence BlueCross BlueShield
United Healthcare of Oregon
Additional information regarding payer policies may be found at OneHealthPort.
- Guidance, waivers, temporary changes and other information specific to telehealth during COVID-19 pandemic
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”).
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
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.”
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.
Washington State Medical Association “COVID-19 and Telehealth”
School-Based-Health-Care-Services-COVID-19 for updated information regarding how to bill for SBHS during COVID
Licensure during COVID-19 Pandemic:
Prescribing over Telehealth - Guidance
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.
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