Telehealth in Washington State

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.

2021

SB 5325

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.

SB 5423

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.

HB 1196

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.

2020

SSB 6061

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.

SB 5385

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.

2019

SB 5387

Clarifies language on credentialing and privileging in telemedicine services.

SSB 5386

Requests those providing clinical telemedicine services to complete a telemedicine training effective January 1, 2020.
Directs the WSTC to make online telemedicine training available.

2017

SB 5436

Defines home as any location determined by the person receiving the services.

2016

SB 6519

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."

2015

SB 5175

Establishes key definitions
Requires coverage parity under specified conditions
Specifies eligible patient locations
Allows originating sites to charge a facility fee
Discusses credentialing

More about Telehealth in Washington State

Washington state telehealth legislation and laws

Current Laws

Revised Code of Washington (RCWs) that pertain to telehealth and telemedicine

RCW 70.41.020: Definitions.

RCW 48.43.735: Reimbursement of health care services provided through telemedicine or store and forward technology. : health plans.

RCW 41.05.700: Reimbursement of health care services provided through telemedicine or store and forward technology. : employer health plans.

RCW 74.09.325: Reimbursement of a health care service provided through telemedicine or store and forward technology—Medicaid manages care plans

RCW 74.09.658: Home health—Reimbursement—Telemedicine. : Medicaid managed care plans.

RCW 70.41.230: Duty of hospital to request information on physicians, physician assistants, or advanced registered nurse practitioners granted privileges. : credential-by-proxy

RCW 28B.20.830: Collaborative for the advancement of telemedicine—Reports—Open meetings.

RCW 43.70.495: Telemedicine training for health care professionals.

RCW 28B.20.830: Collaborative for the advancement of telemedicine—Reports—Open meetings.

RCW 71.24.335: Reimbursement for behavioral health services provided through telemedicine or store and forward technology—Coverage requirements.

RCW 18.71.030: Exemptions.

RCW 18.57.040: Licensing exemptions.

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

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 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),

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

Telehealth training

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.

WAC 246-945-430(5)

of a pharmacist to perform the monthly self-inspection requirement for pharmacies that store, dispense, and deliver drugs without a pharmacist on-site.

WAC 246-945-001(44)

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.

CR-101 : Telemedicine)

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 reimbursement 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: 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.

Teledentistry

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).

Payer policies

Washington Medicaid/Apple Health

Telemedicine & Telehealth Brief (PDF)

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”).

Clinical policy and billing for COVID-19 (PDF)

Electronic signature guidance during the COVID-19 outbreak (PDF)

Provider Billing Guides and Fee Schedules

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

Individual and family health plans & premiums

Premera Blue Cross

Asuris Northwest Health

Community Health Network of Washington

Coordinated Care Washington

Telehealth

Alliance Northwest Health Plan

Coronavirus (COVID-19) Information and Updates : See “Does my health plan cover any type of telehealth and/or virtual doctor visits?”

Kaiser Foundation Health Plan of the Northwest

Lifewise Health Plan of Washington

Find Care | LifeWise (virtual care)

Molina Healthcare of Washington

COVID Telehealth Billing Policy

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”).

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

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

Temporary Telehealth Policy for Naturopathic Physicians