By: John Mark Huff
On June 5, 2020, a new statute covering telehealth services under the West Virginia Public Employees Insurance Act (“PEIA”) went into effect.1 This statute endeavors to formulate definitions regarding telehealth while also setting forth what telehealth services PEIA must cover.2 According to the statute, a distant site is defined as “the telehealth site where the health care practitioner is seeing the patient at a distance or consulting with a patient’s health care practitioner.”3
An originating site is the place where the patient is located “whether or not accompanied by a health care practitioner, at the time services are provided by a health care practitioner through telehealth, including, but not limited to, a health care practitioner’s office, hospital, critical access hospital, rural health clinic, federally qualified health center, a patient’s home, and other nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient.”4 The statute allows for the originating site to charge PEIA a “site fee.”5 The statute defines a healthcare practitioner as a person licensed pursuant to W. Va. Code § 30-1-1 et seq.6
Pursuant to statute, telehealth services mean “the use of synchronous or asynchronous telecommunications technology by a health care practitioner to provide health care services, including, but not limited to, assessment, diagnosis, consultation, treatment, and monitoring of a patient; transfer of medical data; patient and professional health-related education; public health services; and health administration.”7 Telehealth services do not include “audio-only telephone calls, e-mail messages, or facsimile transmissions.”8 Thus, the statute indicates that telehealth services, for the purposes of PEIA, must include a video or in-person component and cannot be solely based on an audio-only telephone call, e-mail message, or fax.9
Remote patient monitoring services are defined to be “the delivery of home health services using telecommunications technology to enhance the delivery of home health care.”10 These services include “monitoring clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other condition-specific data; medication adherence; and interactive video conferencing with or without digital image upload.”11 An example of this would be a remote pacemaker monitoring system whereby a patient’s pacemaker is remotely monitored over the internet with the healthcare provider being alerted of any episodes or events that might require their attention.
The statute provides that after July 1, 2020, PEIA “shall provide coverage of health care services provided through telehealth services if those same services are covered through face-to-face consultation by the policy.”12 Further, after July 1, 2020, PEIA “may not exclude a service for coverage solely because the service is provided through telehealth services.”13 PEIA must also “provide reimbursement for a telehealth service at a rate negotiated between the provider and the insurance company.”14
Moreover, PEIA “may not impose any annual or lifetime dollar maximum on coverage for telehealth services other than an annual or lifetime dollar maximum that applies in the aggregate to all items and services covered under the policy, or impose upon any person receiving benefits pursuant to this section any copayment, coinsurance, or deductible amounts, or any policy year, calendar year, lifetime, or other durational benefit limitation or maximum for benefits or services, that is not equally imposed upon all terms and services covered under the policy, contract, or plan.”15
Additionally, “[t]he coverage required” by the statute “shall include the use of telehealth technologies as it pertains to medically necessary remote patient monitoring services to the full extent that those services are available.”16 Thus, based upon the statute enacted by the West Virginia Legislature, telehealth services are mandated to be covered by PEIA and such services cannot be excluded from coverage so long as the service would also have been covered if the service had been provided in-person.17
1 W. Va. Code § 5-16-7b.
2 Id.
3 W. Va. Code § 5-16-7b(a)(1)
4 W. Va. Code § 5-16-7b(a)(3).
5 W. Va. Code § 5-16-7b(f).
6 W. Va. Code § 5-16-7b(a)(2).
7 W. Va. Code § 5-16-7b(a)(5).
8 Id.
9 Id.
10 W. Va. Code § 5-16-7a(a)(4).
11 Id.
12 W. Va. Code § 5-16-7a(b).
13 W. Va. Code § 5-16-7b(c).
14 W. Va. Code § 5-16-7b(d).
15 W. Va. Code § 5-16-7b(e).
16 W. Va. Code § 5-16-7b(g).
17 See W. Va. Code § 5-16-7b(b); W. Va. Code § 5-16-7b(c).