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Washington

Counselors

Source

"Except as permitted under subsection (3) of this section, beginning January 1, 2021, a health care professional who provides clinical services through telemedicine, other than a physician licensed under chapter 18.71 RCW or an osteopathic physician licensed under chapter 18.57 RCW, shall complete a telemedicine training."

Social Workers

Source

"Except as permitted under subsection (3) of this section, beginning January 1, 2021, a health care professional who provides clinical services through telemedicine, other than a physician licensed under chapter 18.71 RCW or an osteopathic physician licensed under chapter 18.57 RCW, shall complete a telemedicine training."

Marriage and Family Therapists

Source

"Except as permitted under subsection (3) of this section, beginning January 1, 2021, a health care professional who provides clinical services through telemedicine, other than a physician licensed under chapter 18.71 RCW or an osteopathic physician licensed under chapter 18.57 RCW, shall complete a telemedicine training."

Psychologists

Source

"Except as permitted under subsection (3) of this section, beginning January 1, 2021, a health care professional who provides clinical services through telemedicine, other than a physician licensed under chapter 18.71 RCW or an osteopathic physician licensed under chapter 18.57 RCW, shall complete a telemedicine training."

Psychiatrists

Source

State of Washington Medical Quality Assurance Commission

“A. Licensure: A practitioner using Telemedicine to practice medicine on patients in

Washington must be licensed to practice medicine in Washington.

1. This includes practitioners who treat or prescribe to Washington patients through

online service sites.

2. The licensure exemption in RCW 18.71.030(6) does not apply to Telemedicine

practice. RCW 18.71.030(6) exempts from the licensing requirement “The practice of

medicine by any practitioner licensed by another state or territory in which he or she

resides, provided that such practitioner shall not open an office or appoint a place of

meeting patients or receiving calls within this state.” As the legislature created this

exemption in 1909, it clearly was not designed to apply to Telemedicine. Our state

supreme court has stated that this exemption “merely permits out-of-state

physicians temporarily within the state, but without an office or similar professional 

connections, to practice their calling while in Washington.”2 The Commission

interprets this exemption as applying to physicians who are physically in the state

and treating patients in-person, but on a temporary basis, such as a physician for a

sports team visiting the state. The Commission’s interpretation is consistent with the

statement by the state supreme court and with the Commission’s mission to protect

the public. The Commission must have the ability to prevent unqualified physicians

from practicing in our state and to take disciplinary action against practitioners who

commit unprofessional conduct or are impaired.”

 

“B. Standard of Care: Practitioners using Telemedicine will be held to the same standard of

care as practitioners engaging in more traditional in-person care delivery, including the

requirement to meet all technical, clinical, confidentiality and ethical standards required

by law. Failure to conform to the standard of care, whether rendered in person or via

Telemedicine, may subject the practitionerto potential discipline by the Commission.

Some elements of the standard of care as applied to Telemedicine include:

1. Practitioner-Patient Relationship: When practicing Telemedicine, a practitioner

must establish a practitioner-patient relationship with the patient. The absence

of in-person contact does not eliminate this requirement. Patient completion of

a questionnaire does not, by itself, establish a practitioner-patient relationship,

and therefore treatment, including prescriptions, based solely on a questionnaire

does not constitute an acceptable standard of care.

2. Informed Consent: As with medical care involving in-person contact, a

practitioner should obtain and document appropriate informed consent for

Telemedicine encounters. Because of the unique characteristics of Telemedicine,

it is best practice for the informed consent to include:

a. 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;

b. The credentials of the practitioner.

3. Patient Evaluation: An appropriate history and evaluation of the patient must

precede the rendering of any care, including provision of prescriptions. Not all

patient situations will be appropriate for Telemedicine. Since, by definition,

Telemedicine does not involve in-person contact between practitioner and

patient, if circumstances require in-person contact, an appropriate surrogate

examiner acceptable to the Telemedicine practitioner and the patient must be

present, with the patient, to provide necessary in-person observations, or the

Telemedicine practitioner should advise the patient to be seen by a practitioner

in-person. Evaluating the adequacy and significance of any surrogate

examination remains the responsibility of the Telemedicine practitioner.”

Refer to the source provided for all requirements and limitations.

Washington Professional Regulation/Health & Safety Online Prescribing

Source

Washington Medical Quality Assurance Commission, Guidelines for Appropriate Use of the Internet in Medical Practice, p. 3-4

“The WA Medical Quality Assurance Commission has issued guidelines on the use of the Internet in medical practices.  A guideline does not have the force of law, but can be considered by the Commission to be the standard of practice in the state.”

“A documented patient evaluation, including history and physical evaluation adequate to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided, must be obtained prior to providing treatment, including issuing prescriptions, electronically or otherwise.”

“Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in in-person settings.”

“Treatment, including issuing a prescription, based solely on an online questionnaire or consultation does not constitute an acceptable standard of care.”

Source

RCW 69.51A.030 (2)(a)

“(2)(a) A health care professional may provide a qualifying patient or that patient's designated provider with an authorization for the medical use of marijuana in accordance with this section.

(b) In order to authorize for the medical use of marijuana under (a) of this subsection, the health care professional must:

(i) Have a documented relationship with the patient, as a principal care provider or a specialist, relating to the diagnosis and ongoing treatment or monitoring of the patient's terminal or debilitating medical condition;

(ii) Complete an in-person physical examination of the patient or a remote physical examination of the patient if one is determined to be appropriate under (c)(iii) of this subsection;

(iii) Document the terminal or debilitating medical condition of the patient in the patient's medical record and that the patient may benefit from treatment of this condition or its symptoms with medical use of marijuana;

(iv) Inform the patient of other options for treating the terminal or debilitating medical condition and documenting in the patient's medical record that the patient has received this information;

(v) Document in the patient's medical record other measures attempted to treat the terminal or debilitating medical condition that do not involve the medical use of marijuana; and

(vi) Complete an authorization on forms developed by the department, in accordance with subsection (3) of this section.

(c)(i) For a qualifying patient eighteen years of age or older, an authorization expires one year after its issuance. For a qualifying patient less than eighteen years of age, an authorization expires six months after its issuance.

(ii) An authorization may be renewed upon completion of an in-person physical examination or a remote physical examination of the patient if one is determined to be appropriate under (c)(iii) of this subsection and, in compliance with the other requirements of (b) of this subsection.

(iii) Following an in-person physical examination to authorize the use of marijuana for medical purposes, the health care professional may determine and note in the patient's medical record that subsequent physical examinations for the purposes of renewing an authorization may occur through the use of telemedicine technology if the health care professional determines that requiring the qualifying patient to attend a physical examination in person to renew an authorization would likely result in severe hardship to the qualifying patient because of the qualifying patient's physical or emotional condition.

(iv) When renewing a qualifying patient's authorization for the medical use of marijuana on or after July 28, 2019, the health care professional may indicate that the qualifying patient qualifies for a compassionate care renewal of his or her registration in the medical marijuana authorization database and recognition card if the health care professional determines that requiring the qualifying patient to renew a registration in person would likely result in severe hardship to the qualifying patient because of the qualifying patient's physical or emotional condition. A compassionate care renewal of a qualifying patient's registration and recognition card allows the qualifying patient to receive renewals without the need to be physically present at a retailer and without the requirement to have a photograph taken.

(d) A health care professional shall not:

(i) Accept, solicit, or offer any form of pecuniary remuneration from or to a marijuana retailer, marijuana processor, or marijuana producer;

(ii) Offer a discount or any other thing of value to a qualifying patient who is a customer of, or agrees to be a customer of, a particular marijuana retailer;

(iii) Examine or offer to examine a patient for purposes of diagnosing a terminal or debilitating medical condition at a location where marijuana is produced, processed, or sold;

(iv) Have a business or practice which consists primarily of authorizing the medical use of marijuana or authorize the medical use of marijuana at any location other than his or her practice's permanent physical location;

(v) Except as provided in RCW 69.51A.280, sell, or provide at no charge, marijuana concentrates, marijuana-infused products, or useable marijuana to a qualifying patient or designated provider; or

(vi) Hold an economic interest in an enterprise that produces, processes, or sells marijuana if the health care professional authorizes the medical use of marijuana.”

Refer to the source provided for all requirements and limitations.

Nurses

Source

Telehealth/Telenursing For Registered Nurses

“1. Telephone triage and nursing consultation by telephone or other electronic technology, incorporates unique knowledge, skill, and competencies. Nurses employ the full range of the nursing process to gather data, make assessments, and generate plans for care via telephone encounters with patients. 2. Protocols are appropriate tools for implementing treatment plans. A registered nurse may use a protocol that has been written and approved by a physician to initiate a standing order for a medication or treatment. Assuming an appropriate patient-prescriber relationship exists, authorized standing orders may be implemented without consulting an authorized prescriber for a particular patient. The registered nurse should implement only standing orders which include a target population, exclusions, the population served, contraindications, special considerations, a specific order, a description of who has the authority to implement the order, physician signature, and review and approval by nursing as well as other involved disciplines. 3. Practice guidelines and protocols for care should be developed based on scientific/empirical evidence and outcomes data or expert opinion. Methods for periodic review of these tools to evaluate care effectiveness and currency of information should be in place. 4. Practice guidelines should evolve through collaboration and professional consensus among all involved health care disciplines. 5. When functions of the nurse involve complex decision making, even when driven by algorithm and protocol, telenursing should be limited to the practice of registered nursing. Licensed practical nursing activities within this context may include information gathering and the provision of patient education. 6. The registered nurse must be able to access a provider licensed to prescribe if questions or issues arise related to the order or the telephone encounter. 7. Documentation of patient encounters must include a record of the patient’s statements and symptoms, recommendations for care management with reference to the specific protocol or guideline, timely communication with other health care providers if indicated, and confidentiality of clinical information. Documentation in the patient’s permanent record should occur as soon as is reasonably possible.”

Refer to the source provided for all requirements and limitations.

Washington Professional Regulation/Health & Safety Online Prescribing

Source

Washington Medical Quality Assurance Commission, Guidelines for Appropriate Use of the Internet in Medical Practice, p. 3-4

“The WA Medical Quality Assurance Commission has issued guidelines on the use of the Internet in medical practices.  A guideline does not have the force of law, but can be considered by the Commission to be the standard of practice in the state.”

“A documented patient evaluation, including history and physical evaluation adequate to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided, must be obtained prior to providing treatment, including issuing prescriptions, electronically or otherwise.”

“Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in in-person settings.”

“Treatment, including issuing a prescription, based solely on an online questionnaire or consultation does not constitute an acceptable standard of care.”

Source

RCW 69.51A.030 (2)(a)

“(2)(a) A health care professional may provide a qualifying patient or that patient's designated provider with an authorization for the medical use of marijuana in accordance with this section.

(b) In order to authorize for the medical use of marijuana under (a) of this subsection, the health care professional must:

(i) Have a documented relationship with the patient, as a principal care provider or a specialist, relating to the diagnosis and ongoing treatment or monitoring of the patient's terminal or debilitating medical condition;

(ii) Complete an in-person physical examination of the patient or a remote physical examination of the patient if one is determined to be appropriate under (c)(iii) of this subsection;

(iii) Document the terminal or debilitating medical condition of the patient in the patient's medical record and that the patient may benefit from treatment of this condition or its symptoms with medical use of marijuana;

(iv) Inform the patient of other options for treating the terminal or debilitating medical condition and documenting in the patient's medical record that the patient has received this information;

(v) Document in the patient's medical record other measures attempted to treat the terminal or debilitating medical condition that do not involve the medical use of marijuana; and

(vi) Complete an authorization on forms developed by the department, in accordance with subsection (3) of this section.

(c)(i) For a qualifying patient eighteen years of age or older, an authorization expires one year after its issuance. For a qualifying patient less than eighteen years of age, an authorization expires six months after its issuance.

(ii) An authorization may be renewed upon completion of an in-person physical examination or a remote physical examination of the patient if one is determined to be appropriate under (c)(iii) of this subsection and, in compliance with the other requirements of (b) of this subsection.

(iii) Following an in-person physical examination to authorize the use of marijuana for medical purposes, the health care professional may determine and note in the patient's medical record that subsequent physical examinations for the purposes of renewing an authorization may occur through the use of telemedicine technology if the health care professional determines that requiring the qualifying patient to attend a physical examination in person to renew an authorization would likely result in severe hardship to the qualifying patient because of the qualifying patient's physical or emotional condition.

(iv) When renewing a qualifying patient's authorization for the medical use of marijuana on or after July 28, 2019, the health care professional may indicate that the qualifying patient qualifies for a compassionate care renewal of his or her registration in the medical marijuana authorization database and recognition card if the health care professional determines that requiring the qualifying patient to renew a registration in person would likely result in severe hardship to the qualifying patient because of the qualifying patient's physical or emotional condition. A compassionate care renewal of a qualifying patient's registration and recognition card allows the qualifying patient to receive renewals without the need to be physically present at a retailer and without the requirement to have a photograph taken.

(d) A health care professional shall not:

(i) Accept, solicit, or offer any form of pecuniary remuneration from or to a marijuana retailer, marijuana processor, or marijuana producer;

(ii) Offer a discount or any other thing of value to a qualifying patient who is a customer of, or agrees to be a customer of, a particular marijuana retailer;

(iii) Examine or offer to examine a patient for purposes of diagnosing a terminal or debilitating medical condition at a location where marijuana is produced, processed, or sold;

(iv) Have a business or practice which consists primarily of authorizing the medical use of marijuana or authorize the medical use of marijuana at any location other than his or her practice's permanent physical location;

(v) Except as provided in RCW 69.51A.280, sell, or provide at no charge, marijuana concentrates, marijuana-infused products, or useable marijuana to a qualifying patient or designated provider; or

(vi) Hold an economic interest in an enterprise that produces, processes, or sells marijuana if the health care professional authorizes the medical use of marijuana.”

Refer to the source provided for all requirements and limitations.

Medicaid Telehealth Parity Law

Source: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 91

"The agency reimburses medically necessary covered services through telemedicine when the service is provided by a Washington Apple Health provider and is within their scope of practice."

Refer to the source provided for all requirements and limitations.

Originating Site Reimbursement: We are not aware of any mention of the patient/client's home as an approved originating site.

 

Private Pay Telehealth Parity Law

Source: RCW 48.43.735.(1(c))

1) For health plans issued or renewed on or after January 1, 2017, a health carrier shall reimburse a provider for a health care service provided to a covered person through telemedicine or store and forward technology if:


(a) The plan provides coverage of the health care service when provided in person by the provider;
(b) The health care service is medically necessary;
(c) The health care service is a service recognized as an essential health benefit under section 1302(b) of the federal patient protection and affordable care act in effect on January 1, 2015; and
(d) The health care service is 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 used to provide the health care service meets the standards required by state and federal laws governing the privacy and security of protected health information.

Refer to the source provided for all requirements and limitations.

 

Payment Parity

We are not aware of any explicit payment parity.

*Clinicians who have had an experience with telehealth reimbursement in this state are invited to share their experiences in the comments section below: a) type of service provided; b) insurance provider; c) payment parity, payment issues, or insurance requirements

Permission for the Temporary Practice of Clinicians Licensed Outside the State

We are not aware of any permission that allows for services delivered by out-of-state providers.

Note: As this is a free resource and Rules and Regulations regarding Telehealth are always changing, we appreciate any updates or corrections. They can be emailed to us at This email address is being protected from spambots. You need JavaScript enabled to view it. with a link to the source or a citation of the rule or regulation.

THTC Program Button

Telemental health is not a separate service from mental health services. All state licensing boards require that licensed clinicians follow all the regulations for practicing under their license no matter what medium of communication is used. All licensing boards also require that clinicians only practice within the boundaries of their competence. This usually requires education, continuing education, and/or supervision in telemental health. Complete our telehealth training program to cover all the essential competencies of providing telemental health services and earn the THTC (Telemental Health Training Certificate).

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