September 27, 2021

Volume XI, Number 270


September 24, 2021

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The “State” of Telehealth: West Virginia

West Virginia Bill Seeks to Regulate Parity and Out-of-State Providers

On February 10, 2021, members of the West Virginia Legislature introduced Senate Bill 1 (“SB1”) which seeks to regulate the use of telemedicine in the state. If passed, the proposed bill would require the Public Employees Insurance Agency, Medicaid and specified insurance plans to cover telehealth services at the same rate as in-person health care, starting July 1, 2021. The bill would also permit health care providers who are licensed in other states to provide telehealth services in West Virginia.

Like many other states during the public health emergency, in an effort to reduce the potential exposure to the COVID-19 virus, West Virginia providers began seeing patients remotely. These virtual visits provided wider access to healthcare services while reducing the risk of exposure that came with office visits. The proposed bill now attempts to outline the laws governing how healthcare services may be provided through the means of video and audio components.

Parity for Telehealth Services

Under SB1, insurance plans must provide coverage of health care services that are provided through telehealth services, if the policy covers the same services for face-to-face consultation. The bill would prevent insurance policies from excluding a service for coverage, solely because it is provided remotely. The bill also bans annual or lifetime dollar maximum coverage for telehealth services outside of the maximum that applies to all items and services that are already covered under the policy. It would also bar insurance companies from charging a co-payment or deductible that is not equally imposed on all terms and services.

Additionally, if passed, the bill would require that reimbursement for telehealth services is provided at a rate negotiated between the provider and the insurance company for virtual telehealth encounters, and that reimbursement for a telehealth service for an established patient is provided on the same basis and at the same rate under a policy as if the service is provided through an in-person encounter.

SB1 would also permit clinics and hospitals to charge a “site fee” for telemedicine services.

Out of State Providers

An additional component to SB1 is that it would permit health care providers who are licensed and in good standing in other states to provide a telehealth service to West Virginian citizens, from the out-of-state origination site. Under SB1, the out-of-state provider would be required to register as an interstate telehealth practitioner in West Virgini and to meet qualifications set by West Virginia regulatory boards.

The bill would however, prohibit telehealth providers from prescribing Schedule II narcotic drugs and amphetamines, hallucinogens, benzodiazepines like Valium and Xanax and Schedule V drugs like Robitussin AC and codeine, even if the health care provider is authorized to prescribe the drugs under state law. It would also require telehealth patients visit an in-person provider within 12 months of using the telehealth service. The telehealth service will not be available until the patient has seen an in-person provider.

Senator Rollan Roberts, one of the bill’s co-sponsors, noted that, “SB 1 outlines the laws governing how medical services may be provided through the means of video and audio components.”

West Virginia joins the recent push among states to provide parity legislation for its citizens. We will continue to monitor the expansion of telehealth services in the state of Wesr Virginia, and other states across the nation in accordance with our “State” of Telehealth series.

Copyright © 2021, Sheppard Mullin Richter & Hampton LLP.National Law Review, Volume XI, Number 64

About this Author

Matthew Shatzkes Attorney New York Sheppard Mullin

Matthew Shatzkes is a partner in the Corporate Practice Group in the New York office of Sheppard Mullin and is a member of the firm’s healthcare practice team.

Areas of Practice

Matthew provides strategic, regulatory, compliance, and transactional advice to all manner of health care clients, including health systems, hospitals, academic medical centers, long-term care providers, ambulatory surgery centers, diagnostic and treatment centers, physician practices, digital health companies and investors....

Ehiguina L. Borha Corporate Attorney Sheppard Mullin New York, NY

Ehi Borha is an associate in the Corporate Practice Group in the firm's New York office. 

Areas of Practice

Ehi's practice focuses on healthcare M&A and regulatory matters. He is a former member of the New York Due Diligence Group where he worked on the diligence aspect of a number of M&A transactions. Ehi is a 2019 graduate of New York Law School, where he served as a member of the mediation and negotiation clinic and completed a concentration in business and corporate law. He received his Bachelor of Arts in English Literature & Sociology from...