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WV Health Care Authority Issues First Telemedicine Decision

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The West Virginia Health Care Authority ("HCA") recently issued its first decision on a telemedicine Certificate of Need ("CON") application.  The HCA denied the application of a University of Pittsburgh Medical Center affiliate, University of Pittsburgh Physicians ("UPP"), to provide telemedicine services throughout West Virginia.  In re: University of Pittsburgh Physicians, CON File No. 15-WV-10524-P (WV HCA, May 9, 2016).

The Authority reviewed the application under the “ambulatory healthcare facility” standards.  In a 2012 application (later withdrawn), the HCA had previously directed an out-of-state telemedicine applicant to use the ambulatory health care facility standards in completing the application, but that application was later withdrawn.

The Authority denied the UPP application on the basis that need had not been demonstrated and that the “continuum of care” criteria were not met.  With regard to need, the HCA was critical of the state-wide approach by UPP (rather than county by county), and the disparity between its projections and actual experience as to telemedicine utilization.

Under the CON proposal, UPP would have billed patients directly for services.  The decision, therefore, does not necessarily implicate the provision of telemedicine service arrangements in which the service provider does not bill consumers directly.  For example, services billed by local providers, but provided by physicians operating remotely, would not necessarily be affected by the decision.

The most recent statutory changes to the CON laws do not contain any provisions specific to telemedicine, so the decision will remain important to assessing telemedicine proposals.

For questions about CON, or other health care matters, please contact the author of this alert or any member of the Steptoe & Johnson Health Care Team.

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