As the COVID pandemic continues, where does the Oregon Workers’ Compensation Division stand on telemedicine?
In March 2020, the Division set out temporary rules to address fees related to telemedicine appointments following Governor Brown’s “Stay at Home Order.” The temporary rules increased the amount of fees that would be paid to medical providers for telemedicine visits so that providers would be able to serve more injured workers during the pandemic. Essentially, providers would be able to collect the same fee they would be allowed to collect for a regular in-person office visit. At the time the temporary rules were adopted, the Division was encouraging both medical providers and injured workers to utilize telemedicine visits in order to minimize the risk of contracting and spreading the virus. Telemedicine visits were not restricted by type of service or type of provider. Visits were only subject to an “appropriateness” standard.
Now that we are six months into the “Stay at Home Order,” we have seen various counties loosen their restrictions. Each county across the state is in various levels of reopening, depending on their available tracking data and approval from the Governor. What does this mean for telemedicine? Can insurers and third-party administrators deny requests for telemedicine visits if the county the injured worker is seeking treatment in has reopened in some capacity? Starting September 21, 2020, the Division has permanently adopted the temporary rules regarding telemedicine/telehealth visits. Therefore, the insurer and/or third-party administrator can only deny the request for a telemedicine visit if the service is not “appropriate.” And, for the foreseeable future, the fees will stay at the increased rate outlined in OAR 436-009-0040(1)(c).
Practically speaking, many of the providers have set up their offices to maintain social distancing requirements and have plenty of personal protective equipment (PPE) on hand to see injured workers in person. Most of the information that is relevant to evaluating and/or assessing ongoing temporary disability authorization, further treatment recommendations, and entitlement to permanent disability hinges on a physical examination – which cannot be accomplished via telemedicine visits. If any of these issues are present in your case, it may be appropriate to deny a request for telemedicine visit. Of course, determining the “appropriateness” of a request for a telemedicine visit should be evaluated on a case-by-case basis and can complicated. If you have any questions about whether to authorize a request, please contact me at or 503-412-3111.
