• Beginning July 25th, 2021, providers who bill a patient or the patient’s health plan for audio-only telemedicine services must receive patient consent for the billing prior to rendering the service. The patient consent requirement is applicable to PEBB/SEBB plans, private health plans, behavioral health administrative services organizations and managed care organizations contracted with the Health Care Authority, and Medicaid managed care plans contracted with the Health Care Authority.
• Beginning January 1st, 2023, the provider must have an established relationship with a patient for an audio-only telemedicine service to be compensated at the same rate as an in-person visit. An Established Relationship is defined as a prior in-person visit within the last year with the provider, another provider at the same clinic, or with the referring provider.
• The bill also amends RCW 18.130.180(21) – unprofessional conduct, to include as unprofessional conduct a pattern of violations for failing to receive consent prior to billing for audio-only telemedicine services.

• Myocarditis is an inflammation of the heart muscle.
• Pericarditis is an inflammation of the heart muscle covering.
• The body’s immune system can cause inflammation often in response to an infection. The body’s immune system can cause inflammation after other things as well.

• A CDC safety panel has determined there is a “probable association” between myocarditis and pericarditis and the mRNA COVID-19 vaccines, made by Moderna and Pfizer-BioNTech, in some vaccine recipients.
• Reports of myocarditis and pericarditis after vaccination are rare.
• Cases have mostly occurred in adolescents and young adults under the age of 30 years and mostly in males.
• Most patients who developed myocarditis after vaccination responded well to rest and minimal treatment.

• Hundreds of millions of vaccine doses have safely been given to people in the U.S.
• Deaths from COVID-19 disease have occurred in adolescents and young adults. Since the pandemic began, there have been over 2,700 deaths from COVID-19 disease among people 12-29 in the U.S., and over 315 reported just since April.
• Vaccination has been shown to prevent COVID-19 disease or infection cases, hospitalizations, and deaths.
• The vaccine also protects against Multi-Symptom Inflammatory Syndrome in Children and Adults and long-term symptoms (“long COVID”). The risk of getting these conditions from COVID-19 disease is much higher than the risk of myocarditis from the vaccine.
• The vaccine also protects against new, more dangerous variants of the virus.
• The benefits of the vaccines far outweigh the risk of myocarditis. The vaccine prevents thousands of cases of death and disease, while myocarditis is rare and most respond well to minimal treatment and rest.
• For an easy way to understand the benefits of the vaccine outweighing the risk of myocarditis, watch this video from Dr. Paul Offit with your patients or share it with them. In this video, Dr. Paul Offit (the director of the Vaccine Education Center of the Children’s Hospital of Philadelphia) uses a sports stadium to illustrate the benefits and risks in young adults.
• For more examples you can share with your patients, see CDC slides here.

• Chest pain
• Shortness of breath
• Feelings of having a fast-beating, fluttering, or pounding heart

• The best way to protect everyone is to get vaccinated as soon as possible, especially because of the rise of the Delta variant.
• A large number of medical professional and public health associations strongly recommend COVID-19 vaccinations, including the American Academy of Pediatrics, the American Academy of Family Physicians, the American Heart Association, the American College of Obstetricians and Gynecologists, and the American Medical Association.
• Everyone age 12 and older may receive COVID-19 vaccine unless they had an anaphylaxis reaction to the first dose.
• U.S. Health and Human Services statement on vaccine recommendation
• The Western States Scientific Safety Review Workgroup concluded June 23 that the known benefits of COVID-19 vaccination substantially outweigh the very small risk of myocarditis and pericarditis following receipt of mRNA vaccines.

• Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination | CDC
• COVID-19 vaccine information | Washington State Department of Health

• Learn more about the Clinical Immunization Safety Assessment (CISA) Project here, including the links and phone number to request the consult.

• If you diagnose the patient, you must report to the Vaccine Adverse Event Reporting System (VAERS) even if you did not administer the vaccine.
• Reporting the event is mandatory and the responsible party is the clinician who diagnosed the reaction, not the clinician who originally gave the vaccine.

• The CDC continues to recommend COVID-19 vaccination for everyone age 12 and older because of the greater risk of serious complications related to COVID-19, such as hospitalization, multisystem inflammatory syndrome in children (MIS-C), or death.

• Consider myocarditis and pericarditis in adolescents or young adults with acute chest pain, shortness of breath, or palpitations. In this younger population, coronary events are less likely to be a source of these symptoms.
• If you identify these symptoms, ask about prior COVID-19 vaccination, as well as relevant other medical and travel history or exposure to toxins.
• For initial evaluation, consider an ECG, troponin level, and inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate. In the setting of normal ECG, troponin, and inflammatory markers, myocarditis or pericarditis are unlikely.
• For suspected cases, consider consulting with cardiology. Evaluation and management may vary depending on the patient age, clinical presentation, potential causes, or preferences of the provider and patient
• For follow-up of patients with myocarditis, consult the recommendations from the American Heart Association and the American College of Cardiology.
• Rule out other potential causes of myocarditis and pericarditis. Consider consultation with infectious disease and/or rheumatology to assist in this evaluation.

• Clinical considerations for myocarditis and pericarditis | CDC