Kentucky

CURRENT STATE LAWS & POLICY

AT A GLANCE

Medicaid Program

Kentucky Medicaid

Administrator

Kentucky Dept. for Medicaid Services

Regional Telehealth Resource Center

Mid-Atlantic Telehealth Resource Center

Medicaid Reimbursement

Live Video: Yes
Store-and-Forward: Yes
Remote Patient Monitoring: No

Private Payer Law

Law Exists: Yes
Payment Parity: Yes

Professional Requirements

Licensure Compacts: IMLC, PTC, NLC, PSY, ASLP-IC
Consent Requirements: Yes

Last updated 09/14/2021

Audio-Only Delivery

Medicaid: COVID-19 Telehealth for Behavioral Health Providers

STATUS: Active

Medicaid: Provider Letter Regarding 1915(c) Waiver for Home and Community Based Services Waiver

STATUS: Active

Medicaid: Guidance on Well Child Visits during COVID-19

STATUS: Active

Medicaid: COVID-19 FAQs on Telehealth

STATUS: Active, until end of federal PHE

Medicaid 1915(c) Waiver:  Appendix K – Acquired Brain Injury/Supports for Community Living/Home and Community Based Waiver/Model II Waiver

STATUS: Active, extended six months after end of federal PHE

Medicaid 1915(c) Waiver: Appendix K- Acquired Brain Injury/ Acquired Brain Injury Long Term Care/Supports for Community Living/Michelle P Waiver/Home and Community Based Waiver/Model II Waiver

STATUS: Active, Addendum extends waiver six months after end of federal PHE

Last updated 09/14/2021

Cross-State Licensing

Medicaid: COVID-19 FAQs on Telehealth

STATUS: Active, until end of federal PHE

Board of Licensed Professional Counselors: Out-of-State Telehealth Services

STATUS: Active, until end of KY state of emergency.

Board of Licensed Professional Counselors: Telehealth COVID-19 Letter

STATUS: Active

KY Board of Medical Licensure: Out of State Registry for Inpatient Hospital Services and Skilled Nursing Care

STATUS: Active

Last updated 09/14/2021

Easing Prescribing Requirements

Medicaid: COVID-19 FAQs on Telehealth

STATUS: Active, until end of federal PHE

SB 150: Provider-Patient Relationship

STATUS: Enacted

Last updated 09/15/2021

Miscellaneous

Medicaid 1915(c) Waiver:  Appendix K – Extension for Waivers Combined

STATUS: Active, extended six months after end of federal PHE

Last updated 09/14/2021

Originating Site

Medicaid: COVID-19 FAQs on Telehealth

STATUS: Active, until end of federal PHE

Last updated 09/14/2021

Private Payer

Department of Insurance: Telehealth Remote Communications

STATUS: Active

Last updated 09/14/2021

Provider Type

Medicaid: COVID-19 Telehealth for Behavioral Health Providers

STATUS: Active

Medicaid: Provider Letter Regarding 1915(c) Waiver for Home and Community Based Services Waiver

STATUS: Active

Medicaid: COVID-19 FAQs for Medicaid  1915(c) Home and Community Based Services Waivers

STATUS: Active

Medicaid: COVID-19 FAQs on Telehealth

STATUS: Active, until end of federal PHE

Last updated 09/14/2021

Service Expansion

Medicaid: COVID-19 Telehealth for Behavioral Health Providers

STATUS: Active

Medicaid: Provider Letter Regarding 1915(c) Waiver for Home and Community Based Services Waiver

STATUS: Active

Medicaid: COVID-19 FAQs for Medicaid  1915(c) Home and Community Based Services Waivers

STATUS: Active

Medicaid: Guidance on Well Child Visits during COVID-19

STATUS: Active

Medicaid: COVID-19 FAQs on Telehealth

STATUS: Active, until end of federal PHE

Medicaid: Emergency Rule Establishing a Glossary of Telehealth Terminology

STATUS: Active

Medicaid: Emergency Rule on Enhanced HANDS Services

STATUS: Expired

Medicaid 1915(c) Waiver:  Appendix K – Acquired Brain Injury/Supports for Community Living/Home and Community Based Waiver/Model II Waiver

STATUS: Active, extended six months after end of federal PHE; see Addendum below

Medicaid 1915(c) Waiver: Appendix K- Acquired Brain Injury/ Acquired Brain Injury Long Term Care/Supports for Community Living/Michelle P Waiver/Home and Community Based Waiver/Model II Waiver

STATUS: Active, Addendum extends waiver six months after end of federal PHE

Cabinet for Health and Family Services: Early Intervention Services

STATUS: Effective starting Mar. 5, 2021 and lasts 270 days

Last updated 09/15/2021

Definitions

“Telehealth” or “digital health” means a mode of delivering healthcare services through the use of telecommunication technologies, including but not limited to synchronous and asynchronous technology, remote patient monitoring technology, and audio-only encounters, by a health care provider to a patient or to another health care provider at a different location. Shall not include:

  • The delivery of health care services through electronic mail, text, chat, or facsimile unless a state agency authorized or required to promulgate administrative regulations relating to telehealth determines that health care services can be delivered via these modalities in ways that enhance recipient health and well-being and meet all clinical and technology guidelines for recipient safety and appropriate delivery of services; or
  • Basic communication between a health care provider and a patient, including but not limited to appointment scheduling, appointment reminders, voicemails, or any other similar communication intended to facilitate the actual provision of healthcare services either in-person or via telehealth; and

Unless waived by the applicable federal authority, shall be delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996.

SOURCE: House Bill 140 (2021 Session), (Accessed Sept. 2021).

“Telehealth consultation means a medical or health consultation, for purposes of patient diagnosis or treatment, that meets the definition of telehealth in this section.”

SOURCE: KY Revised Statutes. 205.510. (Accessed Sept 2021).

Telehealth means two-way, real time interactive communication between a patient and a physician or practitioner located at a distant site for the purpose of improving a patient’s health through the use of interactive telecommunication equipment that includes, at a minimum, audio and video equipment.

SOURCE: KY 907 KAR 1:055 (36). (Accessed Sept. 2021).

“Telemedicine” means two-way, real time interactive communication between a patient and a physician or practitioner located at a distant site for the purpose of improving a patient’s health through the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.

SOURCE: KY 907 KAR 9:005. (Accessed Sept. 2021).

“Telehealth” or “digital health” is defined by KRS 211.332(5). “Telehealth” or “digital health”: Means a mode of delivering healthcare services through the use of telecommunication technologies, including but not limited to synchronous and asynchronous technology, remote patient monitoring technology, and audio only encounters, by a health care provider to a patient or to another health care provider at a different location.

Shall not include:

  • The delivery of health care services through electronic mail, text, chat, or facsimile unless a state agency authorized or required to promulgate administrative regulations relating to telehealth determines that health care services can be delivered via these modalities in ways that enhance recipient health and well-being and meet all clinical and technology guidelines for recipient safety and appropriate delivery of services; or
  • Basic communication between a health care provider and a patient, including but not limited to appointment scheduling, appointment reminders, voicemails, or any other similar communication intended to facilitate the actual provision of healthcare services either in-person or via telehealth; and
  • Unless waived by the applicable federal authority, shall be delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. secs. 1320d to 1320d-9.

SOURCE: KY 900 KAR 12:005 Emergency Rule & Ordinary Rule; KY Revised Statute 211.332. (Accessed Sept. 2021)

Last updated 09/15/2021

Email, Phone & Fax

Telehealth services and telehealth consultations shall not be reimbursable under this section if they are provided through the use of a facsimile machine, text, chat, or electronic mail unless the Department for Medicaid Services determines that telehealth can be provided via these modalities in ways that enhance recipient health and well-being and meet all clinical and technology guidelines for recipient safety and appropriate delivery of services.

Medicaid-participating practitioners and home health agencies are strongly encouraged to use audio-only encounters as a mode of delivering telehealth services only when no other approved mode of delivering telehealth services is available.

SOURCE: KY Revised Statute Sec. 205.559 as Revised by House Bill 140 (2021 Session), (Accessed Sept. 2021).

Health care providers performing a telehealth or digital health service shall, as appropriate for the service, provider, and recipient, utilize the following modalities of communication delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA):

  • Live or real-time audio and video synchronous telehealth technology;
  • Asynchronous store-and-forward telehealth technology;
  • Remote patient monitoring using wireless devices, wearable sensors, or implanted health monitors;
  • Audio-only telecommunications systems; or
  • Clinical text chat technology when:
    • Utilized within a secure, HIPAA compliant application or electronic health record system;

and

    • Meeting:
      • The scope of the provider’s professional licensure; and
      • The scope of practice of the provider; and
      • Comply with the following federal laws to prevent waste, fraud, and abuse relating to telehealth:
        • False Claims Act, 31 U.S.C. § 3729-3733;
        • Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b); and
        • Physician Self-Referral, Section 1877 of the Social Security Act

SOURCE: KY 900 KAR 12:005 Emergency Rule & Ordinary Rule. (Accessed Sept. 2021).

Last updated 09/15/2021

Live Video

POLICY

The department must reimburse an eligible telehealth care provider for a telehealth service in an amount that is at least 100 percent of the amount for a comparable in-person service. A managed care plan may establish a different rate for telehealth reimbursement via contract.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Sept 2021).

A request for reimbursement shall not be denied solely because:

  • An in-person consultation between a Medicaid-participating practitioner and a patient did not occur; or
  • A Medicaid-participating provider employed by a rural health clinic, federally qualified health center, or federally qualified health center look-alike was not physically located on the premises of the clinic or health center when the telehealth service or telehealth consultation was provided.

SOURCE: KY Revised Statute Sec. 205.559, as revised by House Bill 140 (2021 Session), (Accessed Sept. 2021).

The Department for Medicaid Services and any managed care organization with whom the department contracts for the delivery of Medicaid services shall not:

  • Require a Medicaid provider to be physically present with a Medicaid recipient, unless the provider determines that it is medically necessary to perform those services in person;
  • Require prior authorization, medical review, or administrative clearance for telehealth that would not be required if a service were provided in person;
  • Require a Medicaid provider to be employed by another provider or agency in order to provide telehealth services that would not be required if that service were provided in person;
  • Require demonstration that it is necessary to provide services to a Medicaid recipient through telehealth;
  • Restrict or deny coverage of telehealth based solely on the communication technology or application used to deliver the telehealth services; or
  • Require a Medicaid provider to be part of a telehealth network.

Nothing in this section shall be construed to require the Medicaid program or a Medicaid managed care organization to:

  • Provide coverage for telehealth services that are not medically necessary; or
  • Reimburse any fees charged by a telehealth facility for transmission of a telehealth encounter.

The cabinet, in implementing Sections 2 and 3 of this Act, shall maintain telehealth policies and guidelines to providing care that ensure that Medicaid-eligible citizens will have safe, adequate, and efficient medical care, and that prevent waste, fraud, and abuse of the Medicaid program.

SOURCE: KY Revised Statute Sec. 205.5591, as revised by House Bill 140 (2021 Session), (Accessed Sept. 2021).

Health care providers performing a telehealth or digital health service shall, as appropriate for the service, provider, and recipient, utilize the following modalities of communication delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA):

  • Live or real-time audio and video synchronous telehealth technology;
  • Asynchronous store-and-forward telehealth technology;
  • Remote patient monitoring using wireless devices, wearable sensors, or implanted health monitors;
  • Audio-only telecommunications systems; or
  • Clinical text chat technology when:
    • Utilized within a secure, HIPAA compliant application or electronic health record system;

and

    • Meeting:
      • The scope of the provider’s professional licensure; and
      • The scope of practice of the provider; and
      • Comply with the following federal laws to prevent waste, fraud, and abuse relating to telehealth:
        • False Claims Act, 31 U.S.C. § 3729-3733;
        • Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b); and
        • Physician Self-Referral, Section 1877 of the Social Security Act

SOURCE: KY 900 KAR 12:005 Emergency Rule & Ordinary Rule. (Accessed Sept. 2021).


ELIGIBLE SERVICES/SPECIALTIES

The Cabinet for Health and Family Services and any managed care organization with whom the Department for Medicaid Services contracts for the delivery of Medicaid services shall provide Medicaid reimbursement for covered telehealth services and telehealth consultations, if the telehealth service or telehealth consultation:

  • Is provided by a Medicaid-participating practitioner, including those employed by a home health agency licensed pursuant to KRS Chapter 216, to a Medicaid recipient or another Medicaid-participating practitioner at a different physical location; and
  • Meets all clinical, technology, and medical coding guidelines for recipient safety and appropriate delivery of services established by the Department for Medicaid Services or the provider’s professional licensure board.

SOURCE: KY Revised Statute Sec. 205.559 as revised by House Bill 140 (2021 Session), (Accessed Sept. 2021).

Telehealth service means any service that is provided by telehealth that is one of the following:

  • Event
  • Encounter
  • Consultation, including a telehealth consultation
  • Visit
  • Store-and-forward transfer
  • Remote patient monitoring
  • Referral
  • Treatment

A service is not reimbursed if:

  • It is not medically necessary;
  • The equivalent service is not covered by the department if provided in a face-to-face setting; or
  • The provider is not enrolled, participating, or in good standing with the Medicaid program, is on an excluded or terminated provider list, or is an excluded individual or entity, as listed on the US Office of Inspector General List.

Reimbursement is not made for services that are not:

  • Medically necessary;
  • Compliant with administrative regulation;
  • Applicable to this administrative regulation; or
  • Compliant with state or federal law.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Sept. 2021).


ELIGIBLE PROVIDERS

For rural health clinics, federally qualified health centers, and federally qualified health center look-alikes, reimbursement for covered telehealth services and telehealth consultations shall:

  • To the extent permitted under federal law, include an originating site fee in an amount equal to that which is permitted under 42 U.S.C. sec. 1395m for Medicare-participating providers if the Medicaid beneficiary who received the telehealth service or telehealth consultation was physically located at the rural health clinic, federally qualified health center, or federally qualified health center look-alike at the time of service or consultation delivery and the provider of the telehealth service or telehealth consultation is not employed by the rural health clinic, federally qualified health center, or federally qualified health center look-alike; or
  • If the telehealth service or telehealth consultation provider is employed by the rural health clinic, federally qualified health center, or federally qualified health center look-alike, include a supplemental reimbursement paid by the Department for Medicaid Services in an amount equal to the difference between the actual reimbursement amount paid by a Medicaid managed care organization and the amount that would have been paid if reimbursement had been made directly by the department.

SOURCE: KY Revised Statute Sec. 205.559 as revised by House Bill 140 (2021 Session), (Accessed Sept. 2021).

A “telehealth care provider” is a Medicaid provider who is:

  • Currently enrolled as a Medicaid provider;
  • Currently participating as a Medicaid provider;
  • Operating within the scope of the provider’s professional licensure; and
  • Operating within the provider’s scope of practice.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Sept. 2021).

Eligible providers for services NOT in a Community Mental Health Center:

  • A psychiatrist;
  • A licensed clinical social worker directly employed by a psychiatrist if the psychiatrist also interacts with the recipient during the encounter;
  • A psychologist with a license and a doctorate degree in psychology directly employed by a psychiatrist if the psychiatrist also interacts with the recipient during the encounter;
  • A licensed professional clinical counselor directly employed by a psychiatrist if the psychiatrist also interacts with the recipient during the encounter;
  • A licensed marriage and family therapist directly employed by a psychiatrist if the psychiatrist also interacts with the recipient during the encounter;
  • A physician;
  • An APRN;
  • Speech-language pathologist;
  • Occupational therapist;
  • Physical therapist;
  • Licensed dietitian or certified nutritionist; or
  • Registered nurse or dietitian

Eligible providers for services in a Community Mental Health Center:

  • A psychiatrist;
  • A physician;
  • Psychologist with a license in accordance with KRS 319.010(6);
  • A licensed marriage and family therapist;
  • A licensed professional clinical counselor;
  • A psychiatric medical resident;
  • A psychiatric registered nurse;
  • A licensed clinical social worker;
  • An advanced practice registered nurse

Restrictions apply for all professionals.

SOURCE: KY State Plan Amendment. Attachment 3.1-B. Approved 3/9/2011 (Accessed Sept. 2021).


ELIGIBLE SITES

Place of service is anywhere the patient is located at the time a telehealth service is provided, and includes telehealth services provided to a patient at home or office, or a clinic, school or workplace.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Sept. 2021).

For rural health clinics, federally qualified health centers, and federally qualified health center look-alikes, reimbursement for covered telehealth services and telehealth consultations shall:

  • To the extent permitted under federal law, include an originating site fee in an amount equal to that which is permitted under 42 U.S.C. sec. 1395m for Medicare-participating providers if the Medicaid beneficiary who received the telehealth service or telehealth consultation was physically located at the rural health clinic, federally qualified health center, or federally qualified health center look-alike at the time of service or consultation delivery and the provider of the telehealth service or telehealth consultation is not employed by the rural health clinic, federally qualified health center, or federally qualified health center look-alike; or
  • If the telehealth service or telehealth consultation provider is employed by the rural health clinic, federally qualified health center, or federally qualified health center look-alike, include a supplemental reimbursement paid by the Department for Medicaid Services in an amount equal to the difference between the actual reimbursement amount paid by a Medicaid managed care organization and the amount that would have been paid if reimbursement had been made directly by the department.

SOURCE: KY Revised Statute Sec. 205.559 as revised by House Bill 140 (2021 Session), (Accessed Sept. 2021).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

For rural health clinics, federally qualified health centers, and federally qualified health center look-alikes, reimbursement for covered telehealth services and telehealth consultations shall to the extent permitted under federal law, include an originating site fee in an amount equal to that which is permitted under 42 U.S.C. sec. 1395m for Medicare-participating providers if the Medicaid beneficiary who received the telehealth service or telehealth consultation was physically located at the rural health clinic, federally qualified health center, or federally qualified health center look-alike at the time of service or consultation delivery and the provider of the telehealth service or telehealth consultation is not employed by the rural health clinic, federally qualified health center, or federally qualified health center look-alike.

SOURCE: KY Revised Statute Sec. 205.559 as revised by House Bill 140 (2021 Session), (Accessed Sept. 2021).

Last updated 09/15/2021

Miscellaneous

The Cabinet in consultation with the Division of Telehealth Services is required to do the following:

  • Provide guidance and direction to providers delivering health care services using telehealth or digital health
  • Promote access to health care services provided via telehealth or digital health
  • Maintain an online telehealth provider directory for consumer use; and
  • No later than thirty (30) days after the effective date of this Act, promulgate administrative regulations in accordance with KRS Chapter 13A to:
    • Establish a glossary of telehealth terminology to provide standard definitions for all healthcare providers who deliver health care services via telehealth, all state agencies authorized or required to promulgate administrative regulations relating to telehealth, and all payors;
    • Establish minimum requirements for the proper use and security of telehealth, including requirements for confidentiality and data integrity, privacy and security, informed consent, privileging and credentialing, reimbursement, and technology Establish minimum requirements to prevent waste, fraud, and abuse related to telehealth; and
    • Maintain the discretion of state agencies authorized or required to promulgate administrative regulations relating to telehealth to establish requirements to authorize, prohibit, or otherwise govern the use of telehealth in accordance with the state agencies’ respective jurisdictions.

The cabinet is also required to study the impact of telehealth on health care delivery and submit annual reports to the Legislative Research Commission. See bill text for details.

SOURCE: House Bill 140 (2021 Session), (Accessed Sept. 2021).

A health-care facility that receives reimbursement under this section for consultations provided by a Medicaid-participating provider who practices in that facility and a health professional who obtains a consultation under this section shall establish quality-of-care protocols, which may include a requirement for an annual in-person or face-to-face consultation with a patient who receives telehealth services, and patient confidentiality guidelines to ensure that telehealth consultations meet all requirements and patient care standards as required by law.

The Department for Medicaid Services and any managed care organization with whom the department contracts for the delivery of Medicaid services shall not deny reimbursement for telehealth services covered by this section based solely on quality-of-care protocols adopted by a health-care facility.

SOURCE: KY Statute Sec. 205.559, as Revised by House Bill 140 (2021 Session). (Accessed Sept. 2021).

The cabinet shall provide oversight, guidance, and direction to Medicaid providers delivering care using telehealth.

  • The Department for Medicaid Services shall within 30 days after the effective date of the Act do the following:
    • Promulgate administrative regulations in accordance with KRS Chapter 13A to establish requirements for telehealth coverage and reimbursement rates, which shall be equivalent to coverage requirements and reimbursement rates for the same service provided in person unless the telehealth provider and the department or a managed care organization contractually agree to a lower reimbursement rate for telehealth services; and
    • Create, establish, or designate the claim forms, records required, and authorization procedures to be followed in conjunction with this section and Section 7 of this Act,
  • Require that specialty care be rendered by a health care provider who is recognized and actively participating in the Medicaid program;
  • Require that any required prior authorization requesting a referral or consultation for specialty care be processed by the patient’s primary care provider and that any specialist coordinates care with the patient’s primary care provider; and
  • Require a telehealth provider to be licensed in Kentucky, or as allowed under the standards and provisions of a recognized interstate compact, in order to receive reimbursement for telehealth services.

The Cabinet for Health and Family Services cannot require a Medicaid provider to be a part of a telehealth network.

SOURCE: KY Statute Sec. 205.5591, as Revised by House Bill 140 (2021 Session). (Accessed Sept. 2021).

For FQHCs and RHCs, a “visit” is defined as occurring in-person or via telehealth.

SOURCE: KY 907 KAR 1:055 (37). (Accessed Sept. 2021).

See rule for requirements of health care providers performing a telehealth or digital health service, including those related to confidentiality, patient privacy, consent, credentialing

SOURCE: KY 900 KAR 12:005 Emergency Rule & Ordinary Rule. (Accessed Sept. 2021).

Last updated 09/15/2021

Out of State Providers

KY Medicaid program shall require a telehealth provider to be licensed in Kentucky, or as allowed under the standards and provisions of a recognized interstate compact, in order to receive reimbursement for telehealth services.

SOURCE: KY Statute Sec. 205.5591, as amended by HB 140 (2021 Session). (Accessed Sept. 2021).

Last updated 09/15/2021

Overview

The Medicaid program and managed care are required to reimburse for services delivered through telehealth.  The department is required to promulgate administrative regulations to establish requirements for telehealth coverage and reimbursement, which shall be equivalent to the coverage for the same service provided in person unless the telehealth provider and the Medicaid program or a Medicaid managed care organization contractually agree to a lower reimbursement rate for telehealth services, or the department establishes a different reimbursement rate.

Kentucky’s definition of telehealth includes synchronous and asynchronous technology, remote patient monitoring technology, and audio-only encounters.  Store-and-forward is reimbursed by KY Medicaid under certain circumstances and remote patient monitoring is not considered an eligible telehealth service for reimbursement although included as part of KY’s glossary (see reference below).

Medicaid-participating practitioners and home health agencies are strongly encouraged to use audio-only encounters as a mode of delivering telehealth services only when no other approved mode of delivering telehealth services is available.

 

Health care providers performing a telehealth or digital health service shall, as appropriate for the service, provider, and recipient, utilize the following modalities of communication delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA):

  • Live or real-time audio and video synchronous telehealth technology;
  • Asynchronous store-and-forward telehealth technology;
  • Remote patient monitoring using wireless devices, wearable sensors, or implanted health monitors;
  • Audio-only telecommunications systems; or
  • Clinical text chat technology when:
    • Utilized within a secure, HIPAA compliant application or electronic health record system;

and

    • Meeting:
      • The scope of the provider’s professional licensure; and
      • The scope of practice of the provider; and
      • Comply with the following federal laws to prevent waste, fraud, and abuse relating to telehealth:
        • False Claims Act, 31 U.S.C. § 3729-3733;
        • Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b); and
        • Physician Self-Referral, Section 1877 of the Social Security Act

SOURCE: KY 900 KAR 12:005 Emergency Rule & Ordinary Rule. (Accessed Sept. 2021).

Last updated 09/15/2021

Remote Patient Monitoring

POLICY

Remote patient monitoring shall not be an eligible telehealth service within the fee-for-service Medicaid program unless that service is:

  • Expanded pursuant to subsection (4) of this section;
  • Otherwise included as a part of a department approved value based payment arrangement; or
  • Otherwise included as a value added service or payment arrangement.

A managed care organization may reimburse for remote patient monitoring as a telehealth service if expanded pursuant to subsection (4) of this section or provided as a:

  • Value based payment arrangement; or
  • Value added service or payment arrangement.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Sept. 2021).

Health care providers performing a telehealth or digital health service shall, as appropriate for the service, provider, and recipient, utilize the following modalities of communication delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA):

  • Live or real-time audio and video synchronous telehealth technology;
  • Asynchronous store-and-forward telehealth technology;
  • Remote patient monitoring using wireless devices, wearable sensors, or implanted health monitors;
  • Audio-only telecommunications systems; or
  • Clinical text chat technology when:
    • Utilized within a secure, HIPAA compliant application or electronic health record system;

and

    • Meeting:
      • The scope of the provider’s professional licensure; and
      • The scope of practice of the provider; and
      • Comply with the following federal laws to prevent waste, fraud, and abuse relating to telehealth:
        • False Claims Act, 31 U.S.C. § 3729-3733;
        • Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b); and
        • Physician Self-Referral, Section 1877 of the Social Security Act

SOURCE: KY 900 KAR 12:005 Emergency Rule & Ordinary Rule. (Accessed Sept. 2021).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 09/15/2021

Store and Forward

POLICY

KY Medicaid reimburses for telehealth consultations, the definition of which encompasses store-and-forward.

SOURCE: KY Revised Statutes 205.559. For definition, see: KY Revised Statute 205.510. (Accessed Sept. 2021).

A store and forward service shall be permissible if the primary purpose of the asynchronous interaction involves high quality digital data transfer, such as digital image transfers.

An asynchronous telehealth service shall be reimbursable if that service supports an upcoming synchronous telehealth or face-to-face visit to a provider that is providing one of the eligible specialties (see next section).

The department shall evaluate available asynchronous telehealth services quarterly, and may clarify that certain asynchronous telehealth services meet the requirements to be included as permissible asynchronous telehealth, as appropriate and as funds are available, if those asynchronous telehealth services have an evidence base establishing the service’s:

  • Safety; and
  • Efficacy.

A provider shall not receive additional reimbursement for an asynchronous telehealth service if the service is an included or integral part of the billed office visit code or service code.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Sept. 2021).

Health care providers performing a telehealth or digital health service shall, as appropriate for the service, provider, and recipient, utilize the following modalities of communication delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA):

  • Live or real-time audio and video synchronous telehealth technology;
  • Asynchronous store-and-forward telehealth technology;
  • Remote patient monitoring using wireless devices, wearable sensors, or implanted health monitors;
  • Audio-only telecommunications systems; or
  • Clinical text chat technology when:
    • Utilized within a secure, HIPAA compliant application or electronic health record system;

and

    • Meeting:
      • The scope of the provider’s professional licensure; and
      • The scope of practice of the provider; and
      • Comply with the following federal laws to prevent waste, fraud, and abuse relating to telehealth:
        • False Claims Act, 31 U.S.C. § 3729-3733;
        • Anti-Kickback Statute, 42 U.S.C. § 1320a-7b(b); and
        • Physician Self-Referral, Section 1877 of the Social Security Act

SOURCE: KY 900 KAR 12:005 Emergency Rule & Ordinary Rule. (Accessed Sept. 2021).


ELIGIBLE SERVICES/SPECIALTIES

An asynchronous telehealth service within the following specialties or instances of care that meets the criteria established in this section shall be reimbursable as a store-and-forward telehealth service:

  • Radiology;
  • Cardiology;
  • Oncology;
  • Obstetrics and gynecology;
  • Ophthalmology and optometry, including a retinal exam;
  • Dentistry;
  • Nephrology;
  • Infectious disease;
  • Dermatology;
  • Orthopedics;
  • Wound care consultation;
  • A store and forward telehealth service in which a clear digital image is integral and necessary to make a diagnosis or continue a course of treatment;
  • A speech language pathology service that involves the analysis of a digital image, video, or sound file, such as for a speech language pathology diagnosis or consultation; or
  • Any code or group of services included as an allowed asynchronous telehealth service.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Sept. 2021).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 09/15/2021

Definition

Effective until Dec. 31, 2021

Telehealth (a) means the delivery of health care-related services by a health care provider who is licensed in Kentucky to a patient or client through a face-to-face encounter with access to real-time interactive audio and video technology or store-and-forward services that are provided via asynchronous technologies as the standard practice of care where images are sent to a specialist for evaluation. The requirement for a face-to-face encounter shall be satisfied with the use of asynchronous telecommunications technologies in which the health care provider has access to the patient’s or client’s medical history prior to the telehealth encounter; (b) Shall not include the delivery of services through electronic mail, text chat, facsimile, or standard audio-only telephone call; and (c) Shall be delivered over a secure communications connection that complies with HIPAA.

SOURCE: KY Revised Statute Sec. 304.17A-005. (Accessed Sept. 2021).

New Legislation (Effective Jan. 1, 2022)

“Telehealth” or “digital health” means a mode of delivering healthcare services through the use of telecommunication technologies, including but not limited to synchronous and asynchronous technology, remote patient monitoring technology, and audio-only encounters, by a health care provider to a patient or to another health care provider at a different location. Shall not include:

  • The delivery of health care services through electronic mail, text, chat, or facsimile unless a state agency authorized or required to promulgate administrative regulations relating to telehealth determines that health care services can be delivered via these modalities in ways that enhance recipient health and well-being and meet all clinical and technology guidelines for recipient safety and appropriate delivery of services; or
  • Basic communication between a health care provider and a patient, including but not limited to appointment scheduling, appointment reminders, voicemails, or any other similar communication intended to facilitate the actual provision of healthcare services either in-person or via telehealth; and

Unless waived by the applicable federal authority, shall be delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996.

SOURCE: KY Revised Statute Sec. 304.17A-005, as amended by House Bill 140 (2021 Session), (Accessed Sept. 2021).

Last updated 09/15/2021

Parity

SERVICE PARITY

Effective Until Dec. 31, 2021

Payers are not required to provide coverage for telehealth services that are not medically necessary.

SOURCE: KY Revised Statutes § 304.17A-138. (Accessed Sept. 2021).

New Legislation (Effective Jan. 1, 2022)

A health benefit plan, issued or renewed on or after the effective date of this section, shall reimburse for covered services provided to an insured person through telehealth, including telehealth services provided by a home health agency licensed under KRS Chapter 216.

SOURCE: KY Revised Statute Sec. 304.17A-138, as amended by House Bill 140 (2021 Session), (Accessed Sept. 2021).


PAYMENT PARITY

Effective Until Dec. 31, 2021

Telehealth coverage and reimbursement shall be equivalent to the coverage for the same service provided in-person unless the telehealth provider and the health benefit plan contractually agree to a lower reimbursement rate for telehealth services.

Payers are not required to reimburse any fees charged by a telehealth facility for transmission of a telehealth encounter.

SOURCE: KY Revised Statutes § 304.17A-138. (Accessed Sept. 2021).

New Legislation (Effective Jan. 1, 2022)

Telehealth coverage and reimbursement shall, except as provided in paragraph (b) of this subsection, be equivalent to the coverage for the same service provided in person unless the telehealth provider and the health benefit plan contractually agree to a lower reimbursement rate for telehealth services.

Rural health clinics, federally qualified health centers, and federally qualified health center look-alikes shall be reimbursed as an originating site in an amount equal to that which is permitted under 42 U.S.C. sec. 1395m for Medicare-participating providers, if the insured was physically located at the rural health clinic, federally qualified health center, or federally qualified health center look-alike at the time of service or consultation delivery and the provider of the telehealth service or telehealth consultation is not employed by the rural health clinic, federally qualified health center, or federally qualified health center look-alike.

SOURCE: KY Revised Statute Sec. 304.17A-005, as amended by House Bill 140 (2021 Session), (Accessed May 2021).

Last updated 09/15/2021

Requirements

Effective Until Dec. 31, 2021

A health benefit plan shall reimburse for covered services provided to an insured person through telehealth. A health benefit plan shall not:

  • Require a provider be physically present with a patient or client, unless the provider determines that it is necessary to perform those services in-person;
  • Require prior authorization, medical review, or administrative clearance for telehealth that would not be required if a service were provided in-person;
  • Require demonstration that it is necessary to provide services to a patient or client through telehealth;
  • Require a provider to be employed by another provider or agency in order to provide telehealth services that would not be required if that service were provided in-person;
  • Restrict or deny coverage of telehealth based solely on the communication technology or application used to deliver the telehealth services; or
  • Require a provider to be part of a telehealth network.

A provider must be licensed in Kentucky to receive reimbursement for telehealth services.

SOURCE: KY Revised Statute Sec. 304.17A-138. (Accessed Sept. 2021).

New Legislation (Effective Jan. 1, 2022)

 A health benefit plan, issued or renewed on or after the effective date of this section, shall reimburse for covered services provided to an insured person through telehealth, including telehealth services provided by a home health agency licensed under KRS Chapter 216.Telehealth coverage and reimbursement shall, except as provided in paragraph (b) of this subsection, be equivalent to the coverage for the same service provided in person unless the telehealth provider and the health benefit plan contractually agree to a lower reimbursement rate for telehealth services.

Rural health clinics, federally qualified health centers, and federally qualified health center look-alikes shall be reimbursed as an originating site in an amount equal to that which is permitted under 42 U.S.C. sec. 1395m for Medicare-participating providers, if the insured was physically located at the rural health clinic, federally qualified health center, or federally qualified health center look-alike at the time of service or consultation delivery and the provider of the telehealth service or telehealth consultation is not employed by the rural health clinic, federally qualified health center, or federally qualified health center look-alike.

A health plan shall not:

  • Require a provider to be physically present with a patient or client, unless the provider determines that it is necessary to perform those services in person;
  • Require prior authorization, medical review, or administrative clearance for telehealth that would not be required if a service were provided in person;
  • Require demonstration that it is necessary to provide services to a patient or client through telehealth;
  • Require a provider to be employed by another provider or agency in order to provide telehealth services that would not be required if that service were provided in person;
  • Restrict or deny coverage of telehealth based solely on the communication technology or application used to deliver the telehealth services; or
  • Require a provider to be part of a telehealth network.

A health plan Shall:

  • Require that telehealth services reimbursed under this section meet all clinical, technology, and medical coding guidelines for recipient safety and appropriate delivery of services established by the Department of Insurance or the provider’s professional licensure board;
  • Require a telehealth provider to be licensed in Kentucky, or as allowed under the standards and provisions of a recognized interstate compact, in order to receive reimbursement for telehealth services; and
  • Reimburse a rural health clinic, federally qualified health clinic, or federally qualified health center look-alike for covered telehealth services provided by a provider employed by the rural health clinic, federally qualified health clinic, or federally qualified health center look-alike, regardless of whether the provider was physically located on the premises of the rural health clinic, federally qualified health clinic, or federally qualified health clinic look-alike when the telehealth service was provided; and

May utilize audits for medical coding accuracy in the review of telehealth services specific to audio-only encounters.

Benefits for a service provided through telehealth required by this section may be made subject to a deductible, copayment, or coinsurance requirement. A deductible, copayment, or coinsurance applicable to a particular service provided through telehealth shall not exceed the deductible, copayment, or coinsurance required by the health benefit plan for the same service provided in person.

The section does not require the health plan to:

  • Provide coverage for telehealth services that are not medically necessary; or
  • Reimburse any fees charged by a telehealth facility for transmission of a telehealth encounter.

Providers and home health agencies are strongly encouraged to use audio-only encounters as a mode of delivering telehealth services when no other approved mode of delivering telehealth services is available.

SOURCE: KY Revised Statute Sec. 304.17A-138, as amended by House Bill 140 (2021 Session), (Accessed Sept. 2021).

Last updated 09/15/2021

Cross State Licensing

A provider must be licensed in Kentucky with the exception of persons who, being nonresidents of Kentucky and lawfully licensed to practice medicine or osteopathy in their states of actual residence, infrequently engage in the practice of medicine or osteopathy within this state, when called to see or attend particular patients in consultation and association with a Kentucky-licensed physician.

SOURCE: KY Revised Statutes § 311.560. (Accessed Sept. 2021).

Last updated 09/15/2021

Definitions

“Telehealth” or “digital health” means a mode of delivering healthcare services through the use of telecommunication technologies, including but not limited to synchronous and asynchronous technology, remote patient monitoring technology, and audio-only encounters, by a health care provider to a patient or to another health care provider at a different location. Shall not include:

  • The delivery of health care services through electronic mail, text, chat, or facsimile unless a state agency authorized or required to promulgate administrative regulations relating to telehealth determines that health care services can be delivered via these modalities in ways that enhance recipient health and well-being and meet all clinical and technology guidelines for recipient safety and appropriate delivery of services; or
  • Basic communication between a health care provider and a patient, including but not limited to appointment scheduling, appointment reminders, voicemails, or any other similar communication intended to facilitate the actual provision of healthcare services either in-person or via telehealth; and

Unless waived by the applicable federal authority, shall be delivered over a secure communications connection that complies with the federal Health Insurance Portability and Accountability Act of 1996.

SOURCE: KY Revised Statute 211.332. (Accessed Sept. 2021).

Dietitians or Nutritionists & Jail Standards (Department of Corrections)
“Telehealth means the use of interactive audio, video, or other electronic media to deliver health care. It includes the use of electronic media for diagnosis, consultation, treatment, transfer of health or medical data, and continuing education.”

SOURCE: KY Revised Statutes § 310.200 & KAR Title 501, Ch. 13, Sec. 010. (Accessed Sept. 2021).

Last updated 09/15/2021

Licensure Compacts

Member of Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure, Compact Map. (Accessed Sept. 2021).

Member of Nurse Licensure Compact.

SOURCE: Nurse Licensure Compact.  Current NLC States and Status.  NCSBN.  (Accessed Sept. 2021). 

Member of Physical Therapy Compact.

SOURCE: HB 227-2017.  PT Compact. Compact Map. (Accessed Sept. 2021).

Member of the Audiology and Speech-Language Pathology Compact

SOURCE: SB 47 (2021 Session), (Accessed Sept. 2021).

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT, Map, (Accessed Sept. 2021).

Last updated 09/15/2021

Miscellaneous

There is hereby created a Division of Telehealth Services within the Office of Health Data and Analytics to be headed by a director appointed by the secretary pursuant to 12 KRS 12.050. The division shall provide oversight, guidance, and direction to Medicaid providers delivering care using telehealth. The division shall implement telehealth services and develop standards, guidance, resources, and education to help promote access to healthcare services in the Commonwealth.

SOURCE: KY Revised Statute 194A.105 as amended by HB 140 (2021 Session), (Accessed Sept. 2021).

See Medicaid Misc. section for regulation outlining requirements established by the Cabinet for Health and Family Services on health care providers performing a telehealth or digital health service, including those related to confidentiality, patient privacy, consent, credentialing.

Last updated 09/15/2021

Online Prescribing

Prior to prescribing in response to any communication transmitted or received by computer or other electronic means, physicians must establish a proper physician-patient relationship. This includes:

  • Verification that the person requesting medication is in fact who the patient claims to be;
  • Establishment of a documented diagnosis through the use of accepted medical practices;
  • Maintenance of a current medical record.

An electronic, online, or telephone evaluation by questionnaire are inadequate for the initial or any follow-up evaluation.

SOURCE: KY Revised Statutes § 311.597. (Accessed Sept. 2021).

A “good faith prior examination” (needed to establish a physician-patient relationship) can be done through telehealth. Not applicable to hospice providers.

SOURCE: KY Revised Statute § 218A.010(18). (Accessed Sept. 2021).

The Board of Speech Language Pathology and Audiology does not allow for the establishment of a practitioner-patient relationship via telehealth. They require an in-person meeting to occur first.

SOURCE: KY 201 KAR 17:110. (Accessed Sept. 2021).

A physician performing or inducing an abortion shall be present in-person and in the same room with the patient. The use of telehealth shall not be allowed in the performance of an abortion.

SOURCE: KY Revised Statute Sec. 311.728. (Accessed Sept. 2021).

Last updated 09/15/2021

Professional Board Standards

Speech Language Pathology and Audiology

SOURCE: Title 201, Ch. 17, Sec. 110. (Accessed Sept. 2021).

Board of Optometric Examiners

SOURCE: Title 201, Ch. 5, Sec. 055. (Accessed Sept. 2021).

Board of Dentistry Examiners

SOURCE: Title 201, Ch. 8, Sec. 590. (Accessed Sept. 2021).

Physical Therapy

SOURCE: Title 201, Ch. 22, Sec. 160. (Accessed Sept. 2021).

Dietitians and Nutritionists

SOURCE: Title 201, Ch. 33, Sec. 070. (Accessed Sept.2021).

Applied Behavior Analysis

SOURCE: Title 201, Ch. 43, Sec. 100. (Accessed Sept. 2021).

Nursing Board

SOURCE: Title 201, Ch. 20, Sec. 520. (Accessed Sept. 2021).

Board of Psychology

SOURCE: Title 201, Ch. 26, Sec. 310. (Accessed Sept. 2021).

Occupational Therapy

SOURCE: Title 201, Ch. 28, Sec. 235. (Accessed Sept. 2021).

Marriage and Family Therapists

SOURCE: Title 201, Ch. 32, Sec. 110. (Accessed Sept. 2021).

If a state agency authorized or required to promulgate administrative regulations relating to telehealth chooses to promulgate an administrative regulation relating to telehealth, the state agency shall

  • Use terminology consistent with the glossary of telehealth terminology established by the cabinet pursuant to Section 2 of this Act; and
  • Comply with the minimum requirements established below.

State agencies shall not:

  • Require a provider to be physically present with the recipient, unless the state agency or provider determines that it is medically necessary to perform those services in person;
  • Require prior authorization, medical review, or administrative clearance for telehealth that would not be required if a service were provided in person;
  • Require a provider to be employed by another provider or agency in order to provide telehealth services that would not be required if that service were provided in person;
  • Require demonstration that it is necessary to provide services to a patient through telehealth;
  • Restrict or deny coverage of telehealth based solely on the communication technology or application used to deliver the telehealth services;
  • Prohibit the delivery of telehealth services to a person located in Kentucky by a provider who is a participant in a recognized interstate compact and delivers telehealth services to a person in Kentucky under the standards and provisions of that interstate compact;
  • Prohibit an insurer or managed care organization from utilizing audits for medical coding accuracy in the review of telehealth services specific to audio-only encounters; or
  • Require a provider to be part of a telehealth network; and

Rules shall be no more restrictive than administrative regulations for providers who deliver healthcare services in person, to establish additional requirements relating to telehealth, including requirements:

  • For the proper use and security of telehealth;
  • To address emergency situations, including but not limited to suicidal ideations or plans; threats to self or others; evidence of dependency, neglect, or abuse; or other life-threatening conditions;
  • To prevent waste, fraud, and abuse of telehealth services, both in general and specific to the provision of telehealth services delivered via audio-only encounters; or
  • That a telehealth provider be licensed in Kentucky, or as allowed under the standards and provisions of a recognized interstate compact, in order to receive reimbursement for telehealth services

SOURCE: KY Revised Statute Sec. 211.336 (Accessed Sept. 2021).

See Medicaid definitions and Misc. section for regulation outlining requirements established by the Cabinet for Health and Family Services on health care providers performing a telehealth or digital health service, including definitions, and requirements related to confidentiality, patient privacy, consent, credentialing.