Kentucky

Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: Yes
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

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

FQHCs

  • Originating sites explicitly allowed for Live Video: Yes
  • Distant sites explicitly allowed for Live Video: Yes
  • Store and forward explicitly reimbursed: No
  • Audio-only explicitly reimbursed: No
  • Allowed to collect PPS rate for telehealth: No

STATE RESOURCES

  1. Medicaid Program: Kentucky Medicaid
  2. Administrator: Kentucky Dept. for Medicaid Services
  3. Regional Telehealth Resource Center: Mid-Atlantic Telehealth Resource Center
Disclaimer

PLEASE NOTE: CCHP is providing the following for informational purposes only. We are not providing legal advice or interpretation of the laws and regulations and policies. CCHP encourages you to check with the appropriate state agency for further information and direction. This information should not be construed as legal counsel. Consult with an attorney if you are seeking a legal opinion.

Last updated 11/01/2022

Cross-State Licensing

Medicaid: COVID-19 FAQs on Telehealth

STATUS: Active, until end of federal PHE

 

Last updated 11/01/2022

Easing Prescribing Requirements

Medicaid: COVID-19 FAQs on Telehealth

STATUS: Active, until end of federal PHE

Last updated 11/01/2022

Miscellaneous

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

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

Office of Health Data and Analytics: COVID-19 Actions, Guidance and Resources 

STATUS: ACTIVE

Office of Health Data and Analytics: Kentucky COVID-19 Actions and Guidance Related to Telehealth

STATUS: ACTIVE

 

Last updated 11/02/2022

Originating Site

Medicaid: COVID-19 FAQs on Telehealth

STATUS: Active, until end of federal PHE

Last updated 11/01/2022

Private Payer

Previous COVID-19 waivers expired.

Last updated 11/01/2022

Provider Type

Medicaid: COVID-19 Telehealth for Behavioral Health Providers

STATUS: Active, some of the policies have become permanent with updated regulations.

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

STATUS: Active

Medicaid: 1915(c) Home and Community Based Services Waiver Providers

STATUS: Active, waivers were extended until 6 months after the end of the federal PHE, See extension

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 11/01/2022

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 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

Last updated 11/02/2022

Definition

“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.138 which cites 211.332, (Accessed Nov. 2022).

Last updated 11/02/2022

Parity

SERVICE PARITY

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. (Accessed Nov. 2022).


PAYMENT PARITY

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-138. (Accessed Nov. 2022).

Last updated 11/02/2022

Requirements

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. (Accessed Nov. 2022).

Last updated 11/02/2022

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 Statutes 211.332. (Accessed Nov. 2022).

“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 Nov. 2022).

Telehealth means two (2)-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 Nov. 2022).

“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 Nov. 2022).

“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 12:005KY Revised Statute 211.332. (Accessed Nov. 2022).

Last updated 11/02/2022

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. (Accessed Nov. 2022).

Any recipient, upon being offered the option of an asynchronous or audio-only telehealth visit, shall have the opportunity or option to request to be accommodated by that provider in an in-person encounter or synchronous telehealth encounter.

If a telehealth service is delivered as an audio-only encounter and a telephonic code exists for the same or similar service, the department shall reimburse at the lower reimbursement rate between the two (2) types of services.

Telephonic Services. Telephonic code reimbursement shall be:

  • An alternative option for telehealth care providers to deliver audio-only telecommunications services, and shall not supersede reimbursement for an audio-only telehealth service as established pursuant to KRS 205.559 or 205.5591;
  • For a service that has an evidence base establishing the service’s safety and efficacy;
  • Subject to any relevant licensure board restrictions of the telehealth care provider;
  • Subject to any synchronous telehealth limits of this administrative regulation or other state or federal law; and
  • For a service that is listed on the most recent version of the Medicaid Physician Fee Schedule, as established by 907 KAR 3:010, Section 1(17).

SOURCE: KY 907 KAR 3:170. (Accessed Nov. 2022).

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 (Accessed Nov. 2022).

 

Last updated 11/02/2022

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 Nov. 2022).

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. (Accessed Nov. 2022).

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, (Accessed Nov. 2022).

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 (Accessed Nov. 2022).


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.  (Accessed Nov. 2022).

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 Nov. 2022).


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. (Accessed Nov. 2022).

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 Nov. 2022).

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 Nov. 2022).


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 Nov. 2022).

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. (Accessed Nov. 2022).


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. (Accessed Nov. 2022).

Last updated 11/02/2022

Miscellaneous

The cabinet, in consultation with the Division of Telehealth Services within the Office of Inspector General as established in KRS 194A.105, shall:

  • 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 statute for details.

SOURCE: KY Statute Sec.  211.334.  (Accessed Nov. 2022).

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. (Accessed Nov. 2022).

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 KRS 205.559,
  • 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, (Accessed Nov. 2022).

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

SOURCE: KY 907 KAR 1:055 (37). (Accessed Nov. 2022).

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 (Accessed Nov. 2022).

The Telehealth Program

The program provides a repository of information and resources including state telehealth laws, policies and guidelines; answers to frequently asked questions; educational materials and webinars; statewide telehealth services directory; publications and journals; links to associations, organizations and professional licensure boards and other state and national programs and resources.

The program is one of five business units, along with the Cabinet Privacy Program, the Kentucky Health Benefit Exchange, the Kentucky Health Information Exchange (KHIE) and analytics for health and human services. Telehealth has the ability to work with the Cabinet Privacy Program dealing with HIPAA policies and procedures around the proper use and security for telehealth; with KHIE for providers to access clinical comprehensive care documents for telehealth services and with the analytics division to measure the value and effectiveness of telehealth.

SOURCE: Kentucky Cabinet for Health and Family Services. (Accessed Nov. 2022).

Behavioral Health Conditional Dismissal Pilot Program

A pilot program shall be established in no less than ten (10) counties selected by the Chief Justice of the Supreme Court to participate in a behavioral health conditional dismissal program. The pilot program shall begin January 1, 2023, and shall last for four (4) years unless extended or limited by the General Assembly.

Notwithstanding any other provision to the contrary, the clinical assessment may be conducted through telehealth or in person, whether the person charged is in the custody of the jail or has been released.

SOURCE: KY Revised Statutes 533.272533.276. (Accessed Nov. 2022)

Corrections

The Department of Corrections shall:

Promulgate administrative regulations to:

  • Require telehealth services in county jails

The department may promulgate administrative regulations in accordance with KRS Chapter 13A to implement a program that provides for reimbursement of telehealth consultations.

See statute for additional Information.

SOURCE: KY Revised Statutes 197.020. (Nov. 2022).

The Division of Telehealth Services has a Telehealth Terminology Glossary available.

SOURCE: KY 900 KAR 12:005E. (Accessed Nov. 2022).

Last updated 11/02/2022

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. (Accessed Nov. 2022).

Telehealth Provided by an Out-of-State Telehealth Care Provider.
  • The department shall evaluate and monitor the healthcare quality and outcomes for recipients who are receiving healthcare services from out-of-state telehealth care providers.
  • The department shall implement any in-state or out-of-state participation restrictions established by a state licensing board for the impacted provider.

SOURCE: 907 KAR 003:170. (Accessed Nov. 2022).

Last updated 10/31/2022

Overview

KY Medicaid pays for live video telehealth, store-and-forward, remote patient monitoring and audio-only communication under certain circumstances.  See below for more information.

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.

KY Medicaid is required to reimburse for telehealth services and telehealth consultations under certain circumstances, including the RHCs, FQHCs and FQHC look-alikes. Medicaid participating practitioners and home heath 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 Revised Statute Sec. 211.332(5), KY Revised Statute 205.559KY 900 KAR 12:005E (Accessed Oct. 2022).

Last updated 11/02/2022

Remote Patient Monitoring

POLICY

Pursuant to Section 7 of this administrative regulation, remote patient monitoring shall be an eligible telehealth service within the fee-for-service and managed care Medicaid programs.

A recipient participating in a remote patient monitoring service shall:

  • Have the capability to utilize any monitoring tools involved with the ordered remote patient monitoring service. For the purposes of this paragraph, capability shall include the regular presence of an individual in the home who can utilize the involved monitoring tools; and
  • Have the internet or cellular internet connection necessary to accommodate any needed remote patient monitoring equipment in the home.

The department may restrict the remote patient monitoring benefit by excluding:

  • Remote patient monitoring equipment;
  • Upgrades to remote patient monitoring equipment; or
  • An internet connection necessary to transmit the results of the services.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Nov. 2022).

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 (Accessed Nov. 2022).


CONDITIONS

Pursuant to Section 7 of this administrative regulation, remote patient monitoring shall be an eligible telehealth service within the fee-for-service and managed care Medicaid programs.

Conditions for which remote patient monitoring shall be covered include:

  • Pregnancy;
  • Diabetes;
  • Heart disease;
  • Cancer;
  • Chronic obstructive pulmonary disease;
  • Hypertension;
  • Congestive heart failure;
  • Mental illness or serious emotional disturbance;
  • Myocardial infarction;
  • Stroke; or
  • Any condition that the department determines would be appropriate and effective for remote patient monitoring.

Except for a recipient participating due to a pregnancy, a recipient receiving remote patient monitoring services shall have two (2) or more of the following risk factors:

  • Two (2) or more inpatient hospital stays during the prior twelve (12) month period;
  • Two (2) or more emergency department admissions during the prior twelve (12) month period;
  • An inpatient hospital stay and a separate emergency department visit during the prior twelve (12) month period;
  • A documented history of poor adherence to ordered medication regimens;
  • A documented history of falls in the prior six (6) month period;
  • Limited or absent informal support systems;
  • Living alone or being home alone for extended periods of time;
  • A documented history of care access challenges; or
  • A documented history of consistently missed appointments with health care providers.

A recipient may participate in a remote patient monitoring program as the result of a pregnancy if the provider documents that the recipient has a condition that would be improved by a remote patient monitoring service.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Nov. 2022).


PROVIDER LIMITATIONS

Remote patient monitoring shall be ordered by:

  • A physician;
  • An advanced practice registered nurse;
  • A physician assistant; or
  • When operating within their scope of practice and licensure, the following behavioral health practitioners:
    • A psychiatrist;
    • A licensed psychologist;
    • A licensed psychological practitioner;
    • A certified psychologist with autonomous functioning;
    • A licensed clinical social worker;
    • A licensed marriage and family therapist;
    • A licensed professional art therapist;
    • A licensed clinical alcohol and drug counselor; or
    • A licensed behavior analyst.

Providers who may provide remote patient monitoring services include:

  • A home health agency;
  • A hospital;
  • A federally qualified health center;
  • A rural health center;
  • A primary care center;
  • A physician;
  • An advanced practice registered nurse;
  • A physician assistant;
  • A behavioral health multi-specialty group participating in the Medicaid Program pursuant to 907 KAR 15:010;
  • A behavioral health services organization participating in the Medicaid Program pursuant to 907 KAR 15:020 or 907 KAR 15:022;
  • A residential crisis stabilization unit participating in the Medicaid Program pursuant to 907 KAR 15:070;
  • A chemical dependency treatment center participating in the Medicaid Program pursuant to 907 KAR 15:080;
  • A community mental health center that is participating in the Medicaid Program in compliance with 907 KAR 1:044, 907 KAR 1:045, or 907 KAR 1:047; or
  • A certified community behavioral health clinic that is participating in the Medicaid Program.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Nov. 2022).


OTHER RESTRICTIONS

The department may restrict the remote patient monitoring benefit by excluding:

  • Remote patient monitoring equipment;
  • Upgrades to remote patient monitoring equipment; or
  • An internet connection necessary to transmit the results of the services.

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Nov. 2022).

Last updated 11/02/2022

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 & 211.332. (Accessed Nov. 2022).

“Asynchronous telehealth” means a store and forward telehealth service that is electronically mediated.

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 Nov. 2022).

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 (Accessed Aug. 2022).


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 Nov. 2022).


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 11/02/2022

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 Nov. 2022).

Recently Passed Legislation

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 not:

  • 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 the delivery of telehealth services to a person who is a permanent resident of Kentucky who is temporarily located outside of Kentucky by a provider who is credentialed by a Kentucky professional licensure board;
  • Prohibit the delivery of telehealth services to a person who is not a permanent resident of Kentucky who is temporarily located in Kentucky by a provider who is credentialed by a professional licensure board in the person’s state of permanent residence; or
  • Require a health care provider to be physically located in the state that he or she is credentialed in by a professional licensure board in order to provide telehealth services to a person who is a permanent resident of the same state. Nothing in this paragraph shall be construed to imply that the Kentucky Medicaid program would be responsible for reimbursement for any services provided in Kentucky by a provider not credentialed by the Kentucky Medicaid program; and

May promulgate administrative regulations, which 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.

See Professional Board Standards section for the complete statute.

SOURCE: KY Revised Statutes 211.336 as amended by HB 188 (2022 Session). (Accessed Aug. 2022).

Last updated 11/02/2022

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 Nov. 2022).

“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, 312.220, 314.155, 315.310, 319.140, 319A.300, 320.390, 327.200, 334A.200, 335.158, 335.380 , 314A.330, & KAR Title 501, Ch. 13, Sec. 010. (Accessed Nov. 2022).

Last updated 11/02/2022

Licensure Compacts

Member of Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure, Compact Map. (Accessed Nov. 2022).

Member of Nurse Licensure Compact.

SOURCE: Nurse Licensure Compact.  Current NLC States and Status.  NCSBN.  (Accessed Nov. 2022). 

Member of Physical Therapy Compact.

SOURCE: PT Compact. Compact Map. (Accessed Nov. 2022).

Member of the Audiology and Speech-Language Pathology Compact

SOURCE: ASLP-IC, Compact Map, (Accessed Nov. 2022).

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT, Map, (Accessed Nov. 2022).

Member of the Occupational Therapy Licensure Compact.

SOURCE: Occupational Therapy Licensure Compact. (Accessed Nov. 2022). 

Member of the Counseling Compact.

SOURCE: Counseling Compact Map. (Accessed Nov. 2022).

* See Compact websites for implementation and license issuing status and other related requirements.

Last updated 11/02/2022

Miscellaneous

There is hereby created a Division of Telehealth Services within the Office of Inspector General to be headed by a director appointed by the secretary pursuant to KRS 12.050. The division shall:

  • Provide guidance and direction to healthcare providers delivering care using telehealth;
  • Develop guidance, resources, and education to help promote access to healthcare services in the Commonwealth;
  • Assist the Cabinet for Health and Family Services with the implementation of KRS 211.334; and
  • Provide the Department for Medicaid Services with any additional information deemed relevant by the division for inclusion in the report required by KRS 211.334(3).

SOURCE: KY Revised Statute 194A.105, (Accessed Aug. 2022).

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.

Statewide system for heart attack response and treatment – Care levels and standards

Level I Comprehensive Cardiac Centers, Level II Primary Heart Attack Centers, and Level III Acute Heart Attack Ready hospitals are encouraged to coordinate, through a coordinating heart attack care agreement, within their service area to provide appropriate access to care for acute heart attack patients. A coordinating heart attack care agreement shall be in writing and include at a minimum:

  • Transfer protocols for the transport and acceptance of heart attack patients for treatment therapies which the transferring facility is not capable of providing; and
  • Communication criteria and protocols that include but are not limited to telemedicine systems.

The department may suspend or revoke a hospital’s designation as Level I Comprehensive Cardiac Center, Level II Primary Heart Attack Center, or Level III Acute Heart Attack Ready if the department determines that the hospital is not in compliance with the requirements of KRS 211.340 to 211.343.

SOURCE:  KY Revised Statutes 211.341. (Accessed Nov. 2022)

 

 

Last updated 11/02/2022

Online Prescribing

As used in KRS 311.595(9), “dishonorable, unethical, or unprofessional conduct of a character likely to deceive, defraud, or harm the public or any member thereof” shall include but not be limited to the following acts by a licensee:

Prescribes or dispenses any medication:

  • In response to any communication transmitted or received by computer or other electronic means, when the licensee fails to take the following actions to establish and maintain a proper physician-patient relationship:
    • 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; and
    • Maintenance of a current medical record.

For the purposes of this paragraph, an electronic, on-line, or telephonic evaluation by questionnaire is inadequate for the initial evaluation of the patient or for any follow-up evaluation.

SOURCE: KY Revised Statutes § 311.597. (Accessed Nov. 2022).

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 Nov. 2022).

A practitioner-patient relationship may commence via telehealth. An in-person initial meeting shall not be required unless the provider determines it is medically necessary to perform those services in person as set forth in KRS 211.336(2)(a). A licensed health care practitioner may represent the licensee at the initial meeting.

See rule for additional requirements.

SOURCE: KY 201 KAR 17:110. (Accessed Nov. 2022).

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 Nov. 2022).

Last updated 11/02/2022

Professional Board Standards

Speech Language Pathology and Audiology

SOURCE: Title 201, Ch. 17, Sec. 110. (Accessed Nov. 2022).

Board of Dentistry Examiners

SOURCE: Title 201, Ch. 8, Sec. 590. (Accessed Nov. 2022).

Physical Therapy

SOURCE: Title 201, Ch. 22, Sec. 160. (Accessed Nov. 2022).

Dietitians and Nutritionists

SOURCE: Title 201, Ch. 33, Sec. 070. (Accessed Nov. 2022).

Nursing Board

SOURCE: Title 201, Ch. 20, Sec. 520. (Accessed Nov. 2022).

Board of Psychology

SOURCE: Title 201, Ch. 26, Sec. 310. (Accessed Nov. 2022).

Occupational Therapy

SOURCE: Title 201, Ch. 28, Sec. 235. (Accessed Nov. 2022).

Marriage and Family Therapists

SOURCE: Title 201, Ch. 32, Sec. 110. (Accessed Nov. 2022).

Board of Optometric Examiners

SOURCE: Title 201, Ch. 5, Sec. 055. (Accessed Nov. 2022).

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;
  • Prohibit the delivery of telehealth services to a person who is a permanent resident of Kentucky who is temporarily located outside of Kentucky by a provider who is credentialed by a Kentucky professional licensure board;
  • Prohibit the delivery of telehealth services to a person who is not a permanent resident of Kentucky who is temporarily located in Kentucky by a provider who is credentialed by a professional licensure board in the person’s state of permanent residence; or
  • Require a health care provider to be physically located in the state that he or she is credentialed in by a professional licensure board in order to provide telehealth services to a person who is a permanent resident of the same state. Nothing in this paragraph shall be construed to imply that the Kentucky Medicaid program would be responsible for reimbursement for any services provided in Kentucky by a provider not credentialed by the Kentucky Medicaid program; and

May promulgate administrative regulations, which 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 Nov. 2022).

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.

Last updated 10/31/2022

Definition of Visit

“Visit” means an encounter:

  • Between a recipient or enrollee and a health care provider during which an FQHC, FQHC look-alike, or RHC service is delivered; and
  • That occurs:
    • In person; or
    • Via telehealth if authorized by 907 KAR 3:170.

SOURCE: KY 907 KAR 1:055 (37). (Accessed Oct. 2022).

Last updated 10/31/2022

Eligible Distant Site

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. (Accessed Oct. 2022).

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. (Accessed Oct. 2022).

See: KY Medicaid Live Video Eligible Providers

Last updated 10/31/2022

Eligible Originating Site

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-138. (Accessed Oct. 2022).

See: KY Medicaid Live Video Eligible Sites.

Last updated 10/31/2022

Facility 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. (Accessed Oct. 2022).

See: Medicaid Live Video Facility/Transmission Fee

Last updated 10/31/2022

Home Eligible

Health insurers shall:

  • 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 lookalike, 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.

SOURCE: KY Revised Statute Sec. 304.17A-138. (Accessed Oct. 2022).

Last updated 10/31/2022

Modalities Allowed

Live Video

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 Oct. 2022).

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. (Accessed Oct. 2022).

See: KY Medicaid Live Video


Store and Forward

KY Medicaid reimburses for store-and-forward, however it’s not explicitly stated whether or not FQHCs qualify for reimbursement.

See: KY Medicaid Store and Forward


Remote Patient Monitoring

Providers who may provide remote patient monitoring services include:

  • A federally qualified health center

SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Oct. 2022).

See: KY Medicaid Remote Patient Monitoring


Audio-Only

The definition for telehealth or digital health includes audio-only encounters, and Medicaid has added reimbursement for telephonic services but does not explicitly state FQHCs are eligible.  

See: KY Medicaid Audio-Only

Last updated 10/31/2022

Patient-Provider Relationship

No reference found

Last updated 10/31/2022

PPS Rate

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. (Accessed Oct. 2022).

Last updated 10/31/2022

Same Day Encounters

No reference found