Last updated 07/11/2023
Consent Requirements
The cabinet, in consultation with the Division of Telehealth Services within the Office of Inspector General is required to promulgate administrative regulations to 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, among other things.
SOURCE: KY Statute Sec. 211.334, (Accessed Jul. 2023).
Health care providers performing a telehealth or digital health service shall obtain patient informed consent.
SOURCE: KY 900 KAR 12:005 (Accessed Jul. 2023).
Last updated 07/11/2023
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 900 KAR 12:005 & KY Revised Statute 211.332. (Accessed Jul. 2023).
“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 Jul. 2023).
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 Jul. 2023).
“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 Jul. 2023).
Last updated 07/11/2023
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 Jul. 2023).
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 Jul. 2023).
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 Jul. 2023).
Last updated 07/11/2023
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.
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.
A telehealth care provider that has received a request for an in-person encounter or synchronous telehealth encounter shall provide an alternative in-person or synchronous telehealth encounter for the recipient within:
A provider’s failure to accommodate a recipient with a synchronous telehealth or in-person encounter shall be reported to the Office of the Ombudsman and Administrative Review of the Cabinet for Health and Family Services.
SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Jul. 2023).
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 Jul. 2023).
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 Jul. 2023).
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 Jul. 2023).
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 Jul. 2023).
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, as limited by Section 6
- Remote patient monitoring
- Referral
- Treatment
A telehealth service shall not be reimbursed by the department if:
- It is not medically necessary;
- The equivalent service is not covered by the department if provided in an in-person setting; or
- The telehealth care provider of the telehealth service is:
- Not currently enrolled in the Medicaid Program pursuant to 907 KAR 1:672;
- Not currently participating in the Medicaid Program pursuant to 907 KAR 1:671;
- Not in good standing with the Medicaid Program;
- Currently listed on the Kentucky DMS Provider Terminated and Excluded Provider List, which is available at https://chfs.ky.gov/agencies/dms/dpi/pe/Pages/terminated.aspx;
- Currently listed on the United States Department of Health and Human Services, Office of Inspector General List of Excluded Individuals and Entities, which is available at https://oig.hhs.gov/exclusions/;
- Otherwise prohibited from participating in the Medicaid program in accordance with 42 C.F.R. Part 455; or
- Not physically located within the United States or a United States territory at the time of service.
A telehealth service shall be subject to utilization review for:
- Medical necessity;
- Compliance with this administrative regulation; and
- Compliance with applicable state and federal law.
The department shall not reimburse for a telehealth service if the department determines that a telehealth service is not:
- Medically necessary:
- Compliant with this administrative regulation;
- Applicable to this administrative regulation; or
- Compliant with applicable state or federal law.
The department shall recover the paid amount of a reimbursement for a previously reimbursed telehealth service if the department determines that a telehealth service was not:
- Medically necessary;
- Compliant with this administrative regulation;
- Applicable to this administrative regulation; or
- Compliant with applicable state or federal law.
SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Jul. 2023).
Dental
“Direct practitioner interaction” means the billing dentist or oral surgeon is physically present with and evaluates, examines, treats, or diagnoses the recipient, unless the service can be appropriately performed via telehealth pursuant to 907 KAR 3:170.
SOURCE: KY Admin Regs. Title 907 KAR 1:026E, (Accessed Jul. 2023).
Specialized Children’s Services Clinics
Certain services, such as crisis intervention, intensive outpatient program services, behavioral health therapeutic intervention, group outpatient therapy, family outpatient therapy, and peer support services consist of a one-on-one encounter between the provider and recipient conducted in-person or via telehealth as appropriate pursuant to 907 KAR 3:170.
SOURCE: KY Admin Regs. Title 907 KAR 3:160, (Accessed Jul. 2023).
An examination for a petitioner under oath in court can be conducted via telehealth.
SOURCE: KY Statute Sec. 222.433, (Accessed Jul. 2023).
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 Jul. 2023).
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.
Also includes a community mental health center (CMHC) that is participating in the Medicaid program in compliance with 907 KAR 1:045, or 907 KAR 1:047.
SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Jul. 2023).
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 Jul. 2023).
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.
Notwithstanding any provision of law to the contrary, neither the Department for Medicaid Services nor a Medicaid managed care organization with whom the department has contracted for the delivery of Medicaid services shall require that a health professional, as defined in KRS 205.510, or medical group maintain a physical location or address in this state to be eligible for enrollment as a Medicaid provider if the provider or group exclusively offers services via telehealth as defined in KRS 211.332.
SOURCE: KY Revised Statute Sec. 205.559. (Accessed Jul. 2023).
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 Jul. 2023).
Last updated 07/11/2023
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 Jul. 2023).
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 Jul. 2023).
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 Jul. 2023).
For FQHCs and RHCs, a “visit” is defined as occurring in-person or via telehealth if authorized by 907 KAR 3:170.
SOURCE: KY 907 KAR 1:055 (37). (Accessed Jul. 2023).
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 Jul. 2023).
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.
SOURCE: Kentucky Cabinet for Health and Family Services. (Accessed Jul. 2023).
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 533.272 & 533.276. (Accessed Jul. 2023)
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. (Jul. 2023).
The Division of Telehealth Services has a Telehealth Terminology Glossary available.
SOURCE: KY 900 KAR 12:005. (Accessed Jul. 2023).
Last updated 07/11/2023
Out of State Providers
Notwithstanding any provision of law to the contrary, neither the Department for Medicaid Services nor a Medicaid managed care organization with whom the department has contracted for the delivery of Medicaid services shall require that a health professional, as defined in KRS 205.510, or medical group maintain a physical location or address in this state to be eligible for enrollment as a Medicaid provider if the provider or group exclusively offers services via telehealth as defined in KRS 211.332.
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 Jul. 2023).
A telehealth service shall not be reimbursed by the department if: … The telehealth care provider of the telehealth service: … not physically located within the United States or a United States territory at the time of service.
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 Jul. 2023).
Last updated 07/11/2023
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 reimbursed for certain conditions.
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 205.559 & KY 900 KAR 12:005 (Accessed Jul. 2023).
Last updated 07/11/2023
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 Jul. 2023).
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 Jul. 2023).
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.
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[host] any needed remote patient monitoring equipment in the home.
SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Jul. 2023).
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 Jul. 2023).
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 Jul. 2023).
Last updated 07/11/2023
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 Jul. 2023).
“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:
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 Jul. 2023).
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
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- 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 Jul. 2023).
ELIGIBLE SERVICES/SPECIALTIES
An asynchronous telehealth service or store and forward transfer shall be limited to those telehealth services that have an evidence base establishing the service’s safety and efficacy.
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 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.
Unless otherwise prohibited by this section, an asynchronous telehealth service shall be reimbursable if that service supports an upcoming synchronous telehealth or in-person visit to a provider that is providing one (1) of the specialties or instances of care listed in subsection (2) of this section.
The department shall evaluate available asynchronous telehealth services quarterly, and may clarify that certain asynchronous telehealth services meet the requirements of this section 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:
Any asynchronous service that is determined by the department to meet the criteria established pursuant to this subsection shall be available on the department’s Web site.
Each asynchronous telehealth service shall involve timely actual input and responses from the provider, and shall not be solely the result of reviewing an artificial intelligence messaging generated interaction with a recipient.
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.
A telehealth care provider that has received a request for an in-person encounter or synchronous telehealth encounter shall provide an alternative in-person or synchronous telehealth encounter for the recipient within:
- A reasonable time;
- The existing availability constraints of the provider’s schedule; and
- No more than three (3) weeks of the recipient’s request, unless the recipient’s condition or described symptoms suggest a need for an earlier synchronous or in-person encounter.
A provider’s failure to accommodate a recipient with a synchronous telehealth or in-person encounter shall be reported to the Office of the Ombudsman and Administrative Review of the Cabinet for Health and Family Services.
SOURCE: KY Admin. Regs. Title, 907, 3:170. (Accessed Jul. 2023).
GEOGRAPHIC LIMITS
No Reference Found
TRANSMISSION FEE
No Reference Found
