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
- 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 Feb. 2023).