Utah

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: No
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: Yes

PROFESSIONAL REQUIREMENTS

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

FQHCs

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

STATE RESOURCES

  1. Medicaid Program: Utah Medicaid
  2. Administrator: Utah Department of Health
  3. Regional Telehealth Resource Center: Northwest Regional 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.

COVID-19

Last updated 08/23/2022

Audio-Only Delivery

Medicaid: Telehealth FAQs for COVID-19

STATUS: Expired, due to end of State of Emergency June 1, 2021.

Medicaid: Distance Education and LEA Guidance

STATUS: Active.

Medicaid: COVID-19 EMERGENCY Guidance: Temporary Adjustments to Applied Behavior Analysis (ABA) Services Policy

STATUS: Active.

Medicaid 1915(c) Waiver: Appendix K – Combined Utah Community Supports Waiver; Aging Waiver; Acquired Brain Injury Waiver; Physical Disabilities Waiver; New Choices Waiver; Medically Complex Children’s Waiver; Technology Dependent Waiver

STATUS: Active, expires 6 months following the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K – Combined Addendum Utah Community Supports Waiver; Aging Waiver; Acquired Brain Injury Waiver; Physical Disabilities Waiver; New Choices Waiver; Medically Complex Children’s Waiver; Technology Dependent Waiver Community Transitions Waiver

STATUS: Active, expires 6 months following the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K Extension – Combined Addendum Utah Community Supports Waiver; Aging Waiver; Acquired Brain Injury Waiver; Physical Disabilities Waiver; New Choices Waiver; Medically Complex Children’s Waiver; Technology Dependent Waiver Community Transitions Waiver

STATUS: Active, Addendum expires 6 months following the conclusion of the PHE

Last updated 08/23/2022

Cross-State Licensing

Department of Health: Telehealth Resources

STATUS: Page is active, however licensing waiver has expired.

Last updated 08/23/2022

Easing Consent Requirements

Previous COVID-10 waivers expired.

Last updated 08/23/2022

Easing Prescribing Requirements

Previous COVID-19 waivers expired.

Last updated 08/23/2022

Miscellaneous

Medicaid 1915(c) Waiver: Appendix K Extension – Combined Addendum Utah Community Supports Waiver; Aging Waiver; Acquired Brain Injury Waiver; Physical Disabilities Waiver; New Choices Waiver; Medically Complex Children’s Waiver; Technology Dependent Waiver Community Transitions Waiver

STATUS: Active, expires 6 months following the conclusion of the PHE

Last updated 08/23/2022

Originating Site

Medicaid: Telehealth Q&A for COVID-19 Emergency

STATUS: Expired, due to end of State of Emergency June 1, 2021.

Last updated 08/23/2022

Private Payer

Department of Health: Telehealth Resources

STATUS: Active

Last updated 08/23/2022

Provider Type

Medicaid: Teledentistry Guidance

STATUS: Expired, due to end of State of Emergency June 1, 2021.

Medicaid: Distance Education and LEA Guidance

STATUS: Active

Medicaid: COVID-19 EMERGENCY Guidance: Temporary Adjustments to Applied Behavior Analysis (ABA) Services Policy

STATUS: Active.

Last updated 08/23/2022

Service Expansion

Medicaid: Telehealth FAQs for COVID-19

STATUS: Expired, due to end of State of Emergency June 1, 2021.

Medicaid: Teledentistry Guidance

STATUS: Expired, due to end of State of Emergency June 1, 2021.

Medicaid: Distance Education and LEA Guidance

STATUS: Expired, due to end of State of Emergency June 1, 2021.

Medicaid:  Applied Behavior Analysis Services Temporary Policy

STATUS: Active

Medicaid 1915(c) Waiver: Appendix K – Combined Utah Community Supports Waiver; Aging Waiver; Acquired Brain Injury Waiver; Physical Disabilities Waiver; New Choices Waiver; Medically Complex Children’s Waiver; Technology Dependent Waiver

STATUS: Active, expires 6 months following conclusion of the PHE.

Medicaid 1915(c) Waiver: Appendix K – Combined Addendum Utah Community Supports Waiver; Aging Waiver; Acquired Brain Injury Waiver; Physical Disabilities Waiver; New Choices Waiver; Medically Complex Children’s Waiver; Technology Dependent Waiver Community Transitions Waiver

STATUS: Active, expires 6 months following conclusion of the PHE.

Medicaid 1915(c) Waiver: Appendix K Extension – Combined Addendum Utah Community Supports Waiver; Aging Waiver; Acquired Brain Injury Waiver; Physical Disabilities Waiver; New Choices Waiver; Medically Complex Children’s Waiver; Technology Dependent Waiver Community Transitions Waiver

STATUS: Active, expires 6 months following the conclusion of the PHE

Medicaid 1915(c) Waiver: Appendix K Extension – Combined Addendum Utah Community Supports Waiver; Aging Waiver; Acquired Brain Injury Waiver; Physical Disabilities Waiver; New Choices Waiver; Medically Complex Children’s Waiver; Technology Dependent Waiver Community Transitions Waiver

STATUS: Active, Addendum expires 6 months following the conclusion of the PHE

Private Payer

Last updated 08/23/2022

Definition

“Telemedicine services” means telehealth services including:

  • Clinical care;
  • Health education;
  • Health administration;
  • Home health;
  • Facilitation of self-managed care and caregiver support; or
  • Remote patient monitoring occurring incidentally to general supervision; and

Must be provided by a provider to a patient through a method of communication that:

  • Uses asynchronous store-and-forward transfer; or
  • Uses synchronous interaction; and

Meets industry security and privacy standards, including compliance with:

  • The federal Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, 110 Stat. 1936, as amended; and
  • The federal Health Information Technology for Economic and Clinical Health Act, Pub. L. No. 111-5, 123 Stat. 226, 467, as amended.

SOURCE: Utah Code, 26-60-102. (Accessed Aug. 2022).

“Telemedicine services” means the same as that term is defined in Section 26-60-102.

SOURCE: Utah Code 31A-22-649.4 (Accessed Aug. 2022).

Last updated 08/23/2022

Parity

SERVICE PARITY

A health benefit plan shall provide coverage for:

  • telemedicine services that are covered by Medicare; and
  • treatment of a mental health condition through telemedicine services if:
    • the health benefit plan provides coverage for the treatment of the mental health condition through in-person services; and
    • the health benefit plan determines treatment of the mental health condition through telemedicine services meets the appropriate standard of care; and
  • reimburse a network provider that provides the telemedicine services at a negotiated commercially reasonable rate.

SOURCE: UT Code, 31A-22-649.5. (Accessed Aug. 2022).

Telepsychiatric Consultations

A health benefit plan that offers coverage for mental health services shall:

  • Provide coverage for telepsychiatric consultation during or after an initial visit between the patient and a referring in-network physician;
  • Provide coverage for a telepsychiatric consultation from an out-of-network board certified psychiatrist if the telepsychiatric consultant is not made available to a physician within seven business days after the initial request is made by an in-network provider of telepsychiatric consultations; and
  • Reimburse for the services at the equivalent of the in-network or out-of-network rate set by the benefit plan after taking into account cost-sharing that may be required under the health benefit plan.

Telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist, both of whom are licensed to engage in the practice of medicine in the state, that utilizes:

  • The health records of the patient, provided from the patient or the referring physician;
  • A written, evidence-based patient questionnaire; and
  • Telehealth services that meet industry security and privacy standards, including compliance with the:
    • Health Insurance Portability and Accountability Act; and
    • Health Information Technology for Economic and Clinical Health Act

SOURCE: UT Code, 31A-22-649. (Accessed Aug. 2022).

PAYMENT PARITY

A health benefit plan shall reimburse a network provider that provides the telemedicine services at a negotiated commercially reasonable rate.

SOURCE: UT Code, 31A-22-649.5 (2(b)) (Accessed Aug. 2022).

Telepsychiatric Consultations

A health benefit plan that offers coverage for mental health services shall reimburse for the services at the equivalent of the in-network or out-of-network rate set by the benefit plan after taking into account cost-sharing that may be required under the health benefit plan.

SOURCE: UT Code, 31A-22-649, (Accessed Aug. 2022).

Last updated 08/23/2022

Requirements

All health insurance plans must disclose whether the insurer provides coverage for telehealth services in accordance with section 26-18-13.5 and terms associated with that coverage.

SOURCE: UT Code 31A-22-613.5(2)(f). (Accessed Aug. 2022).

A health benefit plan shall provide coverage for:

  • telemedicine services that are covered by Medicare; and
  • treatment of a mental health condition through telemedicine services if:
    • the health benefit plan provides coverage for the treatment of the mental health condition through in-person services; and
    • the health benefit plan determines treatment of the mental health condition through telemedicine services meets the appropriate standard of care; and
  • reimburse a network provider that provides the telemedicine services described in Subsection (2)(a) at a negotiated commercially reasonable rate.

A health benefit plan may not impose originating site restrictions, geographic restrictions, or distance-based restrictions.

A network provider that provides the telemedicine services described above may utilize any synchronous audiovisual technology for the telemedicine services that is compliant with HIPAA.

SOURCE: UT Code, 31A-22-649.5. (Accessed Aug. 2022).

Telepsychiatric Consultations

A health benefit plan that offers coverage for mental health services shall:

  • Provide coverage for telepsychiatric consultation during or after an initial visit between the patient and a referring in-network physician;
  • Provide coverage for a telepsychiatric consultation from an out-of-network board certified psychiatrist if the consultant is not made available to a physician within seven business days after the initial request is made by an in-network provider; and
  • Reimburse for the services at the equivalent of the in-network or out-of-network rate set by the benefit plan after taking into account cost-sharing that may be required under the health benefit plan.

An insurer can also meet the requirement to cover telepsychiatric consultation for a patient by providing coverage for behavioral health treatment; and ensuring that the patient receives an appointment for the behavioral health treatment in person or using telehealth services on a date that is within seven business days after the initial request is made by the in-network referring physician (see statute for details).

Telepsychiatric consultation means a consultation between a physician and a board certified psychiatrist, both of whom are licensed to engage in the practice of medicine in the state, that utilizes:

  • The health records of the patient, provided from the patient or the referring physician;
  • A written, evidence-based patient questionnaire; and
  • Telehealth services that meet industry security and privacy standards, including compliance with the:
    • Health Insurance Portability and Accountability Act; and
    • Health Information Technology for Economic and Clinical Health Act

SOURCE: UT Code, 31A-22-649. (Accessed Aug. 2022).

Medicaid

Last updated 08/23/2022

Consent Requirements

No Reference Found

Last updated 08/23/2022

Definitions

Telehealth services means the transmission of health-related services or information through the use of electronic communication or information technology.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48 (Apr. 2022), & UT Admin. Code R414-42-2. (Accessed Aug. 2022).

Telemedicine is the delivery of medical services and any diagnosis, consultation, treatment, transfer of medical data or education related to health care services using interactive audio or interactive video communication instead of in person contact.

Teledentistry is the use of information technology and telecommunications for dental care, consultation, and education.

Telepsychiatric Consultation is a consultation between a physician and a board-certified psychiatrist that utilizes:

  • the health records of the patient, provided from the patient or the referring physician
  • a written, evidence-based patient questionnaire

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48 (Apr. 2022). (Accessed Aug. 2022).

Last updated 08/23/2022

Email, Phone & Fax

Interprofessional telephone/internet assessment and management services are listed as a covered service for psychiatrists.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49 (Apr. 2022), (Accessed Aug. 2022).

Telephone contact can be billed in the Targeted Case Management for Early Childhood program.

SOURCE: Utah Medicaid Provider Manual: Targeted Case Management, Early Childhood Ages 0-4, p. 10, (Jul. 2016).  (Accessed Aug. 2022).

Last updated 08/23/2022

Live Video

POLICY

The department shall adopt administrative rules which establish:

  • the particular telemedicine services that are considered face-to-face encounters for reimbursement purposes under the state’s medical assistance program; and
  • the reimbursement methodology for the telemedicine services

The reimbursement rate for telemedicine services shall be subject to reimbursement policies set by the state plan; and may be based on:

  • a monthly reimbursement rate;
  • a daily reimbursement rate; or
  • an encounter rate.

SOURCE: UT Code Annotated Sec. 26-18-13. (Accessed Aug. 2022).

Utah Medicaid covers medically necessary, non-experimental and cost-effective services provided via telehealth.

Limitations:  Telehealth encounters must comply with HIPAA privacy and security measures and the Health Information Technology for Economic and Clinical Health Act, Pub. L. No.111-5, 123 Stat. 226, 467, as amended to ensure that all member communications and records, including recordings of telehealth encounters, are secure and remain confidential. The provider is responsible for ensuring the encounter is HIPAA compliant. Security measures for transmission may include password protection, encryption, and other reliable authentication techniques. Compliance with the Utah Health Information Network (UHIN) Standards for Telehealth must be maintained. These standards provide a uniform standard of billing for claims and encounters delivered via telehealth.

CMS 1500 Professional Claims- Provider must indicate that the service(s) was provided via telehealth by indicating Place of Service (POS) 02 – Telehealth Provided Other than in Patient’s Home, or POS 10 – Telehealth Provided in Patient’s Home on the CMS 1500 claim form with the service’s usual billing codes.

UB-04 Institutional Claims- Providers must indicate that the service(s) were provided via telehealth by appending the GT modifier to the UB-04 institutional claim form with the service’s usual billing codes.

  • GT – Via interactive audio and video telecommunication systems

Services provided via telehealth have the same service thresholds, authorization requirements and reimbursement rates as services delivered face-to-face.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48 & 50 (Apr. 2022). (Accessed Aug. 2022).

A licensed provider may deliver services via synchronous telehealth, as clinically appropriate. Services include consultation services, evaluation and management services, teledentistry services, mental health services, substance use disorder services, and telepsychiatric consultations.

Must comply with privacy and security measures set forth by HIPAA and HITECH. The provider is responsible to ensure the encounter is HIPAA compliant. Security measures for transmission may include password protection, encryption, and other reliable authentication techniques.

A provider must comply with the Utah Health Information Network (UHIN) standards for telehealth. These standards provide a uniform standard of billing for claims and encounters delivered via telehealth.

The Department pays the lesser of the amount billed or the rate on the fee schedule. A provider shall not charge the Department a fee that exceeds the provider’s usual and customary charges for the provider’s private pay patients.

SOURCE: UT Admin. Code R414-42-3, R414-42 (Accessed Aug. 2022).

ELIGIBLE SPECIALTIES/SERVICES

Examples of covered telehealth services include but are not limited to:

  • Consultation services
  • Evaluation and management services
  • Mental health services
  • Substance use disorder services
  • Teledentistry
  • Telepsychiatric consultations

It is acceptable to use telehealth to facilitate contact directly between a member and a provider.

Telepsychiatric consultations, as described in Utah Code 26-18-13.5, between a physician and a board-certified psychiatrist are covered a service.  Psychiatrists are limited to certain time-based CPT codes.

Teledentistry services are covered for eligible members statewide.  See manual for eligible codes.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48-49 (Apr. 2022) (Accessed Aug. 2022).

The Medicaid program is required to reimburse for telemedicine services at the same rate the Medicaid program reimburses for other health care services (includes managed care plans). The Medicaid program is required to reimburse for telepsychiatric consultations at a rate set by the Medicaid program.

SOURCE: UT Code 26-18-13.5 (Accessed Aug. 2022).

Rehabilitative Mental Health and Substance Use Disorder

Services may be provided via telemedicine when clinically appropriate.

The scope of rehabilitative behavioral health services includes the following:

  • Psychiatric Diagnostic Evaluation
  • Mental Health Assessment by a Non-Mental Health Therapist
  • Psychological Testing
  • Psychotherapy with Patient and/or Family Member
  • Family psychotherapy with Patient Present and Family Psychotherapy without Patient Present
  • Group Psychotherapy and Multiple Family Group Psychotherapy
  • Psychotherapy for Crisis
  • Psychotherapy with Evaluation and Management (E/M) Services
  • Evaluation and Management (E/M) Services (Pharmacologic Management)
  • Therapeutic Behavioral Services
  • Psychosocial Rehabilitative Services
  • Peer Support Services
  • SUD Services in Licensed SUD Residential Treatment Programs
  • Assertive Community Treatment (ACT)
  • Mobile Crisis Outreach Teams (MCOT)
  • Clinically Managed Residential Withdrawal Management
  • Mental Health Services in Licensed Mental Health Residential Treatment Programs
  • Behavioral Health Receiving Centers

SOURCE: Utah Medicaid Provider Manual: Rehabilitative Mental Health and Substance Use Disorder Services. P. 9-10 (Mar. 2022) (Accessed Aug. 2022).

ELIGIBLE PROVIDERS

The distant site provider may participate in the telehealth interaction from any appropriate location.

Providers may submit claims for procedure codes that they are already eligible to report.

Psychiatrists and dentists are limited to reporting certain CPT codes.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49-50 (Apr. 2022). (Accessed Jun. 2022).

ELIGIBLE SITES

CMS 1500 Professional Claims- Provider must indicate that the service(s) was provided via telehealth by indicating Place of Service (POS) 02 – Telehealth Provided Other than in Patient’s Home, or POS 10 – Telehealth Provided in Patient’s Home on the CMS 1500 claim form with the service’s usual billing codes.

It is acceptable to use telehealth to facilitate contact directly between a member and a provider. For example, services are provided between a member and a distant site provider when they are in their home or another location. Additionally, the distant site provider may participate in the telehealth interaction from any appropriate location.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49-50 (Apr. 2022), (Accessed Aug. 2022).

GEOGRAPHIC LIMITS

There are no geographic restrictions for telehealth services.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48 (Apr. 2022), (Accessed Aug. 2022).

Home and Community Based Services Autism Waiver

For those clients living outside of the Wasatch Front, the BCBA may use tele-health for the supervision time. In-person visits should be used for those clients living inside the Wasatch Front.

SOURCE: Utah Medicaid Provider Manual: Home and Community Based Waiver Services Autism Waiver, p. 10, (Jan. 2016).  (Accessed Aug. 2022).

FACILITY/TRANSMISSION FEE

The provider at the originating site receives no additional reimbursement for the use of telemedicine.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 50 (Apr. 2022) & R414-42-4.(3). (Accessed Aug. 2022).

Last updated 08/23/2022

Miscellaneous

Telepsychiatric consultations are a covered service. Psychiatrist service will be covered by all Managed Care Entities (MCE). If a member receiving the service is part of an MCE, then the provider must be enrolled with the member’s MCE in order to receive reimbursement.

Teledentistry services are covered for eligible members statewide. Providers must bill the appropriate teledentistry code, D9995. See manual for additional teledentistry codes.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49 (Apr. 2022), (Accessed Aug. 2022).

Documentation must include: …setting in which the service was rendered (when via telehealth, the provider setting and notation that the service was provided via telehealth).

SOURCE: Utah Medicaid Provider Manual: All Inclusive Master Manual, p. 20, 609 (May 2022), (Accessed Aug. 2022).

If the required face-to-face encounter for certain durable medical equipment occurred via telehealth it must be documented.

SOURCE: Utah Medicaid Provider Manual: Durable Medical Equipment, p. 6,  (Jan. 2022).  (Accessed Aug. 2022). 

Home and Community Based New Choices Waiver Services

A non face-to-face medication reminder system using telecommunication device is covered.

SOURCE: Utah Medicaid Provider Manual: Home and Community Based Waiver Services, New Choices Waiver, p. 63-64,  (Jul. 2021).  (Accessed Aug. 2022).

Home and Community Based Services Autism Waiver

For those clients living outside of the Wasatch Front, the BCBA may use tele-health for the supervision time. In-person visits should be used for those clients living inside the Wasatch Front.

SOURCE: Utah Medicaid Provider Manual: Home and Community Based Waiver Services Autism Waiver, p. 10, (Jan. 2016).  (Accessed Aug. 2022).

Last updated 08/23/2022

Out of State Providers

No Reference Found

Last updated 08/23/2022

Overview

Utah Medicaid reimburses for medically necessary, non-experimental and cost-effective services via live video telehealth, and does not reference store-and-forward modality in their policy.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, P. 48 (Apr. 2022). (Accessed Aug. 2022).

Home telemetry for outpatient long-term cardiac monitoring is allowable with prior authorization under certain conditions.

SOURCE: Utah Medicaid Provider Manual: Physician Manual, p. 23 (Jan. 2022).  (Accessed Aug. 2022).

Last updated 08/23/2022

Remote Patient Monitoring

POLICY

Home telemetry for outpatient long-term cardiac monitoring is allowed with prior authorization. Criteria include:

  • A cardiologist must order outpatient, long-term cardiac (Holter) monitoring
  • Member must have had a stroke or TIA with no identifiable cause
  • Member should have already had 24-hour monitoring done previously
  • Member should not be currently taking anti-coagulated or Warfarin for any other reason
  • Member should not have a known contraindication for Warfarin
  • Outpatient long-term cardiac monitoring may only be authorized for the 30-day test
  • Data from the test must be reviewed and interpreted by a cardiologist

SOURCE: Utah Medicaid Provider Manual: Physician Manual, p. 23 (Apr. 2022).  (Accessed Aug. 2022).

CONDITIONS

Only for patients with a long-term cardiac health issue.

SOURCE: Utah Medicaid Provider Manual: Physician Manual, p. 23 (Apr. 2022).  (Accessed Aug. 2022).

PROVIDER LIMITATIONS

Test must be ordered by a cardiologist and reviewed and interpreted by a cardiologist.

SOURCE: Utah Medicaid Provider Manual: Physician Manual, p. 23 (Apr. 2022).  (Accessed Aug. 2022).

OTHER RESTRICTIONS

No Reference Found

Last updated 08/23/2022

Store and Forward

POLICY

No Reference Found

ELIGIBLE SERVICES/SPECIALTIES

No Reference Found

GEOGRAPHIC LIMITS

No Reference Found

TRANSMISSION FEE

No Reference Found

Professional Requirements

Last updated 08/23/2022

Consent Requirements

A provider offering telehealth services shall, prior to each patient encounter, and at least annual intervals, obtain informed consent to the use of telehealth services by clear disclosure of:

  • additional fees for telehealth services, if any, and how payment is to be made for those additional fees if they are charged separately;
  • to whom patient health information may be disclosed and for what purpose, including clear reference to any patient consent governing release of patient-identifiable information to a third-party;
  • the rights of the patient with respect to patient health information;
  • appropriate uses and limitations of the site, including emergency health situations;
  • information affirming that the telehealth services meet industry security and privacy standards in Subsection 26-60-102(9)(b)(ii), and warning of potential risks to privacy regardless of the security measures;
  • a warning that information may be lost due to technical failures, and clearly referencing any patient consent to hold the provider harmless for such loss; and
  • information disclosing the website owner-operator, location, and contact information.

SOURCE: UT Admin Code R156-1-603. (Accessed Aug. 2022).

When a licensed dental professional uses teledentistry, the licensed professional shall ensure informed consent.  See regulations for requirements of consent.

SOURCE: UT Code, 58-69-807, (Accessed Aug. 2022).

Last updated 08/23/2022

Cross State Licensing

An out-of-state physician may practice without a Utah license if:

  • The individual is licensed in good standing as a physician in another state with no licensing action pending and no less than 10 years of professional experience
  • The services are rendered as a public service and for a noncommercial purpose;
  • No fee or other consideration of value is charged, expected or contemplated, beyond an amount necessary to cover the proportionate cost of malpractice insurance; and
  • The physician does not otherwise engage in unlawful or unprofessional conduct.

SOURCE: UT Code Annotated Sec. 58-67-305(7). (Accessed Aug. 2022).

A mental health therapist licensed in another state and in good standing can provide short term transitional mental health therapy remotely if:

  • The mental health therapist is present in the state where he/she is licensed;
  • The client relocates to Utah, and was a client immediately before the relocation;
  • The therapy or counseling is provided for a maximum of 45 days after the client relocates;
  • Within 10 days of the client’s relocation, the mental health therapist provides a written notice to the Division of Occupational and Professional Licensing of their intent to provide therapy/counseling remotely; and
  • The mental health therapist does not engage in unlawful or unprofessional conduct.

SOURCE: UT Code, 58-61-307(k) (Accessed Aug. 2022).

Last updated 08/23/2022

Definitions

Telehealth services means the transmission of health-related services or information through the use of electronic communication or information technology.

“Telemedicine services” means telehealth services including:

  • Clinical care;
  • Health education;
  • Health administration;
  • Home health;
  • Facilitation of self-managed care and caregiver support; or
  • Remote patient monitoring occurring incidentally to general supervision; and

Provided by a provider to a patient through a method of communication that:

  • Uses asynchronous store and forward transfer; or
  • Uses synchronous interaction; and

Meets industry security and privacy standards, including compliance with:

  • The federal Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, 110 Stat. 1936, as amended; and
  • The federal Health Information Technology for Economic and Clinical Health Act, Pub. L. No. 111-5, 123 Stat. 226, 467, as amended.

SOURCE: UT Code, 26-60-102(8-9) (Accessed Aug. 2022).

“Teledentistry” means the practice of dentistry using synchronous or asynchronous technology.

SOURCE: UT Code, 58-69-102 (12), (Accessed Aug. 2022).

Last updated 08/23/2022

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. (Accessed Aug. 2022).

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT Compact. (Accessed Aug. 2022).

Member of the Nurse Licensure Compact.

SOURCE: Nurse Licensure Compact (Accessed Aug. 2022).

Member of the Physical Therapy Licensure Compact.

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

Member of the Audiology and Speech-language Pathology Interstate Compact.

SOURCE: ASPL Compact. Compact Map. (Accessed Aug. 2022).

Member of the Emergency Medical Services Compact.

SOURCE: EMS Compact. (Accessed Aug. 2022).

Member of the Occupational Therapy Licensure Compact.

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

Member of the Counseling Compact.

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

Advanced Practice Registered Nurse (APRN) Compact

SOURCE: NCSBN, APRN Compact, (Accessed Aug. 2022).

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

Last updated 08/23/2022

Miscellaneous

If a hospital participates in telemedicine, it shall develop and implement policies governing the practice of telemedicine in accordance with the scope and practice of the hospital.

These policies shall address security, access and retention of telemetric data, and define the privileging of physicians and allied health professionals who participate in telemedicine.

SOURCE: UT Admin. Code R432-100-33. (Accessed Aug. 2022).

Utah established the Early Childhood Psychotherapeutic Telehealth Consultation Program.

SOURCE: UT Code Sec. 62A-15-1602, (Accessed Aug. 2022)

Last updated 08/23/2022

Online Prescribing

A provider offering telehealth services shall at all times:

  • act within the scope of the provider’s license; and
  • be held to the same standards of practice as those applicable in traditional health care settings

If the provider does not already have a provider-patient relationship with the patient, establish a provider-patient relationship during the patient encounter in a manner consistent with the standards of practice, including providing the provider’s licensure and credentials to the patient;

Before providing treatment or prescribing a prescription drug, establish a diagnosis and identify underlying conditions and contraindications to a recommended treatment after:

  • obtaining from the patient or another provider the patient’s relevant clinical history; and
  • documenting the patient’s relevant clinical history and current symptoms;

Be available to a patient who receives telehealth services from the provider for subsequent care related to the initial telemedicine services, in accordance with community standards of practice.

Be familiar with available medical resources, including emergency resources near the originating site, in order to make appropriate patient referrals when medically indicated.

Make available to each patient receiving telehealth services the patient’s medical records; and

If the patient has a designated health care provider who is not the telemedicine provider:

  • Consult with the patient regarding whether to provide the patient’s designated health care provider a medical record or other report containing an explanation of the treatment provided to the patient and the telemedicine provider’s evaluation, analysis, or diagnosis of the patient’s condition;
  • Collect from the patient the contact information of the patient’s designated health care provider; and
  • Within two weeks after the day on which the telemedicine provider provides services to the patient, and to the extent allowed under HIPAA as that term is defined in Section 26-18-17, provide the medical record or report to the patient’s designated health care provider, unless the patient indicates that the patient does not want the telemedicine provider to send the medical record or report to the patient’s designated health care provider.

Unless a provider has established a provider-patient relationship with a patient, a provider offering telemedicine services may not diagnose a patient, provide treatment, or prescribe a prescription drug based solely on one of the following:

  • an online questionnaire;
  • an email message; or
  • a patient-generated medical history.

A provider may not offer telehealth services if:

  • the provider is not in compliance with applicable laws, rules, and regulations regarding the provider’s licensed practice; or
  • the provider’s license under Title 58, Occupations and Professions, is not active and in good standing.

SOURCE: UT Code, 26-60-103. (Accessed Aug. 2022).

It is considered unprofessional conduct to issue, or aid and abet in the issuance of, an order or prescription for a drug or device:

  • without first obtaining information in the usual course of professional practice, that is sufficient to establish a diagnosis, to identify conditions, and to identify contraindications to the proposed treatment; or
  • with prescriptive authority conferred by an exception issued under this title, or a multi-state practice privilege recognized under this title, if the prescription was issued without first obtaining information, in the usual course of professional practice, that is sufficient to establish a diagnosis, to identify underlying conditions, and to identify contraindications to the proposed treatment.

SOURCE: UT Code, 58-1-501(2(m)). (Accessed Aug. 2022).

Last updated 08/23/2022

Professional Board Standards

Utah has scope of telehealth practice that applies to providers offering telehealth services.  See regulations for details.

SOURCE: R156-1-603, (Accessed Aug. 2022).

Federally Qualified Health Center (FQHC)

Last updated 08/23/2022

Definition of Visit

FQHC Provider manual refers providers to Federal Law (Title 42, Subpart X) for definitions specific to FQHCs.

SOURCE: UT Division of Medicaid and Health Financing. Utah Medicaid Provider Manual, Rural Health Clinics and Federally Qualified Health Centers Services, Oct. 2021, pg. 3, (Accessed Aug. 2022).

For FQHCs, a visit is either of the following:

  • A visit as described in paragraph (a)(1)(i) or (ii) of this section.
  • A face-to-face encounter between a patient and either of the following:
    • A qualified provider of medical nutrition therapy services as defined in part 410, subpart G, of this chapter.
    • A qualified provider of outpatient diabetes self-management training services as defined in part 410, subpart H, of this chapter.

A medical visit is a face-to-face encounter between a RHC or FQHC patient and one of the following:

  • Physician.
  • Physician assistant.
  • Nurse practitioner.
  • Certified nurse midwife.
  • Visiting registered professional or licensed practical nurse.

A medical visit for a FQHC patient may be either of the following:

  • Medical nutrition therapy visit.
  • Diabetes outpatient self-management training visit.

A mental health visit is a face-to-face encounter or an encounter furnished using interactive, real-time, audio and video telecommunications technology or audio-only interactions in cases where the patient is not capable of, or does not consent to, the use of video technology for the purposes of diagnosis, evaluation or treatment of a mental health disorder, including an in-person mental health service furnished within 6 months prior to the furnishing of the telecommunications service and that an in-person mental health service (without the use of telecommunications technology) must be provided at least every 12 months while the beneficiary is receiving services furnished via telecommunications technology for diagnosis, evaluation, or treatment of mental health disorders, unless, for a particular 12-month period, the physician or practitioner and patient agree that the risks and burdens outweigh the benefits associated with furnishing the in-person item or service, and the practitioner documents the reasons for this decision in the patient’s medical record, between an RHC or FQHC patient and one of the following:

  • Clinical psychologist.
  • Clinical social worker.
  • Other RHC or FQHC practitioner, in accordance with paragraph (b)(1) of this section, for mental health services.

SOURCE:  Code of Federal Regulation, Title 42, Part 405, Sec. 2463, (Accessed Jun. 2022).

Diabetes self-management training (DSMT).

  • FQHCs – Offer DSMT services. A face-to-face encounter is required and must be provided as part of an encounter to qualify for coverage.

SOURCE: UT Division of Medicaid and Health Financing. Utah Medicaid Provider Manual, Rural Health Clinics and Federally Qualified Health Centers Services, Oct. 2021, pg. 4, (Accessed Aug. 2022).

Last updated 08/23/2022

Eligible Distant Site

Not mentioned explicitly, however state does not have a specific provider list.

See: UT Medicaid Live Video Eligible Providers

Last updated 08/23/2022

Eligible Originating Site

Not mentioned explicitly, however state does not have a specific originating site list.

See: UT Medicaid Live Video Eligible Sites

Last updated 08/23/2022

Facility Fee

UT Medicaid does not reimburse a facility fee.

See: UT Medicaid Live Video Facility/Transmission Fee

Last updated 08/23/2022

Home Eligible

FQHCs must provide preventive health services onsite or by arrangement with another provider and include:

  • well-child services,
  • pediatric eye, ear, and dental screening,
  • mental health and substance use referrals,
  • services that enable individuals to use the services of the health center (including outreach and transportation services,
  • prenatal and perinatal services,
  • voluntary family planning services, and
  • immunizations against vaccine-preventable diseases.

SOURCE: UT Division of Medicaid and Health Financing. Utah Medicaid Provider Manual, Rural Health Clinics and Federally Qualified Health Centers Services, Oct. 2021, pg. 4, (Accessed Aug. 2022).

Last updated 08/23/2022

Modalities Allowed

Live Video

FQHC Manual refers providers to refer to Section 1: General Information manual for Telemedicine instructions.  General Information manual allows for medically necessary, non-experimental and cost-effective services provided via telehealth.

See:  UT Medicaid Live Video

Store and Forward

FQHC Manual refers providers to refer to Section 1: General Information manual for Telemedicine instructions.  No reference was found in General Information manual for store and forward.

See: UT Medicaid Store-and-Forward

Remote Patient Monitoring

FQHC Manual refers providers to refer to Section 1: General Information manual for Telemedicine instructions.  No reference was found in General Information manual for store and forward.  There is an allowance for home telemetry in the Physician manual however no reference was found how those policies may or may not apply to FQHCs.

See: UT Medicaid Remote Patient Monitoring

Audio-Only

FQHC Manual refers providers to refer to Section 1: General Information manual for Telemedicine instructions.  General Information manual allows for interprofessional telephone/internet assessments and management services. No reference found on whether or not that service applies to FQHCs.

See: UT Medicaid Email, Phone and Fax

Last updated 08/23/2022

Patient-Provider Relationship

No reference found.

For general information about forming a patient-provider relationship

See: Utah Professional Requirements Online Prescribing

Last updated 08/23/2022

PPS Rate

FQHC Provider manual refers providers to Federal regulations (Title 42, Subpart X) for definitions specific to FQHCs.  Federal regulations contains a section on supplemental payment for interactive, real-time, audio and video telecommunications technology or audio-only interactions. Unclear if this policy applies in Utah Medicaid. See next citation.

SOURCE: UT Division of Medicaid and Health Financing. Utah Medicaid Provider Manual, Rural Health Clinics and Federally Qualified Health Centers Services, Oct. 2021, pg. 3, (Accessed Aug. 2022).

Last updated 08/23/2022

Same Day Encounters

Reporting encounters for RHCs and FQHCs is limited to one encounter per day per patient. Encounters with more than one health professional or multiple visits with the same health professional on the same day constitute a single visit. The provider may bill up to, but not exceeding, the established encounter rate.

SOURCE: UT Division of Medicaid and Health Financing. Utah Medicaid Provider Manual, Rural Health Clinics and Federally Qualified Health Centers Services, Oct. 2021, pg. 5, (Accessed Aug. 2022).

FQHC Provider manual refers providers to Federal Law (Title 42, Subpart X) for definitions specific to FQHCs.

SOURCE: UT Division of Medicaid and Health Financing. Utah Medicaid Provider Manual, Rural Health Clinics and Federally Qualified Health Centers Services, Oct. 2021, pg. 3, (Accessed Aug. 2022).

For RHCs and FQHCs that are authorized to bill under the reasonable cost system, encounters with more than one health professional and multiple encounters with the same health professional that take place on the same day and at a single location constitute a single visit, except when the patient –

  • Suffers an illness or injury subsequent to the first visit that requires additional diagnosis or treatment on the same day;
  • Has a medical visit and a mental health visit on the same day; or
  • Has an initial preventive physical exam visit and a separate medical or mental health visit on the same day.

For RHCs and FQHCs that are authorized to bill under the reasonable cost system, Medicare pays RHCs and FQHCs for more than 1 visit per day when the conditions in paragraph (c)(1) of this section are met.

For FQHCs that are authorized to bill under the reasonable cost system, Medicare pays for more than 1 visit per day when a DSMT or MNT visit is furnished on the same day as a visit described in paragraph (c)(1) of this section are met.

For FQHCs billing under the PPS, and grandfathered tribal FQHCs that are authorized to bill as a FQHC at the outpatient per visit rate for Medicare as set annually by the Indian Health Service –

  • Suffers an illness or injury subsequent to the first visit that requires additional diagnosis or treatment on the same day; or
  • Has a medical visit and a mental health visit on the same day.

SOURCE:  Code of Federal Regulation, Title 42, Part 405, Sec. 2463, (Accessed Aug. 2022).