Utah

CURRENT STATE LAWS & POLICY


AT A GLANCE

Medicaid Program

Utah Medicaid

Administrator

Utah Department of Health

Regional Telehealth Resource Center

Northwest Regional Telehealth Resource Center

Medicaid Reimbursement

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

Private Payer Law

Law Exists: Yes
Payment Parity: No

Professional Requirements

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

Last updated 02/28/2021

Cross-State Licensing

Department of Health: Telehealth Resources

STATUS: Active

Last updated 02/28/2021

Easing Prescribing Requirements

Office of the Governor:  Executive Order on Telehealth Services

STATUS: Active, until UT state of emergency ends

Last updated 02/28/2021

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

Office of the Governor: Executive Order related to HIPAA

STATUS: Active, until UT state of emergency ends

Last updated 02/28/2021

Originating Site

No Reference Found

Last updated 02/28/2021

Private Payer

Department of Insurance:  Telehealth Services by Insurers

STATUS: Active

Department of Health: Telehealth Resources

STATUS: Active

Last updated 02/28/2021

Provider Type

Medicaid: Teledentistry Guidance

STATUS: Active, until the end of the month in which the UT state of emergency ends

Medicaid: Distance Education and LEA Guidance

STATUS: Active, until the end of the month in which the UT state of emergency ends

Service Expansion

Medicaid: Telehealth FAQs for COVID-19

STATUS: Active, until the end of the month in which the UT state of emergency ends

Medicaid: Teledentistry Guidance

STATUS: Active, until the end of the month in which the UT state of emergency ends

Medicaid: Distance Education and LEA Guidance

STATUS: Active, until the end of the month in which the UT state of emergency ends

Medicaid:  Applied Behavior Analysis Services Temporary Policy

STATUS: Active

Medicaid:  Emergency Rule related to teledentistry and synchronous telehealth

STATUS: Expired

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: Expired January 26, 2021 (extended)

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: Expired January 26, 2021 (extended)

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 02/28/2021

Definitions

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.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48 (Jul. 2020). (Accessed Feb. 2021).

“Telemedicine” is two-way, real-time interactive communication between the member and the physician or authorized provider at the distant site. This electronic communication uses interactive telecommunications equipment that includes, at a minimum, audio and video equipment.

SOURCE: UT Admin. Code R414-42-2. (Accessed Feb. 2021).

Last updated 02/28/2021

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 (Jul. 2020), (Accessed Feb. 2021).

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 Feb. 2021).

Last updated 02/28/2021

Live Video

POLICY

Providers are eligible for reimbursement for telemedicine services under Utah’s Medical Assistance Program.

SOURCE: UT Code Annotated Sec. 26-18-13. (Accessed Feb. 2021).

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

Limitations:

  • Must be HIPAA compliant
  • Must comply with Utah Health Information Network Standards for Telehealth

CMS 1500 Professional Claims- Provider must indicate that the service(s) were provided via telehealth by indicating Place of Service 02 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.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48 & 50 (Jul. 2020). (Accessed Feb. 2021).

Covered services may be delivered by means of telemedicine, as clinically appropriate, including consultation, evaluation and management services, mental health services, substance use disorder services and telepsychiatric consultations. Must comply with privacy and security measures set forth by HIPAA and with Utah Health Information Network 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, R414-42-4, & R414-42-5 (Accessed Feb. 2021).


ELIGIBLE SPECIALTIES/SERVICES

Eligible services include but are not limited to:

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

See manual for high level list of services that can be delivered via telemedicine.

Rural health clinic and federally qualified health clinic services may be delivered via telemedicine.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48-49 (Jul. 2020) & Utah Medicaid Provider Manual: Rural Health Clinics and Federally Qualified Health Centers Services. p.3 (Jan. 2019). (Accessed Feb. 2021).

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.(3) (Accessed Feb. 2021).

Telepsychiatric consultations between a physician and a board-certified psychiatrist are a covered service. See Medicaid Information Bulletin for specific CPT codes to bill.

SOURCE: Medicaid Information Bulletin. Jul. 2018. Sec. 18-67. (Accessed Feb. 2021).

Teledentistry services are limited to certain CPT codes.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49 (Jul. 2020), (Accessed Feb. 2021).

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)

SOURCE: Utah Medicaid Provider Manual: Rehabilitative Mental Health and Substance Use Disorder Services. P. 9-10 (Jan. 2021) (Accessed Feb.2021).


ELIGIBLE PROVIDERS

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

Psychiatrists are limited to reporting certain CPT codes.

Rural health clinic and federally qualified health clinic services may be delivered via telemedicine.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49-51 (Jul. 2020). (Accessed Feb. 2021).


ELIGIBLE SITES

It is acceptable to use telehealth to facilitate contact directly between a member and a provider. Services can be provided between a member and a distant site provider when a member is in their home or other location of their choice.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49 (Jul. 2020), (Accessed Feb. 2021).


GEOGRAPHIC LIMITS

There are no geographic restrictions for telehealth services.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 48 (Jul. 2020), (Accessed Feb. 2021).

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 Feb. 2021).


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 (Jul. 2020) & R414-42-4.(3). (Accessed Feb. 2021).

Last updated 02/28/2021

Miscellaneous

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.

SOURCE: Utah Medicaid Provider Manual: Section I: General Information, p. 49 (Jul. 2020), (Accessed Feb. 2021).

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. 2021).  (Accessed Feb. 2021). 

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. 75,  (Oct.. 2020).  (Accessed Feb. 2021). 

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 Feb. 2021).

Last updated 02/28/2021

Out of State Providers

No Reference Found

Last updated 02/28/2021

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 (Jul. 2020). (Accessed Feb. 2021).

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. 2021).  (Accessed Feb. 2021).

Last updated 02/28/2021

Remote Patient Monitoring

POLICY

Bulletin indicates The Skilled Nursing Pilot Project has been removed from manual.

SOURCE: Medicaid Information Bulletin July 2019 (Accessed Feb. 2021).

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

  • Must be ordered by a neurologist
  • 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 (Jan. 2021).  (Accessed Feb.2021).


CONDITIONS

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

SOURCE: Utah Medicaid Provider Manual: Physician Manual, p. 24 (Jan. 2021).  (Accessed Feb. 2021).


PROVIDER LIMITATIONS

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

SOURCE: Utah Medicaid Provider Manual: Physician Manual, p. 23 (Jan. 2021).  (Accessed Feb. 2021).


OTHER RESTRICTIONS

No Reference Found

Last updated 02/28/2021

Store and Forward

POLICY

No Reference Found


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 02/28/2021

Definition

“Digital health service means the electronic transfer, exchange, or management of related data for diagnosis, treatment, consultation, educational, public health, or other related purposes.”

SOURCE: UT Code, 26-9f-102. (Accessed Feb. 2021).

“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

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 Feb. 2021).

Last updated 02/28/2021

Parity

SERVICE PARITY

A health benefit plan offered in the individual market, the small group market, or the large group market and entered into or renewed on or after January 1, 2021, shall provide coverage for telemedicine services that are covered by Medicare.

SOURCE: UT Code, 31A-22-649.5 (2(a)) & (HB 313 -2020 Session) (Accessed Feb. 2021).


PAYMENT PARITY

A health benefit plan offered in the individual market, the small group market, or the large group market and entered into or renewed on or after January 1, 2021, shall reimburse, at a commercially reasonable rate, a network provider that provides the telemedicine services covered by Medicare.

SOURCE: UT Code, 31A-22-649.5 (2(b)) & (HB 313 -2020 Session) (Accessed Feb. 2021).

Last updated 02/28/2021

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 Feb. 2021).

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 (see statute for details).

SOURCE: UT Code, 31A-22-649. (Accessed Feb. 2021).

Last updated 02/28/2021

Cross State Licensing

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

  • The physician is licensed in another state, with no licensing action pending and at least 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 Feb. 2021).

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 Feb. 2021).

Last updated 02/28/2021

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 Feb. 2021).

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

SOURCE: UT Code, 58-69-102 (12), (SB 135 – 2020 Session) (Accessed Feb. 2021).

Last updated 02/28/2021

Licensure Compacts

Member of the Interstate Medical Licensure Compact.

SOURCE: Interstate Medical Licensure Compact. (Accessed Feb. 2021).

Member of Psychology Interjurisdictional Compact.

SOURCE: PSYPACT Compact. (Accessed Feb. 2021).

Member of the Nurse Licensure Compact.

SOURCE: Nurse Licensure Compact (Accessed Feb. 2021).

Member of the Physical Therapy Licensure Compact.

SOURCE: PT Compact. Compact Map. (Accessed Feb. 2021).

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

SOURCE: ASPL Compact. Compact Map. (Accessed Feb. 2021).

Member of the Emergency Medical Services Compact.

SOURCE: EMS Compact. (Accessed Feb. 2021).

Last updated 02/28/2021

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 all health professionals who participate in telemedicine.

SOURCE: UT Admin. Code R432-100-33. (Accessed Feb. 2021).

Last updated 02/28/2021

Online Prescribing

Before providing treatment or prescribing a prescription drug, provider must:

  • Obtain and document patient’s relevant clinical history and current symptoms

Except as specifically provided in Title 58, Chapter 83, Online Prescribing, Dispensing, and Facilitation Licensing Act, and 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.

See statute for requirements if the patient has a designated health care provider who is not the telemedicine provider.

SOURCE: UT Code, 26-60-103(1(c) & 3). (Accessed Feb. 2021).

Providers must first obtain 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 Feb. 2021).

Last updated 02/28/2021

Professional Board Standards

No Reference Found