2018 Kentucky Revised Statutes CHAPTER 205 - PUBLIC ASSISTANCE AND MEDICAL ASSISTANCE .5591 Medicaid providers using telehealth -- Duties of cabinet and managed care organizations -- Reimbursement for covered services -- Administrative regulations -- Deductible, copayment, and reinsurance requirements -- Policies and guidelines. (Effective July 1, 2019)
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205.5591 Medicaid providers using telehealth -- Duties of cabinet and managed
care organizations -- Reimbursement for covered services -- Administrative
regulations -- Deductible, copayment, and reinsurance requirements -- Policies
and guidelines. (Effective July 1, 2019)
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The cabinet shall provide oversight, guidance, and direction to Medicaid providers
delivering care using telehealth as defined in KRS 205.510.
The cabinet shall:
(a) Develop policies and procedures to ensure the proper use and security for
telehealth, including but not limited to confidentiality and data integrity,
privacy and security, informed consent, privileging and credentialing,
reimbursement, and technology;
(b) Promote access to health care provided via telehealth;
(c) Maintain a list of Medicaid providers who may deliver telehealth services to
Medicaid recipients throughout the Commonwealth;
(d) Require that specialty care be rendered by a health care provider who is
recognized and actively participating in the Medicaid program; and
(e) 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 coordinate care with the patient's primary care
provider.
The cabinet or a Medicaid managed care organization shall not:
(a) 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;
(b) Require prior authorization, medical review, or administrative clearance for
telehealth that would not be required if a service were provided in person;
(c) 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;
(d) Require demonstration that it is necessary to provide services to a Medicaid
recipient through telehealth;
(e) Restrict or deny coverage of telehealth based solely on the communication
technology or application used to deliver the telehealth services; or
(f) Require a Medicaid provider to be part of a telehealth network.
The Medicaid program or a Medicaid managed care organization shall require a
telehealth provider to be licensed in Kentucky in order to receive reimbursement for
telehealth services.
The Medicaid program or a Medicaid managed care organization shall reimburse
for covered services provided to a Medicaid recipient through telehealth, as defined
in KRS 205.510. The department shall 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
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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.
Benefits for a service provided to a Medicaid recipient through telehealth may be
made subject to a deductible, copayment, or coinsurance requirement. A deductible,
copayment, or coinsurance applicable to a particular service provided through
telehealth shall not exceed the deductible, copayment, or coinsurance required by
the Medicaid program for the same service provided in person.
Nothing in this section shall be construed to require the Medicaid program or a
Medicaid managed care organization to:
(a) Provide coverage for telehealth services that are not medically necessary; or
(b) Reimburse any fees charged by a telehealth facility for transmission of a
telehealth encounter.
The cabinet 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.
Effective: July 1, 2019
History: Created 2018 Ky. Acts ch. 187, sec. 1, effective July 1, 2019.
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