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304.17A-138 Telehealth coverage and reimbursement -- Requirements for health
benefit plan -- Benefits subject to deductible, copayement, or coinsurance -Payment subject to provider network arrangements -- Administrative
regulations. (Effective July 1, 2019)
(1)
(2)
(3)
(4)
(5)
(6)
(a)
A health benefit plan shall reimburse for covered services provided to an
insured person through telehealth as defined in KRS 304.17A-005. Telehealth
coverage and reimbursement shall be equivalent to the coverage for the same
service provided in person unless the telehealth provider and the health benefit
plan contractually agree to a lower reimbursement rate for telehealth services.
(b) A health benefit plan shall not:
1.
Require a provider to be physically present with a patient or client,
unless the provider determines that it is necessary to perform those
services in person;
2.
Require prior authorization, medical review, or administrative clearance
for telehealth that would not be required if a service were provided in
person;
3.
Require demonstration that it is necessary to provide services to a
patient or client through telehealth;
4.
Require a 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;
5.
Restrict or deny coverage of telehealth based solely on the
communication technology or application used to deliver the telehealth
services; or
6.
Require a provider to be part of a telehealth network.
A health benefit plan shall require a telehealth provider to be licensed in Kentucky
in order to receive reimbursement for telehealth services.
Benefits for a service provided through telehealth required by this section 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 health benefit plan for the same service provided in person.
Nothing in this section shall be construed to require a health benefit plan 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.
Payment made under this section may be consistent with any provider network
arrangements that have been established for the health benefit plan.
The department shall promulgate an administrative regulation in accordance with
KRS Chapter 13A to designate the claim forms and records required to be
maintained in conjunction with this section.
Effective: July 1, 2019
History: Amended 2018 Ky. Acts ch. 187, sec. 5, effective July 1, 2019. -- Amended
2010 Ky. Acts ch. 24, sec. 1215, effective July 15, 2010. -- Amended 2007 Ky. Acts
ch. 24, sec. 28, effective June 26, 2007. -- Created 2000 Ky. Acts ch. 376, sec. 7,
effective July 15, 2001.
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