KRS § 205.5591 — KY Code / Title XVII / Chapter 205 / Section 205.5591
205.5591 Medicaid providers using telehealth -- Duties of cabinet, Department for Medicaid Services, and managed care organizations -- Administrative regulations -- Policies and guidelines
Status: in_force

205.5591 Medicaid providers using telehealth -- Duties of cabinet, Department for

Medicaid Services, and managed care organizations -- Administrative

regulations -- Policies and guidelines.

(1) For purposes of this section, "equivalent" has the same meaning as in KRS

304.17A-138.

(2) The cabinet shall provide oversight, guidance, and direction to Medicaid providers

delivering care using telehealth.

(3) The Department for Medicaid Services shall:

(a) Within thirty (30) days after June 29, 2021:

1. Promulgate administrative regulations in accordance with KRS Chapter

13A to establish requirements for telehealth coverage and

reimbursement rates, which shall be equivalent to coverage requirements

and reimbursement rates for the same service provided in person unless

the telehealth provider and the department or a managed care

organization contractually agree to a lower reimbursement rate for

telehealth services; and

2. Create, establish, or designate the claim forms, records required, and

authorization procedures to be followed in conjunction with this section

and KRS 205.559;

(b) Require that specialty care be rendered by a health care provider who is

recognized and actively participating in the Medicaid program;

(c) 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; and

(d) Require a telehealth provider to be licensed in Kentucky, or as allowed under

the standards and provisions of a recognized interstate compact, in order to

receive reimbursement for telehealth services.

(4) In accordance with KRS 211.336, the Department for Medicaid Services and any

managed care organization with whom the department contracts for the delivery of

Medicaid services 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.

(5) 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.

(6) The cabinet, in implementing KRS 211.334 and 211.336, 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.

(7) In order to comply with the deadline for the promulgation of administrative

regulations established in subsection (3) of this section, the Department for

Medicaid Services may promulgate emergency administrative regulations in

accordance with KRS 13A.190.