Kentucky Administrative Regulations › Title 907 - CABINET FOR HEALTH AND FAMILY SERVICES - DEPARTMENT FOR MEDICAID SERVICES › Chapter 3 - Payment and Services › Section 907 KAR 3:170 - Telehealth service coverage and reimbursement

Current through Register Vol. 51, No. 1, July 1, 2024
RELATES TO:
				KRS
				194A.060,
				205.510(16),
				(17),
				205.559,
				205.5591,
				205.560,
				304.38-240,
				422.317, 434.840-434.860,
				42 C.F.R.
				400.203,
				415.174,
				415.184,
				431.300-431.307,
				440.50,
				Part 455, 45 C.F.R. 164.530,
				42 U.S.C.
				1395m
NECESSITY, FUNCTION, AND CONFORMITY: In accordance with
				KRS
				194A.030(2), the Cabinet for
				Health and Family Services, Department for Medicaid Services, has
				responsibility to administer the Medicaid Program.
				KRS
				205.520(3) authorizes the
				cabinet, by administrative regulation, to comply with any requirement that may
				be imposed or opportunity presented by federal law to qualify for federal
				Medicaid funds. KRS
				205.559 establishes the requirements
				regarding Medicaid reimbursement of telehealth providers, and
				KRS
				205.5591 requires the cabinet to promulgate
				an administrative regulation relating to telehealth services and reimbursement.
				This administrative regulation establishes the Department for Medicaid
				Services' coverage and reimbursement policies relating to telehealth services
				in accordance with KRS 205.559 and
				205.5591.
Section 1. Definitions.
(1) "Asynchronous telehealth" means a store
			 and forward telehealth service that is electronically mediated.
(2) "Department" means the Department for
			 Medicaid Services or its designated agent.
(3) "Federal financial participation" is
			 defined by
			 42 C.F.R.
			 400.203.
(4) "In-person" means a healthcare encounter
			 occurring:
(a) Via direct contact and
			 interaction between the individual and healthcare provider;
(b) At the same location; and
(c) Not via telehealth.
(5) "Medical necessity" or "medically
			 necessary" means a covered benefit is determined to be needed in accordance
			 with
			 907
			 KAR 3:130 or pursuant to the process established by
			 KRS
			 304.38-240.
(6) "Place of service" means anywhere the
			 patient is located at the time a telehealth service is provided, and includes
			 telehealth services provided to a patient located at the patient's home or
			 office, or a clinic, school, or workplace.
(7) "Remote patient monitoring" means a
			 digital technology that collects medical and health data from an individual in
			 one (1) location and electronically and securely transmits that data to a
			 telehealth care provider in a different location.
(8) "Synchronous telehealth" means a
			 telehealth service that simulates an in-person encounter via real-time
			 interactive audio and video technology between a telehealth care provider and a
			 Medicaid recipient.
(9)
			 "Telehealth" is defined by
			 KRS
			 205.510(16).
(10) "Telehealth care provider" means a
			 Medicaid provider who is:
(a)
1. Currently enrolled as a Medicaid provider
			 in accordance with
			 907
			 KAR 1:672;
2. Currently participating as a Medicaid
			 provider in accordance with
			 907
			 KAR 1:671;
3. Operating within the scope of the
			 provider's professional licensure; and
4. Operating within the provider's scope of
			 practice; or
(b) A
			 community mental health center (CMHC) that is participating in the Medicaid
			 Program in compliance with
			 907
			 KAR 1:044,
			 907
			 KAR 1:045, or
			 907
			 KAR 1:047.
(11) "Telehealth service" means any service
			 that is provided by telehealth and is one (1) of the following:
(a) Event;
(b) Encounter;
(c) Consultation, including a telehealth
			 consultation as defined by
			 KRS
			 205.510(17);
(d) Visit;
(e) Store and forward transfer, as limited by
			 Section 6 of this administrative regulation;
(f) Remote patient monitoring;
(g) Referral; or
(h) Treatment.