KRS 304.17A-138: Telehealth coverage and reimbursement -- Requirements for health

benefit plan -- Reimbursement for rural health clinics, federally qualified

health centers, and federally qualified health center look -alikes -- Benefits

subject to deductible, copayment, or coinsurance -- Payment subject to

provider network arrangements -- Audio-only encounters -- Administrative

regulations.

(1) As used in this section:

(a) "Equivalent" means reimbursement in an amount equal to what

reimbursement would have been had the service been furnished in person by

that provider at the provider's place of service;

(b) "Federally qualified health center" means the same as in 42 U.S.C. sec. 1396d;

(c) "Federally qualified health center look -alike" means an organiza tion that

meets all of the eligibility requirements of a federally qualified health center

but does not receive federal grants issued pursuant to 42 U.S.C. sec. 254b;

(d) "Originating site" means the site at which a Medicaid beneficiary is physically

located at the time a telehealth service or telehealth consultation is provided;

(e) "Provider" means the same as in KRS 304.17A -005 and also includes

behavioral health professionals licensed under KRS Chapters 309, 319, and

335;

(f) "Telehealth" has the same meaning as in KRS 211.332; and

(g) "Rural health clinic" means the same as in 42 U.S.C. sec. 1395x.

(2) (a) A health benefit plan, issued or renewed on or after January 1, 2022, shall

reimburse for covered services provided to an insured person through

telehealth, including telehealth services provided by a home health agency

licensed under KRS Chapter 216. Telehealth coverage and reimbursement

shall, except as provided in paragraph (b) of this subsection, be equivalent to

the coverage for the same service p rovided in person unless the telehealth

provider and the health benefit plan contractually agree to a lower

reimbursement rate for telehealth services.

(b) Rural health clinics, federally qualified health centers, and federally qualified

health center look -alikes shall be reimbursed as an originating site in an

amount equal to that which is permitted under 42 U.S.C. sec. 1395m for

Medicare-participating providers, if the insured was physically located at the

rural health clinic, federally qualified health c enter, or federally qualified

health center look-alike at the time of service or consultation delivery and the

provider of the telehealth service or telehealth consultation is not employed by

the rural health clinic, federally qualified health center, or f ederally qualified

health center look-alike.

(3) In accordance with KRS 211.336, a health benefit plan, issued or renewed on or

after January 1, 2022:

(a) 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 w ould 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 t elehealth 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;

(b) Shall:

1. Require that telehealth services reimbursed under this section meet all

clinical, technology, and medical coding guidelines for recipient safety

and appropriate delivery of services established by the Depar tment of

Insurance or the provider's professional licensure board;

2. 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; and

3. Reimburse a rural health clinic, federally qualified health clinic, or

federally qualified health center look -alike for covered telehealth

services provided by a provider employed by the rural health clinic,

federally qualified health clinic, or federally qualified health center look-

alike, regardless of whether the provider was physically located on the

premises of the rural health clinic, federally qualified health clinic, or

federally qualified health clinic look -alike when the tel ehealth service

was provided; and

(c) May utilize audits for medical coding accuracy in the review of telehealth

services specific to audio-only encounters.

(4) 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.

(5) 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 fac ility for transmission of a

telehealth encounter.

(6) Providers and home health agencies are strongly encouraged to use audio -only

encounters as a mode of delivering telehealth services when no other approved

mode of delivering telehealth services is available.

(7) 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.