{"data":{"id":"us-ky/krs-205.559","jurisdiction":"us-ky","citation":"KRS 205.559","heading":"Requirements for Medicaid reimbursement to participating providers for","body":"telehealth consultations -- Reimbursement for rural health clinics, federally\nqualified health centers, and federally qualified health center look -alikes --\nLocation in state not required if provider offers services exclusively by\ntelehealth -- Audio-only encounters.\n(1) The Cabinet for Health and Family Services and any managed care organization\nwith whom the Department for Medicaid Services contracts for the delivery of\nMedicaid services shall provide Medicaid reimbursement for covered telehealth\nservices and telehealth consultations, if the telehealth service or telehealth\nconsultation:\n(a) Is provided by a Medicaid -participating practitioner, including those\nemployed by a home health agency licensed pursuant to KRS Chapter 216, to\na Medicaid recipient or another Medicaid -participating practitioner at a\ndifferent physical location; and\n(b) Meets all clinical, technology, and medical coding guidelines for recipient\nsafety and appropriate delivery of services established by the Department for\nMedicaid Services or the provider's professional licensure board.\n(2) (a) For rural health clinics, federally qualified health centers, and federally\nqualified health center look -alikes, reimbursement for covered telehealth\nservices and telehealth consultations shall:\n1. To the extent permitted under federal law, include an originating site fee\nin an amount equal to that which is permitted under 42 U.S.C. sec.\n1395m for Medicare-participating providers if the Medicaid beneficiary\nwho received the telehealth service or telehealth consultation was\nphysically located at the rural health clinic, federally qualified health\ncenter, or federally qualified health center look -alike at the time of\nservice or consultation delivery and the provider of the telehealth service\nor telehealth consultation is not employed by the rural health clinic,\nfederally qualified health center, or federally qualified health center\nlook-alike; or\n2. If the telehealth se rvice or telehealth consultation provider is employed\nby the rural health clinic, federally qualified health center, or federally\nqualified health center look -alike, include a supplemental\nreimbursement paid by the Department for Medicaid Services in an\namount equal to the difference between the actual reimbursement\namount paid by a Medicaid managed care organization and the amount\nthat would have been paid if reimbursement had been made directly by\nthe department.\n(b) A request for reimbursement shall not be denied solely because:\n1. An in-person consultation between a Medicaid -participating practitioner\nand a patient did not occur; or\n2. A Medicaid -participating provider employed by a rural health clinic,\nfederally qualified health center, or federally qualified health center\nlook-alike was not physically located on the premises of the clinic or\nhealth center when the telehealth service or  telehealth consultation was\nprovided.\n(c) Telehealth services and telehealth consultations shall not be reimbursable\nunder this section if they are provided through the use of a facsimile machine,\ntext, chat, or electronic mail unless the Department for M edicaid Services\ndetermines that telehealth can be provided via these modalities in ways that\nenhance recipient health and well -being and meet all clinical and technology\nguidelines for recipient safety and appropriate delivery of services.\n(3) (a) A healt h-care facility that receives reimbursement under this section for\nconsultations provided by a Medicaid -participating provider who practices in\nthat facility and a health professional who obtains a consultation under this\nsection shall establish quality -of-care protocols, which may include a\nrequirement for an annual in-person or face-to-face consultation with a patient\nwho receives telehealth services, and patient confidentiality guidelines to\nensure that telehealth consultations meet all requirements and patient care\nstandards as required by law.\n(b) The Department for Medicaid Services and any managed care organization\nwith whom the department contracts for the delivery of Medicaid services\nshall not deny reimbursement for telehealth services covered by t his section\nbased solely on quality -of-care protocols adopted by a health -care facility\npursuant to paragraph (a) of this subsection.\n(4) The cabinet shall not require a telehealth consultation if an in -person consultation\nwith a Medicaid -participating pro vider is reasonably available where the patient\nresides, works, or attends school or if the patient prefers an in-person consultation.\n(5) Notwithstanding any provision of law to the contrary, neither the Department for\nMedicaid Services nor a Medicaid man aged care organization with whom the\ndepartment has contracted for the delivery of Medicaid services shall require that a\nhealth professional, as defined in KRS 205.510, or medical group maintain a\nphysical location or address in this state to be eligible for enrollment as a Medicaid\nprovider if the provider or group exclusively offers services via telehealth as\ndefined in KRS 211.332.\n(6) The cabinet shall request any waivers of federal laws or regulations that may be\nnecessary to implement this section and KRS 205.5591.\n(7) Medicaid-participating practitioners and home health agencies are strongly\nencouraged to use audio-only encounters as a mode of delivering telehealth services\nonly when no other approved mode of delivering telehealth services is available.\n(8) As used in this section:\n(a) \"Federally qualified health center\" means the same as in 42 U.S.C. sec.\n1396d;\n(b) \"Federally qualified health center look -alike\" means an organization that\nmeets all of the eligibility requirements of a federally quali fied health center\nbut does not receive federal grants issued pursuant to 42 U.S.C. sec. 254b;\n(c) \"Originating site\" means the site at which a Medicaid beneficiary is physically\nlocated at the time a telehealth service or telehealth consultation is provid ed;\nand\n(d) \"Rural health clinic\" means the same as in 42 U.S.C. sec. 1395x.","path":["KRS Chapter 205"],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=54178","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:52:03Z","sha256":"c69b42fceb43c4d3ee42daf47bc77a01e9af544b5d064dd514d70031d0f37c81","source_id":"us-ky","stale":false,"prev":"us-ky/krs-205.558","next":"us-ky/krs-205.5591"},"notice":"GroundRules: Original legal text. Not legal advice."}