{"data":{"id":"us-ky/krs-304.17a-138","jurisdiction":"us-ky","citation":"KRS 304.17A-138","heading":"Telehealth coverage and reimbursement -- Requirements for health","body":"benefit plan -- Reimbursement for rural health clinics, federally qualified\nhealth centers, and federally qualified health center look -alikes -- Benefits\nsubject to deductible, copayment, or coinsurance -- Payment subject to\nprovider network arrangements -- Audio-only encounters -- Administrative\nregulations.\n(1) As used in this section:\n(a) \"Equivalent\" means reimbursement in an amount equal to what\nreimbursement would have been had the service been furnished in person by\nthat provider at the provider's place of service;\n(b) \"Federally qualified health center\" means the same as in 42 U.S.C. sec. 1396d;\n(c) \"Federally qualified health center look -alike\" means an organiza tion that\nmeets all of the eligibility requirements of a federally qualified health center\nbut does not receive federal grants issued pursuant to 42 U.S.C. sec. 254b;\n(d) \"Originating site\" means the site at which a Medicaid beneficiary is physically\nlocated at the time a telehealth service or telehealth consultation is provided;\n(e) \"Provider\" means the same as in KRS 304.17A -005 and also includes\nbehavioral health professionals licensed under KRS Chapters 309, 319, and\n335;\n(f) \"Telehealth\" has the same meaning as in KRS 211.332; and\n(g) \"Rural health clinic\" means the same as in 42 U.S.C. sec. 1395x.\n(2) (a) A health benefit plan, issued or renewed on or after January 1, 2022, shall\nreimburse for covered services provided to an insured person through\ntelehealth, including telehealth services provided by a home health agency\nlicensed under KRS Chapter 216. Telehealth coverage and reimbursement\nshall, except as provided in paragraph (b) of this subsection, be equivalent to\nthe coverage for the same service p rovided in person unless the telehealth\nprovider and the health benefit plan contractually agree to a lower\nreimbursement rate for telehealth services.\n(b) Rural health clinics, federally qualified health centers, and federally qualified\nhealth center look -alikes shall be reimbursed as an originating site in an\namount equal to that which is permitted under 42 U.S.C. sec. 1395m for\nMedicare-participating providers, if the insured was physically located at the\nrural health clinic, federally qualified health c enter, or federally qualified\nhealth center look-alike at the time of service or consultation delivery and the\nprovider of the telehealth service or telehealth consultation is not employed by\nthe rural health clinic, federally qualified health center, or f ederally qualified\nhealth center look-alike.\n(3) In accordance with KRS 211.336, a health benefit plan, issued or renewed on or\nafter January 1, 2022:\n(a) Shall not:\n1. Require a provider to be physically present with a patient or client,\nunless the provider determines that it is necessary to perform those\nservices in person;\n2. Require prior authorization, medical review, or administrative clearance\nfor telehealth that w ould not be required if a service were provided in\nperson;\n3. Require demonstration that it is necessary to provide services to a\npatient or client through telehealth;\n4. Require a provider to be employed by another provider or agency in\norder to provide t elehealth services that would not be required if that\nservice were provided in person;\n5. Restrict or deny coverage of telehealth based solely on the\ncommunication technology or application used to deliver the telehealth\nservices; or\n6. Require a provider to be part of a telehealth network;\n(b) Shall:\n1. Require that telehealth services reimbursed under this section meet all\nclinical, technology, and medical coding guidelines for recipient safety\nand appropriate delivery of services established by the Depar tment of\nInsurance or the provider's professional licensure board;\n2. Require a telehealth provider to be licensed in Kentucky, or as allowed\nunder the standards and provisions of a recognized interstate compact, in\norder to receive reimbursement for telehealth services; and\n3. Reimburse a rural health clinic, federally qualified health clinic, or\nfederally qualified health center look -alike for covered telehealth\nservices provided by a provider employed by the rural health clinic,\nfederally qualified health clinic, or federally qualified health center look-\nalike, regardless of whether the provider was physically located on the\npremises of the rural health clinic, federally qualified health clinic, or\nfederally qualified health clinic look -alike when the tel ehealth service\nwas provided; and\n(c) May utilize audits for medical coding accuracy in the review of telehealth\nservices specific to audio-only encounters.\n(4) Benefits for a service provided through telehealth required by this section may be\nmade subject to a deductible, copayment, or coinsurance requirement. A deductible,\ncopayment, or coinsurance applicable to a particular service provided through\ntelehealth shall not exceed the deductible, copayment, or coinsurance required by\nthe health benefit plan for the same service provided in person.\n(5) Nothing in this section shall be construed to require a health benefit plan to:\n(a) Provide coverage for telehealth services that are not medically necessary; or\n(b) Reimburse any fees charged by a telehealth fac ility for transmission of a\ntelehealth encounter.\n(6) Providers and home health agencies are strongly encouraged to use audio -only\nencounters as a mode of delivering telehealth services when no other approved\nmode of delivering telehealth services is available.\n(7) The department shall promulgate an administrative regulation in accordance with\nKRS Chapter 13A to designate the claim forms and records required to be\nmaintained in conjunction with this section.","path":[],"source_url":"https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=52666","current_through":"Includes enactments through the 2026 Regular Session","vintage":"09/05/2026","retrieved_at":"2026-09-05T20:57:46Z","sha256":"e46d19a155c8875674473c80b706224a273d582384e0540cfa0ec62405bbf1cf","source_id":"us-ky","stale":false,"prev":"us-ky/krs-304.17a-137","next":"us-ky/krs-304.17a-139"},"notice":"GroundRules: Original legal text. Not legal advice."}