205.559 Requirements for Medicaid reimbursement to participating providers for
867 words·~4 min read·
/ky/205-559A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
telehealth consultations -- Reimbursement for rural health clinics, federally
qualified health centers, and federally qualified health center look-alikes --
Location in state not required if provider offers services exclusively by
telehealth -- Audio-only encounters.
(1)The Cabinet for Health and Family Services and any managed care organization
with whom the Department for Medicaid Services contracts for the delivery of
Medicaid services shall provide Medicaid reimbursement for covered telehealth
services and telehealth consultations, if the telehealth service or telehealth
consultation:
(a)Is provided by a Medicaid-participating practitioner, including those
employed by a home health agency licensed pursuant to KRS Chapter 216, to
a Medicaid recipient or another Medicaid-participating practitioner at a
different physical location; and
(b)Meets all clinical, technology, and medical coding guidelines for recipient
safety and appropriate delivery of services established by the Department for
Medicaid Services or the provider's professional licensure board.
(a)For rural health clinics, federally qualified health centers, and federally
qualified health center look-alikes, reimbursement for covered telehealth
services and telehealth consultations shall:
1. To the extent permitted under federal law, include an originating site fee
in an amount equal to that which is permitted under 42 U.S.C. sec.
1395m for Medicare-participating providers if the Medicaid beneficiary
who received the telehealth service or telehealth consultation was
physically located at the rural health clinic, federally qualified health
center, 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 federally qualified health center
look-alike; or
2. If the telehealth service or telehealth consultation provider is employed
by the rural health clinic, federally qualified health center, or federally
qualified health center look-alike, include a supplemental
reimbursement paid by the Department for Medicaid Services in an
amount equal to the difference between the actual reimbursement
amount paid by a Medicaid managed care organization and the amount
that would have been paid if reimbursement had been made directly by
the department.
(b)A request for reimbursement shall not be denied solely because:
1. An in-person consultation between a Medicaid-participating practitioner
and a patient did not occur; or
2. A Medicaid-participating provider employed by a rural health clinic,
federally qualified health center, or federally qualified health center
look-alike was not physically located on the premises of the clinic or
health center when the telehealth service or telehealth consultation was
provided.
(c)Telehealth services and telehealth consultations shall not be reimbursable
under this section if they are provided through the use of a facsimile machine,
text, chat, or electronic mail unless the Department for Medicaid Services
determines that telehealth can be provided via these modalities in ways that
enhance recipient health and well-being and meet all clinical and technology
guidelines for recipient safety and appropriate delivery of services.
(a)A health-care facility that receives reimbursement under this section for
consultations provided by a Medicaid-participating provider who practices in
that facility and a health professional who obtains a consultation under this
section shall establish quality-of-care protocols, which may include a
requirement for an annual in-person or face-to-face consultation with a patient
who receives telehealth services, and patient confidentiality guidelines to
ensure that telehealth consultations meet all requirements and patient care
standards as required by law.
(b)The Department for Medicaid Services and any managed care organization
with whom the department contracts for the delivery of Medicaid services
shall not deny reimbursement for telehealth services covered by this section
based solely on quality-of-care protocols adopted by a health-care facility
pursuant to paragraph
(a)of this subsection.
(4)The cabinet shall not require a telehealth consultation if an in-person consultation
with a Medicaid-participating provider is reasonably available where the patient
resides, works, or attends school or if the patient prefers an in-person consultation.
(5)Notwithstanding any provision of law to the contrary, neither the Department for
Medicaid Services nor a Medicaid managed care organization with whom the
department has contracted for the delivery of Medicaid services shall require that a
health professional, as defined in KRS 205.510, or medical group maintain a
physical location or address in this state to be eligible for enrollment as a Medicaid
provider if the provider or group exclusively offers services via telehealth as
defined in KRS 211.332.
(6)The cabinet shall request any waivers of federal laws or regulations that may be
necessary to implement this section and KRS 205.5591.
(7)Medicaid-participating practitioners and home health agencies are strongly
encouraged to use audio-only encounters as a mode of delivering telehealth services
only when no other approved mode of delivering telehealth services is available.
(8)As used in this section:
(a)"Federally qualified health center" means the same as in 42 U.S.C. sec.
1396d;
(b)"Federally qualified health center look-alike" means an organization 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;
(c)"Originating site" means the site at which a Medicaid beneficiary is physically
located at the time a telehealth service or telehealth consultation is provided;
and
(d)"Rural health clinic" means the same as in 42 U.S.C. sec. 1395x.