205.5591 Medicaid providers using telehealth -- Duties of cabinet, Department for
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/ky/205-5591A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Medicaid Services, and managed care organizations -- Administrative
regulations -- Policies and guidelines.
(1)For purposes of this section, "equivalent" has the same meaning as in KRS
304.17A-138.
(2)The cabinet shall provide oversight, guidance, and direction to Medicaid providers
delivering care using telehealth.
(3)The Department for Medicaid Services shall:
(a)Within thirty
(30)days after June 29, 2021:
1. Promulgate administrative regulations in accordance with KRS Chapter
13A to establish requirements for telehealth coverage and
reimbursement rates, which shall be equivalent to coverage requirements
and reimbursement rates for the same service provided in person unless
the telehealth provider and the department or a managed care
organization contractually agree to a lower reimbursement rate for
telehealth services; and
2. Create, establish, or designate the claim forms, records required, and
authorization procedures to be followed in conjunction with this section
and KRS 205.559;
(b)Require that specialty care be rendered by a health care provider who is
recognized and actively participating in the Medicaid program;
(c)Require that any required prior authorization requesting a referral or
consultation for specialty care be processed by the patient's primary care
provider and that any specialist coordinate care with the patient's primary care
provider; and
(d)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.
(4)In accordance with KRS 211.336, the Department for Medicaid Services and any
managed care organization with whom the department contracts for the delivery of
Medicaid services shall not:
(a)Require a Medicaid provider to be physically present with a Medicaid
recipient, unless the provider determines that it is medically necessary to
perform those services in person;
(b)Require prior authorization, medical review, or administrative clearance for
telehealth that would not be required if a service were provided in person;
(c)Require a Medicaid provider to be employed by another provider or agency in
order to provide telehealth services that would not be required if that service
were provided in person;
(d)Require demonstration that it is necessary to provide services to a Medicaid
recipient through telehealth;
(e)Restrict or deny coverage of telehealth based solely on the communication
technology or application used to deliver the telehealth services; or
(f)Require a Medicaid provider to be part of a telehealth network.
(5)Nothing in this section shall be construed to require the Medicaid program or a
Medicaid managed care organization to:
(a)Provide coverage for telehealth services that are not medically necessary; or
(b)Reimburse any fees charged by a telehealth facility for transmission of a
telehealth encounter.
(6)The cabinet, in implementing KRS 211.334 and 211.336, shall maintain telehealth
policies and guidelines to providing care that ensure that Medicaid-eligible citizens
will have safe, adequate, and efficient medical care, and that prevent waste, fraud,
and abuse of the Medicaid program.
(7)In order to comply with the deadline for the promulgation of administrative
regulations established in subsection
(3)of this section, the Department for
Medicaid Services may promulgate emergency administrative regulations in
accordance with KRS 13A.190.