205.632 Pilot project to create coverage provisions and reimbursement criteria for

287 words·~1 min read·/ky/205-632

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

telemonitoring services based on evidence-based best practices provided by a

qualified medical provider or community action agency.

(1)As used in this section:

(a)"Department" means the Department for Medicaid Services;

(b)"Evidence-based best practices" means the integration of the best available

research with clinical expertise in the context of patient characteristics and

patient and family caregiver preferences;

(c)"Qualified medical provider" means a credentialed and enrolled Medicaid-

participating healthcare provider, hospital, rural health center, or licensed

home health agency as defined in KRS 216.935; and

(d)"Telemonitoring services" means services that require scheduled remote

monitoring of data related to a patient's health where the monitoring is

conducted at the patient's place of residence or other site determined by the

department.

(2)Not later than July 1, 2017, the department shall establish a pilot project in which it

creates coverage provisions and reimbursement criteria for telemonitoring services

based on evidence-based best practices provided by a qualified medical provider or

a community action agency as defined in KRS 273.410.

(3)In order to effectuate the pilot project, the department may:

(a)Submit a state plan amendment, waiver, or waiver amendment for approval to

the Centers for Medicare and Medicaid Services in order to provide coverage

for medically necessary telemonitoring services performed for a Medicaid

beneficiary;

(b)Request funding from the General Assembly to support telemonitoring

services rendered by a qualified medical provider or a community action

agency under this section;

(c)Ensure that clinical information gathered by a qualified medical provider or a

community action agency while providing telemonitoring services is shared

with the patient's treating health care professionals; and

(d)Promulgate administrative regulations in accordance with KRS Chapter 13A

for the implementation and administration of this section.