Utah State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

Utah Medicaid

Utah

Medicaid Program: Utah Medicaid

Medicaid Program Administrator: Utah Dept. of Health

Regional Telehealth Resource Center:
Northwest Regional Telehealth Resource Center 2900 1ih Ave. N., Ste. 30W
Billings, MT 59101
(888) 662-5601
www.nrtrc.org

STATE LAW/REGULATIONS
MEDICAlO PROGRAM
Definition of telemedicine/telehealth
“Digital health service means the electronic transfer, exchange, or management of related data for diagnosis, treatment, consultation, educational, public health, or other related purposes.”

Source: UT Code Annotated Sec. 26-9f-102.

Recently Passed Legislation (Effective May 91 2017)
“Telehealth services” means the transmission of health­ related services or information through the use of electronic communication or information technology.

“Telemedicine services” means telehealth services including:
⦁ Clinical care;
⦁ Health education;
⦁ Health administration;
⦁ Home health; or
⦁ Facilitation of self-managed care and caregiver support; and.. .

Must be provided by a provider to a patient through a method of communication that:
⦁ Uses asynchronous store and forward transfer; or
⦁ Uses synchronous interaction; and…

Meets industry security and privacy standards, including compliance with:
⦁ The federal Health Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191, 110 Stat. 1936, as amended; and
⦁ The federal Health Information Technology for Economic and Clinical Health Act, Pub. L. No. 111-5, 123 Stat. 226, 467, as amended.

Source: Utah Code, Sec. 26-59-102 (HB 154- 2017). Telehealth or Telemedicine is a technological method of providing auditory and visual connection between the skilled home health care nurse at a Telehealth site and the patient living in a rural Utah area.

Source: Utah Medicaid Provider Manual: Home Health Agencies, p.
18 (Jan. 2016-). (Accessed Mar . 2017).

Telemedicine “is two-way, real-time interactive communication between the member and the physician or authorized provider at the distant site. This electronic communication uses interactive telecommunications equipment that includes, at a minimum, audio and video equipment.”

Source: Utah Medicaid Provider Manual: Section I: General Information, p. 47 (Jan. 2017). (Accessed Mar. 2017).

Live Video Reimbur se m en t
Pro vide rs are e ligi b le fo r rei mbursement under Utah’s Medical Assistance Program.

Source: UT Code Annoteted Sec. 26-18-13.

Recently Passed Legislation (Effective May 91 2017) All health insurance plans must disclose whether the insurer provides coverage for telehealth services in accordance with section 26-18-13.5 and terms associated with that coverage.

Source: UTCode31A-22-613.5 (HB 154 – 2017). Utah Medicaid covers medically necessary services delivered via telemedicine delivered by an authorized provider.

Services include but are not limited to:
⦁ Consultation services
⦁ Evaluation and management services
⦁ Mental health services
⦁ Substance use disorder services

Limitations:
⦁ Must be HIPAA compliant
⦁ Must comply with Utah Health Information Network Standards for Telehealth

The provider at the originating site receives no additional reimbursement for the use of telemedicine.

Source: Utah Medicaid Provider Manual: Section I: General Information, p. 47 (Jan. 2017). (Accessed Mar. 2017).

Recently Passed Legislation (Effective May 91 2017) The Medicaid program is required to reimburse for personal mental health therapy office visits provided
through telemedicine services at a rate set by the Medicaid program (includes managed care plans). Also see Misc. section.

Source: UT Code 26-18-13.5 (HB 154- 2017).
Store and Forward Reimbursement
No reference found. Utah Medicaid defines telemedicine as “two-way, real time interactive communication” excluding store and forward from the definition.

Home Health:
Asynchronous transmission of telehealth data such as radiology or electrocardiogram is not a covered service for the Medicaid Telehealth home health care project.

Source: Utah Medicaid Provider Manual: Home Health Agencies, p. 20 (Jan. 2016). (Accessed Mar. 2017).
Remote Patient Monitoring Reimbursement
(see Medicaid column) Skilled Nurse Pilot Project for Patients in Rur al Are as
There is reimb ursement in the UT Medicaid Telehealth Skilled Nurse Pilot Project for Patients in Rural Areas. Beneficiaries diagnosed with diabetes are eligible for participation. Utilization management preauthorization required.

Patient eligibility requirements:

⦁ Patients diagnosed with diabetes and meets criteria (see below)

STATE LAW/REGULATIONS MEDICAID PROGRAM
⦁ Live in a rural area
⦁ Requires two or more home care nursing visits per week
⦁ Agrees to participate in Telehealth home care services

Participation Criteria:

⦁ Must be physically able to use equipment
⦁ Ability to follow directions, push two colored buttons
⦁ Hear and see
⦁ Apply the blood pressure cuff or stethoscope appropriately
⦁ Want to participate in the telehealth project
⦁ If patient is unable to use equipment, may still be included in pilot if they have a full time care
giver.
⦁ Skilled nurse must determine if beneficiary care needs and quality of care delivery will be met
through telehealth.

The following services are covered for Telehealth home care patients:
⦁ Monitoring for compliance in taking medications, foot condition/assessment of wounds or
inflamed areas, blood glucose monitoring
⦁ Education which may include a review in knowledge of the disease process, diet or
nutritional counseling
⦁ Exercise and activity, diet /activity adjustment in illness/stress, medication, and glucometer use
evaluation
⦁ RN visits are covered for Telehealth home care reimbursement.

Home health care has a four-hour limit for all education purposes, which may include some diabetes training.

Source: Utah Medicaid Provider Manual: Home Health Agencies, p. 18-20 (Jan. 2016). (Accessed Mar. 2017).

Home telemetry for outpatient long-term cardiac monitoring is allowed with prior authorization. Criteria include:
⦁ Must be ordered by a BC/BE neurologist
⦁ Client must have had a stroke or TIA with no identifiable cause
⦁ Client should have already had 24 hour monitoring done previously
⦁ Client should not be currently taking anti- coagulated or Warfarin for any other reason

STATE LAW/REGULATIONS MEDICAID PROGRAM
⦁ Client should not have a known contraindication for Warfarin
⦁ Outpatient long-term cardiac monitoring may only be authorized for the 30 day test
⦁ Data from the test must be reviewed and interpreted by a BC/BE cardiologist

Source: Utah Medicaid Provider Manual: Physician Manual, p. 65 (Jul. 2016). (Accessed Mar. 2017).

Patients must need more than two home health agency visits per week. Telehealth home health services are limited to diabetic monitoring and education.
The agency must provide at least two in-person visits per week by a home health nurse, and may use telehealth home health services only as a supplement to the in-person visits.

Source: UT Admin. Code R414–42-3. (Access ed Mar. 2017).
Email/Phone/FAX
No reference found. No reference found.
Online Prescribing
Recently Passed Legislation (Effective May 91 2017) Before providing treatment or prescribing a prescription drug, provider must:
⦁ Obtain and document patient’s relevant clinical history and current symptoms;
⦁ Be available to a patient who receives telehealth services for subsequent care related to the initial telemedicine services, in accordance with community standards of practice;
⦁ Be familiar with available medical resources, including emergency resources near the originating site, in order to make appropriate patient referrals when medically indicated; and
⦁ Make available to each patient receiving telehealth services the patient’s medical records.

Source: Utah Code, Sec. 26-59-103 (HB 154- 2017).

Providers mustfirstobtaininformtaionintheusual courseofprofesional practicethat is sufficietnto establish adiagnosis, to ideniftyconditions, andto ideniftypotentialrisks tothe proposed treatment.

Internet-based questionnaires or interactions on toll-free telephone numbers, when there exists no other bona fide patient-practitioner relationship or bona fide referral by a practitioner involved in an existing patient­ practitioner relationship, are prohibited.

Source: UT Code Annotated Sec. 58-1-501. No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Consent
No reference found. No reference found.
Location
No reference found.
C r oss -St ate Li censing IN o refere n ce fo u nd.

An out-of-state physician may practice without a Utah license if:

⦁ The physician is licensed in another state, with no licensing action pending and at least 10
years of professional experience;
⦁ The services are rendered as a public service and for a noncommercial purpose;
⦁ No fee or other consideration of value is charged, expected or contemplated, beyond an
amount necessary to cover the proportionate cost of malpractice insurance;
⦁ The physician does not otherwise engage in unlawful or unprofessional conduct.

Source: UT Code Annotated Sec. 58-67-305.

A mental health therapist licensed in another state can provide short term transitional mental health therapy or transitional substance use disorder counseling remotely if:
⦁ The mental health therapist is present in the state where he/she is licensed;
⦁ The client relocates to Utah, and was a client immediately before the relocation;
⦁ The therapy or counseling is provided for a maximum of 45 days after the client relocates;
⦁ Within 10 days of the client’s relocation, the mental health therapist provides a written notice
to the Division of Occupational and Professional Licensing of their intent to provide therapy/counseling remotely; and
⦁ The mental health therapist does not engage in
unlawful or unprofessional conduct.

Source: Laws of UT. 68-61-307

Utah adopted the Federation of State Medical Board (FSMB)’s model language for an interstate medical licensure compact.

Source: UT House Bi/I121 (2015). MN Statute Sec 58-67b-101-125.

Utah adopted the Psychology lnterjurisdictional Compact. No reference found.

STATE LAW/REGULATIONS MEDICAID PROGRAM
Source : UT 58-61b-101 (SB 106- 2017.)
Prviate Payers
No reference found. No reference found.
Site/Transmission Fee
No reference found. The provider at the originating site receives no additional reimbursement for the use of telemedicine.

Source: Utah Medicaid Provider Manual: Section I: General Information, p. 47 (Jan. 2017). (Accessed Mar. 2017).

Home Health Services:
No payment made for transmission expense or facility charge.

Source: Utah Medicaid Provider Manual: Home Health Agencies, p. 20 (Jan. 2016). (Accessed Mar. 2017).
Miscellaneous
If a hospital participates in telemedicine, it shall develop and implement policies governing the practice of telemedicine in accordance with the scope and practice of the hospital.

These policies shall address security, access and retention of telemetric data, and define the privileging of all health professionals who participate in telemedicine.

Source: UT Code R432-100-33.

A Health Reform Task Force (comprised of House and Senate members) shall review and make recommendations on telehealth services.

Source: UT Code Annotated Sec. 49.1(b) HB 0036.

Recent!)! Passed Legislation (Effective Ma)! 91 2017} UT Department of Health is required to issue a RFP for telehealth grant proposals to develop and implement a
telehealth pilot project in the state.

Source: UT Code, Sec. 26-59-101 (HB 345- 2017). Recent!)!Passed Legislation
Before Dec. 1, 2017, the Medicaid program must issue a report on the results of reimbursement of telemedicine personal mental health therapy office visits, among other components.

Source: UT Code 26-18-13.5 & 26-59-105 (HB 154- 2017).

COMMENTS:

During the 2016 legislative session the Utah Educationand Telehealth Network was appropriated
$1,160,000 in one time funding.

Source: UT HB Bill 2n (2016).

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