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                                                                                 Center for Connected Health Policy

           Kentucky


             Medicaid Program:  Kentucky Medicaid

           Program Administrator:  KY Dept. for Medicaid Services

           Regional Telehealth Resource Center:
           Mid-Atlantic Telehealth Resource Center
           PO Box. 800711
           Charlottesville, VA 22908-0711
           (434) 906-4960 / (855) MATRC4U
           www.matrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM
            Definition of telemedicine/telehealth
            "Telehealth means the use of interactive audio, video, or  "Telehealth consultation means a medical or health
            other electronic media to deliver health care. It includes   consultation, for purposes of patient diagnosis or
            the use of electronic media for diagnosis, consultation,   treatment, that requires the use of advanced
            treatment, transfer of health or medical data, and   telecommunications technology, including, but not
            continuing education.”                             limited to: (a) compressed digital interactive video,
                                                               audio, or data transmission; (b) clinical data
            Source: KY Revised Statutes § 310.200  (2012).     transmission via computer imaging for tele-radiology or
                                                               tele-pathology; and (c) other technology that facilitates
            (also see Medicaid column)                         access to health care services or medical specialty
                                                               expertise.”

                                                               Source: KY Revised Statutes § 205.510 (2012).

                                                               Telehealth means two-way, real time interactive
                                                               communication between a patient and a physician or
                                                               practitioner located at a distant site for the purpose of
                                                               improving a patient’s health through the use of
                                                               interactive telecommunication equipment that includes,
                                                               at a minimum, audio and video equipment.

                                                               Source: KY 907 KAR 1:055E.

                                                               "Telemedicine" means two-way, real time interactive
                                                               communication between a patient and a physician or
                                                               practitioner located at a distant site for the purpose of
                                                               improving a patient’s health through the use of
                                                               interactive telecommunications equipment that includes,
                                                               at a minimum, audio and video equipment.

                                                               Source: KY 907 KAR 9:005.

                                                               “Telehealth medical services: The originating-site or
                                                               spoke site is the location of the eligible Kentucky
                                                               Medicaid recipient at the time the telehealth service is
                                                               being furnished via an interactive telehealth service
                                                               communications system. The distant or hub site is the
                                                               location of the provider and is considered the place of
                                                               service. An interactive telehealth service communication
                                                               system includes interactive audio and video equipment
                                                               permitting two-way real time interactive communication

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               between the patient and the practitioner at the
                                                               originating and distant-sites.”

                                                               Source: KY State Plan Amendment. Attachment 3.1-B. Approved
                                                               3/9/2011.
            Live Video Reimbursement

            Kentucky law states that insurers may not deny     Kentucky Medicaid will reimburse for a “telehealth
            coverage because it is “provided through telehealth and  consultation”, which includes live video.
            not provided through face-to-face consultation” therefore
            requiring reimbursement for live video.            Source: KY Revised Statutes 205.559 (2012).

            Source: KY Revised Statutes § 304.17A-138 (2012).   Reimbursement shall not be denied solely because an
                                                               in-person consultation between a provider and a patient
            (See Medicaid column and “Private Payers” section)   did not occur.

                                                               Source: KY Revised Statutes § 205.559 (2012).

                                                               Except for a telehealth consultation provided by an
                                                               Advanced Registered Nurse Practitioner or Community
                                                               Mental Health Clinic, an amount equal to the amount
                                                               paid for a comparable in-person service.

                                                               Source: KY Admin. Regs., Title, 907, 3:170, Sec. 4(a) (2011).

                                                               Telehealth is covered to the same extent the service and
                                                               provider are covered when furnished face-to-face.

                                                               Providers must be approved through the Kentucky e-
                                                               Health Network Board. Must be approved member of KY
                                                               telehealth network.

                                                               Coverage is limited to:
                                                                   •   Consultation
                                                                   •   Mental health evaluation and management
                                                                       services
                                                                   •   Individual and group psychotherapy
                                                                   •   Pharmacologic management
                                                                   •   Psychiatric/psychological/mental health
                                                                       diagnostic interview examinations
                                                                   •   Individual medical nutrition services

                                                               All telehealth services are subject to utilization review.

                                                               Prior authorization is needed for select telehealth
                                                               procedures.

                                                               Eligible providers for services NOT in a Community
                                                               Mental Health Center:
                                                                   •   A psychiatrist;
                                                                   •   A licensed clinical social worker;
                                                                   •   A psychologist;
                                                                   •   A licensed professional clinical counselor;
                                                                   •   A licensed marriage and family therapist;
                                                                   •   A physician*;
                                                                   •   An ARNP*;


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                   •   Speech-language pathologist*;
                                                                   •   Occupational therapist*;
                                                                   •   Physical therapist*;
                                                                   •   Licensed dietitian or certified nutritionist*; or
                                                                   •   Registered nurse or dietician*

                                                               * Certain restrictions apply.

                                                               Eligible providers for services in a Community Mental
                                                               Health Center:
                                                                   •   A psychiatrist;
                                                                   •   A physician;
                                                                   •   Psychologist with a license in accordance with
                                                                       KRS 319.010(5);
                                                                   •   A licensed marriage and family therapist;
                                                                   •   A licensed professional clinical counselor;
                                                                   •   A psychiatric medical resident;
                                                                   •   A psychiatric registered nurse;
                                                                   •   A licensed clinical social worker;
                                                                   •   An advanced registered nurse practitioner;

                                                               Source: KY State Plan Amendment. Attachment 3.1-B. Approved
                                                               3/9/2011.
            Store and Forward Reimbursement
            (see Medicaid column)                              Kentucky reimburses for tele-radiology but there is no
                                                               other reference to reimbursing for other specialties.

                                                               Source: KY Provider Billing Instructions for Physician’s Services
                                                               Provider Type – 64, 65, Version 6.2, p. 44 (Dec. 16, 2014).
                                                               http://www.kymmis.com/kymmis/pdf/billingInstr/PT64-
                                                               65withMedicare_v6.5_(12-16-14).pdf

                                                               Medicaid does not cover other forms of store and
                                                               forward, as a telehealth consultation requires a two-way
                                                               interactive video.

                                                               Source: KY Admin. Regs., Title, 907, 3:170, Sec. 3, 3(a) (2011).
            Remote Patient Monitoring Reimbursement
            No reference found.                                No reference found.

            Email/Phone/FAX
            No reimbursement for email.                        No reimbursement for email.
            No reimbursement for telephone.                    No reimbursement for telephone.
            No reimbursement for FAX.                          No reimbursement for FAX.

            Source: KY Revised Statutes § 304.17A-138 (2012).   Source: KY Revised Statutes § 205.559 (2012).
            Online Prescribing
            Prior to prescribing in response to any communication   No reference found.
            transmitted or received by computer or other electronic
            means, physicians must establish a proper physician-
            patient relationship. This includes:



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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

               •   Verification that the person requesting
                   medication is in fact who the patient claims to
                   be;
               •   Establishment of a documented diagnosis
                   through the use of accepted medical practices;
               •   Maintenance of a current medical record.

            An electronic, online, or telephone evaluation by
            questionnaire are inadequate for the initial or any follow-
            up evaluation.

            Source: KY Revised Statutes § 311.597 (2012).




            A “good faith prior examination” (needed to establish a
            physician-patient relationship) can be done through
            telehealth.
            Source: KY Rev. Statute 218A.010.

            The Board of Speech Language Pathology and
            Audiology does not allow for the establishment of a
            practitioner-patient relationship via telehealth.  They
            require an in-person meeting to occur first.  A
            practitioner-patient relationship is required to issue a
            prescription.

            Source: KY 201 KAR 17:110.
            Consent
            The provider who delivers or facilitates the telehealth   Before providing a telehealth consultation, providers
            service shall obtain the informed consent of the patient   must document written patient informed consent.
            before services are provided.
                                                               This includes:

            Patient consent must be obtained by:                   •   The patient may refuse the telehealth
               •   Physicians;                                         consultation at any time without affecting the
               •   Chiropractors;                                      right to future care or treatment, and without
               •   Nurses;                                             risking the loss or withdrawal of a benefit to
               •   Dentists;                                           which the patient is entitled;
               •   Dieticians;                                     •   The recipient shall be informed of alternatives to
               •   Pharmacist;                                         the telehealth consult;
               •   Psychologists;                                  •   The recipient shall have access to medical
               •   Occupational therapists;                            information resulting from the telehealth consult
               •   Behavioral analysts;                                as provided by law;
               •   Ophthalmologists;                               •   The dissemination, storage, or retention of an
               •   Physical therapists;                                identifiable recipient image or other information
               •   Speech language pathologists or audiologists;       from the telehealth consult shall comply with all
               •   Social workers;                                     state and federal confidentiality laws and
                                                                       regulations;
               •   Marriage/family therapists.                     •   The patient shall have the right to be informed of
                                                                       the parties who will be present at the spoke site
            Source: KY Revised Statutes § 311.5975 (2012).
                                                                       and the hub site during the telehealth consult,
            (also see Medicaid column)                                 and shall have the right to exclude anyone from
                                                                       either site;

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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                   •   The patient shall have the right to object to the
            The Board of Speech Language Pathology and                 videotaping of a telehealth consult.
            Audiology requires their licensees to inform the client in
            writing, in an initial in-person meeting, about:   Source: KY Admin. Regs., Title, 907, 3:170 (2011).
            •  The limitations of using technology in the provision of
              telepractice;
            •  Potential risks to confidentiality of information due to
              technology in the provision of telepractice;
            •  Potential risks of disruption in the use of telepractice;
            •  When and how the licensee will respond to routine
              electronic messages;
            •  In what circumstances the licensee will use
              alternative communications for emergency purposes;
            •  Who else may have access to client communications
              with the licensee;
            •  How communications can be directed to a specific
              licensee;
            •  How the licensee stores electronic communications
              from the client; and
            •  That the licensee may elect to discontinue the
              provision of services through telehealth.

            Source: KY 201 KAR 17:110.
            Location

            No reference found.                                No reference found.
            Cross-State Licensure

            A provider must be licensed in Kentucky with the   No reference found.
            exception of  persons who, being nonresidents of
            Kentucky and lawfully licensed to practice medicine or
            osteopathy in their states of actual residence,
            infrequently engage in the practice of medicine or
            osteopathy within this state, when called to see or attend
            particular patients in consultation and association with a
            Kentucky-licensed physician.

            Source: KY Revised Statutes § 311.560 (2012).
            Private Payers

            Payers shall not exclude services solely because the   No reference found.
            service is provided through telehealth. A health benefit
            plan may provide coverage for a consultation at a site
            not within the telehealth network at the discretion of the
            insurer.

            Source: KY Revised Statutes § 304.17A-138 (2012).

            Site/Transmission Fee
            (see Medicaid column)                              No reimbursement for transmission fees.

                                                               Source: KY Admin. Regs., Title, 907, 3:170 (2012).
            Miscellaneous


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                                                                                 Center for Connected Health Policy

            STATE LAW/REGULATIONS                              MEDICAID PROGRAM



           Comments:    Kentucky created its e-Health Network in 2005, to develop a secure electronic network.  The
                         network oversees development of ways to use health information technology to improve the health
                         and lives of state residents.

                         The network is providing decision support on security of protected information, electronic data
                         interchange, and clinical practice software packages. This includes the feasibility of developing a
                         software purchasing alliance to decrease the cost of software, and tax incentives to encourage
                         network members purchase software that meets state standards.

                         Kentucky e-Health Network Board.  http://ehealth.ky.gov/board/Pages/default.aspx; accessed Jan. 7, 2015.


                         KY Telehealth Regulations:
                             •   Speech Language Pathology and Audiology (Source: Title 201, Ch. 17, Sec. 110)
                             •   Board of Optometric Examiners (Source: Title 201, Ch. 5, Sec. 055)
                             •   Physical Therapy (Source: Title 201, Ch. 22, Sec. 160)
                             •   Psychologist (Source: Title 201, Ch. 26, Sec. 310)
                             •   Dieticians and Nutritionists (Source: Title 201, Ch. 33, Sec. 070)
                             •   Applied Behavior Analysis (Source: Title 201, Ch. 43, Sec. 10)


















































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