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                                                                                 Center for Connected Health Policy

           Utah


             Medicaid Program:  Utah Medicaid

           Medicaid Program Administrator:  Utah Dept. of Health

           Regional Telehealth Resource Center:
           Northwest Regional Telehealth Resource Center
                  th
           2900 12  Ave. N., Ste. 30W
           Billings, MT 59101
           (888) 662-5601
           www.nrtrc.org


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Definition of telemedicine/telehealth

            "Digital health service means the electronic transfer,   Telehealth or Telemedicine is a technological method of
            exchange, or management of related data for diagnosis,  providing auditory and visual connection between the
            treatment, consultation, educational, public health, or   skilled home health care nurse at a Telehealth site and
            other related purposes.”                           the patient living in a rural Utah area.

            Source: UT Code Annotated Sec. 26-9f-102.          Source: Utah Medicaid Provider Manual: Home Health Agencies, p.
                                                               18 (Jan. 2015).

                                                               “Telemedicine is two-way, real-time interactive
                                                               communication between the patient and the physician or
                                                               practitioner 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 (Jan. 2015), pg. 13.

            Live Video Reimbursement
            Providers are eligible for reimbursement under Utah’s   Utah Medicaid covers medically necessary physician
            Medical Assistance Program.                        and nurse practitioner services delivered via
                                                               telemedicine.
            Source: UT Code Annotated Sec. 26-18-13.
                                                               Must comply with Utah Health Information Network
                                                               Standards for Telehealth, which includes billing
                                                               standards.

                                                               Source: Utah Medicaid Provider Manual. Section I. General
                                                               Information (Jan. 2015), pg. 13.
            Store and Forward Reimbursement
            No reference found.                                No reference found.

            Remote Patient Monitoring Reimbursement
            (see Medicaid column)                              Home telemetry is reimbursed under the following
                                                               conditions:
                                                                   •   Must be ordered by a BC/BE neurologist
                                                                   •   Must have had a stroke or transient ischemic


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                                                                                 Center for Connected Health Policy


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                                       attack with no identifiable cause
                                                                   •   24 hour monitoring done previously
                                                                   •   Not be currently anti-coagulated on Warfarin.
                                                                   •   Not have a known contra-indication for Warfarin
                                                                   •   Only authorized for the 30-day test

                                                               Source: UT Physician Manual. Section 2. Pg. 64 (Jan. 2015).

                                                               Skilled Nurse Pilot Project for Patients in Rural
                                                               Areas
                                                               There is reimbursement in the UT Medicaid Telehealth
                                                               Skilled Nurse Pilot Project for Patients in Rural Areas.

                                                               Patient eligibility requirements:

                                                                   •   Reside in underserved rural areas;
                                                                   •   Would have to travel more than 50 paved road
                                                                       miles to obtain these services in person;
                                                                   •   Be eligible for Medicaid coverage;
                                                                   •   Require medical monitoring for diabetes;
                                                                   •   Be willing and able to use required technology.

                                                               Home health agency service delivery requirements:

                                                                  •  The service is delivered through secure, HIPAA-
                                                                   compliant transmission lines, and takes place
                                                                   between the home health agency and the patient’s
                                                                   home;
                                                                  •  Patient and provider are able to see and hear each
                                                                   other in real time;
                                                                  •  An assessment at the patient’s home by a home
                                                                   health agency registered nurse finds that the patient
                                                                   is unable to leave the home; is suitable for
                                                                   participation in the program; and requires at least
                                                                   two skilled nursing home visits a week;
                                                                  •  Formulates a nursing care plan.

                                                               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.


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                                                                                 Center for Connected Health Policy


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

                                                               Source: Utah Medicaid Provider Manual: Home Health Agencies,
                                                               p. 18-20 (Jan. 2015).

                                                               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.
            Email/Phone/FAX

            No reference found.                                No reference found.
            Online Prescribing

            Providers must first obtain information in the usual   No reference found.
            course of professional practice that is sufficient to
            establish a diagnosis, to identify conditions, and to
            identify potential risks to the 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.
            Consent
            No reference found.                                No reference found.
            Location

            No reference found.                                Rural Health Clinics may serve as an originating site for
                                                               telehealth services.  They are not allowed to serve as a
                                                               distant site.

                                                               Source: UT Rural Health Clinics and FQHC Medicaid Manual, pg.
                                                               6, (Apr. 2014).
            Cross-State Licensing
            An out-of-state physician may practice without a Utah   No reference found.
            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;


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                                                                                 Center for Connected Health Policy


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

               •   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
            Private 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 (Jan. 2015), pg. 14.

            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 R432-100-32.

            The definition of “practice as a substance use disorder
            counselor” and “practice of mental health therapy” in the
            Mental Health Professional Practice Act and
            Psychologist Licensing Act was recently modified to
            include service delivery “in person or remotely”.



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                                                                                 Center for Connected Health Policy


            STATE LAW/REGULATIONS                              MEDICAID PROGRAM

            Source: Laws of UT 68-60-102.

            In order for a provider to qualify for payment through the
            Autism Treatment Account, providers must be
            collaborating with existing telehealth networks.

            Source: UT Regulation Text R398-15-3.

           Comments:
                         During the 2014 legislative session the Utah legislature appropriated $1,000,000 in one-time funding
                         for telehealth infrastructure enhancements to enhance the feasibility of providing Medicaid services via
                         telehealth.

                         Source:  Utah Department of Health, Medicaid, Utah Medicaid and Telehealth PPT, Michael Hales, July 16, 2014
                         (accessed Feb. 2, 2015) http://le.utah.gov/interim/2014/pdf/00003809.pdf


























































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