Telehealth Update

Posted November 7, 2018

The telehealth law passed last year becomes effective July 1, 2019 and requires Medicaid, managed care organizations (MCOs) and commercial health plans to cover medical services provided via telehealth to the same extent they cover medical services provided in-person. In some cases Medicaid and MCOs can negotiate a lower reimbursement rate for telehealth services if the healthcare provider agrees to a lower reimbursement rate contractually.

Patients may live anywhere and receive telehealth treatment but physicians and other covered health care practitioners using telehealth must be licensed in Kentucky. The law does not restrict or deny coverage of telehealth based solely on the communication technology or application used to deliver the telehealth services. The privacy and security components of HIPAA have been discussed at length since the communication technology is no longer limited.

Another equally important component of HIPAA is administrative simplification which provides requirements for standardized code sets such as Current Procedural Terminology (CPT) and includes modifiers and uniform place of service indicators.

Additionally, a health plan may not:

  1. Require a provider to be physically present with a patient unless the provider determines that it is necessary to perform those services in person;
  2. Require prior authorization, medical review, or administrative clearance for telehealth that would not be required if the service were provided in person;
  3. Require demonstration that it is necessary to provide services to a patient through telehealth;
  4. Require a 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;
  5. Restrict or deny coverage of telehealth based solely on the communication technology or application used to deliver the telehealth services; or
  6. Require a provider to be part of a telehealth network.