{"id":5368,"date":"2018-05-23T13:42:39","date_gmt":"2018-05-23T13:42:39","guid":{"rendered":"http:\/\/tele.healthcare\/?p=5368"},"modified":"2018-05-23T13:42:39","modified_gmt":"2018-05-23T13:42:39","slug":"kentuckys-new-telehealth-law-expands-insurance-coverage-and-reimbursement","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/kentuckys-new-telehealth-law-expands-insurance-coverage-and-reimbursement\/","title":{"rendered":"Kentucky\u2019s New Telehealth Law Expands Insurance Coverage and Reimbursement"},"content":{"rendered":"

Effective July 1st, 2019 providers from the State of Kentucky delivering care using telehealth will be able to receive reimbursement for their services. No more parity requirements and healthcare coverage resistance!\u00a0<\/strong><\/p>\n

May 23, 2018 by\u00a0Foley & Lardner LLP<\/p>\n

Kentucky health care providers and patients will soon enjoy a revamped, and significantly improved, telehealth commercial insurance coverage law.\u00a0 Kentucky Governor Matt Bevin signed\u00a0SB 112<\/a>\u00a0into law on April 26, 2018, imposing both telehealth coverage and payment parity requirements for Kentucky Medicaid, Medicaid managed care organizations, and commercial health plans in the Bluegrass State.\u00a0 The law is effective July 1, 2019.<\/p>\n

Rob Sprang, Director of\u00a0Kentucky TeleCare<\/a>, noted the legislation \u201cwill help providers from across the Commonwealth care for patients, no matter where they live\u201d allowing healthcare providers to \u201cleverage telehealth technology to extend vital healthcare services to our most vulnerable citizens, bringing the right care to the right people at the right time in the right place.\u201d<\/p>\n

Patient-Friendly Changes to Kentucky\u2019s Insurance Code<\/h4>\n

The changes to Kentucky\u2019s Insurance Code (Title XXV, Chapter 304, Subtitle 17a, Section 138) are even more provider and patient-friendly than some other recent state law changes (e.g.,\u00a0Iowa<\/a>,\u00a0Nebraska<\/a>,\u00a0New Jersey) because the statute mandates both coverage\u00a0and payment parity.\u00a0 The key language in the statute states, in pertinent part, as follows:<\/p>\n

\u201cA health benefit plan shall reimburse for covered services provided to an insured person through telehealth as defined in Section 4 of this Act.\u00a0 Telehealth coverage and reimbursement shall be equivalent to the coverage for the same service provided in person unless the telehealth provider and the health benefit plan contractually agree to a lower reimbursement rate for telehealth services.\u201d<\/em><\/p>\n

Telehealth payment parity\u00a0(i.e., that reimbursement rates for a service delivered via telehealth are equal to rates paid for the identical service delivered in-person) is an essential issue for lawmakers to consider when drafting and evaluating a proposed telehealth coverage bill, or when revisiting a previously-enacted coverage law. \u00a0We have\u00a0discussed this issue extensively\u00a0in prior articles, and handled these issues in connection with our legislative work drafting bills to amend state insurance coverage laws.<\/p>\n

Kentucky Commercial Health Plan Requirements<\/h3>\n

For\u00a0Kentucky commercial health plans<\/strong><\/em>, telehealth is defined as \u201cthe delivery of healthcare-related services by a health care provider who is licensed in Kentucky to a patient through a face-to-face encounter with access to real-time interactive audio and video technology or store and forward services that are provided via asynchronous technologies as the standard practice of care where images are sent to a specialist for evaluation. The requirement for a face-to-face encounter shall be satisfied with the use of asynchronous telecommunications technologies in which the health care provider has access to the patient\u2019s or client\u2019s medical history prior to the telehealth encounter.\u201d\u00a0 The definition does not include \u201cthe delivery of services through electronic mail, text chat, facsimile, or standard audio-only telephone call.\u201d<\/p>\n

Under the new law, a health plan may not:<\/p>\n

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

    Changes to Kentucky Medicaid and Medicaid Managed Care Laws<\/h3>\n

    For\u00a0<\/strong>Kentucky Medicaid and Medicaid Managed Care<\/strong><\/em>, the bill changes Kentucky Medicaid and Medicaid Managed Care laws (Title XVII, Chapter 205) in a manner that largely mirrors the changes to the Kentucky Insurance Code. \u00a0Kentucky\u2019s Cabinet for Health and Family Services will provide oversight, guidance, and direction to Medicaid providers delivering care using telehealth.\u00a0 These activities include:<\/p>\n

      \n
    • Developing policies and procedures to ensure the proper use and security for telehealth, including but not limited to confidentiality and data integrity, privacy and security, informed consent, privileging and credentialing, reimbursement, and technology;<\/li>\n
    • Promoting access to health care provided via telehealth;<\/li>\n
    • Maintaining a list of Medicaid providers who may deliver telehealth services to Medicaid recipients;<\/li>\n
    • Requiring that specialty care be rendered by a health care provider who is recognized and actively participating in the Medicaid program;<\/li>\n
    • Requiring that any required prior authorization requesting a referral or consultation for specialty care be processed by the patient\u2019s primary care provider and that any specialist coordinate care with the patient\u2019s primary care provider; and<\/li>\n
    • Maintaining telehealth policies and guidelines to providing care that ensure that Medicaid-eligible citizens will have safe, adequate, and efficient medical care, and that prevent waste, fraud, and abuse of the Medicaid program.<\/li>\n<\/ul>\n

      Additional Changes Worth Noting<\/h3>\n

      Other highlights of the new law include the following:<\/p>\n

        \n
      • Kentucky Telehealth Network<\/strong>. The state\u2019s prior telehealth coverage law required Kentucky Medicaid and commercial insurers to cover telemedicine-based services only if the services were provided at a site within the state\u2019s official telehealth network. The new law no longer requires telehealth services be provided through the state\u2019s telehealth network to receive reimbursement.<\/li>\n
      • Licensure<\/strong>. A telehealth provider must be licensed in Kentucky in order to receive reimbursement for telehealth services.<\/li>\n
      • Abortion<\/strong>. The law imposes an additional telemedicine practice standard which expressly prohibits the use of telehealth in the performance of an abortion.<\/li>\n<\/ul>\n

        The enactment of Kentucky\u2019s telehealth insurance coverage law brings the count to approximately 36 states plus D.C. as having laws requiring insurance plans to cover telehealth services, and approximately nine states with payment parity language. \u00a0We will continue to monitor Kentucky for any rule changes that affect or improve telemedicine opportunities in the state.<\/p>\n","protected":false},"excerpt":{"rendered":"

        Effective July 1st, 2019 providers from the State of Kentucky delivering care using telehealth will […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_uag_custom_page_level_css":"","_uf_show_specific_survey":0,"_uf_disable_surveys":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center 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