Federal and State Legal and Regulatory Resources

As of July 1, 2019, Kentucky’s new telehealth rules for Medicaid and Commercial Health Plans have changed significantly.  Previous requirements for registering with the Kentucky TeleHealth Network have been eliminated.  The restrictions on providers and types of clinical encounters that qualify for telehealth reimbursement have been eliminated.  Kentucky is now a telehealth parity state.  If a clinical encounter is reimbursable when conducted in a traditional in-person visit, that same encounter will be reimbursable when conducted via telehealth technology.  This includes all services, providers and locations and the value of a telehealth encounter is equivalent to a traditional in-person encounter unless the payer and provider have negotiated a reduced payment rate.  Refer to the documentation noted above but most services will require interactive videoconference technology that replicates a traditional face-to-face encounter with the provider.

 

  • Medicare reimbursement for telehealth

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf

 

  • Elimination of the GT modifier for telehealth/New Place of Service - Medicare

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10152.pdf

 

  • Rural Health Clinics and Telehealth – Medicare

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/RuralHlthClinfctsht.pdf

 

  • Federally Qualified Health Centers  and Telehealth – Medicare

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/fqhcfactsheet.pdf

 

  • Remote virtual check in and remote evaluation service – Medicare

https://www.web.narhc.org/News/27640/CMS-Proposes-New-Virtual-Check-In-and-Remote-Evaluation-Benefit-for-RHCs

 

  • One page infographic on the Medicare telehealth physician fee schedule changes, CY 2019 from the Center for Connected Health Policy

https://www.cchpca.org/sites/default/files/2018-11/Finalized%20PFS%202019%20Infographic%20Final%20V.%204.pdf

 

  • Medicare telehealth reimbursement from the Center for Connected Health Policy

https://www.cchpca.org/sites/default/files/2019-03/TELEHEALTH%20REIMBURSEMENT%202019%20FINAL.pdf

 

  • 2019 Physician Fee Schedule from the Center for Connected Health Policy

https://www.cchpca.org/sites/default/files/2018-11/FINAL%20PFS%20CY%202019%20COMBINED_0.pdf

 

  • Kentucky’s Telehealth Statute for Medicaid and Commercial Health Plan reimbursement for telehealth

http://apps.sos.ky.gov/Executive/Journal/execjournalimages/2018-Reg-SB-0112-2550.pdf

 

  • Kentucky’s Telehealth Administrative Regulation for Commercial Health Plan reimbursement for telehealth

https://apps.legislature.ky.gov/law/statutes/statute.aspx?id=48459

 

  • Kentucky’s emergency regulation for Medicaid reimbursement for telehealth

https://chfs.ky.gov/agencies/dms/Documents/907%20KAR%203_170_E.pdf

 

  • Kentucky Medicaid Payments to an FQHC or RHC

https://apps.legislature.ky.gov/law/kar/907/001/055.pdf

 

 

  • Nate Lacktman is one of the nation’s most important resources for legal and regulatory information related to Telehealth.  He is a partner with Foley Lardner LLP.

https://www.foley.com/en/people/l/lacktman-nathaniel-m

 

  • The Center for Connected Health Policy, the HRSA funded National Telehealth Policy Resource Center is an important resource for federal and state telehealth policies, especially related to reimbursement.

https://www.cchpca.org/

 

 

Medicare’s telehealth reimbursement rules are clearly stated in the resources noted above.  Several issues must be considered when planning telehealth services for Medicare beneficiaries.  The patient must be located in an approved “Originating Site” which is a healthcare facility that is located in a rural or medically underserved community.  The “Medicare Reimbursement for Telehealth” document above includes a weblink to the Medicare Payment Analyzer that will report on the eligibility of any street address to be an Originating Site.  The “Distant Site Practitioner” is the healthcare provider who is performing the telehealth encounter and an approved list of healthcare professionals is included in the same document.  Specific services and billing codes have been approved by Medicare and are noted in the documents above.  The Originating Site, where the patient is located is also eligible to bill a facility fee.