Kentucky Telehealth Act – SB112 Fact Sheet

SB112 Telehealth Act, effective July 1, 2019, redefines telehealth, widens the scope of payment parity, and includes the home to be an originating site.  It applies to fully-insured Kentucky Medicaid, Medicaid managed organizations, health benefit plans, and self-insured plans.

Amends 304.17A-005 to redefine “telehealth”:
  • “The delivery of healthcare-related services by a health care provider who is licensed in Kentucky to a patient or client 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.”
    • Inclusion of store-and-forward as a new addition
  • “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’s or client’s medical history prior to the telehealth encounter.”
    • Asynchronous options include remote patient monitoring (RPM) and store-and-forward only
    • Delivery via a secure communications connection is required
Section 5. KRS 304.17A-138 is amended as follows:
  • “A health benefit plan shall reimburse for covered services provided to an insured person through telehealth as defined in Section 4 of this Act.  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.”
    • Expanding telehealth coverage and payment parity across services
  • Telehealth coverage and reimbursement will receive coverage equivalent for services provided in-person unless the telehealth provider and the health benefit plan agree to a lower reimbursement rate for telehealth service
    • Complete telehealth and payment parity
    • Eliminates the restriction requiring the provider to be in the same physical location as the patient – allowing the home to be an originating site
    • Eliminates any prior authorizations, reviews, or clearances normally not required for equivalent in-person services
  • Specifies health benefit plans shall not be required to provide coverage for services that are not medically necessary