AN ACT relating to telehealth coverage.

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AN ACT relating to telehealth coverage. 1
Be it enacted by the General Assembly of the Commonwealth of Kentucky: 2
Section 1. KRS 304.17A-138 is amended to read as follows: 3
(1) As used in this section: 4
(a) "Equivalent" means reimbursement in an amount equal to what 5
reimbursement would have been had the service been furnished in person by 6
that provider at the provider's place of service; 7
(b) "Federally-qualified[Federally qualified] health center" has the same 8
meaning[means the same] as in 42 U.S.C. sec. 1396d; 9
(c) "Federally qualified health center look -alike" means an organization that 10
meets all of the eligibility requirements of a federally-qualified[federally 11
qualified] health center but does not receive federal grants issued pursuant to 12
42 U.S.C. sec. 254b; 13
(d) "Originating site" means the site at which a Medicaid beneficiary is physically 14
located at the time a telehealth service or telehealth consultation is provided; 15
(e) "Provider" has the same meaning [means the same] as in KRS 304.17A -005 16
and also includes beh avioral health professionals licensed under KRS 17
Chapters 309, 319, and 335; 18
(f) ["Telehealth" has the same meaning as in KRS 211.332; and 19
(g) ]"Rural health clinic" has the same meaning[means the same] as in 42 U.S.C. 20
sec. 1395x; and 21
(g) "Telehealth" has the same meaning as in KRS 211.332. 22
(2) (a) A health benefit plan [, issued or renewed on or after January 1, 2022,] shall 23
reimburse for covered services provided to an insured person through 24
telehealth, including telehealth services provided by a home healt h agency 25
licensed under KRS Chapter 216. 26
(b) Telehealth coverage and reimbursement shall, except as provided in paragraph 27
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(c)[(b)] of this subsection, be equivalent to the coverage for the same service 1
provided in person unless the telehealth provider and the health benefit plan 2
contractually agree to a lower reimbursement rate for telehealth services. 3
(c)[(b)] Rural health clinics, federally-qualified[federally qualified] health 4
centers, and federally qualified health center look -alikes shall be reimbursed 5
as an originating site in an amount equal to that which is permitted under 42 6
U.S.C. sec. 1395m for Medicare-participating providers, if: 7
1. The insured was physically located at the rural health clinic, federally-8
qualified[federally qualified] health center, or federally qualified health 9
center look-alike at the time of service or consultation delivery; and 10
2. The provider of the telehealth service or telehealth consultation is not 11
employed by the rural health clinic, federally-qualified[federally 12
qualified] health center, or federally qualified health center look-alike. 13
(3) In accordance with KRS 211.336, a health benefit plan [, issued or renewed on or 14
after January 1, 2022]: 15
(a) Shall not: 16
1. Require a provider to be physically present with a patient or client, 17
unless the provider determines that it is necessary to perform those 18
services in person; 19
2. Require prior authorization, medical review, or administrative clearance 20
for telehealth that would not be required if a service were provided in 21
person; 22
3. Require demonstration that it is necessary to provide services to a 23
patient or client through telehealth; 24
4. Require a provider to be employed by another provider or agency in 25
order to provide telehealth services that would not be required if that 26
service were provided in person; 27
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5. Restrict or deny coverage of telehealth based solely on the 1
communication technology or application used to deliver the telehealth 2
services; or 3
6. Require a provider to be part of a telehealth network; 4
(b) Shall: 5
1. Require that telehealth services reimbursed under this section meet all 6
clinical, technology, and medical coding guidelines for recipient safety 7
and appropriate delivery of services established by the department [ of 8
Insurance] or the provider's professional licensure board; and 9
2. [Require a telehealth provider to be licensed in Kentucky, or as allowed 10
under the standards and provisions of a recognized interstate compact, in 11
order to receive reimbursement for telehealth services; and 12
3. ]Reimburse a rural health clinic , federally qualified health clinic, or 13
federally qualified health center look -alike for covered telehealth 14
services provided by a provider employed by the rural health clinic, 15
federally qualified health clinic, or federally qualified health center 16
look-alike, regardless of whether the provider was physically located on 17
the premises of the rural health clinic, federally qualified health clinic, 18
or federally qualified health clinic look-alike when the telehealth service 19
was provided; and 20
(c) May: 21
1. Utilize audits for medical coding accuracy in the review of telehealth 22
services specific to audio-only encounters; and 23
2. Require a telehealth provider to be licensed in Kentucky, or as allowed 24
under the standards and provisions of a recognized interstate compact, 25
in order to receive reimbursement for telehealth services. 26
(4) (a) Benefits for a service provided through telehealth required by this section may 27
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be made subject to a deductible, copayment, or coinsurance requirement. 1
(b) A deductible, copayment, or coinsurance applicable to a particular service 2
provided through teleheal th shall not exceed the deductible, copayment, or 3
coinsurance required by the health benefit plan for the same service provided 4
in person. 5
(5) Nothing in this section shall be construed to require a health benefit plan to: 6
(a) Provide coverage for telehealth services that are not medically necessary;[ or] 7
(b) Reimburse any fees charged by a telehealth facility for transmission of a 8
telehealth encounter; or 9
(c) Provide in-network coverage or reimbursement to out -of-network providers 10
unless the coverage or reimbursement is provided under the health benefit 11
plan for the same service provided in person. 12
(6) Providers and home health agencies are strongly encouraged to use audio -only 13
encounters as a mode of delivering telehealth services when no other approved 14
mode of delivering telehealth services is available. 15
(7) The commissioner[department] shall promulgate an administrative regulation in 16
accordance with KRS Chapter 13A to designa te the claim forms and records 17
required to be maintained in conjunction with this section. 18
Section 2. KRS 164.2871 is amended to read as follows: 19
(1) The governing board of each state postsecondary educational institutio n is 20
authorized to purchase liability insurance for the protection of the individual 21
members of the governing board, faculty, and staff of such institutions from liability 22
for acts and omissions committed in the course and scope of the individual's 23
employment or service. Each institution may purchase the type and amount of 24
liability coverage deemed to best serve the interest of such institution. 25
(2) All retirement annuity allowances accrued or accruing to any employee of a state 26
postsecondary educational in stitution through a retirement program sponsored by 27
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the state postsecondary educational institution are hereby exempt from any state, 1
county, or municipal tax, and shall not be subject to execution, attachment, 2
garnishment, or any other process whatsoever, nor shall any assignment thereof be 3
enforceable in any court. Except retirement benefits accrued or accruing to any 4
employee of a state postsecondary educational institution through a retirement 5
program sponsored by the state postsecondary educational ins titution on or after 6
January 1, 1998, shall be subject to the tax imposed by KRS 141.020, to the extent 7
provided in KRS 141.010 and 141.0215. 8
(3) Except as provided in KRS Chapter 44, the purchase of liability insurance for 9
members of governing boards, fac ulty and staff of institutions of higher education 10
in this state shall not be construed to be a waiver of sovereign immunity or any 11
other immunity or privilege. 12
(4) The governing board of each state postsecondary education institution is authorized 13
to provide a self -insured employer group health plan to its employees, which plan 14
shall: 15
(a) Conform to the requirements of Subtitle 32 of KRS Chapter 304; and 16
(b) Except as provided in subsection (5) of this section, be exempt from 17
conformity with Subtitle 17A of KRS Chapter 304. 18
(5) A self-insured employer group health plan provided by the governing board of a 19
state postsecondary education institution to its employees shall comply with: 20
(a) KRS 304.17A-129; 21
(b) KRS 304.17A-133; 22
(c) Section 1 of this Act; 23
(d) KRS 304.17A-145; 24
(e)[(d)] KRS 304.17A-163 and 304.17A-1631; 25
(f)[(e)] KRS 304.17A-261; 26
(g)[(f)] KRS 304.17A-262; 27
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(h)[(g)] KRS 304.17A-264; and 1
(i)[(h)] KRS 304.17A-265. 2
(6) (a) A self-insured employer group health plan provided by the governing board of 3
a state postsecondary education institution to its employees shall provide a 4
special enrollment period to pregnant women who are eligible for coverage in 5
accordance with the requirements set forth in KRS 304.17-182. 6
(b) The governing board of a state postsecondary education institution shall, at or 7
before the time an employee is initially offered the opportunity to enroll in the 8
plan or coverage, provide the employee a notice of the special enrollment 9
rights under this subsection. 10
Section 3. Section 2 of this Act applies to health benefit plans issued or 11
renewed on or after the effective date of this Act. 12