No. 32103 (New Rule): R414-42. Telehealth Home Health Services

DAR File No.: 32103
Filed: 10/30/2008, 02:42
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

This rule is mandated by H.B. 16 passed in the 2008 General Session, and is needed to provide telehealth home health services to Medicaid eligible clients. (DAR NOTE: H.B. 16 (2008) is found at Chapter 41, Laws of Utah 2008, and was effective 05/05/2008.)

Summary of the rule or change:

This rule outlines eligibility, access requirements, coverage, limitations, and reimbursement for telehealth home health services.

State statutory or constitutional authorization for this rule:

Sections 26-18-12 and 26-18-3

Anticipated cost or savings to:

the state budget:

There is no budget impact because no funds were appropriated for these services. The Department will absorb the cost with the resources it currently has.

local governments:

There no budget impact to local governments because they do not fund telehealth home health services and they are not Medicaid providers.

small businesses and persons other than businesses:

The providers of home health services will be reimbursed for qualifying services to Medicaid recipients. The expectation is that the service delivery will be more efficient and benefit clients. More clients are expected to be served for the same total cost.

Compliance costs for affected persons:

This service is intended to be budget neutral. Telehealth services are anticipated to replace visits to a provider's office. Access to medical care may increase. This program is voluntary and any costs incurred will be at the choice of the provider.

Comments by the department head on the fiscal impact the rule may have on businesses:

Remote monitoring of home health clients has the promise of better patient care at a lower cost per patient served. This rule should have a positive impact on providers and Medicaid recipients without increasing overall costs to Medicaid. David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

Direct questions regarding this rule to:

Kimi McNutt at the above address, by phone at 801-538-6381, by FAX at 801-538-6099, or by Internet E-mail at [e-mail]

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

12/15/2008

This rule may become effective on:

12/22/2008

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-42. Telehealth Home Health Services.

R414-42-1. Introduction and Authority.

(1) This rule outlines eligibility, access requirements, coverage, limitations, and reimbursement for Telehealth Home Health Services. This rule is authorized by Title 26, Chapter 18, Section 12, UCA.

(2) Telehealth Home Health Services are an optional program.

 

R414-42-2. Telehealth Home Health Services Eligibility.

(1) To qualify for Telehealth home health services the recipient must:

(a) be eligible for Medicaid coverage;

(b) require medical monitoring for diabetes; and

(c) be willing and able to use the technology required to deliver the service.

(2) A home health agency may provide telehealth services if:

(a) the service is delivered through secure transmission lines at the home health agency to audio-visual computer equipment installed in the patients home;

(b) the secure transmission is between the home health agency and the patients home; and

(c) the home health agency has sent a registered nurse to the patient's home to provide a physical health assessment and evaluation of a patient's condition and the patient is:

(i) determined unable to leave the home by the home health agency;

(ii) determined suitable for participation by the home health agency;

(iii) formulated a nursing care plan by the home health agency; and

(iv) determined by the home health agency to require at least two skilled nursing home visits per week.

(3) Telehealth home health services are limited to patients residing in under served rural areas where the patient would be required to travel more than 50 paved road miles to obtain the service.

 

R414-42-3. Telehealth Home Health Services Requirements.

(1) Telehealth home health services are limited to diabetic monitoring and education.

(2) Telehealth home health services must meet all of the following:

(a) provide the level of confidentiality required under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) for safe and secure information exchange;

(b) require the patient to see and hear the provider in real time;

(c) require the provider to see and hear the patient in real time; and

(d) provide audio and visual clarity sufficient to complete diabetic monitoring and education activities.

(3) The individual receiving telehealth home health services must need more than two home health agency visists per week. A home health agency that provides telehealth home health services must provide at least two in-person visits by a home health nurse per week and may use telehealth home health services only as a supplement to the in-person visits.

 

R414-42-4. Reimbursement of Services.

(1) Medicaid reimburses telehealth home health services in accordance with the Utah Medicaid State Plan, Attachment 4.19-B.

(2) The Department pays the lesser of the amount billed or the rate on the fee schedule. A provider shall not charge the Department a fee that exceeds the provider's usual and customary charges for the provider's private pay patients.

(3) The Department does not make payments separate from telehealth home health monitoring and education for transmission charges, equipment, or facility fees.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: 2008

Authorizing, and Implemented or Interpreted Law: 26-18-12