No. 42236 (Amendment): Rule R414-42. Telehealth Home Health Services

(Amendment)

DAR File No.: 42236
Filed: 10/17/2017 07:55:16 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this change is to update and implement, by rule, the Medicaid policy for telemedicine services.

Summary of the rule or change:

This amendment includes new definitions, clarifies service coverage, and specifies limitations in the provision of telemedicine services. It also makes other minor corrections.

Statutory or constitutional authorization for this rule:

• Section 26-18-3
• Section 26-1-5

Anticipated cost or savings to:

the state budget:

There is no impact to the state budget because this change only updates, by rule, ongoing Medicaid policy. It neither affects service coverage to Medicaid members nor reimbursement to Medicaid providers.

local governments:

There is no budget impact to local governments because they neither fund nor provide telemedicine services to Medicaid members.

small businesses:

There is no impact to small businesses because this change only updates, by rule, ongoing Medicaid policy. It neither affects service coverage to Medicaid members nor reimbursement to Medicaid providers.

persons other than small businesses, businesses, or local governmental entities:

There is no impact to Medicaid providers and to Medicaid members because this change only updates, by rule, ongoing Medicaid policy. It neither affects service coverage nor reimbursement.

Compliance costs for affected persons:

There are no compliance costs to a single Medicaid provider or to a Medicaid member because this change only updates, by rule, ongoing Medicaid policy. It neither affects service coverage nor reimbursement.

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

After conducting a thorough analysis, it was determined that this proposed rule will not result in a fiscal impact to businesses.

Joseph K. Miner, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Office 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:

• Craig Devashrayee at the above address, by phone at 801-538-6641, 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:

12/15/2017

This rule may become effective on:

01/01/2018

Authorized by:

Joseph Miner, Executive Director

RULE TEXT

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

R414-42. [Telehealth Home Health Services]Telemedicine.

R414-42-1. Introduction and Authority.

[(1)]This rule outlines eligibility, access requirements, coverage, limitations, and reimbursement for [Telehealth Home Health Services]telemedicine. This rule is authorized by [Title 26, Chapter 18, Section 12, UCA]Section 26-18-13.

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

 

R414-42-2. Definitions.

(1) "Telemedicine" is two-way, real-time interactive communication between the member and the physician or authorized provider at the distant site. This electronic communication uses interactive telecommunications equipment that includes, at a minimum, audio and video equipment.

(2) "Authorized provider" means a provider in compliance with requirements as specified in Section I: General Information of the Utah Medicaid Provider Manual, Chapter 3, Provider Participation and Requirements.

(3) "Distant site" is the location of the provider when delivering the service via the telecommunications system.

(4) "Originating site" is the location of the Medicaid member at the time the service is furnished via a telecommunications system.

[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]Covered Services.

[(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.] Covered services may be delivered by means of telemedicine, as clinically appropriate. Services include consultation services, evaluation and management services, mental health services, and substance use disorder services.

 

R414-42-4. Limitations.

(1) Telemedicine encounters must comply with privacy and security measures set forth under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) to ensure that all patient communications and records, including recordings of telemedicine encounters, are secure and remain confidential. The provider is responsible for determining whether the encounter is HIPAA compliant. Security measures for transmission may include password protection, encryption, and other reliable authentication techniques.

(2) Compliance with the Utah Health Information Network (UHIN) standards for telehealth must be maintained. These standards provide a uniform standard of billing for claims and encounters delivered via telehealth.

(3) The originating site receives no reimbursement for the use of telemedicine.

 

R414-42-[4]5 . 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: [December 29, 2008]2018

Notice of Continuation: September 17, 2013

Authorizing, and Implemented or Interpreted Law: 26-18-1[2]3

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