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Utah Administrative Code (Current through November 1, 2019) |
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R414. Health, Health Care Financing, Coverage and Reimbursement Policy |
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R414-42. Telemedicine |
| R414-42-1. Introduction and Authority |
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This rule outlines eligibility, access requirements, coverage, limitations, and reimbursement for telemedicine. This rule is authorized by Section 26-18-13. |
| R414-42-2. Definitions |
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(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. (5) "Telepsychiatric consultation" means a consultation between a physician and a board-certified psychiatrist that utilizes: (a) the health records of the patient, provided from the patient or the referring physician; and (b) a written, evidence-based patient questionnaire. |
| R414-42-3. Covered Services |
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Covered services may be delivered by means of telemedicine, as clinically appropriate. Services include consultation services, evaluation and management services, mental health services, substance use disorder services, and telepsychiatric consultations. |
| R414-42-4. Limitations |
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(1) Telemedicine encounters must comply with privacy and security measures set forth under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act, Pub. L. No. 111-5, 123 Stat. 226, 467, as amended, to ensure that all patient communications and records, including recordings of telemedicine encounters, are secure and remain confidential. The provider is responsible to ensure 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. |
| R414-42-5. Reimbursement of Services |
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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. |