DAR File No. 42236
This rule was published in the November 15, 2017, issue (Vol. 2017, No. 22) of the Utah State Bulletin.
Health, Health Care Financing, Coverage and Reimbursement Policy
Rule R414-42
Telehealth Home Health Services
Notice of Proposed Rule
(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:
HealthHealth 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 cdevashrayee@utah.gov
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
Additional Information
More information about a Notice of Proposed Rule is available online.
The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull_pdf/2017/b20171115.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.
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For questions regarding the content or application of this rule, please contact Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov. For questions about the rulemaking process, please contact the Office of Administrative Rules.