DAR File No. 42871

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-42

Telemedicine

Notice of Proposed Rule

(Amendment)

DAR File No.: 42871
Filed: 05/01/2018 03:16:29 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

H.B. 139, passed during the 2018 General Session, directs the Medicaid program to provide coverage and reimbursement for telepsychiatric consultations between a physician and a board-certified psychiatrist.

Summary of the rule or change:

These amendments include telepsychiatric consultations as a covered Medicaid service. It also includes a definition of "telepsychiatric consultation", and clarifies the authority under which patient records are to remain confidential.

Statutory or constitutional authorization for this rule:

• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

There is a total annual cost of about $12,500 to the state budget to implement telepsychiatric consultations.

local governments:

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

small businesses:

About 10 psychiatric providers may see a portion of $12,500 in annual revenue with the implementation of telepsychiatric consultations.

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

Some providers of telepsychiatric consultations may see a portion of $12,500 in revenue with the implementation of telepsychiatric consultations. Medicaid members may also see a portion of $12,500 in out-of-pocket savings.

Compliance costs for affected persons:

There are no compliance costs because these changes can only create individual savings or business revenue.

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

Small businesses and individual providers may see a portion of $12,500 in annual revenue as a result of these changes.

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 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:

06/14/2018

This rule may become effective on:

07/01/2018

Authorized by:

Joseph Miner, Executive Director

Appendix 1: Regulatory Impact Summary Table*

Fiscal Costs	FY 2018	FY 2019	FY 2020
State Government	$0	$12,500	$0
Local Government	$0	$0	$0
Small Businesses	$0	$0	$0
Non-Small Businesses	$0	$0	$0
Other Person	$0	$0	$0
Total Fiscal Costs:	$0	$12,500	$0
Fiscal Benefits
State Government	$0	$0	$0
Local Government	$0	$0	$0
Small Businesses	$0	$6,250	$0
Non-Small Businesses	$0	$0	$0
Other Persons	$0	$6,250	$0
Total Fiscal Benefits:	$0	$12,500	$0
Net Fiscal Benefits:	$0	$0	$0

 

*This table only includes fiscal impacts that could be measured. If there are inestimable fiscal impacts, they will not be included in this table. Inestimable impacts for State Government, Local Government, Small Businesses and Other Persons are described above. Inestimable impacts for Non - Small Businesses are described below.

 

Appendix 2: Regulatory Impact to Non - Small Businesses

This rule is not expected to impact non-small businesses as it only affects individual providers and small businesses.

 

The Executive Director of the Department of Health, Joseph K. Miner, M.D., has reviewed and approved this fiscal analysis.

 

 

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

R414-42. Telemedicine.

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.

(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.

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[.], and telepsychiatric consultations.

 

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) 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 [for determining whether]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.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: [January 1], 2018

Notice of Continuation: September 17, 2013

Authorizing, and Implemented or Interpreted Law: 26-18-13