Kentucky expands Medicaid reimbursement for telehealth services, but lets managed-care firms keep authority over fees

By Molly Burchett
Kentucky Health News

Recent changes in Kentucky's telehealth regulations are making it easier for providers around the state and country to deliver health-care services to Medicaid patients, thus improving access to specialty care for many patients in Kentucky's rural areas. But the amount of their reimbursement can still be determined by Medicaid managed-care companies.

Patients in rural Kentucky sometimes need the care of a specialist not in their home community, and programs like the University of Kentucky’s telehealth program and the statewide Kentucky TeleHealth Network use videoconference tools to bring these physicians to the patients.

Kentucky has been among the leading states for driving reimbursement of telehealth services. As of July 2012, it was one of the 13 states requiring some level of private insurance coverage of telehealth. It is also one of the 15 states that requires reimbursement from Medicaid for some services, which are mostly mental-health and specialty services.
The new regulation expands the types of services eligible for Medicaid reimbursement. While the Kentucky TeleHealth Network has been operating since 2000, the old regulations limited the use of this type of technology, Rob Sprang, director of Kentucky TeleCare and chair of the state's Telehealth Board, told Greg Stotelmyer of Public News Service. "The previous regulations were very restrictive on who could see a patient on television, what services they could deliver on TV, and where those services could be delivered," he said.

The new rules lift restrictions on both the type and number of services covered by Medicaid. A much longer list of providers can be reimbursed for telehealth services, "including people like social workers, speech language pathologists, physical therapists, occupational therapists, a very broad group of providers outside of just physicians," said Sprang.

The regulation also includes certain services provided by a physician, psychiatrist, nurse practitioner, psychologist, dietitian and certified nutritionist. To provide telehealth services in Kentucky, a provider has to be approved for membership in the Kentucky Telehealth Network.

Reimbursement is technically the same as the amount paid for face-to-face services, but the regulation says managed-care firms are not required to reimburse those amounts. Thus, the role that telehealth will play in Kentucky could depend on how much the companies and the state decide to pay for it.

Still, the Foundation for a Healthy Kentucky has endorsed these changes to telehealth coverage and reimbursement, saying "it has the potential to help make quality specialty health services more accessible throughout Kentucky," reports Stotelmyer.

Telehealth will play a big role in health reform, said Sprang. "It's not rocket science," he told Stotelmyer. "You know, if you look at where providers are located today, there are no nephrologists, no kidney doctors, in most of our small communities. There are no child psychiatrists, there are no psychiatrists. There's so many medical specialties that are not available in our rural communities."

A recent report by Deloitte Consulting recommends increasing reimbursement for telehealth to address the state's doctor shortage problem, and that reimbursement needs to include primary care. "Given the potential benefits of using technologies such as telehealth to reach rural areas, where Medicaid populations can be large, the lack of Medicaid reimbursement for primary care could be a barrier to the overall effectiveness of Kentucky’s current and future investments in telehealth," says the report, which was released before the new regulations were issued.
Kentucky expands Medicaid reimbursement for telehealth services, but lets managed-care firms keep authority over fees | Admin | 5