United States: Telehealth Reform: Coverage Expansion, Reimbursement Criteria Will Improve Access To Care

Last Updated: July 2 2018
Article by Sarah Cronan Spurlock and Ozair M. Shariff

Technology advancements have had a significant impact on the way healthcare is delivered, particularly to patients in rural areas and to those with restricted access to medical care.

Medical providers use technology to remotely monitor patients, prescribe medications and provide a wide range of preventive medical services, in some cases, reducing the frequency of office visits and enabling more effective care management options for patients with chronic illnesses.

A provider's use of technology to deliver healthcare to a patient in another location—commonly known as telemedicine or telehealth—is not new to Kentucky. Historically, however, Medicare and Kentucky Medicaid programs have not reimbursed providers for this type of medical service, or limited reimbursement to very narrow circumstances, posing a significant obstacle to the use and expansion of telemedicine.

Telehealth Reform Bill

In April 2018, Kentucky passed SB 112, a telehealth reform bill expanding Medicaid and insurance coverage and reimbursement for Kentucky-licensed providers who deliver healthcare services to Kentucky residents using telehealth technology.

Sponsor Senator Ralph Alvarado explained that SB 112 will positively impact healthcare delivery as it "allows providers to implement cost-saving strategies such as video conference follow-ups and remote patient monitoring that decreases hospitalizations and increases the quality of care." The bill takes effect July 1, 2019.

SB 112 defines telehealth as the "delivery of healthcare-related services by a healthcare provider who is licensed in Kentucky to a patient or client through a face-to-face encounter with access to real-time interactive audio and video technology or store and forward services that are provided via asynchronous technologies as the standard practice of care where images are sent to a specialist for evaluation."

The bill further states that the requirement for a face-to-face encounter is satisfied with the use of asynchronous telecommunications technologies where the provider has access to the patient's medical history prior to the telehealth encounter. As such, this definition of telehealth allows for the use of both real-time interactive video encounter between a patient and provider in different locations as well as store and forward platforms where an image (such as a radiology film) is created and stored in one location and forwarded for clinical evaluation to a specialist in another location.

By contrast, the delivery of services through email, text chat, facsimile or standard audio-only telephone call do not qualify as telehealth services. The bill prohibits the use of telehealth for the performance of an abortion, specifying that a physician performing or inducing an abortion must be present in person and in the same room with the patient.

Reimbursement Provisions

In addition to defining what qualifies as telehealth, SB 112 sets forth important provisions impacting reimbursement for these services, specifically:

  • Requiring Medicaid, Medicaid managed care organizations and other health plans to reimburse for covered services provided through telehealth.
  • Providing that payors must require a telehealth provider to be licensed in Kentucky to receive reimbursement.
  • Establishing telehealth payment parity requirements, ensuring that reimbursement rates for telehealth services are equal to the rates paid by health plans for those same services that are delivered in person.

Additionally, the bill prohibits Medicaid, Medicaid managed care organizations and health plans from taking certain actions relating to telehealth, including:

  • Restricting reimbursements by requiring provider to be physically present with patients.
  • Requiring prior authorization, or imposing other restrictions for telehealth services that would otherwise not be required for services provided in person.
  • Requiring a demonstration that telehealth is necessary.
  • Restricting coverage solely based on the technology used to deliver telehealth services.
  • Requiring that a provider be a part of a telehealth network to be reimbursed for the services.

Providers interested in providing care via telehealth should consider their ethical obligations and professional licensure requirements in this context, particularly with respect to the physician-patient relationship, patient safety and patient confidentiality.

The Kentucky Board of Medical Licensure addressed telehealth practice considerations in a 2014 Board Opinion "Regarding the Use of Telemedicine Technologies in the Practice of Medicine."

The Board Opinion provides guidance on various topics that will be of interest to physicians, including:

  • Determining when a physician-patient relationship is established.
  • Proper evaluation and treatment
  • Obtaining informed consent
  • Referrals for emergency services
  • Privacy and security of patient information
  • Prescribing

When considering telehealth technology, providers should also note that SB 112 requires telehealth services to be delivered using a secure communications connection that complies with HIPAA.

Ensuring a secure communication is used to provide telehealth services is also an important component of a provider's legal and ethical duty to maintain patient confidentiality, as transmitted images and telehealth encounters may otherwise be vulnerable to eavesdropping by a third party.

Originally published by Medical News | The business of healthcare

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Similar Articles
Relevancy Powered by MondaqAI
In association with
Related Topics
Similar Articles
Relevancy Powered by MondaqAI
Related Articles
Related Video
Up-coming Events Search
Font Size:
Mondaq on Twitter
Mondaq Free Registration
Gain access to Mondaq global archive of over 375,000 articles covering 200 countries with a personalised News Alert and automatic login on this device.
Mondaq News Alert (some suggested topics and region)
Select Topics
Registration (please scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.


The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.


Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions