Utah Medicaid reimburses for live video. Store-and-forward is not reimbursable as telehealth is required to be a “two-way, real time interactive connection.”
Telemedicine in your state
Utah Telehealth State Laws & Reimbursement Policies
Medicaid Telehealth Reimbursement
Summary
Definitions
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.”
Live Video
Policy
Providers are eligible for reimbursement under Utah’s Medical Assistance Program.
Eligible Services/Specialties
Click to view list of eligible services.
Eligible Providers
Rural health clinic and federally qualified health clinic services may be delivered via telemedicine.
Eligible Sites
No reference found.
Geographic Limits
No reference found.
Facility/Transmission Fee
The provider at the originating site receives no additional reimbursement for the use of telemedicine.
Store-and-Forward
Policy
Utah Medicaid defines telemedicine as “two-way, real time interactive communication” excluding store-and-forward from the definition.
Eligible Services/Specialties
No reference found.
Geographic Limits
No reference found.
Transmission Fee
No reference found.
Remote Patient Monitoring
Policy
Bulletin indicates The Skilled Nursing Pilot Project has been removed from manual, however it is still listed in the Home Health Services manual, as of their last update in Aug. 2017. See Home Health Services Manual for details.
Conditions
Only for patients with a long-term cardiac health issue.
Provider Limitations
Test must be ordered by a neurologist and reviewed and interpreted by a cardiologist.
Other Restrictions
No reference found.
Email/Phone/Fax
No reference found.
Consent
No reference found.
Out of State Providers
No reference found.
Miscellaneous
No reference found.
Private Payer Laws
Definitions
“Digital health service means the electronic transfer, exchange, or management of related data for diagnosis, treatment, consultation, educational, public health, or other related purposes.”
Requirements
All health insurance plans must disclose whether the insurer provides coverage for telehealth services in accordance with section 26-18-13.5 and terms associated with that coverage.
Parity
No service parity.
Professional Regulation/Health & Safety
Definitions
No reference found.
Consent
No reference found.
Online Prescribing
Before providing treatment or prescribing a prescription drug, provider must obtain and document patient’s relevant clinical history and current symptoms.
Cross State Licensing
An out-of-state physician may practice without a Utah license under certain circumstances. Click to see criteria.
Miscellaneous
If a hospital participates in telemedicine, it shall develop and implement policies governing the practice of telemedicine in accordance with the scope and practice of the hospital.