Utah Telehealth State Laws & Reimbursement Policies

Medicaid Telehealth Reimbursement

Summary

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.”

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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.”

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Live Video

Policy
Providers are eligible for reimbursement under Utah’s Medical Assistance Program.

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Eligible Services/Specialties
Click to view list of eligible services.

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Eligible Providers
Rural health clinic and federally qualified health clinic services may be delivered via telemedicine.

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Eligible Sites
Geographic Limits
Facility/Transmission Fee
The provider at the originating site receives no additional reimbursement for the use of telemedicine.

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Store-and-Forward

Policy
Utah Medicaid defines telemedicine as “two-way, real time interactive communication” excluding store-and-forward from the definition.

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Eligible Services/Specialties
Geographic Limits
Transmission Fee

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.

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Conditions
Only for patients with a long-term cardiac health issue.

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Provider Limitations
Test must be ordered by a neurologist and reviewed and interpreted by a cardiologist.

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Other Restrictions

Email/Phone/Fax

Consent

Out of State Providers

Miscellaneous

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.”

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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.

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Parity

Professional Regulation/Health & Safety

Definitions

Consent

Online Prescribing

Before providing treatment or prescribing a prescription drug, provider must obtain and document patient's relevant clinical history and current symptoms.

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Cross State Licensing

An out-of-state physician may practice without a Utah license under certain circumstances. Click to see criteria.

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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.

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Source: Center for Connected Health Policy
https://www.cchpca.org

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