Telehealth and telesupervision for ABA in Kentucky

Yes.

Licensed Behavior Analyst

Kentucky Applied Behavior Analysis Licensing Board

KRS 319C.020 and KRS 319C.080 (2010 Ky. Acts ch. 150, effective July 15, 2010); board created by KRS 319C.030; penalty in KRS 319C.990. Application, temporary license, fees, and renewal: 201 KAR 43:010, 43:020, 43:030, and 43:080 (history: 48–49 Ky.R.; effective October 4, 2022). KRS 319C.020(1) bars practicing applied behavior analysis, assisting in that practice, rendering services designated as applied behavior analysis, or holding oneself out as an ABA practitioner in Kentucky without a Chapter 319C license, and bars the titles "licensed behavior analyst" and "licensed assistant behavior analyst" (or a substantially similar title) without board licensure. KRS 319C.990: fine of not less than $100 and not more than $1,000 per violation of KRS 319C.020(1). KRS 319C.080(1) requires BCBA education standards, a passed BCBA examination, an active certification-board BCBA credential, and continued BCBA renewal/recertification. KRS 319C.020(2) exemptions: ABA services in a public school setting; implementing ABA intervention for an immediate family member or as a supervisee; persons licensed, certified, or registered under other Kentucky health or allied-health statutes (including students in those accredited programs); and persons providing applicable Medicaid waiver services.

Licensed behavior analyst (BCBA path), 201 KAR 43:030 §1 (eff. 10-4-2022): $400 combined application-review and licensure fee for the first two-year period; $300 renewal for each later two-year period. A licensed assistant behavior analyst, temporary licensed behavior analyst, or temporary licensed assistant behavior analyst upgrading to licensed behavior analyst for the remainder of a current two-year period pays a nonrefundable $100 application-review fee. 201 KAR 43:080 §1: renew biennially on or before the last day of the calendar month in which the license was issued, on Form ABA-004, plus the renewal fee. Late renewal through the last day of the next calendar month adds $50 (201 KAR 43:030 §6(1); 201 KAR 43:080 §2). If not renewed by then, the license expires and the person shall not practice in Kentucky (201 KAR 43:080 §3). Reinstatement after that date: $250 plus the applicable renewal fee, Form ABA-004, and documentation of employment from expiration to the present (201 KAR 43:030 §6(2); 201 KAR 43:080 §4). 201 KAR 43:010: Form ABA-001, copy of the degree, proof of KRS 319C.080(1) education/exam/BCBA credential, and at least 5 hours of training in adult abuse and neglect, child abuse/neglect/dependency, or a combination, with proof that abuse, neglect, or dependency was explicitly covered. Board FAQ revised 12/2022: applications are reviewed at board meetings, usually once a month; no regulatory decision deadline was found. Temporary behavior-analyst license (coursework done and accumulating BACB experience; not a BCBA license): $300 for a two-year period, one renewal at $200, and the temporary license expires two years from issuance and may be renewed only once (201 KAR 43:030 §3; 201 KAR 43:020 §1(a)(3)). Denied applicants may request a 50% refund of the application and licensure review fee in writing within 90 days (201 KAR 43:030 §7).

We could not verify this yet - check with the state Medicaid agency or licensing board.

Licensure and consent: KRS 319C.140 (eff. 7-15-2010) requires a treating behavior analyst or assistant behavior analyst who provides or facilitates telehealth to obtain informed consent before telehealth services and to keep medical information confidential. Its definition of telehealth is interactive audio, video, or other electronic media for diagnosis, consultation, treatment, data transfer, and continuing education. 201 KAR 43:100 Section 1 requires technology competence (including effects on clients and supervisees), compliance with KRS Chapter 319C and 201 KAR Chapter 43, local emergency contacts at the start of telehealth, confidentiality, and lawful disposal of data. If care starts by telehealth, the initial meeting must include reasonable identity verification, non-electronic contact methods both ways, documentation that the client has the knowledge and skills to benefit, and written informed consent covering technology limits, confidentiality risks, disruption risk, response to routine electronic messages, emergency communications, who else may access communications, how to reach a specific licensee, how electronic communications are stored, and that either party may stop telehealth at any time. Section 2: anyone providing ABA by telehealth to a person physically in Kentucky must be licensed by the board; anyone providing it from a physical location in Kentucky must be licensed by the board and may also need the license of the state where the client is. Section 3 prohibits false advertising and fee-splitting. The 10-4-2022 amendment deleted the former requirement of an initial in-person meeting. Statewide telehealth, KRS 211.332 (eff. 6-29-2021) and KRS 205.510(16), includes synchronous and asynchronous technology, remote patient monitoring, and audio-only, by a health care provider at a different location, over a HIPAA-secure connection unless federally waived. It excludes email, text, chat, and fax unless a telehealth agency finds those modalities safe, and it excludes scheduling and similar basic messages. KRS 211.332(3)(b) names the Kentucky Applied Behavior Analysis Licensing Board as a professional licensure board. Medicaid: 907 KAR 3:170 applies to fee-for-service and to managed care organizations (MCOs), including Kentucky Children's Health Insurance Program coverage. Place of service is anywhere the patient is, including home, office, clinic, school, or workplace. A new patient and an initial visit may be synchronous telehealth unless the licensing board prohibits it. Reimbursement is at least 100 percent of the comparable in-person rate; an MCO and a provider may contract a different rate (Section 4(1) and KRS 205.5591(3)(a)1, eff. 7-14-2022). Telehealth must be denoted by place of service or another method the Department for Medicaid Services or the MCO contract designates. The rendering provider must be physically in the United States or a U.S. territory. Within 48 hours of reconciling the record, the chart must state the service was telehealth. Audio-only is payable, but if a telephonic code exists for the same or similar service the department pays the lower of the two rates; a visit that drops to telephone because of technology failure is paid as the telehealth encounter. Store-and-forward is limited to listed specialties and evidence-based uses; ABA is not named. A licensed behavior analyst may order remote patient monitoring for listed conditions, including mental illness or serious emotional disturbance; that is not ABA treatment. KRS 205.5591 and KRS 205.559: Medicaid and MCOs must pay for a covered telehealth service by a participating practitioner at a different physical location; they cannot require an in-state physical address for a provider or group that exclusively uses telehealth; fax, text, chat, and email are not reimbursable unless the department determines otherwise. The ABA subsections do not set an age cap, hour cap, or visit cap. 907 KAR 15:010 Section 4(3) generally withholds payment if no diagnosis is documented within three visits; screening, assessment, crisis intervention, and specified emergency-department peer support are excepted. Direct contact is required for each service except listed collateral, family, testing-feedback, and service-planning codes in which the recipient is not present (Section 1(2)). A practitioner-under-supervision note must be co-signed within 30 days. Private autism coverage: KRS 304.17A-142 (eff. 1-1-2019) requires health benefit plans issued or renewed on or after that date to cover diagnosis and treatment of autism spectrum disorders, including ABA prescribed or ordered by a licensed health or allied health professional. There is no maximum annual dollar limit and no visit limit. Cost sharing may not be less favorable than for other medical services. Utilization review of non-inpatient treatment may not be requested more than once every 12 months unless the insurer and the individual's licensed physician, licensed psychologist, or licensed psychological practitioner agree that more frequent review is necessary. No reimbursement is required for services by persons not licensed as required by law. The mandate does not itself address modality.

Yes. Commercial: KRS 304.17A-138 (eff. 7-14-2022) requires a health benefit plan issued or renewed on or after 1-1-2022 to reimburse covered services delivered by telehealth, including by a home health agency, equivalent to the same service in person unless the telehealth provider and the plan contract a lower rate. 'Equivalent' means the amount that would have been paid had that provider furnished the service in person at the provider's place of service. Deductible, copayment, and coinsurance may not exceed the in-person amount. The plan may not require the provider to be physically present unless the provider determines an in-person service is necessary; may not require prior authorization, medical review, or administrative clearance that would not apply in person; may not require proof that telehealth is necessary; may not restrict or deny coverage based solely on the technology or application; and may not require a telehealth network. Audio-only is encouraged only when no other approved mode is available, and coding audits of audio-only encounters are allowed. The section's 'provider' definition is KRS 304.17A-005 plus behavioral health professionals licensed under KRS Chapters 309, 319, and 335. It does not name KRS Chapter 319C. 806 KAR 17:580 (eff. 11-30-2021) adds only a KRS Chapter 315 pharmacy to that provider definition. Medicaid: KRS 205.5591(1) and (3)(a) use that same 'equivalent' standard, at least 100 percent under 907 KAR 3:170 Section 4(1)(a), unless the department or an MCO contracts a lower rate. KRS 205.5591(4) bars Medicaid and MCOs from requiring physical presence unless the provider determines it is medically necessary, from extra prior authorization, from an employment relationship not required in person, from proof that telehealth is necessary, from technology-only denials, and from requiring a telehealth network.

No board rule requires an initial in-person ABA visit. That requirement was removed effective 10-4-2022. KRS 205.5591(4)(a) and KRS 304.17A-138(3)(a)1 prohibit Medicaid, MCOs, and health benefit plans from requiring the provider to be physically with the patient unless the provider determines the service must be in person. 907 KAR 3:170 Section 3(1)(a) makes its telehealth rules supersede in-person requirements elsewhere in KAR Title 907, except an in-person requirement in state or federal law (including the state plan or a waiver), a professional criterion such as ASAM where applicable, a licensing body, or a department-utilized procedure-code descriptor. If the patient is offered only asynchronous or audio-only telehealth, the patient may request an in-person or synchronous audio-video visit, and the provider must offer an alternative within a reasonable time and no later than three weeks, subject to schedule availability and sooner if the condition requires it (Section 2). The request is recorded in the medical record. KRS 205.559(3)(a) allows, and does not require, a facility quality protocol to include an annual in-person or face-to-face visit. KRS 205.559(4) says the cabinet shall not require telehealth when a reasonably available in-person visit exists where the patient lives, works, or attends school, or when the patient prefers in person. The Medicaid rendering provider must be in the United States or a U.S. territory. The licensing-body exception that does require in-person contact is direct supervision of a licensed supervisee, described below. No Medicaid ABA age or hour minimum for in-person treatment was found.

201 KAR 43:050 (LRC current text; filed with LRC 6-14-2022; 7-year expiration listed as 10/4/2029) defines direct supervision as in-person interaction with the licensee that includes direct observation of actual service, and general supervision as real-time visual and auditory contact, in person or by electronic means. For an LABA, temporary LBA, or temporary LABA with fewer than five years of full-time post-certification practice (1,500 hours equals one year) or with a temporary license, the supervisor must provide general supervision at least twice per month and direct (in-person) supervision at least once every three months. For an LABA with more than five years, general supervision is at least once per month and direct supervision at least twice a year. Those duties run even if the LABA is not currently providing services, unless the board has granted inactive status. The supervisor must be a Kentucky LBA in good standing who has completed Behavior Analyst Certification Board supervision training shown on the BACB certificant registry. Supervisory-session records (type, place, and general content) are kept at least seven years. KRS 319C.010(10) defines a supervisee as an unlicensed person acting under the extended authority and direction of an LBA or LABA. KRS 319C.020(2)(b) exempts a supervisee who is implementing ABA intervention services from the chapter. 201 KAR 43:050 Section 1(4) requires a paraprofessional to practice under the direction and close supervision of an LBA or an LABA qualified to supervise. The direct- and general-supervision definitions are written as contact with 'the licensee,' and the regulation sets no percentage, monthly contact minimum, or video-versus-in-person rule for RBT or other paraprofessional supervision. Medicaid allows the RBT to furnish ABA support services only under an appropriate practitioner in 907 KAR 15:010 Section 3(3)(r)4 and the parallel 907 KAR 15:020 paragraph, and 907 KAR 3:170 Section 3(2)(b) conditions telehealth on the licensing board of the delivering or supervising provider not prohibiting it. Notes by a practitioner under supervision must be co-signed within 30 days. A proposed amendment, 201 KAR 43:050REG, was filed with LRC on 8-11-2026 and is not effective; the text reviewed did not change the in-person definition of direct supervision.