Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 27 - Department of Medical Services › Rule 016.27.21-006 - Section I-1-21 Telemedicine

Current through Register Vol. 49, No. 6, June, 2024
105.190
Telemedicine
1-1-22
Telemedicine is defined as the use of electronic information
				and communication technology to deliver healthcare services including without
				limitation, the assessment, diagnosis, consultation, treatment, education, care
				management, and self-management of a client. Telemedicine includes
				store-and-forward technology and remote client monitoring.
Store-and-forward technology is the transmission of a client's
				medical information from a healthcare provider at an originating site to a
				healthcare provider at a distant site. An originating site includes the home of
				a client. Remote client monitoring means the use of electronic information and
				communication technology to collect personal health information and medical
				data from a client at an originating site that is transmitted to a healthcare
				provider at a distant site for use in the treatment and management of medical
				conditions that require frequent monitoring.
Arkansas Medicaid shall provide payment to a licensed or
				certified healthcare professional or a licensed or certified entity for
				services provided through telemedicine if the service provided through
				telemedicine is comparable to the same service provided in person. Payment will
				include a reasonable facility fee to the originating site operated by a
				licensed or certified healthcare professional or licensed or certified
				healthcare entity if the professional or entity is authorized to bill Arkansas
				Medicaid directly for healthcare services. There is no facility fee for the
				distant site. The professional or entity at the distant site must be an
				enrolled Arkansas Medicaid Provider. Any other originating sites are not
				eligible to bill a facility fee.
Coverage and reimbursement for services provided through
				telemedicine will be on the same basis as for services provided in person.
				While a distant site facility fee is not authorized under the Telemedicine Act,
				if reimbursement includes payment to an originating site (as outlined in the
				above paragraph), the combined amount of reimbursement to the originating and
				distant sites may not be less than the total amount allowed for healthcare
				services provided in person.
Professional Relationship
The distant site healthcare provider will not utilize
				telemedicine services with a client unless a professional relationship exists
				between the provider and the client. A professional relationship exists when,
				at a minimum:
1. The healthcare
			 provider has previously conducted an in-person examination of the client and is
			 available to provide appropriate follow-up care;
2. The healthcare provider personally knows
			 the client and the client's health status through an ongoing relationship and
			 is available to provide follow-up care;
3. The treatment is provided by a healthcare
			 provider in consultation with, or upon referral by, another healthcare provider
			 who has an ongoing professional relationship with the client and who has agreed
			 to supervise the client's treatment including follow-up care;
4. An on-call or cross-coverage arrangement
			 exists with the client's regular treating healthcare provider or another
			 healthcare provider who has established a professional relationship with the
			 client;
5. A relationship exists in
			 other circumstances as defined by the Arkansas State Medical Board (ASMB) or a
			 licensing or certification board for other healthcare providers under the
			 jurisdiction of the appropriate board if the rules are no less restrictive than
			 the rules of the ASMB.
a. A professional
			 relationship is established if the provider performs a face to face examination
			 using real time audio and visual telemedicine technology that provides
			 information at least equal to such information as would have been obtained by
			 an in-person examination. (See ASMB Regulation 2.8);
b. If the establishment of a professional
			 relationship is permitted via telemedicine under the guidelines outlined in
			 ASMB regulations, telemedicine may be used to establish the professional
			 relationship only for situations in which the standard of care does not require
			 an in-person encounter and only under the safeguards established by the
			 healthcare professional's licensing board (See ASMB Regulation 38 for these
			 safeguards including the standards of care); or
6. The healthcare professional who is
			 licensed in Arkansas has access to a client's personal health record maintained
			 by a healthcare professional and uses any technology deemed appropriate by the
			 healthcare professional, including the telephone, with a client located in
			 Arkansas to diagnose, treat, and if clinically appropriate, prescribe a
			 noncontrolled drug to the client.
A health record is created with the use of telemedicine,
				consists of relevant clinical information required to treat a client, and is
				reviewed by the healthcare professional who meets the same standard of care for
				a telemedicine visit as an in-person visit.
A professional relationship does not include a relationship
				between a healthcare provider and a client established only by the
				following:
1. An internet
			 questionnaire;
2. An email
			 message;
3. A client-generated
			 medical history;
4. Text
			 messaging;
5. A facsimile machine
			 (Fax) and EFax;
6. Any combination
			 of the above; or
7. Any future
			 technology that does not meet the criteria outlined in this section.
The existence of a professional relationship is not required
				when:
1. An emergency situation
			 exists; or
2. The transaction
			 involves providing information of a generic nature not meant to be specific to
			 an individual client.
Once a professional relationship is established, the healthcare
				provider may provide healthcare services through telemedicine, including
				interactive audio, if the healthcare services are within the scope of practice
				for which the healthcare provider is licensed or certified and in accordance
				with the safeguards established by the healthcare professionals licensing
				board.
Telemedicine with a Minor Client
Regardless of whether the provider is compensated for
				healthcare services, if a healthcare provider seeks to provide telemedicine
				services to a minor in a school setting and the minor client is enrolled in
				Arkansas Medicaid, the healthcare provider shall:
1. Be the designated Primary Care Provider
			 (PCP) for the minor client;
2. Have
			 a cross-coverage arrangement with the designated PCP of the minor client;
			 or
3. Have a referral from the
			 designated PCP of the minor client.
If the minor client does not have a designated PCP, this
				section does not apply. Only the parent or legal guardian of the minor client
				may designate a PCP for a minor client.
Telemedicine Standard of Care
Healthcare services provided by telemedicine, including without
				limitation a prescription through telemedicine, shall be held to the same
				standard of care as healthcare services provided in person. A healthcare
				provider providing telemedicine services within Arkansas shall follow
				applicable state and federal laws, rules and regulations regarding:
1. Informed consent;
2. Privacy of individually identifiable
			 health information;
3. Medical
			 record keeping and confidentiality, and
4. Fraud and abuse.
A healthcare provider treating clients in Arkansas through
				telemedicine shall be fully licensed or certified to practice in Arkansas and
				is subject to the rules of the appropriate state licensing or certification
				board. This requirement does not apply to the acts of a healthcare provider
				located in another jurisdiction who provides only episodic consultation
				services.
Telemedicine Exclusions
Telemedicine does not include the use of:
1. Audio-only communication unless the
			 audio-only communication is in real-time, is interactive, and substantially
			 meets the requirements for a health care service that would otherwise be
			 covered by the health benefit plan:
a.
			 Documentation of the engagement between patient and provider via audio-only
			 communication shall be placed in the medical record addressing the problem,
			 content of the conversation, medical decision-making, and plan of care after
			 the contact;
b. Medical
			 documentation is subject to the same audit and review process required by
			 payers and governmental agencies when requesting documentation of other care
			 delivery such as in-office or face-to-face visits;
2. A facsimile machine;
3. Text messaging; or
4. Email.