Arkansas Administrative Code › Agency 016 - DEPARTMENT OF HUMAN SERVICES › Division 06 - Medical Services › Rule 016.06.18-003 - Telemdeicine

Current through Register Vol. 49, No. 6, June, 2024
Section I
GENERAL POLICY
105.190
			 Telemediclne
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 patient. Telemedicine includes
				store-and-fonward technology and remote patient monitoring.
Store-and-forward technology is the transmission of a patient's
				medical infonnalion from a healthcare provider at an originating site to a
				healthcare provider at a distant site. Remote patient monitoring means the use
				of electronic infonmation and communication technology to collect personal
				health information and medical data from a patient 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 sen/ice provided through
				telemedicine is comparable to the same sen/ice 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 Ari[LESS
				THAN]ansas Medicaid directly for healthcare sen/ices. There is no facility fee
				for the distant site. The professional or entity at the distant site must be an
				enrolled Ari[LESS THAN]ansas Medicaid Provider.
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 patient unless a professional relationship exists
				between the provider and the patient. A professional relationship exists
				when:
1. The healthcare provider has
			 previously conducted an in-person examination of the patient and is available
			 to provide appropriate follow-up care;
2. The healthcare provider personally knows
			 the patient and the patient'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 relationship with the patient and who has agreed to
			 supervise the patient's treatment including follow-up care;
4. An on-call or cross-coverage arrangement
			 exists with the patient's regular treating healthcare provider or another
			 healthcare provider who has established a professional relationship with the
			 patient; or
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 tetemedicine technology that
			 provides infomiation at least equal to such information as would have been
			 obtained by an in-person examination. (See ASIVIB Regulation 2.8); or
b. If the establishment of a
			 professional relationship is pennitted 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).
A professional relationship does not include a relationship
				between a healthcare provider and a patient established only by the
				following:
1. An Internet
			 questionnaire;
2. An email
			 message;
3. A patient-generated
			 medical history;
4. Audio only
			 communication, including without limitation interactive audio;
5. Text messaging;
6. A facsimile machine (Fax) and EFax;
			 or
7. Any combination of the
			 above;
8. 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 patient.
Once a professional relationship is established, the healthcare
				provider may provide healthcare services through telemedicine, including
				Interactive audio, if the healthcare sen/ices 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. The use of interactive audio is not reimbursable under Arl[LESS
				THAN]ansas Medicaid.
Telemedicine with a Minor
Regardless of whether the individual is compensated for
				healthcare services, if a healthcare provider seeks to provide telemedicine
				services to a minor in a school setting and the minor is enrolled in Arkansas
				Medicaid, the healthcare provider shall:
1. Be the designated Primary Care Provider
			 (PCP) for the minor;
2. Have a
			 cross-coverage an-angement with the designated PCP of the minor; or
3. Have a referral from the designated PCP of
			 the minor.
If the minor does not have a designated PCP, this section does
				not apply. Only the parent or legal guardian of the minor may designate a PCP
				for a minor.
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. infomied consent;
2. Privacy of individually identifiable
			 health information,
3. Medical
			 record keeping and confidentiality, and
4. Fraud and abuse.
A healthcare provider treating patients 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.