007-33-20 Ark. Code R. § 18

Current through Register Vol. 49, No. 6, June, 2024

Rule 007.33.20-018 - XIV. Telemedicine

Arkansas Social Work Licensing Board

Emergency Telemedicine Rule

XIV. Telemedicine (Ark. Code Ann. § 17-103-309 )

A. Definitions:

1. "Distant site" means the location of the healthcare professional delivering services through telemedicine at the time the services are provided. Ark. Code Ann. § 17-80-402(1).

2. "Originating site" means a site at which a patient is located at the time healthcare services are provided to him or her by means of telemedicine. Ark. Code Ann. § 17-80-402(2).

3. "Remote patient monitoring" means the use of synchronous or asynchronous electronic information and communication technology to collect personal health information and medical data from a patient at an originating site that is transmitted to a healthcare professional at a distant site for use in the treatment and management of medical conditions that require frequent monitoring. Ark. Code Ann. & § 17-80-402(5).

4. "Store-and-forward technology" means the asynchronous transmission of a patient's medical information from a healthcare professional at an originating site to a healthcare professional at a distant site. Ark. Code Ann. § 17-80-402(6).

5. "Telemedicine" means 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-forward technology and remote patient monitoring. Ark. Code Ann. § 17-80-402(7).

B. Establishing a Social Worker/Client Relationship:

A social worker/client relationship must be established in accordance with Ark. Code Ann. §§ 17-80-402 & 403 and Rule XIV before the delivery of services via telemedicine. A client completing a psychosocial history online and forwarding it to a social worker is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology. A social worker exhibits gross negligence if he or she provides and/or recommends any form of treatment via telemedicine without first establishing a proper social worker/client relationship.

C. Minimum Requirements for a Social Worker/Client Relationship:

For the purpose of this Rule, a proper social worker/client relationship, at a minimum requires that:

1. The social worker performs an "in person" psychosocial assessment of the client adequate to establish a diagnosis and develop a treatment plan, OR

2. The social worker performs a face to face psychosocial assessment 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 psychosocial assessment, OR

3. The social worker knows the client and the client's general psychosocial issues through a previously established professional relationship; AND

4. Appropriate follow-up be provided or arranged, when necessary.

D. When a Social Worker/Client Relationship is Deemed to Exist:

For the purpose of this Rule, a proper social worker/client relationship is deemed to exist in the following situations:

1. When treatment is provided in consultation with, or upon referral by, another provider or treatment team who has an ongoing relationship with the client, and who has agreed to supervise the client's treatment, including follow up care.

2. On-call or cross-coverage situations arranged by the client's treating provider or treatment team.

E. Exceptions:

Recognizing a social worker's duty to adhere to the applicable standard of care and to comply with mandatory reporting laws, the following situations are excluded from the requirement of this rule by Ark. Code Ann. § 17-80-403(a)(2):

1. Emergency situations where the life or health of the client is in danger or imminent danger.

2. Simply providing information of a generic nature not meant to be specific to an individual client.

F. Professional Relationship Exceptions:

Under Ark. Code Ann. § 17-80-403(c), "Professional relationship" does not include a relationship between a social worker and a client established only by the following:

1. An internet questionnaire;

2. An email message;

3. Patient-generated medical history;

4. Audio-only communication, including without limitation interactive audio;

5. Text messaging;

6. A facsimile machine; or

7. Any combination thereof.

G. Requirements for Services Provided Via Telemedicine:

The following requirements apply to all services provided by social workers using telemedicine:

1. The practice of counseling via telemedicine shall be held to the same standards of care as traditional in-person encounters.

2. The social worker must obtain a detailed explanation of the client's complaint from the client or the client's treating provider or treatment team.

3. If a decision is made to provide treatment, the social worker must agree to accept responsibility for the care of the client.

4. If follow-up care is indicated, the social worker must agree to provide or arrange for such follow-up care.

5. The social worker must keep a documented treatment record, including, but not limited to psychosocial history.

6. At the client's request, the social worker must make available to the client an electronic or hardcopy version of the client's treatment record documenting the encounter. Additionally, unless the client declines to consent, the social worker must forward a copy of the record of the encounter to the client's regular treating provider or treatment team if that provider or treatment team is not the same social worker delivering the service via telemedicine.

7. Services must be delivered in a transparent manner, including providing access to information identifying the social worker's licensure and other relevant certifications, as well as client financial responsibilities, in advance of the encounter.

8. If the client, at the recommendation of the social worker, needs to be seen in person, the social worker must arrange to see the client in person or direct the client to their regular treating provider or treatment team or other appropriate provider if the client does not have a treating provider or treatment team. Such recommendation shall be documented in the client's treatment record.

9. Social workers who deliver services through telemedicine must establish protocols for referrals for emergency services.

H. Scope of Practice:

Social workers may practice social work via telemedicine within the definitions found in Ark. Code Ann. § 17-103-103.

I. Confidentiality:

Social workers who use technology to facilitate supervision, consultation, or other confidential meetings shall use appropriate precautions to protect the confidentiality of those communications. Precautions to protect confidentiality depend on the type of technology being used, and may isnclude using passwords, firewalls, encryption, and antivirus software; using electronic service providers that rely on standards of security for data that are transmitted and stored; and ensuring a private setting when using their electronic devices. See NASW, ASWB, CSWE, & CSWA Standards for Technology in Social Work Practice.

007.33.20 Ark. Code R. § 018

Adopted by Arkansas Register Volume MMXXI Number 09, Effective 3/20/2020