Rule 15-19-60-8.1.5 - Requirements to Provide TelehealthTelehealth is a mode of service delivery for the provision of occupational therapy services delivered by an occupational therapy practitioner to a client at a different physical location using telecommunications or information technology. Telehealth, in this rule, refers only to the practice of occupational therapy by occupational therapy practitioners who are licensed by this Board with clients who are located in Mississippi at the time of the provision of occupational therapy services. Telehealth may be known by other terms including but not limited to telemedicine, telepractice, telecare, telerehabilitation, and e-health services. Occupational therapy practitioners must have direct contact with the client for the duration of the intervention session via telehealth using synchronous audiovisual technology. Other telecommunications or information technology may be used to aid in the intervention session but may not be the primary means of contact or communication.
1. Practice requirements: a. An occupational therapist using telehealth technologies to deliver health-care services to a patient must, prior to diagnosis and treatment, establish a providerpatient relationship by one of the following methods:i. The occupational therapist has previously conducted an in-person examination for the current condition requiring treatment and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;ii. The occupational therapist personally knows the patient and the patient's relevant health status through an ongoing personal or professional relationship and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;iii. The treatment is provided by an occupational therapist in consultation with or upon referral by, another occupational therapist who has an ongoing relationship with the patient and who has agreed to supervise the patient's treatment, including follow-up care;iv. An on-call or cross-coverage arrangement exists with the patient's regular treating occupational therapist who has established a professional relationship with the patient.b. An appropriate occupational therapy evaluation may be composed of multiple components, tests, or measurement tools. It is the responsibility of the evaluating occupational therapist to select and utilize evaluation components that are appropriate and reliable to administer via telehealth.c. Telehealth services are to be provided based on the patient/client's needs and only if treatment delivery via telehealth is determined to be an appropriate/safe/effective means of delivering occupational therapy services for the patient/client's condition subject to the same standard of care or practice standards as are applicable to in person settings. If telehealth services would not be consistent with this standard of care, the occupational therapist shall direct the patient to seek in-person care. Clinical reasoning for providing occupational therapy via telehealth must be documented at the onset of treatment in the patient/client's record. Telehealth is not appropriate if the decision to deliver treatment is solely for the practitioner's convenience and not based upon the individual needs of the patient.d. If a licensee determines, either before or during the provision of occupational therapy services, that services cannot be provided through telehealth in a manner that is consistent with in-person standards of care, the licensee shall not provide or supervise services through telehealth. In making the determination of whether services should be performed in-person or via telehealth, the licensee shall consider at a minimum: i. The complexity of the patient's condition;ii. The licensee's knowledge, skills, and abilities;iii. The patient's environment and resources;iv. The nature and complexity of the required intervention; andv. The capacity and quality of the technological interface availablee. Occupational therapy assistants working under general supervision, as defined in Rule 8.10.1, can provide services via telehealth. Telehealth cannot be used when direct supervision, as defined in Rule 8.10.2,(1), (3), is required (i.e. Limited Permit holders, students, aides).f. An employer may not require a practitioner, by an employment contract, an agreement, a policy, or any other means, to provide a health care service through telehealth if the practitioner believes that providing occupational therapy services through telehealth would: i. negatively impact the patient's health; orii. result in a lower standard of care than if the occupational therapy service was provided in an in-person setting.2.Patient Identity and Communication. The occupational therapist/occupational therapy assistant using telehealth to deliver occupational therapy services or who practices telehealth services, upon an initial contact with the patient shall: a. Verify the identity of the patient prior to each session;b. Obtain alternative means of contacting the patient;c. Arrange for the patient to have alternative means of contacting the occupational therapist or occupational therapy assistant;d. Provide contact methods of alternative communication the occupational therapist or occupational therapy assistant shall use for emergency purposes;e. Use personal identifying information only in secure communications;f. Obtain written, informed consent from the patient or other appropriate person with authority to make health care treatment decisions for the patient before services are provided through telehealth3.Informed Consent. The informed consent shall, minimally, inform the patient and document acknowledgment of the risk and limitations and potential benefits associated with:a. The use of electronic communications in the provision of occupational therapy;b. The potential breach of confidentiality, or inadvertent access, of protected health information using electronic communication in the provision of occupational therapy;c. The potential disruption of electronic communication in the use of telehealth;d. Video-taping and recording of treatment session.4.Confidentiality. The licensee shall ensure that the electronic communication is secure to maintain confidentiality of the patient's medical information as required by the Health Insurance Portability and Accountability Act (HIPAA) and other applicable Federal and State laws. Confidentiality shall be maintained through appropriate processes, practices, and technology, including disposal of electronic equipment and data.5.Competence and Scope of Practice. A licensee using electronic communication to deliver occupational therapy services or who practices telehealth services shall: a. Be responsible for determining and documenting that telehealth is appropriate for provision of occupational therapy;b. Limit the practice of telehealth services to the area of competence in which proficiency has been gained through education and training;c. Ensure that confidential communications obtained and stored electronically shall not be recovered and accessed by unauthorized persons when the occupational therapist or occupational therapy assistant disposes of electronic equipment and data by use of a secure telecommunication mechanism;d. Assure the technology proficiency of those involved in patient care.6.Maintenance and Retention of Records. The licensee shall document in the file or record which services were provided by telehealth and adhere to the record-keeping requirements as outlined in section 7 of this rule.7.Documentation Requirements for telehealth.a. A written record of occupational therapy treatment shall be maintained for each patient and shall include:i. A prescription or referral when required showing the written request for occupational therapy evaluation or treatment signed by a healthcare provider lawfully authorized to make such request;ii. The clinical reasoning for providing occupational therapy via telehealthiii. Written documentation in each patient's record, along with the occupational therapist's signature, of the treatment program goals and plan of care. An initial occupational therapy evaluation shall not be documented or signed by an occupational therapy assistant or any other personnel;iv. Progress notes regarding the client's or patient's subjective status, changes in objective findings, and progression or regression toward established goals;v. A record of the reassessment or re-evaluation of the patient or client, written and signed by the supervising occupational therapist;vi. Written documentation of each patient or client visit which includes specific treatment and services provided;vii. Written documentation of supervisory visits and/or conferences including: treatment plans and/or changes in the treatment plan; other communications between the supervising occupational therapist and the occupational therapy assistant; and findings or subsequent decisions made. The written documentation must be signed and dated by the supervising occupational therapist or the occupational therapy assistant;viii. Documentation of a discharge evaluation by the supervising occupational therapist and a discharge summary which must be written and signed by the supervising occupational therapist. If the supervising occupational therapist is unable to provide a patient discharge evaluation and plan, the reason for or circumstances of such inability must be documented in the occupational therapy treatment record; andix. Accurate patient or client treatment and billing records.b. A signature stamp shall not be used in lieu of a written signature on occupational therapy patient or client records. Forms of electronic signatures, established pursuant to written policies and procedures to assure that only the author can authenticate his or her own entry, may be acceptable.15 Miss. Code. R. 19-60-8.1.5
Miss. Code Ann. § 73-24-13