Okla. Admin. Code § 340:100-3-41

Current through Vol. 42, No. 4, November 1, 2024

Section 340:100-3-41 - Telehealth

(a)Applicability and scope. Telehealth services do not expand services covered through Developmental Disabilities Services (DDS) Home and Community-Based Services (HCBS) waivers. Telehealth services are a delivery option for certain covered services. Telehealth services apply to contract professional services, including speech therapy, physical therapy, occupational therapy, audiology, psychology, nutrition, family training, family counseling, nursing, and dental care.

(1) When there are technological difficulties in performing an objective or a thorough assessment, or there are problems in the service recipient's understanding of telehealth, hands-on-assessment, in-person care, or both is provided for the service recipient.

(2) Any service delivered using telehealth technology is appropriate for telehealth delivery and meets the same quality level and is otherwise on par with the same service delivered in person.

(3) A telehealth encounter maintains the confidentiality and security of protected health information in accordance with applicable state and federal law, including, but not limited to, Section 1-109 of Title 43A of the Oklahoma Statutes, Part 2 of Title 42 of the Code of Federal Regulations ( 42 C.F.R., Part 2), and 45 C.F.R., Parts 160 and 164.

(4) For purposes of DDS HCBS waiver reimbursement, telehealth is the use of interactive audio, video, or other electronic media for the purpose of diagnosis, consultation, or treatment that occurs in real-time and when the service recipient is actively participating during the transmission.

(b)Definitions. The following words and terms when used in this Section shall have the following meaning, unless the context clearly indicates otherwise.

(1)"Remote patient monitoring" means using digital technologies to collect medical and other forms of health data, such as vital signs, weight, blood pressure, and blood sugar, from individuals in one location, and electronically transmitting that information securely to health care providers in a different location for assessment and recommendations.

(2)"Store and forward" means transmitting a service recipient's medical information from an originating site to the health care provider at a distant site. Photographs provided through a telecommunications system are specific to the service recipient's medical condition and adequate for furnishing or confirming a diagnosis or treatment plan. Store and forward technologies do not include:

(A) consultations provided by telephone audio-only communication;

(B) electronic mail;

(C) text message or instant messaging conversation;

(D) website questionnaire;

(E) non-secure video conference; or

(F) facsimile transmission.

(3)"Telehealth" means the practice of health care delivery, diagnosis, consultation, evaluation and treatment, transfer of medical data or exchange of medical education information through two-way, real-time interactive communication. This definition does not exclude store and forward technologies. Telehealth occurs between a service recipient and a health care provider with access to the service recipient's relevant clinical information prior to the telemedicine visit. Telehealth does not include website questionnaires, non-secure video conference, or facsimile transmission.

(c)Requirements. The following requirements apply to all services rendered via telehealth.

(1) Audio and video telecommunications are compliant with the Interactive Health Insurance Portability and Accountability Act (HIPAA), permitting encryption. The telecommunication service is secure and adequate to protect the confidentiality and integrity of the telehealth information transmitted. As a payment condition, the service recipient is an active participate in the telehealth visit.

(2) The telehealth equipment and transmission speed and image is technologically sufficient to support the service billed. Contract providers involved in the telehealth visit are trained in the use of the telehealth equipment and are competent in its operation.

(3) The medical or behavioral health related service is provided at an appropriate site for telehealth service delivery.

(A) An appropriate telehealth site is one that has the proper security measures in place and appropriate administrative, physical, and technological safeguards to ensure the confidentiality, integrity, and security of electronic protected health information.

(B) The room location for the encounter ensures comfort, privacy, and confidentiality on both ends. There is both visual and audio privacy, and the room's placement and selection takes this into consideration.

(C) Appropriate telehealth equipment and networks are used considering factors such as appropriate screen size, resolution, and security.

(D) Providers, service recipients, or both, may provide or receive telehealth services outside of Oklahoma when medically necessary; however, prior authorization may be required, per Oklahoma Administrative Code 317:30-3-89 through 317:30-3-91.

(4) The provider is contracted with DDS and SoonerCare when required, appropriately licensed or certified, and in good standing. Services provided are within the scope of the provider's license or certification. If the provider is outside of Oklahoma, the provider complies with all laws and regulations of the provider's location, including health care and telehealth requirements.

(5) The service recipient retains the right to withdraw from telehealth services at any time.

(6) All telehealth activities comply with Oklahoma Health Care Authority policy, and all other applicable state and federal laws and regulations, including, but not limited to, 59 O.S § 478.1.

(7) The service recipient has access to all transmitted information, with the exception of live interactive video as there is often no stored data in such encounters.

(8) The service recipient's image and personal information is not disseminated to other entities without written consent from the service recipient or legal guardian, or a minor service recipient's parent or legal guardian.

(9) A telehealth service is subject to the same DDS HCBS waiver program restrictions, limitations, and coverage that exist for the service when not provided through telehealth, as only certain telehealth codes are reimbursable through a DDS HCBS waiver.

(e)Reimbursement. Telehealth services are billed with the appropriate modifier.

(f)Documentation.

(1) The service provider maintains documentation to substantiate the services rendered.

(2) Documentation indicates the services were rendered via telehealth and the location of the services.

(3) All other DDS documentation guidelines apply to the services rendered via telehealth. Examples include but are not limited to:

(A) chart notes;

(B) start and stop times;

(C) service provider credentials; and

(D) service provider signature.

(g)Final authority. DDS has discretion and the final authority to approve or deny any telehealth services based on DDS's or the service recipient's needs.

Okla. Admin. Code § 340:100-3-41

Adopted by Oklahoma Register, Volume 39, Issue 24, September 1, 2022, eff. 9/15/2022