Current through Register Vol. 50, No. 9, March 1, 2024
RELATES TO:
KRS
211.332,
211.334,
211.335,
211.336,
312.019,
312.220,
29 U.S.C.
794(d)
NECESSITY, FUNCTION, AND CONFORMITY:
KRS
312.220(2) requires the
board to promulgate administrative regulations in accordance with KRS Chapter
13A to implement and as necessary to:
(a) Prevent abuse and fraud through the use
of telehealth services; (b) Prevent fee-splitting through the use of telehealth
services; and (c) Utilize telehealth in the provision of chiropractic services
and in the provision of continuing education.
KRS
312.220(1) requires that a
treating chiropractor utilizing telehealth ensures the patient's informed
consent and maintains confidentiality.
KRS
211.336 establishes requirements for a state
agency that promulgates administrative regulations relating to telehealth. This
administrative regulation establishes the requirements for telehealth for
chiropractic services.
Section 1.
Definitions.
(1) "Client" means the person
receiving the services of the chiropractor.
(2) "Telehealth" is defined by
KRS
211.332(5) and
312.220(3).
(3) "Telehealth chiropractic services " means
the practice of chiropractic as defined by
KRS
312.220(3), between the
chiropractor and the patient that is provided, using:
(a) Interactive audio, video, or other
electronic media; or
(b) Electronic
media for diagnosis, consultation, treatment, and transfer of health or medical
data.
Section
2. Client Requirements. A practitioner-patient relationship may
commence via telehealth. An in-person initial meeting shall not be required
unless the provider determines it is medically necessary to perform those
services in person as set forth in
KRS
211.336(2)(a). A licensed
health care practitioner may represent the client at the initial meeting. A
credential holder using telehealth to deliver chiropractic services shall, upon
initial contact with the client:
(1) Make
attempts to verify the identity of the client;
(2) Obtain alternative means of contacting
the client other than electronically such as by the use of a telephone number
or mailing address;
(3) Provide to
the client alternative means of contacting the credential holder other than
electronically such as by the use of a telephone number or mailing
address;
(4) Provide contact
methods of alternative communication the credential holder shall use for
emergency purposes such as an emergency on call telephone number;
(5) Document if the client has the necessary
knowledge and skills to benefit from the type of telehealth provided by the
credential holder;
(6) Use secure
communications with clients, including encrypted text messages via e-mail or
secure Web sites, and not use personal identifying information in non-secure
communications;
(7) In accordance
with KRS
312.220(1)(a) and
900 KAR 12:005, Section 2(3),
obtain the informed consent of the client; and
(8) Inform the client in writing about:
(a) The limitations of using technology in
the provision of telehealth chiropractic services;
(b) Potential risks to confidentiality of
information, or inadvertent access of protected health information, due to
technology in the provision of telehealth chiropractic services;
(c) Potential risks of disruption in the use
of telehealth chiropractic services;
(d) When and how the credential holder will
respond to routine electronic messages;
(e) In what circumstances the credential
holder will use alternative communications for emergency purposes;
(f) Who else may have access to client
communications with the credential holder;
(g) How communications may be directed to a
specific credential holder;
(h) How
the credential holder stores electronic communications from the client;
and
(i) How the credential holder
may elect to discontinue the provision of services through telehealth.
Section 3.
Competence, Limits on Practice, Maintenance, and Retention of Records. A
credential holder using telehealth to deliver telehealth chiropractic services
shall:
(1) Limit the practice of telehealth
chiropractic services to the area of competence in which proficiency has been
gained through education, training, and experience;
(2) Maintain current competency in the
practice of telehealth chiropractic through continuing education, consultation,
or other procedures, in conformance with current standards of scientific and
professional knowledge;
(3)
Document the client's presenting problem, purpose, or diagnosis;
(4) Follow the record-keeping requirements of
201 KAR 21:100;
(5) Use methods for protecting health
information, which shall include authentication and encryption technology as
required by KRS
211.332(5)(c) and
312.220(1)(b);
and
(6) Ensure that confidential
communications obtained and stored electronically shall not be recovered and
accessed by unauthorized persons when the credential holder disposes of
electronic equipment and data.
Section
4. Compliance with Federal, State, and Local Law. A credential
holder using telehealth to deliver telehealth chiropractic services shall:
(1) Maintain patient privacy and security in
accordance with
900 KAR 12:005, Section
2(2);
(2) Comply with Section 508
of the Rehabilitation Act, 29 U.S.C. 794(d),
to make technology accessible to a client with disabilities;
(3) Be licensed or otherwise authorized by
law to practice chiropractic where the client is physically present;
and
(4) Comply with applicable
state laws and administrative regulations if the credential holder provides
telehealth services from a location outside of Kentucky.
Section 5. Representation of Services and
Code of Conduct. A credential holder using telehealth to deliver chiropractic
services or who practices telehealth chiropractic:
(1) Shall not engage in false, misleading, or
deceptive advertising of telehealth chiropractic services;
(2) Shall comply with the code of ethical
conduct and standards of practice established in
201 KAR 21:015;
(3) Shall not allow fee-splitting through the
use of telehealth chiropractic services in compliance with
KRS
312.220(2)(b); and
(4) Shall conform to KRS Chapter 312 and
201 KAR 21:001 through
201 KAR 21:105 governing the
provision of chiropractic services in Kentucky and in consideration of the
scope of practice relating to chiropractic.
Section 6. A person holding a license as a
chiropractor who provides telehealth services to a person physically located in
Kentucky shall be subject to the laws and administrative regulations governing
chiropractic services in Kentucky.