Ohio Administrative Code
Title 4731 - State Medical Board
Chapter 4731-37
Section 4731-37-01 - Telehealth
Universal Citation: OH Admin Code 4731-37-01
Current through all regulations passed and filed through September 16, 2024
(A) As used in Chapters 4730, 4731, 4759, 4761, and 4778 of the Administrative Code:
(1)
"Telehealth services" means health care services
provided through the use of information and communication technology by a
health care professional licensed in Ohio, within the professional's scope of
practice, who is located at a site other than the site where the patient is
receiving the services or the site where another health care professional with
whom the provider of the services is formally consulting regarding the patient
is located.
(2)
"Synchronous communication technology" means audio
and/or video technology that permits two-way, interactive, real-time electronic
communication between the health care professional and the patient or between
the health care professional and the consulting health care professional
regarding the patient.
(3)
"Asynchronous communication technology", also called
store and forward technology, has the same meaning as asynchronous store and
forward technologies as that term is defined in
42 C.F.R.
410.78 (effective January 1,
2022).
(4)
"Remote monitoring device" means a medical device
cleared, approved, or authorized by the United States food and drug
administration for the specific purpose which the health care professional is
using it and which reliably transmits data electronically and
automatically.
(5)
"Health care professional" means any of the
following:
(a)
A physician assistant licensed under Chapter 4730. of the Revised
Code;
(b)
A physician licensed under Chapter 4731. of the Revised
Code to practice medicine and surgery, osteopathic medicine and surgery, or
podiatric medicine and surgery;
(c)
A dietitian
licensed under Chapter 4759. of the Revised Code;
(d)
A respiratory
care professional licensed under Chapter 4761. of the Revised Code;
or
(e)
A genetic counselor licensed under Chapter 4778. of the
Revised Code.
(6)
"Consent for telehealth treatment" means a process of
communication between a patient or, if applicable, the patient's legal
representative and the health care professional discussing the risks and
benefits of, and alternatives to, treatment through a remote evaluation that
results in the agreement to treatment that is documented in the medical record
or signed authorization for the patient to be treated through an evaluation
conducted through appropriate technology, as specified in this rule, when the
health care professional is in a location remote from the
patient.
(7)
"Formal consultation" means when a health care
professional seeks the professional opinion of another health care professional
regarding the diagnosis or treatment recommended for the patient's medical
condition presented, transfers the relevant portions of the patient's medical
record to the consulting health care professional, and documents the formal
consultation in the patient's medical record.
(B) A health care professional may provide telehealth services to a patient located in this state. The health care professional shall comply with all of the following requirements:
(1)
The standard of care for a telehealth visit is the same
as the standard of care for an in-person visit.
(2)
The health care
professional shall follow all standard of care requirements which include but
are not limited to the standard of care requirements in paragraph (C) of this
rule.
(3)
The health care professional may provide the telehealth
services through the use of synchronous or asynchronous communication
technology provided that the standard of care for an in-person visit can be met
for the patient and the patient's medical condition through the use of the
technology selected. Telephone calls, as a synchronous communication
technology, may only be used for telehealth services when all of the elements
of a bona fide health care visit meeting the standard of care are performed.
Telephone calls that are routine or simply involve communication of information
do not constitute a telehealth service.
(4)
If a health care
professional determines at any time during the provision of telehealth services
that a telehealth visit will not meet the standard of care for the medical
condition of the patient or if additional in-person care is necessary, the
health care professional shall see the patient in a reasonable timeframe or
make the appropriate referral to another health care professional to meet the
standard of care.
(a)
If the patient needs emergency care, the health care
professional shall assist the patient in obtaining emergency care by doing one
of the following:
(i)
If the patient is able to safely travel or be
transported to the emergency department without emergency transport services,
help the patient identify the closest emergency department and, if necessary,
in the health care professional's discretion, provide notification to the
emergency department of the patient's potential arrival;
(ii)
If the patient
is unable to safely travel or be transported to the emergency department
without emergency transport services, advise the patient to call 911 and remain
on the videoconference, telephone, or other synchronous communication
technology with the patient; or
(iii)
If patient is
incapacitated, call for emergency services and remain on the videoconference,
telephone, or other synchronous communication technology with the
patient.
(b)
The health care professional shall document the
in-person visit or the referral in the patient's medical
record.
(c)
All referrals shall be made in an amount of time that
is appropriate for that patient and their condition presented.
(C) A health care professional shall comply with all standard of care requirements to provide telehealth services to a patient including but not limited to:
(1)
The health care professional shall verify the patient's
identity and physical location in Ohio, and communicate the health care
professional's name and type of active Ohio license held to the patient if the
health care professional has not previously treated the patient. This may be
done verbally as long as it is documented by the health care professional in
the patient's medical record;
(2)
The health care
professional shall document the consent for telehealth treatment of the patient
or, if applicable, the patient's legal representative;
(3)
The health care
professional shall provide the telehealth services in a manner that complies
with the privacy and security requirements for the patient and their protected
health information required by the law of this state and federal law. Also, the
health care professional shall ensure that any username or password information
and any electronic communications between the health care professional and the
patient are securely transmitted and stored;
(4)
If applicable,
the health care professional shall forward the medical record to the patient's
primary care provider, other health care provider, or to an appropriate health
care provider to whom the patient is referred as provided in paragraph (B)(4)
of this rule;
(5)
The health care professional shall, through interaction
with the patient, complete a medical evaluation that is appropriate for the
patient and the condition with which the patient presents and that meets the
minimal standards of care for an in-person visit, which may include portions of
the evaluation having been conducted by other Ohio licensed healthcare
providers acting within the scope of their professional
license;
(6)
The health care professional shall establish or
confirm, as applicable, a diagnosis and treatment plan, which for those health
care professionals designated as prescribers in section
4729.01 of the Revised Code,
includes documentation of the necessity for the utilization of a prescription
drug. The diagnosis and treatment plan shall include the identification of any
underlying conditions or contraindications to the recommended
treatment;
(7)
The health care professional shall promptly document in
the patient's medical record the patient's or, if applicable, the patient's
legal representative, consent for telehealth treatment, pertinent history,
evaluation, diagnosis, treatment plan, underlying conditions, any
contraindications, and any referrals to appropriate health care providers,
including primary care providers or health care facilities;
(8)
The health care
professional shall provide appropriate follow-up care or recommend follow-up
care with the patient's primary care provider, other appropriate health care
provider, or health care facility in accordance with the minimal standards of
care;
(9)
The health care professional shall make the medical
record of the visit available to the patient or if applicable, the patient's
legal representative, upon request.
(D) A health care professional shall comply with the following requirements to provide telehealth services that involve a formal consultation with another health care professional:
(1)
The health care professional who seeks a formal
consultation shall document the acknowledgement of the patient or if
applicable, the patient's legal representative, before seeking the telehealth
services formal consultation with the consulting health care
professional;
(2)
The consulting health care professional shall meet the
licensure or certification requirements in division (C) of section
4743.09 of the Revised Code;
and
(3)
The health care professional who seeks a formal
consultation shall send the medical records relevant to the patient's medical
condition to the consulting health care professional who shall review the
medical records of the patient relevant to the medical condition which is the
subject of the consultation before the formal consultation occurs, unless this
is not possible due to an emergency situation.
(E) While providing telehealth services, a health care professional that is a physician or a physician assistant who holds a valid prescriber number issued by the state medical board and who has been granted physician-delegated prescriptive authority shall comply with the following requirements regarding prescription drugs:
(1)
The
physician or physician assistant may only prescribe, personally furnish,
otherwise provide, or cause to be provided a prescription drug that is not a
controlled substance to a patient through the provision of telehealth services
by complying with all requirements of this rule;
(2)
The physician or
physician assistant may only prescribe, personally furnish, otherwise provide,
or cause to be provided a prescription drug to a patient that is a controlled
substance through the provision of telehealth services by complying with the
following requirements:
(a)
Federal law governing prescription drugs that are
controlled substances;
(b)
The requirements of this rule; and
(c)
The requirements
in rule 4731-11-09 of the Administrative
Code.
(F) A physician or physician assistant may provide telehealth services through the use of remote monitoring devices provided that:
(1)
The patient or, if applicable, the patient's legal
representative, gives consent to the use of remote monitoring
devices;
(2)
The medical devices that enable remote monitoring have
been cleared, approved, or authorized by the United States food and drug
administration for the specific purpose for which the physician or physician
assistant are using it for the patient, and the remote monitoring devices
otherwise comply with all federal requirements.
(G) A violation of any provision of this rule, as determined by the board, shall constitute any or all of the following:
(1)
For a physician:
(a)
"Failure to
maintain minimal standards applicable to the selection or administration of
drugs," as that clause is used in division (B)(2) of section
4731.22 of the Revised
Code;
(b)
"Selling, giving away, personally furnishing,
prescribing, or administering drugs for other than legal and legitimate
therapeutic purposes," as that clause is used in division (B)(3) of section
4731.22 of the Revised Code;
or
(c)
"A departure from or the failure to conform to minimal
standards of care of similar practitioners under the same or similar
circumstances, whether or not actual injury to a patient is established," as
that clause is used in division (B)(6) of section
4731.22 of the Revised
Code.
(2)
For a physician assistant:
(a)
"A departure
from, or failure to conform to, minimal standards of care of similar physician
assistants under the same or similar circumstances, regardless of whether
actual injury to a patient is established," as that clause is used in division
(B)(19) of section 4730.25 of the Revised
Code;
(b)
"Failure to comply with the requirements of this
chapter, Chapter 4731. of the Revised Code, or any rules adopted by the board,"
as that clause is used in division (B)(2) of section
4730.25 of the Revised Code;
or
(c)
"Violating or attempting to violate, directly or
indirectly, or assisting in or abetting the violation of, or conspiring to
violate, any provision of this chapter, Chapter 4731. of the Revised Code, or
the rules adopted by the board," as that clause is used in division (B)(3) of
section 4730.25 of the Revised
Code.
(3)
For a dietitian:
(a)
"Violating or
attempting to violate, directly or indirectly, or assisting in or abetting the
violation of, or conspiring to violate, any provision of this chapter or the
rules adopted by the board," as that clause is used in division (A)(1) of
section 4759.07 of the Revised Code;
or
(b)
"A departure from, or failure to conform to, minimal
standards of care of similar practitioners under the same or similar
circumstances, whether or not actual injury to a patient is established," as
that clause is used in division (A)(11) of section
4759.07 of the Revised
Code.
(4)
For a respiratory care professional:
(a)
"Violating or
attempting to violate, directly or indirectly, or assisting in or abetting the
violation of, or conspiring to violate, any provision of this chapter or the
rules adopted by the board," as that clause is used in division (A)(7) of
section 4761.09 of the Revised Code;
or
(b)
"A departure from, or failure to conform to, minimal
standards of care of similar practitioners under the same or similar
circumstances, whether or not actual injury to a patient is established," as
that clause is used in division (A)(10) of section
4761.09 of the Revised
Code.
(5)
For a genetic counselor:
(a)
"Failure to
comply with the requirements of this chapter, Chapter 4731. of the Revised
Code, or any rules adopted by the board." as that clause is used in division
(B)(2) of section 4778.14 of the Revised
Code;
(b)
"Violating or attempting to violate, directly or
indirectly, or assisting in or abetting the violation of, or conspiring to
violate, any provision of this chapter, Chapter 4731. of the Revised Code, or
the rules adopted by the board," as that clause is used in division (B)(3) of
section 4778.14 of the Revised Code;
or
(c)
"A departure from, or failure to conform to, minimal
standards of care of similar practitioners under the same or similar
circumstances whether or not actual injury to the patient is established," as
that clause is used in division (B)(4) of section
4778.14 of the Revised
Code.
Replaces: 4731-11-09
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