Current through Vol. 42, No. 1, September 16, 2024
(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.