Counselors and Marriage and Family Therapists

Source

Board of Examiners in Counseling, section 3.6: “Specializations”

"(7)        Technology-Assisted Distance Counseling or Marriage and Family Therapy

Specialization license standards for issue for Counseling or Marriage and Family Therapy or Supervision being:

1. A licensed LPC/LAC or LMFT/LAMFT in good standing with the Board must apply for the Technology-assisted Distance Counseling or Marriage Family Therapy specialization license and submit documentation of training for approval by the Board. As training sources are developed, the responsibility for seeking Board endorsement for the training rests with the provider of the training, The provider must submit a written request with materials documenting the training content for Board review and approval prior to endorsement of the training.
2. The written submission of a detailed plan that delineates how the applicant will meet provisions of the Board adopted the American Counseling Association Code of Ethics and the Standards regulating Technology-Assisted Distance Counseling or Marriage and Family Therapy for Board approval.
3.  Revised Statement of Intent (scope of practice) that includes a description of the Technology-Assisted Distance Counseling or Marriage and Family Therapy.
4. The Board may require an oral examination if there are unresolved questions about requirements (9) (A-F).
5. The submitted materials must be approved by the Board prior to the Technology-Assisted Distance Counseling or Marriage and Family Therapy Specialization license being issued.
6. Any Technology-Assisted Distance Counseling or Marriage and Family Therapy that occurs within the State of Arkansas, whether by an Arkansas counselor or by an out of state Counselor or Marriage and Family Therapist, is deemed to have occurred in Arkansas. All providers of services whether traditional or Technology-Assisted who may offer or provide Counseling or Marriage and Family Therapy services to individuals or groups must hold a valid Arkansas license to provide such services.
7.  Specialization requests not already specified will be reviewed by the Board and standards established as needed.
8. Licensed Counselors or Therapist who apply for a specialization license will be issued such license upon completion of the application for a specialization, documentation of a valid national or required credential

(certificate, registry, or license), pass on the oral examination (if required), payment of the specialization fee, and approval by a majority vote of the Board."

Board of Examiners in Counseling, section XII: “THE PRACTICE OF INTERNET OR TELEPHONE SERVICES”

• Adopts the NBCC document titled “The Practice of Internet Counseling”
• Includes Standards for the Ethical Practice of Internet Counseling
  • Internet Counseling Relationship (greatly abbreviated)
    1. Verify the identity of internet client
    2. Need for parental consent and verification of parent/guardian ID
• Contact/communication procedures explained to contact
• Explain the possibility of technology failure and alternative modes of communication 

1. Explain how to cope with misunderstanding due to lack of visual cues
2. Crisis management and local care
3. Make the client aware of free points of access to the internet
4. Barrier-free access for clients with disabilities
5. Be aware that clients speak different languages, live in different time zones, and have unique cultural perspectives. Be aware that local conditions and events may impact the client.

• Inform the client of encryption methods being used to ensure security 

• Inform client if, how, and how long session data are being preserved

• Follow appropriate procedures regarding the release of information for sharing Internet client information with other electronic sources.
• Review pertinent legal and ethical codes for guidance on the practice of Internet counseling and supervision.

Social Workers

Source

XIV. Telemedicine (Ark. Code Ann. $17-103-309)
"A. Definitions:
1. 'Distant site" means the location of the healthcare professional delivering services through telemedicine at the time the services are provided. Ark. Code Ann. $1 7-80-402(1).
2. "Originating site" means a site at which a patient is located at the time healthcare services are provided to him or her by means of telemedicine. Ark. Code Ann. $17-80-402(2).23 Arkansas Social Work Licensing Board 2020 Rule Revisions
3. "Remote patient monitoring" means the use of synchronous or asynchronous electronic information and communication technology to collect personal health information and medical data from a patient at an originating site that is transmitted to a healthcare professional at a distant site for use in the treatment and management of medical conditions that require frequent monitoring. fuk. Code Ann. $17-80-402(5).
4. "Store-and-forward technology" means the asynchronous transmission of a patient's medical information from a healthcare professional at an originating site to a healthcare professional at a distant site. Ark. Code Ann. $ 17-80-402(6).
5. "Telemedicine" means the use of electronic information and communication technology to deliver healthcare services, including without limitation the assessment, diagnosis, consultation, treatment, education, care management, and self-management of a patient. Telemedicine includes store-and-forward technology and remote patient monitoring. Ark. Code Ann. $ 17-80-402(7)."

"B. Establishing a Social Worker/Client Relationship:
A social worker/client relationship must be established in accordance with Ark. Code Ann. $$ 17-80-402 & 403 and Rule XIV before the delivery of services via telemedicine. A client completing a psychosocial history online and forwarding it
to a social worker is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology. A social worker exhibits gross negligence if he or she provides and/or recommends any form of treatment via telemedicine
without first establishing a proper social worker/client relationship."

"C. Minimum Requirements for a Social Worker/Client Relationship:
For the purpose of this Rule, a proper social worker/client relationship, at a minimum requires that:
1. The social worker performs an "in person" psychosocial assessment of the client adequate to establish a diagnosis and develop a treatment plan, OR Arkansas Social Work Licensing Board 2020 Rule Revisions
2. The social worker performs aface to face psychosocial assessment using real time audio and visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person psychosocial assessment, OR
3. The social worker knows the client and the client's general psychosocial issues through a previously established professional relationship; AND
4. Appropriate follow-up be provided or arranged, when necessary."

"D. When a Social Worker/Client Relationship is Deemed to Exist:
For the pu{pose of this Rule, a proper social worker/client relationship is deemed to exist in the following situations:
1. When treatment is provided in consultation with, or upon referral by, another provider or treatment team who has an ongoing relationship with the client, and who has agreed to supervise the client's treatment, including follow up care.
2, On-call or cross-coverage situations arranged by the client's treating provider or treatment team."

"E. Exceptions:
Recognizing a social worker's duty to adhere to the applicable standard of care and to comply with mandatory reporting laws, the following situations are excluded from the requirement of this rule by Ark. Code Ann. $17-80-a03(a)(2):
1. Emergency situations where the life or health of the client is in danger or imminent danger.
2. Simply providing information of a generic nature not meant to be specific to an individual client."

"F. Professional Relationship Exceptions:
Under Ark. Code Ann. $17-80-403(c), "Professional relationship" does not include a relationship between a social worker and a client established only by the following:
1. An internet questionnaire;
2. An email message;
3. Patient-generated medical history;
4. Audio-only communication, including without limitation interactive audio;
5. Text messaging;
6. A facsimile machine; or
7. Any combination thereof."

"G. Requirements for Services Provided Via Telemedicine:
The following requirements apply to all services provided by social workers using telemedicine:
1. The practice of counseling via telemedicine shall be held to the same standards ofcare as traditional in-person encounters.
2, The social worker must obtain a detailed explanation of the client's complaint from the client or the client's treating provider or treatment team.
3. If a decision is made to provide treatment, the social worker must agree to accept responsibility for the care of the client.
4. If follow-up care is indicated, the social worker must agree to provide or alrange for such follow-up care.
5. The social worker must keep a documented treatment record, including, but not limited to psychosocial history.
6. At the client's request, the social worker must make available to the client an electronic or hardcopy version of the client's treatment record documenting the encounter. Additionally, unless the client declines to consent, the social worker must forward a copy of the record of the encounter to the client's regular treating provider or treatment team if that provider or treatment team is not the same social worker delivering the service via telemedicine.
7. Services must be delivered in a transparent manner, including providing access to information identifring the social worker's licensure and other relevant certifications, as well as client financial responsibilities, in advance of the encounter.
8. If the client, at the recommendation of the social worker, needs to be seen in person, the social worker must arrange to see the client in person or direct the client to their regular treating provider or treatment team or other appropriate provider if the client does not have a treating provider or treatment team. Such recommendation shall be documented in the client's
treatment record.
9. Social workers who deliver services through telemedicine must establish protocols for referrals for emergency services."

"H. Scope of Practice:
Social workers may practice social work via telemedicine within the definitions found in Ark. Code Ann. $17-103-103."

"I. Confidentiality:
Social workers who use technology to facilitate supervision, consultation, or other confidential meetings shall use appropriate precautions to protect the confidentiality of those communications. Precautions to protect confidentiality depend on the type of technology being used, and may include using passwords, firewalls, encryption, and antivirus software; using electronic service providers that rely on standards of security for data that are transmitted and stored; and ensuring a private setting when using their electronic devices. See NASW, ASWB, cswE, & cswA standards for Technology in Social work Practice."

Psychologists

Source

SECTION 19. TELEPSYCHOLOGY 

"19.1 Minimum standards for establishing psychologist/psychological examine patient/client relationships.

A psychologist/psychological examiner exhibits gross negligence if he provides and/or recommends any form of treatment/service, without first establishing a proper psychologist/psychological examiner-patient/client relationship.

19.1.A. For purposes of this rule, a proper psychologist/psychological examine patient/client relationship, at a minimum requires that:

19.1.A. (1) The psychologist/psychological examiner performs a history and an “in-person” interview of the patient/client adequate to establish a diagnosis and identify underlying conditions and/or contraindications to the treatment/service recommended/provided, OR

19.1.A. (2) The psychologist/psychological examiner performs a face to face examination using real-time audio and visual telepsychology technology that provides information at least equal to such information as would have been obtained by an in-person interview; OR

19.1. (3) The psychologist/psychological examiner personally knows the patient/client and the patient/client's general health status through an “ongoing” personal or professional relationship;

19.1.A. (2) Appropriate follow-up be provided or arranged, when necessary, at necessary intervals.

19.1.B. For the purposes of this rule, a proper psychologist/psychological examiner-patient/client relationship is deemed to exist in the following situations:

19.1.B. (1) When treatment/service is provided in consultation with, or upon referral by, another provider who has an ongoing relationship with the patient/client, and who has agreed to supervise the patient/client's treatment/service, including follow up care. 

19.1.B. (2) On-call or cross-coverage situations arranged by the patient/client's treating psychologist/psychological examiner.

19.1.C. Exceptions -- Recognizing a psychologist/psychological examiner's duty to adhere to the applicable standard of care, the following situations are hereby excluded from the requirement of this rule:

1. Emergency situations where the life or health of the patient/client is in danger or imminent danger.

2. Simply providing information of a generic nature is not meant to be specific to an individual patient/client.

19.2 Requirement for All Services Provided by Providers using Telepsychology

19.2.A. A Patient/client/Provider relationship must be established in accordance with Rule 19.1 before the delivery of services via telepsychology. The provider is defined as a person licensed by the Arkansas Psychology Board who has documented training in telepsychology. A patient/client completing a history online and forwarding it to a Provider is not sufficient to establish the

relationship, nor does it qualify as store-and-forward technology.

19.2.B. The following requirements apply to all services provided by Providers using telepsychology:

19.2.B. (1) The practice of psychology via telepsychology shall be held to the same standards of care as traditional in-person encounters. 

19.2.B. (2) The Provider must obtain a detailed explanation of the patient/client's complaint from the patient/client or the patient/client's treating Provider.

19.2.B. (3) If a decision is made to provide treatment/service, the Provider must agree to accept responsibility for the care of the

patient/client.

19.2.B. (4) If follow-up care is indicated, the Provider must agree to provide or arrange for such follow-up care.

19.2.B. (5) The Provider must keep a documented record, including history.

19.2.B. (6) At the patient/client's request, the Provider must make available to the patient/client an electronic or hardcopy version of the patient/client's record documenting the encounter. Additionally, unless the patient/client declines to consent, the Provider must forward a copy of the record of the encounter to the patient/client's regular treating Provider if that Provider is not the same one delivering the service via telepsychology.

19.2.B. (7) Services must be delivered in a transparent manner with proper informed consent, including providing access to information identifying the Provider in advance of the encounter, with licensure and board certifications, as well as patient/client financial responsibilities. 

19.2.B. (8) If the patient/client, at the recommendation of the Provider, needs to be seen in person for their current issue, the Provider must arrange to see the patient/client in person or direct the patient/client to their regular treating Provider or other appropriate providers if the patient/client does not have a treating Provider. Such recommendations shall be documented in the patient/client's record.

19.2.B. (9) Providers who deliver services through telepsychology must establish protocols for referrals for emergency services. 

19.2.B. (10) All Providers providing care via telepsychology to a patient/client located within the State of Arkansas shall be licensed to practice psychology in the State of Arkansas."

Adopted July 3, 2020

Refer to the source provided for all requirements and limitations.

Psychiatrists

Source

REGULATION NO. 38 - TELEMEDICINE (PAGE 116)

Arkansas Professional Regulation/Health & Safety Online Prescribing

No References Found

Nurses

“As a party state to the Nurse Licensure Compact (NLC), Arkansas issues multistate licenses to nurses and applicants who reside in the state and recognizes multistate licenses issued by other party states, for practice in Arkansas. A nurse holding a multistate license is entitled to practice in any NLC party state, but must comply at all times with the laws of the state where he or she is currently practicing.”

“It should be noted that not every state in the US is an NLC party state; a map of participating states, as well as further resources related to the NLC, are available on the Nurse Licensure Compact website.”

Refer to the source provided for all requirements and limitations.

Arkansas Professional Regulation/Health & Safety Online Prescribing

No references found

Medicaid Telehealth Parity Law

Source: AR Medicaid Provider Manual. Section I General Policy. Rule 105.190 (Accessed 11/25/19)

“Arkansas Medicaid shall provide payment to a licensed or certified healthcare professional or a licensed or certified entity for services provided through telemedicine if the service provided through telemedicine is comparable to the same service provided in person.  Payment will include a reasonable facility fee to the originating site operated by a licensed or certified healthcare professional or licensed or certified healthcare entity if the professional or entity is authorized to bill Arkansas Medicaid directly for healthcare services. There is no facility fee for the distant site. The professional or entity at the distant site must be an enrolled Arkansas Medicaid Provider.

Coverage and reimbursement for services provided through telemedicine will be on the same basis as for services provided in person. While a distant site facility fee is not authorized under the Telemedicine Act, if reimbursement includes payment to an originating site (as outlined in the above paragraph), the combined amount of reimbursement to the originating and distant sites may not be less than the total amount allowed for healthcare services provided in person.”

Private Pay Telehealth Parity Law

AR Code Sec. 23-79-1602 Deals with Payment Parity for services provided through Telemedicine

“(B) A healthcare professional providing a healthcare service provided through telemedicine shall comply with the requirements of the Telemedicine Act, § 17-80-401 et seq.

(C)

(1) A health benefit plan shall provide coverage and reimbursement for healthcare services provided through telemedicine on the same basis as the health benefit plan provides coverage and reimbursement for health services provided in-person unless this subchapter specifically provides otherwise.

(2) A health benefit plan is not required to reimburse for a healthcare service provided through telemedicine that is not comparable to the same service provided in person.

(3) A health benefit plan may voluntarily reimburse for healthcare services provided through means described in § 23-79-1601(7)(C).

(D)

(1) A health benefit plan shall provide a reasonable facility fee to an originating site operated by a healthcare professional or a licensed healthcare entity if the healthcare professional or licensed healthcare entity is authorized to bill the health benefit plan directly for healthcare services.

(2) The combined amount of reimbursement that a health benefit plan allows for the compensation to the distant site and the originating site shall not be less than the total amount allowed for healthcare services provided in person.

(3) Payment for healthcare services provided through telemedicine shall be provided to the distant site and the originating site upon submission of the appropriate procedure codes.

(4) This section does not:

(A) Prohibit a health benefit plan from paying a facility fee to a provider at the distant site in addition to a fee paid to the healthcare professional; or

(B) Require a health benefit plan to pay more for a healthcare service provided through telemedicine than would have been paid if the healthcare service was delivered in person.”

Source: AR Code Sec. 23-79-1602

Refer to the source provided for all requirements and limitations. 

Payment Parity

AR Code Sec. 23-79-1602 Deals with Payment Parity for services provided through Telemedicine

“(B) A healthcare professional providing a healthcare service provided through telemedicine shall comply with the requirements of the Telemedicine Act, § 17-80-401 et seq.

(C)

(1) A health benefit plan shall provide coverage and reimbursement for healthcare services provided through telemedicine on the same basis as the health benefit plan provides coverage and reimbursement for health services provided in-person unless this subchapter specifically provides otherwise.

(2) A health benefit plan is not required to reimburse for a healthcare service provided through telemedicine that is not comparable to the same service provided in person.

(3) A health benefit plan may voluntarily reimburse for healthcare services provided through means described in § 23-79-1601(7)(C).

(D)

(1) A health benefit plan shall provide a reasonable facility fee to an originating site operated by a healthcare professional or a licensed healthcare entity if the healthcare professional or licensed healthcare entity is authorized to bill the health benefit plan directly for healthcare services.

(2) The combined amount of reimbursement that a health benefit plan allows for the compensation to the distant site and the originating site shall not be less than the total amount allowed for healthcare services provided in person.

(3) Payment for healthcare services provided through telemedicine shall be provided to the distant site and the originating site upon submission of the appropriate procedure codes.

(4) This section does not:

(A) Prohibit a health benefit plan from paying a facility fee to a provider at the distant site in addition to a fee paid to the healthcare professional; or

(B) Require a health benefit plan to pay more for a healthcare service provided through telemedicine than would have been paid if the healthcare service was delivered in person.”

Source: AR Code Sec. 23-79-1602 

Refer to the source provided for all requirements and limitations.

Permission for the Temporary Practice of Clinicians Licensed Outside the State

“A healthcare provider treating patients in Arkansas through telemedicine shall be fully licensed or certified to practice in Arkansas and is subject to the rules of the appropriate state licensing or certification board. This requirement does not apply to the acts of a healthcare provider located in another jurisdiction who provides only episodic consultation services.” 

Source: AR Medicaid Provider Manual. Section I General Policy. Rule 105.190 (Accessed 11/25/19)

Refer to the source provided for all requirements and limitations.