Counselors
Counselors, Social Workers, and Marriage and Family Therapists
Ohio Counselor, Social Worker, and Marriage and Family Therapist Board
4757-5-13 Standards of practice and professional conduct: electronic service delivery (internet, email, teleconference, etc.).
Source
Source
Electronic service delivery is defined in paragraph (EE) of rule 4757-3-01 of the Administrative Code. Licensees are reminded that standards of ethical practice and professional conduct rules 4757-5-01 to 4757-5-12 of the Administrative Code apply to electronic service delivery.
(A) These standards govern the practice of electronic service delivery and address practices that are unique to electronic service delivery and electronic service delivery practitioners.
(1) All practitioners providing counseling, social work, or marriage and family therapy via electronic service delivery to persons physically present in Ohio shall be licensed in Ohio.
(2) All licensees of this board providing services to clients outside the state of Ohio shall comply with the laws and rules of that jurisdiction.
(3) Electronic service delivery shall require an initial face-to-face meeting, which may be via video/audio electronically, to verify the identity of the electronic service delivery client. At that meeting, steps shall be taken to address impostor concerns, such as by using passwords to identify the client in future electronic contacts.
(4) Informed consent shall include information defining electronic service delivery as practiced by the licensee and the potential risks and ethical considerations per paragraph (B) of rule 4757-5-02 of the Administrative Code.
(a) Licensees shall obtain written informed consent.
(b) Licensees shall not provide services without client signed informed consent.
(5) Licensees shall provide links to websites for all of their certification bodies and licensure boards to facilitate consumer protection.
(6) Licensees shall identify an appropriately trained professional who can provide local assistance, including crisis intervention if needed. Licensees shall provide electronic service delivery clients the local crisis hotline telephone number and the local emergency mental health telephone number.
(7) Licensees shall provide a link to the board's online license verification site on their web page.
(B) Confidentiality in electronic service delivery shall be maintained by the licensee:
(1) Licensees shall use encryption methods for electronic service delivery, except for treatment reminders, scheduling contacts, or other information provided outside of a therapeutic context; and
(2) Shall inform electronic service delivery clients details of data record storage.
Effective: 7/1/2016
Five Year Review (FYR) Dates: 09/20/2017
Promulgated Under: 119.03
Statutory Authority: 4757.11
Rule Amplifies: 4757.11
Prior Effective Dates: 10/18/09
Social Workers
Counselors, Social Workers, and Marriage and Family Therapists
Ohio Counselor, Social Worker, and Marriage and Family Therapist Board
4757-5-13 Standards of practice and professional conduct: electronic service delivery (internet, email, teleconference, etc.).
Source
Source
Electronic service delivery is defined in paragraph (EE) of rule 4757-3-01 of the Administrative Code. Licensees are reminded that standards of ethical practice and professional conduct rules 4757-5-01 to 4757-5-12 of the Administrative Code apply to electronic service delivery.
(A) These standards govern the practice of electronic service delivery and address practices that are unique to electronic service delivery and electronic service delivery practitioners.
(1) All practitioners providing counseling, social work, or marriage and family therapy via electronic service delivery to persons physically present in Ohio shall be licensed in Ohio.
(2) All licensees of this board providing services to clients outside the state of Ohio shall comply with the laws and rules of that jurisdiction.
(3) Electronic service delivery shall require an initial face-to-face meeting, which may be via video/audio electronically, to verify the identity of the electronic service delivery client. At that meeting, steps shall be taken to address impostor concerns, such as by using passwords to identify the client in future electronic contacts.
(4) Informed consent shall include information defining electronic service delivery as practiced by the licensee and the potential risks and ethical considerations per paragraph (B) of rule 4757-5-02 of the Administrative Code.
(a) Licensees shall obtain written informed consent.
(b) Licensees shall not provide services without client signed informed consent.
(5) Licensees shall provide links to websites for all of their certification bodies and licensure boards to facilitate consumer protection.
(6) Licensees shall identify an appropriately trained professional who can provide local assistance, including crisis intervention if needed. Licensees shall provide electronic service delivery clients the local crisis hotline telephone number and the local emergency mental health telephone number.
(7) Licensees shall provide a link to the board's online license verification site on their web page.
(B) Confidentiality in electronic service delivery shall be maintained by the licensee:
(1) Licensees shall use encryption methods for electronic service delivery, except for treatment reminders, scheduling contacts or other information provided outside of a therapeutic context; and
(2) Shall inform electronic service delivery clients details of data record storage.
Effective: 7/1/2016
Five Year Review (FYR) Dates: 09/20/2017
Promulgated Under: 119.03
Statutory Authority: 4757.11
Rule Amplifies: 4757.11
Prior Effective Dates: 10/18/09
Marriage and Family Therapists
Counselors, Social Workers, and Marriage and Family Therapists
Ohio Counselor, Social Worker, and Marriage and Family Therapist Board
4757-5-13 Standards of practice and professional conduct: electronic service delivery (internet, email, teleconference, etc.).
Source
Source
Electronic service delivery is defined in paragraph (EE) of rule 4757-3-01 of the Administrative Code. Licensees are reminded that standards of ethical practice and professional conduct rules 4757-5-01 to 4757-5-12 of the Administrative Code apply to electronic service delivery.
(A) These standards govern the practice of electronic service delivery and address practices that are unique to electronic service delivery and electronic service delivery practitioners.
(1) All practitioners providing counseling, social work, or marriage and family therapy via electronic service delivery to persons physically present in Ohio shall be licensed in Ohio.
(2) All licensees of this board providing services to clients outside the state of Ohio shall comply with the laws and rules of that jurisdiction.
(3) Electronic service delivery shall require an initial face-to-face meeting, which may be via video/audio electronically, to verify the identity of the electronic service delivery client. At that meeting, steps shall be taken to address impostor concerns, such as by using passwords to identify the client in future electronic contacts.
(4) Informed consent shall include information defining electronic service delivery as practiced by the licensee and the potential risks and ethical considerations per paragraph (B) of rule 4757-5-02 of the Administrative Code.
(a) Licensees shall obtain written informed consent.
(b) Licensees shall not provide services without client signed informed consent.
(5) Licensees shall provide links to websites for all of their certification bodies and licensure boards to facilitate consumer protection.
(6) Licensees shall identify an appropriately trained professional who can provide local assistance, including crisis intervention if needed. Licensees shall provide electronic service delivery clients the local crisis hotline telephone number and the local emergency mental health telephone number.
(7) Licensees shall provide a link to the board's online license verification site on their web page.
(B) Confidentiality in electronic service delivery shall be maintained by the licensee:
(1) Licensees shall use encryption methods for electronic service delivery, except for treatment reminders, scheduling contacts or other information provided outside of a therapeutic context; and
(2) Shall inform electronic service delivery clients details of data record storage.
Effective: 7/1/2016
Five Year Review (FYR) Dates: 09/20/2017
Promulgated Under: 119.03
Statutory Authority: 4757.11
Rule Amplifies: 4757.11
Prior Effective Dates: 10/18/09
Psychologists
Psychologists
Ohio State Board of Psychology
Chapter 4732-17 Rules of Professional Conduct
Source
(I) Telepsychology.
(1) "Telepsychology" means the practice of psychology or school psychology as those terms are defined in divisions (B) and (E) of section 4732.01 of the Revised Code, including psychological and school psychological supervision, by distance communication technology such as but not necessarily limited to telephone, email, Internet-based communications, and videoconferencing.
(2) In order to practice telepsychology in the state of Ohio one must hold a current, valid license issued by the Ohio board of psychology or shall be a registered supervisee of a licensee being delegated telepsychology practices in compliance with paragraphs (B) and (C) of rule 4732-13-04 of the Administrative Code.
(3) License holders understand that this rule does not provide licensees with authority to practice telepsychology in service to clients domiciled in any jurisdiction other than Ohio, and licensees bear responsibility for complying with laws, rules, and/or policies for the practice of telepsychology set forth by other jurisdictional boards of psychology.
(4) License holders practicing telepsychology shall comply with all of these rules of professional conduct and with requirements incurred in state and federal statutes relevant to the practice of psychology and school psychology.
(5) License holders shall establish and maintain current competence in the professional practice of telepsychology through continuing education, consultation, or other procedures, in conformance with prevailing standards of scientific and professional knowledge. License holders shall establish and maintain competence in the appropriate use of the information technologies utilized in the practice of telepsychology.
(6) License holders recognize that telepsychology is not appropriate for all psychological problems and clients, and decisions regarding the appropriate use of telepsychology are made on a case-by-case basis. License holders practicing telepsychology are aware of additional risks incurred when practicing psychology or school psychology through the use of distance communication technologies and take special care to conduct their professional practice in a manner that protects the welfare of the client and ensures that the client's welfare is paramount. License holders practicing telepsychology shall:
(a) Conduct a risk-benefit analysis and document findings specific to:
(i) Whether the client's presenting problems and apparent condition is consistent with the use of telepsychology to the client's benefit; and
(ii) Whether the client has sufficient knowledge and skills in the use of the technology involved in rendering the service or can use a personal aid or assistive device to benefit from the service.
(b) Not provide telepsychology services to any person or persons when the outcome of the analysis required in paragraphs (I)(6)(a)(i) and (I)(a)(ii) of this rule is inconsistent with the delivery of telepsychology services, whether related to clinical or technological issues.
(c) Upon initial and subsequent contacts with the client, make reasonable efforts to verify the identity of the client;
(d) Obtain alternative means of contacting the client;
(e) Provide to the client alternative means of contacting the licensee;
(f) Establish a written agreement relative to the client's access to face-to-face emergency services in the client's geographical area, in instances such as, but not necessarily limited to, the client experiencing a suicidal or homicidal crisis;
(g) Licensees, whenever feasible, use secure communications with clients, such as encrypted text messages via email or secure websites, and obtain and document consent for the use of non-secure communications.
(h) Prior to providing telepsychology services, obtain the written informed consent of the client, in language that is likely to be understood and consistent with accepted professional and legal requirements, relative to:
(i) The limitations and innovative nature of using distance technology in the provision of psychological or school psychological services;
(ii) Potential risks to the confidentiality of information due to the use of distance technology;
(iii) Potential risks of sudden and unpredictable disruption of telepsychology services and how an alternative means of re-establishing electronic or other connection will be used under such circumstances;
(iv) When and how the licensee will respond to routine electronic messages;
(v) Under what circumstances the licensee and service recipient will use alternative means of communications under emergency circumstances;
(vi) Who else may have access to communications between the client and the licensee;
(vii) Specific methods for ensuring that a client's electronic communications are directed only to the licensee or supervisee;
(viii) How the licensee stores electronic communications exchanged with the client;
(7) Ensure that confidential communications stored electronically cannot be recovered and/or accessed by unauthorized persons when the licensee disposes of electronic equipment and data;
(8) If in the context of a face-to-face professional relationship the following are exempt from this rule:
(a) Electronic communication used specific to appointment scheduling, billing, and/or the establishment of benefits and eligibility for services; and,
(b) Telephone or other electronic communications made for the purpose of ensuring client welfare in accord with reasonable professional judgment.
Psychiatrists
“(A) For the purposes of this rule, the following definitions apply;
(1) "Active patient" means that within the previous twelve months at least one in-person physical exam or assessment of the patient has been conducted by the telehealth practice or practitioner acting within the scope of their professional license or by the patient's usual source of medical care that is not an emergency department.
(2) "Patient site" is the physical location of the patient at the time a health care service is provided through the use of telehealth. The patient site shall be one of the following locations:
(a) The office or service location of a provider type specified in paragraph (B) (1) of this rule;
(b) The patient's home (including but not limited to a homeless shelter, assisted living facility, group home, or temporary lodging);
(c) School;
(d) Inpatient hospital;
(e) Outpatient hospital;
(f) Nursing facility; or
(g) Intermediate care facility for individuals with an intellectual disability (ICF/ IID).
(3) "Practitioner site" is the physical location of the treating practitioner at the time a health care service is provided through the use of telehealth. The practitioner site shall not be the same location as the patient site.
(4) "Telehealth" is the direct delivery of health care services to a patient via secure, synchronous, interactive, real-time electronic communication comprised of both audio and video elements. The following activities are not considered telehealth:
(a) The delivery of health care service by electronic mail, telephone call, or facsimile transmission;
(b) Conversations between practitioners regarding a patient without the patient present either physically or via secure, synchronous, interactive, real-time electronic communication.
(B) Eligible providers and service locations
(1) The following practitioners are eligible to render services through the use of telehealth:
(a) Physician as defined in Chapter 4731. of the Revised Code;
(b) Psychologist as defined in Chapter 4732. of the Revised Code;
(c) Physician assistant as defined in Chapter 4730. of the Revised Code;
(d) Clinical nurse specialist, certified nurse-midwife, or certified nurse practitioner as defined in Chapter 4723. of the Revised Code;
(e) Licensed independent social worker, licensed independent chemical dependency counselor, licensed independent marriage and family therapist, or licensed professional clinical counselor as defined in Chapter 4757. of the Revised Code.
(2) The following provider types are eligible to bill for services rendered through the use of telehealth:
(a) A practitioner identified in paragraph (B)(1) of this rule;
(b) A professional medical group;
(c) A federally qualified health center (FQHC) or rural health clinic (RHC) as defined in Chapter 5160-28 of the Administrative Code;
(d) The following ambulatory health care clinics (AHCC) as described in Chapter 5160-13 of the Administrative Code:
(i) Public health department;
(ii) Primary care clinic;
(iii) Family planning clinic.
(3) Unless otherwise provided in this rule, the practitioner site must be the practitioner's service location as reported to the Ohio Department of Medicaid (ODM) in accordance with rule 5160-1-17.8 of the Administrative Code.
(4) There are no restrictions to practitioner site location for services delivered via telehealth when rendered by practitioners identified in paragraph (B)(1) of this rule when any of the following apply:
(a) The patient is an active patient as defined in this rule;
(b) The practice is enrolled as a patient-centered medical home as defined in rule 5160-1-71 of the Administrative Code; or
(c) The service provided is an inpatient or office consultation as described in paragraph (D)(3) of this rule.”
(C) Requirements and Responsibilities.
“(1) All services provided via telehealth shall be provided in accordance with all state and federal laws including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and 42 C.F.R. part 2 (as in effect on January 1, 2019).
(2) The practitioner site must have access to the medical records of the patient at the time of service and is responsible for maintaining documentation in accordance with paragraph (C)(1) of this rule for the health care service delivered through the use of telehealth.
(3) For practitioners who provide services to an individual via telehealth for a period longer than twelve consecutive months, the individual must remain an active patient as defined in paragraph (A)(1) of this rule.
(4) Practitioner and patient site locations must be consistent with the current procedural terminology (CPT) and health care common procedure coding systems (HCPCS) guidelines for the service being provided.
(5) Entities who provide services certified by the Ohio department of mental health and addiction services (OhioMHAS) are not subject to this rule. Requirements for these entities are covered in Chapter 5160-27 of the Administrative Code.”
“(D) Payment may be made only for the following health care services identified in the appendix to this rule when delivered through the use of telehealth from the practitioner site:
(1) When provided by a patient-centered medical home as defined in rule 5160-1-71 of the Administrative Code, evaluation and management of a new patient described as "office or other outpatient visits" with medical decision making not to exceed moderate complexity.
(2) Evaluation and management of an established patient described as "office or other outpatient visits" with medical decision making not to exceed moderate complexity.
(3) Inpatient or office consultation for a new or established patient when providing the same quality and timeliness of care to the patient other than by telehealth is not possible, as documented in the medical record.
(4) Mental health or substance use disorder services described as "psychiatric diagnostic evaluation" or "psychotherapy." “
(E) Submission and payment of telehealth claims.
“(1) The practitioner site may submit a professional claim for health care services delivered through the use of telehealth.
(2) The practitioner site may submit a professional claim for health care services delivered through the use of telehealth.
(3) Eligible Medicaid-covered services provided through telehealth and identified in a student's approved individualized education program (IEP) are payable under the Medicaid school program as defined in Chapter 5160-35 of the Administrative Code.
(4) Except for FQHCs and RHCs, the payment amount for a health care service delivered through the use of telehealth is the lesser of the submitted charge or the maximum amount shown in Appendix DD to rule 5160-1-60 of the Administrative Code for the date of service.
(5) For a covered service delivered by an FQHC or RHC through the use of telehealth, payment is made in accordance with Chapter 5160-28 of the Administrative Code.
(6) Individuals who meet the definition of an inmate in a penal facility or a public institution as defined in rule 5160:1-1-03 of the Administrative Code are not eligible for reimbursement for telehealth services.
(7) For any professional claim submitted for health care services utilizing telehealth to be paid it must include:
(a) A "GT" modifier;
(b) If the patient site is a location as stated in paragraph (A)(3)(b) to (A)(3)(g) of this rule, a modifier indicating the physical location of the patient.
(c) A place of service code that reflects the physical location of the treating practitioner at the time a health care service is provided through the use of telehealth.”
Replaces: 5160-1-18
Effective: 7/4/2019
Five Year Review (FYR) Dates: 7/04/2024
Promulgated Under: 119.03
Statutory Authority: 5164.02, 5164.95
Rule Amplifies: 5164.02, 5164.95
Prior Effective Dates: 01/02/2015
Refer to the source provided for all requirements and limitations.
Ohio Professional Regulation/Health & Safety Online Prescribing
“A physician shall not prescribe, personally furnish or otherwise provide, or cause to be provided any controlled substance or non-controlled substance to a person on whom the physician has never conducted a physical examination, with the exceptions listed below.”
Source:
OH Admin. Code 4731-11-09. (Accessed Sept. 2019).
Non-Controlled Substances Exceptions
“Prescribing is allowed when a patient is remote from the physician by complying with the following:
- Establish the patient’s identity and physical location;
- Obtain the patient’s informed consent;
- Forward medical record to the patient’s primary care provider (upon consent);
- Conduct an appropriate evaluation;
- Establish or confirm a diagnosis and treatment plan;
- Document information in patient’s medical record;
- Provide appropriate follow-up care;
- Make a medical record of the visit available to the patient; and
- Use appropriate technology sufficient to conduct all steps.”
“Separate exceptions exist for prescribing controlled substances when the patient is remote from the physician. See regulation.”
Source:
OH Admin. Code 4731-11-09. (Accessed Feb. 2020).
“A patient evaluation performed within the previous twenty-four months via telemedicine by a healthcare provider acting within the scope of their professional license is acceptable for satisfying the criteria to be an “active patient”. “
Source:
OAC 4731-11-01. (Accessed Feb. 2020).
Refer to the source provided for all requirements and limitations.
Nurses
We are not aware of any specific rules and regulations of the practice of telemental health services for Nurses.
Ohio Professional Regulation/Health & Safety Online Prescribing
“A physician shall not prescribe, personally furnish or otherwise provide, or cause to be provided any controlled substance or non-controlled substance to a person on whom the physician has never conducted a physical examination, with the exceptions listed below.”
Source:
OH Admin. Code 4731-11-09. (Accessed Sept. 2019).
Non-Controlled Substances Exceptions
“Prescribing is allowed when a patient is remote from the physician by complying with the following:
- Establish the patient’s identity and physical location;
- Obtain the patient’s informed consent;
- Forward medical record to the patient’s primary care provider (upon consent);
- Conduct an appropriate evaluation;
- Establish or confirm a diagnosis and treatment plan;
- Document information in patient’s medical record;
- Provide appropriate follow-up care;
- Make a medical record of the visit available to the patient; and
- Use appropriate technology sufficient to conduct all steps.”
“Separate exceptions exist for prescribing controlled substances when the patient is remote from the physician. See regulation.”
Source:
OH Admin. Code 4731-11-09. (Accessed Feb. 2020).
“A patient evaluation performed within the previous twenty-four months via telemedicine by a healthcare provider acting within the scope of their professional license is acceptable for satisfying the criteria to be an “active patient”. “
Source:
OAC 4731-11-01. (Accessed Feb. 2020).
Refer to the source provided for all requirements and limitations.
Medicaid Telehealth Parity Law
Source: OAC 5160-1-18
Originating Site Reimbursement: The Patient's home is an eligible originating site.
Refer to the source provided for all requirements and limitations.
Private Pay Telehealth Parity Law
Source: OH Revised Code Annotated, 3902.30. (HB – 166)
"(B)(1) A health benefit plan shall provide coverage for telemedicine services on the same basis and to the same extent that the plan provides coverage for the provision of in-person health care services.
(2) A health benefit plan shall not exclude coverage for service solely because it is provided as a telemedicine service."
Refer to the source provided for all requirements and limitations.
Payment Parity
We are not aware of any explicit payment parity.
*Clinicians who have had an experience with telehealth reimbursement in this state are invited to share their experiences in the comments section below: a) type of service provided; b) insurance provider; c) payment parity, payment issues, or insurance requirements.
Permission for the Temporary Practice of Clinicians Licensed Outside the State
We are not aware of any permission that allows for services delivered by out-of-state providers.
Social Workers
Counselors, Social Workers, and Marriage and Family Therapists
Ohio Counselor, Social Worker, and Marriage and Family Therapist Board
4757-5-13 Standards of practice and professional conduct: electronic service delivery (internet, email, teleconference, etc.).
Source
Source
Electronic service delivery is defined in paragraph (EE) of rule 4757-3-01 of the Administrative Code. Licensees are reminded that standards of ethical practice and professional conduct rules 4757-5-01 to 4757-5-12 of the Administrative Code apply to electronic service delivery.
(A) These standards govern the practice of electronic service delivery and address practices that are unique to electronic service delivery and electronic service delivery practitioners.
(1) All practitioners providing counseling, social work, or marriage and family therapy via electronic service delivery to persons physically present in Ohio shall be licensed in Ohio.
(2) All licensees of this board providing services to clients outside the state of Ohio shall comply with the laws and rules of that jurisdiction.
(3) Electronic service delivery shall require an initial face-to-face meeting, which may be via video/audio electronically, to verify the identity of the electronic service delivery client. At that meeting, steps shall be taken to address impostor concerns, such as by using passwords to identify the client in future electronic contacts.
(4) Informed consent shall include information defining electronic service delivery as practiced by the licensee and the potential risks and ethical considerations per paragraph (B) of rule 4757-5-02 of the Administrative Code.
(a) Licensees shall obtain written informed consent.
(b) Licensees shall not provide services without client signed informed consent.
(5) Licensees shall provide links to websites for all of their certification bodies and licensure boards to facilitate consumer protection.
(6) Licensees shall identify an appropriately trained professional who can provide local assistance, including crisis intervention if needed. Licensees shall provide electronic service delivery clients the local crisis hotline telephone number and the local emergency mental health telephone number.
(7) Licensees shall provide a link to the board's online license verification site on their web page.
(B) Confidentiality in electronic service delivery shall be maintained by the licensee:
(1) Licensees shall use encryption methods for electronic service delivery, except for treatment reminders, scheduling contacts or other information provided outside of a therapeutic context; and
(2) Shall inform electronic service delivery clients details of data record storage.
Effective: 7/1/2016
Five Year Review (FYR) Dates: 09/20/2017
Promulgated Under: 119.03
Statutory Authority: 4757.11
Rule Amplifies: 4757.11
Prior Effective Dates: 10/18/09