Ohio Admin. Code 4758-8-04 - Codes of ethical practice and professional conduct: telehealth services
(A)
Telehealth means the use of real-time audio or
audiovisual communications that permit accurate and meaningful interaction
between at least two people, one of whom is a licensee or certificate holder.
For the purposes of this rule, modalities, including but not limited to phone,
video, text, email, instant messaging/chat, are considered telehealth.
(1)
The licensee or
certificate holder providing services within their scope of practice via
telehealth to persons physically present in Ohio shall be licensed in
Ohio.
(2)
The licensee or certificate holder providing services
to a client outside the state of Ohio shall comply with the laws and rules of
the jurisdiction where the client is located at the time services are
rendered.
(3)
The licensee or certificate holder shall confirm the
client's location at the time services are rendered.
(B)
The licensee or
certificate holder shall consider their education, training, and experience
before providing telehealth services and provide only services for which they
are competent. The licensee or certificate holder shall assume responsibility
to continually assess both their professional and technical competence when
providing telehealth services.
(C)
No initial in
person or face to face audiovisual visit is necessary to initiate services
using telehealth modalities.
(D)
The licensee or
certificate holder shall screen each client for appropriateness to receive
services via telehealth throughout the course of treatment, which includes
considering their current mental and emotional status, conducive treatment
modalities, and ongoing effectiveness of the service. The licensee or
certificate holder shall screen each client's technological capabilities as
part of the intake process and document any assistance provided to facilitate
access.
(1)
The
licensee or certificate holder shall regularly review whether the use of
telehealth is meeting the clinical needs of the client. This review should also
occur in clinical supervision of the dependent licensee or certificate
holder.
(2)
Ongoing review of appropriateness of telehealth to meet
the clinical needs of the client should be reviewed in the clinical supervision
of the dependent licensee or certificate holder.
(E)
The licensee or
certificate holder is under no obligation to provide services via telehealth if
their clinical judgement indicates telehealth is not an appropriate modality
for delivering services to the client.
(F)
No licensee or
certificate holder shall engage in telehealth services while operating a motor
vehicle or similar equipment, nor engage in activities during telehealth that
do not allow the licensee or certificate holder to focus on the client or
prepare to document session. The licensee or certificate holder should
terminate a session if it is determined while in a session the client is
engaged in activities that could endanger themselves or others.
(G)
A licensee or
certificate holder shall not provide telehealth when either the client or
licensee or certificate holder is in a setting where the confidentiality of the
session could reasonably be expected to be compromised.
(H)
When using video
conferencing for telehealth services, the licensee or certificate holder shall
remain on camera throughout the session.
(I)
The licensee or
certificate holder shall be aware of cultural and developmental differences and
how they can affect non-verbal cues. The licensee or certificate holder shall
also be aware of audio, visual, and cognitive impairment, and the impact of
these on the use of telehealth services. Telehealth methods should be
appropriate to the client and their environment.
(J)
The licensee or
certificate holder must maintain records in accordance with state and federal
regulations. Such records must clearly indicate when services are provided
through telehealth.
(K)
The licensee or certificate holder shall document all
relevant communication with clients, to include emails, texts, instant
messages, and chat history.
(L)
The licensee or
certificate holder is not responsible for client misuse of telehealth devices
during the provision of services.
(M)
During the
initial session, the licensee or certificate holder must establish informed
consent and shall include information defining telehealth delivery as practiced
by the licensee, as well as potential risks, security issues, and
confidentiality issues when receiving telehealth. In the case of a minor
client, the licensee or certificate holder must address any potential issues
specifically associated with treating minors.
(1)
Each client shall
be given sufficient opportunity to ask questions and receive answers about
telehealth. These discussions should be documented in the client
record.
(2)
Informed consent should include a discussion of how
telehealth may affect billing and access to insurance benefits.
(3)
The licensee or
certificate holder shall document permission prior to recording any part of the
telehealth session. If the licensee or certificate holder is storing
audiovisual records from sessions, these cannot be released to the client
unless authorization from the client is obtained specifically stating the
records are to be released.
(4)
The licensee or
certificate holder shall not provide services without client informed consent
which can be documented through verbal acknowledgement, online signature, or by
signing a hard copy form. The licensee or certificate holder must make
available to the client a copy of the consent documents regardless of the form
of consent by the client.
(5)
The licensee or certificate holder shall make available
to client access to information for all certification bodies and licensure
boards to facilitate consumer protection and include a link to the board online
license verification site.
(6)
The licensee or
certificate holder shall provide to the client information on how to access
assistance in a crisis and outside of established business
hours.
(N)
The licensee or certificate holder shall have a
contingency plan for providing services to client when technical problems occur
during a telehealth session, or when technical problems prevent a session from
occurring.
(O)
The licensee or certificate holder shall comply with
all requirements under state and federal law regarding the protection of client
confidentiality while providing services. Each provider shall ensure that any
username or password information and any electronic communications between the
provider, client, or third parties are securely transmitted and
stored.
Notes
Promulgated Under: 119.03
Statutory Authority: 4758.20
Rule Amplifies: 4758.23, 4758.80
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