Arkansas State Telehealth Laws and Reimbursement Policies

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Information Provided ByCenter for Connected Health Policy

© Public Health Institute/ Center for
Connected Health Policy 2019: http://cchpca.org

Arkansas Medicaid

Arkansas
Medicaid Program: Arkansas Medicaid

Program Administrator: Arkansas Department of Human Services

Regional Telehealth Resource Center

South Central Telehealth Resource Center
4301 W. Markham St. #519

Little Rock, AR 72205
(855) 664-3450
learntelehealth.org

STATE LAW/REGULATIONS MEDICAID PROGRAM

Definition of telemedicine/telehealth

Recently Passed Legislation (Effective Jan. 1, 2018)

“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.

Telemedicine does not mean the use of audio-only communication, including without limitation interactive audio; a facsimile machine; text messaging; or electronic mail systems.”

Source: AR Code Sec. 17-80-402 (SB 146 – 2017)

Arkansas Medicaid defines telemedicine services as “medical services performed as electronic transactions in real time. In order for a telemedicine encounter to be covered by Medicaid, the practitioner and the patient must be able to see and hear each other in real time.”

Source: 016 06 06 Code of AR Rules and Regs. (CARR) 024 (2012).

The Medicaid manual describes telemedicine as, “Interactive electronic consultations are physician consultations, ‘face-to-face’ in real time, via two-way electronic data exchange.”

Source: AR Provider Manual, Section II: Physician/Independent Labe/CRNA/Radiation Therapy Center, p. 32. (Accessed Oct. 2017)

Arkansas Medicaid defines telemedicine services as medical services performed as electronic transactions in real time. In order for a telemedicine encounter to be covered by Medicaid, the practitioner and the patient must be able to see and hear each other in real time. Physician interpretation of fetal ultrasound is covered as a telemedicine service if the physician views the echography or echocardiography output in real time while the patient is undergoing the procedure.

Source: AR Provider Manual, Section II: Rural Health Clinic, p. 6 & Federally Qualified Health Centers, p. 10 (Accessed Oct. 2017).

“Telemedicine” means the medium of delivering clinical healthcare services by means of real-time two-way electronic audio-visual communications, including without limitation the application of secure video conferencing, to provide or support healthcare delivery that facilitates the assessment, diagnosis, consultation, or treatment of a patient’s health care while the patient is at an originating site and the healthcare professional is at a distant site.

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Source: AR Code 23-79-1601(5).

Live Video Reimbursement

A health plan shall cover the telehealth-delivered healthcare services on the same basis it would if the services were delivered in-person.

Source: AR Code 23-79-1602(c) (1).

A distant site provider will not utilize telemedicine to treat a patient located in Arkansas unless a professional relationship exists between the healthcare provider and the patient or as otherwise meets the definition of a professional relationship as defined in Section 17-80-402. (See Online Prescribing section below).

Existence of a professional relationship is not required in the following circumstances:

Emergency situations where life or health of the patient is in danger or imminent danger or

Simply providing information in a generic nature not meant to be specific to an individual patient.

Source: AR Code 17-80-402

Arkansas Medicaid will reimburse for up to two visits per patient, per year. A benefit extension request may be approved if it is medically necessary.

Covered visits:

Consults;

Fetal echography and echocardiography (must be transmitted in real time); Non-emergency visits in a physician’s office, a clinic or a hospital outpatient department; Inpatient hospital visits;

Federally Qualified Health Centers (FQHC)

encounters.

Specific CPT codes apply. See manual for special billing instructions.

AR Medicaid covers telemedicine evaluation and management services of an attending physician at the local site only when the physician is physically attending the patient and is presenting the case to a consulting physician at the remote site by means of telemedicine media.

Source: AR Provider Manual, Section II: Physician/Independent Lab/CRNA/Radiation Therapy Center, p. 68 & 129. (Accessed Oct. 2017)

Source: (fetal echography and echocardiography): AR Provider

Manual, Section II: Hospital/CAH/End Stage Renal Disease, p. 32.
and Section II: Rural Health Clinics, p. 6. (Accessed Oct. 2017)

Source (FQHC only): AR Provider Manual, Section II: Federally Qualified Health Center, p. 11. (Accessed Oct. 2017)

There is reimbursement for live video for “Telepsych” services under the Rehabilitative Services for Persons with Mental Illness (RSPMI) program. See Medicaid manual for list of rehabilitative services that can be provided through telemedicine to beneficiaries under age 21 and above age 21.

Note: These services are only available when, at a minimum, the Arkansas Telehealth Network (ATN) recommended audio video standards for real- time, two-way interactive audiovisual transmissions are met. Providers also must be able to link or connect to ATN, to ensure HIPAA compliance. Providers must receive prior authorization. An employee of the clinic must also be in the same room as the beneficiary.

Source: AR Provider Manual, Section II: Rehabilitative Services for Persons with Mental Illnesses, p. 15. (Accessed Oct. 2017)

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Live video services will be reimbursed the same as if the
services were provided in-person if conditions in AR
Code 17-80-117 such as provision of services provided
by an Arkansas licensed or certified healthcare provider,
professional relationship (see Comments section) and
eligible originating site.
Source: AR Code 23-79-1602.

Store and Forward Reimbursement

Recently Passed Legislation (Effective Jan. 1, 2018) No reimbursement. Arkansas Medicaid requires
Health plans required to reimburse for telemedicine, telemedicine to occur in real-time.
which includes store and forward. Source: AR Provider Manual, Section II: Physician/Independent

Source: AR Code 23-79-1602 (SB 146 – 2017). Labe/CRNA/Radiation Therapy Center, p. 68. (Accessed Oct.
2017)
Store and forward shall not be considered telemedicine,
but the use of it is not prohibited.
Source: AR Code 17-80-117(b) (4) (A).
Radiology procedures are reimbursed as telemedicine
when billed properly.
Source: AR Provider Manual, Section II: Physician/Independent
Labe/CRNA/Radiation Therapy Center, p. 132. (Accessed Oct.
2017)

Remote Patient Monitoring Reimbursement

Recently Passed Legislation (Effective Jan. 1, 2018) No reference found.
Health plans required to reimburse for telemedicine,
which includes RPM.
Source: AR Code 23-79-1602 (SB 146 – 2017).

Email/Phone/FAX

No reference found. No reference found.

Online Prescribing

A proper physician or physician assistant/patient No reference found.
relationship can be established via real time audio and
video telemedicine.
Source: AR Rules and Regulation. Sec. 060.00.16.
A patient completing a medical history online and
forwarding it to a physician is not sufficient to establish
the relationship, nor does it qualify as store-and-forward
technology.
A physician may not use telemedicine to issue a
prescription for a controlled substance under schedules
II through V unless they have seen the patient in-person
or a relationship exists through consultation or referral;
on-call or cross coverage situations; or through an

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STATE LAW/REGULATIONS MEDICAID PROGRAM

ongoing personal or professional relationship.

Source: AR Rules and Regulation. Sec. 060.00.16. Reg. 38,
codified in ACA Sec. 17-80-117.

When abortion inducing drugs are used, the initial

administration must occur in the same room and in the
physical presence of the prescribing physician.

Source: AR Rules and Regulation. Sec. 060.00.16.

Without a prior and proper patient-provider relationship,

providers are prohibited from issuing prescriptions solely
in response to an Internet questionnaire, an Internet
consult, or a telephone consult.

Source: AR Code Annotated Sec. 17-92-1003 (2012).

Recently Passed Legislation (Effective Jan. 1, 2018)

Under specified circumstances, the standard of care
must not require an in-person encounter. A professional
relationship cannot be established only through:

An internet questionnaire

Email message

Patient generated medical history

Audio only communication, including without

limitation interactive audio

Text messaging

Facsimile machine

Any combination thereof

Source: AR Code 17-80-403, (SB 146 – 2017).

The standards of appropriate practice in traditional

health care professional-patient settings shall govern the
licensed healthcare professional’s treatment
recommendations made via electronic means, including
issuing a prescription via telemedicine.

Source: AR Code 17-80-117(b).

A written medical marijuana certification is not allowed

when an assessment is performed through telemedicine.

Source: AR Rules and Regulation. Sec. 060.00.16. Reg. 38.

Consent

The healthcare professional shall follow applicable state and federal laws, rules and regulations for informed consent.

Source: AR Code 17-80-117(c) (1).

The healthcare professional shall follow applicable state and federal laws, rules and regulations for informed consent.

Source: AR Code 17-80-117(c) (1).

Location

Patients must be in a physician’s office or a hospital. Eligible Originating Site
Source: 016 06 Code of AR Rules and Regs. (CARR) 036 (2012). In-patient or non-emergency hospital

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STATE LAW/REGULATIONS MEDICAID PROGRAM

Physician office or clinic

Ambulatory surgical center

FQHC; or

Emergency department.

Source: AR Provider Manual, Section II: Physician/Independent
Lab/CRNA/Radiation Therapy Center, p. 128. (Accessed Oct.

2017)

Cross-State Licensing

An out of state physician utilizing an electronic medium who performs an act that is part of a patient care service that was initiated in Arkansas, including interpretation of an X-ray, that would affect the diagnosis or treatment, is engaged in the practice of medicine and subject to regulation by the Arkansas State Medical Board.

Source: AR Code Revised 17-95-206 (2012)

Healthcare providers must be fully licensed or certified in Arkansas to provide services in the state unless the out-of-state provider is only providing episodic consultation services.

Source: AR Code 17-80-117(d) (1-2).

AR Medical Board required to perform an analysis of the Interstate Medical Licensure Compact to determine whether the State of AR should participate.

Source: SB 78 (2017)

Healthcare providers must be fully licensed or certified in Arkansas to provide services in the state unless the out-of-state provider is only providing episodic consultation services.

Source: 17-80-117(d) (1-2).

Private Payers

A health plan shall cover the telehealth-delivered No reference found.

healthcare services on the same basis it would if the
services were delivered in-person.
Source: AR Code 23-79-1602.

Site/Transmission Fee

Recently Passed Legislation (Effective Jan. 1, 2018) A facility fee is not prohibited, but it is not mandated.
A healthcare plan must provide a reasonable facility fee
to an originating site operated by a healthcare Source: AR Code 23-79-1602(d) (3).
professional or licensed healthcare entity if licensed to
bill the health benefit plan.
Source: AR Code Sec. 23-79-1602 (SB 146 – 2017).

Miscellaneous

The Board of Examiners in Speech-Language Pathology

and Audiology defines “telepractice” as tele-speech,
teleaudiology, teleSLP, telehealth or telerehabilitation
when used separately or together.

It defines “telepractice service” as the application of

telecommunication technology equivalent in quality to

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STATE LAW/REGULATIONS MEDICAID PROGRAM

services delivered face-to-face to deliver speech-
language pathology or audiology services, or both, at a
distance for assessment, intervention or consultation, or
both.
Source: AR Code Sec. 17-100-103.
Recently Passed Legislation (Effective Jan. 1, 2018)
A health benefit plan cannot prohibit its providers from
charging patients directly for telephone calls that aren’t
reimbursed by the plan.
Source: AR Code Sec. 23-79-1602 (SB 146 – 2017).

COMMENTS:

New Regulations Passed

AR Board of Examiners in Speech-Language Pathology and Audiology (Source: Title 17-100-202,

Sec. 12) http://www.abespa.com/pdf/rules_regs092615.pdf

Arkansas prohibits the use of telemedicine to administer drugs that provide medical abortions.

Source: AR Code 20-16-603.

A “professional relationship” between healthcare provider and patient means at a minimum:

The healthcare professional has previously conducted an in-person examination and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;

The healthcare professional personally knows the patient and the patient’s relevant health status through an ongoing personal or professional relationship, and is available to provide appropriate follow-up care, when necessary, at medically necessary intervals;

The treatment is provided by a healthcare professional in consultation with, or upon referral by, another healthcare professional who has an ongoing relationship with the patient and who has agreed to supervise the patient’s treatment, including follow-up care;

An on-call or cross-coverage arrangement exists with the patient’s regular treating healthcare professional or another healthcare professional who has established a professional relationship with the patient;

A relationship exists in other circumstances as defined by rule of the Arkansas State Medical Board for healthcare professionals under its jurisdiction and their patients; or

A relationship exists in other circumstances as defined by rule of a licensing or certification board for other healthcare professionals under the jurisdiction of the appropriate board and their patients if the rules are no less restrictive than the rules of the Arkansas State Medical Board.

Source: 17-80-402.

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