Arkansas

At A Glance
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MEDICAID REIMBURSEMENT

  • Live Video: Yes
  • Store-and-Forward: No
  • Remote Patient Monitoring: Yes
  • Audio Only: Yes

PRIVATE PAYER LAW

  • Law Exists: Yes
  • Payment Parity: No

PROFESSIONAL REQUIREMENTS

  • Licensure Compacts: NLC, PSY, PTC
  • Consent Requirements: Yes

STATE RESOURCES

  1. Medicaid Program: Arkansas Medicaid
  2. Program Administrator: Arkansas Department of Human Services
  3. Regional Telehealth Resource Center: South Central Telehealth Resource Center

Last updated 03/08/2022

Audio Only Delivery

Department of Human Services:  Telemedicine COVID-19 Response Manual

Status: Expired

Division of Developmental Disabilities Services: COVID-19 Response Manual

STATUS: Expired. Replaced by Manual with no mention of telehealth.

Medicaid 1915(c) Waiver: Appendix K Autism Waiver

STATUS: Extended to July 1, 2022.

HB 1176:  Reimbursement for Audio-Visual Technology & Telephone Services

STATUS: Enacted

Last updated 03/08/2022

Cross State Licensing

Previous COVID-19 waivers expired.

Last updated 03/08/2022

Easing Prescribing Requirements

Department of Human Services:  Telemedicine COVID-19 Response Manual

Status: Expired

Last updated 03/08/2022

Miscellaneous

Medicaid 1915(c) Waiver: Appendix K AR Community and Employment Supports Waiver and Autism Waiver

STATUS: Active, extended until July 1, 2022.

HB 1063: Amends Telemedicine Act and authorizes reimbursement for telemedicine via telephone & AR code 17-80-420

STATUS: Enacted & Implements Permanent Policy

Last updated 03/08/2022

Originating Site

Department of Human Services:  Telemedicine COVID-19 Response Manual

STATUS: Expired.

Division of Developmental Disabilities Services: COVID-19 Response Manual

STATUS: Expired, replaced by manual with no mention of telehealth.

Medicaid: Behavioral Health FAQ’s

STATUS: Varies.  Some answers based on Executive Orders have expired.

Last updated 03/08/2022

Private Payer

Previous COVID-19 waivers expired.

Last updated 03/08/2022

Provider Type

Department of Human Services:  Telemedicine COVID-19 Response Manual

Status: Expired.

Division of Developmental Disabilities Services: COVID-19 Response Manual

STATUS: Expired. Replaced by Manual with no mention of telehealth.

Last updated 03/08/2022

Service Expansion

Department of Human Services:  Telemedicine COVID-19 Response Manual

STATUS: Expired.

Division of Developmental Disabilities Services: COVID-19 Response Manual

STATUS: Expired. Replaced by Manual with no mention of telehealth.

HB 1176: Ensures that reimbursement in the Medicaid program for certain behavioral and mental health services provided via telemedicine continues after the PHE.

STATUS: Enacted

Last updated 03/09/2022

Definition

Telemedicine is defined as 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 clientmonitoring.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190.  Updated Jan. 1, 2022 & Section III Billing Documentation.  Rule 305.000.  Updated Jan. 2, 2022 (Accessed Mar. 2022).

Provider-Led Arkansas Shared Savings Entity (PASSE) Program

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. It included store-and-forward technology and remote patient monitoring. The following activities will not be considered a reportable encounter when delivered to a member of the PASSE:

  • Audio-only communication, including without-limitation, interactive audio;
  • A facsimile machine;
  • Text messaging; or
  • Electronic mail systems.

Virtual services are telemedicine, telehealth, e-consulting, and provider home visits that are part of a patient care treatment plan and are provided at the individual’s home or in a community setting. These services are provided using mobile secure telecommunication devices, electronic monitoring equipment, and include clinical provider care, behavioral health therapies, speech, occupational and physical therapy services, and treatment provided to an individual at their residence.

SOURCE: PASSE Program (3/1/19). (Accessed Mar. 2022)

Rural Health Centers

Arkansas Medicaid defines telemedicine services as medical services performed as electronic transactions in real time.

SOURCE: AR Medicaid Provider Manual. Section II Rural Health.  Rule 211.300. , p. 6, Updated Oct. 13, 2003. (Accessed Mar. 2022).

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 and remote patient monitoring. For the purposes of this subchapter, “telemedicine” does not include the use of:

  • Audio-only communication, unless the audio-only communication is real-time, interactive, and substantially meets the requirements for a healthcare service that would otherwise be covered by the health benefit plan.
  • As with other medical services covered by a health benefit plan, documentation of the engagement between patient and provider via audio-only communication shall be placed in the medical record addressing the problem, content of conversation, medical decision-making, and plan of care after the contact.
  • The documentation described in subdivision (7)(C)(i)(b)of this section is subject to the same audit and review process required by payers and governmental agencies when requesting documentation of other care delivery such as in-office or face-to-face visits;
  • A facsimile machine;
  • Text messaging; or

SOURCE: AR Code 23-79-1601(7). (Accessed Mar. 2022).

Last updated 03/09/2022

Email, Phone & Fax

Telemedicine does not include the use of:

  • Audio-only communication unless the audio-only communication is in real-time, is interactive, and substantially meets the requirements for a health care service that would otherwise be covered by the health benefit plan:
    • Documentation of the engagement between patient and provider via audio-only communication shall be placed in the medical record addressing the problem, content of the conversation, medical decision-making, and plan of care after the contact;
    • Medical documentation is subject to the same audit and review process required by payers and governmental agencies when requesting documentation of other care delivery such as in-office or face-to-face visits;
  • A facsimile machine;
  • Text messaging; or
  • Email

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190. Updated Jan. 1, 2022, (Accessed Mar. 2022).

Provider-Led Arkansas Shared Savings Entity (PASSE) Program

The following activities will not be considered a reportable encounter when delivered to a member of the PASSE:

  • Audio-only communication including without-limitation, interactive audio;
  • A facsimile machine;
  • Text messaging; or
  • Electronic mail systems

SOURCE: PASSE Program, p. II-8, (3/1/19).  (Accessed Mar. 2022).

Last updated 03/09/2022

Live Video

POLICY

Arkansas Medicaid provides 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.

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.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190. , p. 13 Updated Jan. 1, 2022 (Accessed Mar. 2022).

Arkansas Medicaid shall provide payment for telemedicine healthcare services to licensed or certified healthcare professionals or entities that are authorized to bill Arkansas Medicaid directly for healthcare services. Coverage and reimbursement for healthcare services provided through telemedicine shall be reimbursed on the same basis as healthcare services provided in person.

SOURCE: Section III Billing Documentation.  Rule 305.000. , p. 24 Updated Jan. 1, 2022.  (Accessed Mar. 2022).

Rural Health Centers

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: AR Medicaid Provider Manual. Section II Rural Health.  Rule 211.300. p. 6 Updated Oct. 13, 2003. (Accessed Mar. 2022).

Occupational Therapy, Physical Therapy and Speech-Language Pathology Services

The service provider is responsible for ensuring service delivery through telemedicine is equivalent to in-person, face-to-face service delivery.

  • The service provider is responsible for ensuring the calibration of all clinical instruments and the proper functioning of all telecommunications equipment.
  • All services delivered through telemedicine must be delivered in a synchronous manner, meaning through real-time interaction between the practitioner and client via a telecommunication link.
  • A store and forward telecommunication method of service delivery where either the client or practitioner records and stores data in advance for the other party to review at a later time is prohibited, although correspondence, faxes, emails, and other non-real time interactions may supplement synchronous telemedicine service delivery.

Services delivered through telemedicine are reimbursed in the same manner and subject to the same benefit limits as in-person, face-to-face service delivery. View or print the billable telecommunication codes and descriptions.

SOURCE: AR Medicaid Provider Manual. Section II Occupational Therapy, Physical Therapy and Speech-Language Pathology Services, Rule 214.600. Updated Jan. 1, 2022, (Accessed Mar. 2022).


ELIGIBLE SERVICES/SPECIALTIES

Arkansas Medicaid must provide coverage and reimbursement for healthcare services provided through telemedicine on the same basis as they provide coverage and reimbursement for health services provided in-person.

SOURCE: AR Code 23-79-1602(c). (Accessed Mar. 2022).

Telemedicine is listed as an allowed delivery throughout the the Outpatient Behavioral Health Services manual. See manual for specific services and special instructions of dyadic treatment by telemedicine.

SOURCE: AR Medicaid Provider Manual. Section II OBHS Manual. Updated Feb. 1, 2022.  (Accessed Mar. 2022).

Occupational Therapy, Physical Therapy and Speech-Language Pathology Services

An enrolled provider may be reimbursed for medically necessary occupational therapy, physical therapy, and speech-language pathology services delivered through telemedicine.

Occupational therapy, physical therapy, and speech-language pathology evaluation and treatment planning services may not be conducted through telemedicine and must be performed through traditional in-person methods.

SOURCE: AR Medicaid Provider Manual. Section II Occupational Therapy, Physical Therapy and Speech-Language Pathology Services, Rule 214.600. Updated Jan. 1, 2022, (Accessed Mar. 2022).

Rural Health Centers

Arkansas Medicaid covers RHC encounters and two ancillary services (fetal echography and echocardiology) as “telemedicine services”. 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 Medicaid Provider Manual. Section II Rural Health.  Rule 211.300. Updated Oct. 13, 2003. (Accessed Mar. 2022).

Patient-Led Arkansas Shared Savings Entity (PASSE) Program

Virtual services can be provided using mobile secure telecommunication devices, electronic monitoring equipment and include clinical provider care, behavioral health therapies, speech, occupational and physical therapy services, and treatment provided to an individual at their residence.  They may include the provision of on-going care management, remote telehealth monitoring and consultation, face to face or through the use secure web-based communication and mobile telemonitoring technologies to remotely monitor and evaluate the patient’s functional and health status.

SOURCE: PASSE Program, Section. II, p. 9, (3/1/19).  (Accessed Mar. 2022).

Telemedicine for group therapy provided to adults who are participants in a program or plan authorized and funded under 42 U.S.C. § 1396a, as approved by the United States Secretary of Health and Human Services, may only be permitted if the Centers for Medicare and Medicaid Services allows telemedicine for group therapy provided to adults. Telemedicine shall not be used for group therapy provided to a child who is eighteen (18) years of age or younger.

SOURCE: AR CODE 17-80-404 (Accessed Mar. 2022).

Home Health 

The face-to-face encounter may occur through telemedicine when applicable to the program manual of the performing provider of the encounter.

SOURCE: AR Medicaid Provider Manual. Section II Nurse Practitioner.  Rule 203.020, II-6. Updated July 1, 2017 & AR Medicaid Provider Manual. Section II Home Health.  Rule 206.000, II-5. Updated July 1, 2017 & AR Medicaid Provider Manual. Section II Certified Nurse-Midwife.  Rule 204.101, II-6. Updated July 1, 2017. (Accessed Mar. 2022).


ELIGIBLE PROVIDERS

The distant site is the location of the healthcare provider delivering telemedicine services.

SOURCE: Section III Billing Documentation.  Rule 305.000.  Updated Jan. 1, 2022 (Accessed Mar. 2022).

Services at the distant site must be provided by an enrolled Arkansas Medicaid Provider who is authorized by Arkansas law to administer healthcare.

The professional or entity at the distant site must be an enrolled Arkansas Medicaid Provider.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190.  Updated Jan. 1, 2022. (Accessed Oct. 2021) & Section III Billing Documentation.  Rule 305.000.  Updated Jan. 1, 2022, (Accessed Mar. 2022).

The provider of the distant site must submit claims for telemedicine services using the appropriate CPT or HCPCS code for the professional service delivered. The provider must use Place of Service two (02) (telemedicine distant site) when billing the CPT or HCPCS codes.

SOURCE: AR Medicaid Provider Manual. Section III Billing Documentation.  Rule 305.000.  Updated Jan. 1, 2022. (Accessed Mar. 2022.)

The distant site healthcare provider will not utilize telemedicine services with a client unless a
professional relationship exists between the provider and the client. A professional relationship
exists when, at a minimum:

  • The healthcare provider has previously conducted an in-person examination of the client and is available to provide appropriate follow-up care;
  • The healthcare provider personally knows the client and the client’s health status through an ongoing relationship and is available to provide follow-up care;
  • The treatment is provided by a healthcare provider in consultation with, or upon referral by, another healthcare provider who has an ongoing professional relationship with the client and who has agreed to supervise the client’s treatment including follow-up care;
  • An on-call or cross-coverage arrangement exists with the client’s regular treating healthcare provider or another healthcare provider who has established a professional relationship with the client;
  • A relationship exists in other circumstances as defined by the Arkansas State Medical Board (ASMB) or a licensing or certification board for other healthcare providers under the jurisdiction of the appropriate board if the rules are no less restrictive than the rules of the ASMB.
    • A professional relationship is established if the provider performs a face to face examination 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 examination. (See ASMB Regulation 2.8);
    • If the establishment of a professional relationship is permitted via telemedicine under the guidelines outlined in ASMB regulations, telemedicine may be used to establish the professional relationship only for situations in which the standard of care does not require an in-person encounter and only under the safeguards established by the healthcare professional’s licensing board (See ASMB Regulation 38 for these safeguards including the standards of care); or
  • The healthcare professional who is licensed in Arkansas has access to a client’s personal health record maintained by a healthcare professional and uses any technology deemed appropriate by the healthcare professional, including the telephone, with a client located in Arkansas to diagnose, treat, and if clinically appropriate, prescribe a noncontrolled drug to the client.

See Miscellaneous section for additional restrictions.

SOURCE: AR Medicaid Provider Manual. Section I General Policy. Rule 105.190. Updated Jan. 1, 2022 (Accessed Mar. 2022).

Medication Assisted Treatment (MAT) for Opioid Use Disorder

The provider at the distance site shall use both the GT modifier and the X2 or X4 modifier on the service claim.

SOURCE: AR Medicaid Provider Manual Physician Section II-136, Feb. 1, 2022, (Accessed Mar. 2022)

Patient-Led Arkansas Shared Savings Entity (PASSE) Program

The provision of virtual care can include an interdisciplinary care team or be provided by individual clinical service provider.

SOURCE: PASSE Program, p. II-9 (3/1/19).  (Accessed Mar. 2022).

Medication-Assisted Treatment for Opioid Use Disorder

Providers are encouraged to use telemedicine services when in-person treatment is not readily accessible.

SOURCE: AR Admin. Rule 230.000 p. 12 (9/1/2020) (Accessed Mar. 2022).

The Arkansas Medicaid Program shall reimburse for the following behavioral and mental health services provided via telemedicine:

  • Counseling and psychoeducation provided by a person licensed as:
    • A psychologist;
    • A psychological examiner;
    • A professional counselor;
    • An associate counselor;
    • An associate marriage and family therapist;
    • A marriage and family therapist;
    • A clinical social worker; or
    • A master social worker;
  • Crisis intervention services;
  • Substance abuse assessments;
  • Mental health diagnosis assessments for an individual under twenty-one (21) years of age; and
  • Group therapy for individuals who are eighteen (18) years of age or older under the current service definition determined by the Arkansas Medicaid Program and when provided via audio-visual technology that is compliant with the HIPPA and composed of beneficiaries of similar age and clinical presentation to qualified beneficiaries.

SOURCE: AR Code 20-77-141 (Accessed Mar. 2022).


ELIGIBLE SITES

Patient-Led Arkansas Shared Savings Entity (PASSE) Program

Virtual and telehealth services can be provided at the individual’s home or in a community setting.

SOURCE: PASSE Program, II-9 (3/1/19).  (Accessed Mar. 2022).

“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, which includes the home of a patient.

SOURCE: AR Code 23-79-1601(4) (Accessed Mar. 2022).

School Based

Regardless of whether the provider is compensated for healthcare services, if a healthcare provider seeks to provide telemedicine services to a minor in a school setting and the minor client is enrolled in Arkansas Medicaid, the healthcare provider shall:

  • Be the designated Primary Care Provider (PCP) for the minor client;
  • Have a cross-coverage arrangement with the designated PCP of the minor client; or
  • Have a referral from the designated PCP of the minor client.

If the minor client does not have a designated PCP, this section does not apply. Only the parent
or legal guardian of the minor client may designate a PCP for a minor client.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190.  Updated Jan. 1, 2022 (Accessed Mar. 2022).


GEOGRAPHIC LIMITS

No Reference Found


FACILITY/TRANSMISSION FEE

Payment will include a reasonable facility fee to the originating site (the site at which the patient is located at the time telemedicine healthcare services are provided). In order to receive reimbursement, the originating site must be operated by a healthcare professional or licensed healthcare entity that is authorized to bill 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. Any other originating sites are not eligible to bill a facility fee.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190.  Updated Jan. 1, 2022.  & Section III Billing Documentation.  Rule 305.000.  Updated Jan. 1, 2022, (Accessed Mar. 2022).

The originating site shall submit a telemedicine claim under the billing providers “pay to” information, using HCPCS code Q3014. The code must be submitted for the same date of service as the professional code and must indicate the place of service (where the member was at the time of the telemedicine encounter). Except in the case of hospital facility claims, the provider who is responsible for the care of the member at the originating site shall be entered as the performing provider in the appropriate field of the claim. For outpatient claims that occur in a hospital setting, the provider must also use Place of Service code twenty-two (22) with the originating site billing Q3014. In the case of in-patient services, HCPCS code Q3014 is not separately reimbursable because it is included in the hospital per diem.

SOURCE:  AR Medicaid Provider Manual. Section III Billing Documentation.  Rule 305.000. p. 24, Updated Jan. 1, 2022 (Accessed Mar. 2022).

Federally Qualified Health Centers

Use procedure code and type of service code Y (paper claims only) to indicate telemedicine charges.

The charge associated with this procedure code should be an amount attributable to the telemedicine service, such as line (or wireless) charges. Medicaid will deny the charge and capture it in the same manner as with ancillary charges.

SOURCE:  AR Medicaid Provider Manual. Section II FQHC. Rule 262.120. Updated Feb. 1, 2022. pg. 74, (Accessed Mar. 2022).

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.

SOURCE: AR Code 23-79-1602(d) (1). (Accessed Mar. 2022).

Last updated 03/25/2022

Miscellaneous

The distant site provider is prohibited from utilizing telemedicine with a patient unless a professional relationship exists between the provider and patient.  See manual for ways to establish the relationship.   A professional relationship is established if the provider performs a face-to-face examination 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 examination; or if the establishment of a professional relationship is permitted via telemedicine under the guidelines outlined in ASMB regulations.  Telemedicine may be used to establish the professional relationship only for situations in which the standard of care does not require an in-person encounter and only under the safeguards established by the healthcare professional’s licensing board (See ASMB Regulation 38 for these safeguards including the standards of care).  See manual for full list of requirements on establishing a professional relationship.  Special requirements also exist for providing telemedicine services to a minor in a school setting (see manual).

A healthcare provider providing telemedicine services within Arkansas shall follow applicable state and federal laws, rules and regulations regarding:

  • Informed consent;
  • Privacy of individually identifiable health information;
  • Medical record keeping and confidentiality, and
  • Fraud and abuse.

A health record is created with the use of telemedicine, consists of relevant clinical information required to treat a client, and is reviewed by the healthcare professional who meets the same
standard of care for a telemedicine visit as an in-person visit.  A professional relationship does not include a relationship between a healthcare provider and a client established only by the following:

  • An internet questionnaire;
  • An email message;
  • A client-generated medical history;
  • Text messaging;
  • A facsimile machine (Fax) and EFax;
  • Any combination of the above; or
  • Any future technology that does not meet the criteria outlined in this section.

The existence of a professional relationship is not required when:

  • An emergency situation exists; or
  • The transaction involves providing information of a generic nature not meant to be
    specific to an individual client.

Once a professional relationship is established, the healthcare provider may provide healthcare services through telemedicine, including interactive audio, if the healthcare services are within
the scope of practice for which the healthcare provider is licensed or certified and in accordance with the safeguards established by the healthcare professionals licensing board.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190.  Updated Jan. 1, 2022, (Accessed Mar. 2022).

Occupational Therapy, Physical Therapy and Speech-Language Pathology Services

The plan of care and client service record must include the following:

  • A detailed assessment of the client that determines they are an appropriate candidate for service delivery by telemedicine based on the client’s age and functioning level;
  • A detailed explanation of all on-site assistance or participation procedures the therapist or speech-language pathologist is implementing to ensure:
    • The effectiveness of telemedicine service delivery is equivalent to face-to-face service delivery; and
    • Telemedicine service delivery will address the unique needs of the client.
  • A plan and estimated timeline for returning service delivery to in-person if a client is not progressing towards goals and outcomes through telemedicine service delivery.

SOURCE: AR Medicaid Provider Manual. Section II Occupational Therapy, Physical Therapy and Speech-Language Pathology Services, Rule 214.600. Updated Jan. 1, 2022, (Accessed Mar. 2022).

Patient-Led Arkansas Shared Savings Entity (PASSE) Program

If the PASSE allows the use of telemedicine, the PASSE must document what services the PASSE allows, the settings allowed, and the qualifications for individuals to perform services via telemedicine.

SOURCE: AR Medicaid Provider Manual PASSE Program, II-32, (3/1/19).  (Accessed Mar. 2022).

Last updated 03/25/2022

Out of State Providers

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. Updated Jan. 1, 2022, (Accessed Mar. 2022).

Last updated 03/08/2022

Overview

Arkansas Medicaid reimburses for live video when the telemedicine service is comparable to an in-person service.  Store-and-forward and remote patient monitoring is included in Medicaid’s definition of telemedicine, but there was no specific information found regarding reimbursement of the modalities. Audio-only communication is covered in certain circumstances.

Last updated 03/09/2022

Remote Patient Monitoring

POLICY

Remote client monitoring means the use of electronic information and communication technology to collect personal health information and medical data from a client at an originating site that is transmitted to a healthcare provider at a distant site for use in the treatment and management of medical conditions that require frequent monitoring.

SOURCE: AR Medicaid Provider Manual. Section I General Policy. Rule 105.190. Updated Jan. 1, 2022, (Accessed Mar. 2022).

Although remote patient monitoring is included in Medicaid’s definition of telemedicine, no information was found regarding reimbursement of store-and-forward.

Patient-Led Arkansas Shared Savings Entity (PASSE) Program
Virtual providers can use mobile telemonitoring technologies to remotely monitor and evaluate the patient’s functional and health status.

SOURCE: PASSE Program, p. II-9 (3/1/19). (Accessed Mar. 2022).


CONDITIONS

No Reference Found


PROVIDER LIMITATIONS

No Reference Found


OTHER RESTRICTIONS

No Reference Found

Last updated 03/09/2022

Store and Forward

POLICY

Store-and-forward technology is the transmission of a client’s medical information from a healthcare provider at an originating site to a healthcare provider at a distant site. An originating site includes the home of a client.

SOURCE: AR Medicaid Provider Manual. Section I General Policy. Rule 105.190. Updated Jan. 1, 2022, (Accessed Mar. 2022).

Although store-and-forward is included in Medicaid’s definition of telemedicine, no information was found regarding reimbursement of store-and-forward.

Patient-Led Arkansas Shared Savings Entity (PASSE) Program
Virtual providers can use secure web-based communication to remotely monitor and evaluate the patient’s functional and health status.

SOURCE: PASSE Program. P. II-9, (3/1/19). (Accessed Mar. 2022).

Occupational Therapy, Physical Therapy and Speech-Language Pathology Services

All services delivered through telemedicine must be delivered in a synchronous manner, meaning through real-time interaction between the practitioner and client via a telecommunication link.

A store and forward telecommunication method of service delivery where either the client or practitioner records and stores data in advance for the other party to review at a later time is prohibited, although correspondence, faxes, emails, and other non-real time interactions may supplement synchronous telemedicine service delivery.

SOURCE: AR Medicaid Provider Manual. Section II Occupational Therapy, Physical Therapy and Speech-Language Pathology Services, Rule 214.600. Updated Jan. 1, 2022, (Accessed Mar. 2022).


ELIGIBLE SERVICES/SPECIALTIES

No Reference Found


GEOGRAPHIC LIMITS

No Reference Found


TRANSMISSION FEE

No Reference Found

Last updated 03/25/2022

Definition

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 and remote patient monitoring. For the purposes of this subchapter, “telemedicine” does not include the use of:

  • Audio-only communication, unless the audio-only communication is real-time, interactive, and substantially meets the requirements for a healthcare service that would otherwise be covered by the health benefit plan.
  • As with other medical services covered by a health benefit plan, documentation of the engagement between patient and provider via audio-only communication shall be placed in the medical record addressing the problem, content of conversation, medical decision-making, and plan of care after the contact.
  • The documentation described in subdivision (7)(C)(i)(b) of this section is subject to the same audit and review process required by payers and governmental agencies when requesting documentation of other care delivery such as in-office or face-to-face visits;
  • A facsimile machine;
  • Text messaging; or
  • Email.

SOURCE: AR Code 23-79-1601(7). (Accessed Mar. 2022).

Network Adequacy

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, as well as store-and-forward technology and remote patient monitoring.

SOURCE: AR Admin Code, Title 054, 00, Sec. 106, (Accessed Mar. 2022).

Last updated 03/25/2022

Parity

SERVICE PARITY

Health plans must reimburse “on the same basis” if the service were delivered in-person.  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.

SOURCE: AR Code 23-79-1602(c). (Accessed Mar. 2022).


PAYMENT PARITY

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.

SOURCE: AR Code 23-79-1602(d)(2).  (Accessed Mar. 2022).

Last updated 03/25/2022

Requirements

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

A healthcare plan must provide a reasonable facility fee to an originating site operated by a healthcare professional or licensed healthcare entity if licensed to bill the health benefit plan.

A health benefit plan cannot prohibit its providers from charging patients directly for services provided by audio-only communication that aren’t reimbursed by the plan.

A health plan may not impose:

  • An annual or lifetime dollar maximum on coverage for services provided through telemedicine unless it applies to the aggregate of all items and services covered
  • A deductible, copayment, coinsurance, benefit limitation or maximum benefit that is not equally imposed upon other healthcare services;
  • A prior authorization requirement for services provided through telemedicine that exceeds the prior authorization requirement for in-person healthcare services under the health benefit plan
  • A requirement for a covered person to choose any commercial telemedicine service provider or a restricted network of telemedicine-only providers rather than the covered person’s regular doctor or provider of choice; or
  • A copayment, coinsurance, or deductible that is not equally imposed upon commercial telemedicine providers as those imposed on network providers.

SOURCE: AR Code Sec. 23-79-1602, (Accessed Mar. 2022).

Network Adequacy

The Commissioner, pursuant to his or her discretion, may publish more detailed and specific network adequacy time/distance standards, as well as guidelines regarding the use of telemedicine to meet network adequacy standards, via SERFF Network Adequacy Data Submission Instructions, and/or annual bulletin for setting forth certification requirements for ACA submissions. Such new standards will become effective for review on January 1, of the following year.

SOURCE: AR Admin Code, Title 054, 00, Sec. 106, (Accessed Mar. 2022).

Last updated 03/25/2022

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. This section does not apply to:

  • The acts of a medical specialist located in another jurisdiction who provides only episodic consultation services;
  • The acts of a physician located in another jurisdiction who is providing consultation services to a medical school;
  • Decisions regarding the approval of coverage under any insurance or health maintenance organization plan;
  • A service to be performed which is not available in the state;
  • A physician physically seeing a patient in person in another jurisdiction; or
  • Other acts exempted by the board by rule.

SOURCE: AR Code Revised 17-95-206. (Accessed Mar. 2022).

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 17-80-404(d).  (Accessed Mar. 2022).

Last updated 03/25/2022

Definitions

“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 include the use of audio-only electronic technology by a physician to renew a written certification that was previously issued to the same patient.

SOURCE: AR Code Sec. 17-80-402 & Rules and Regulations, Social Work Licensing Board, Sec. XIV, & Board of Examiners in Counseling, Rule XII, Sec. 12.1 (Accessed Mar. 2022).

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 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. (Accessed Mar. 2022).

Last updated 03/25/2022

Licensure Compacts

Member of Nurse Licensure Compact.

SOURCE:  Nurse Licensure Compact. Current NLC States and Status.  (Accessed Mar. 2022). 

Member of Physical Therapy Licensure Compact.

SOURCE: PT Compact.  Compact Map.  (Accessed Mar. 2022).

Member of the Psychological Interjurisdictional Compact.

SOURCE: Psypact Compact Map, (Accessed Mar. 2022).

Last updated 03/25/2022

Miscellaneous

No Reference Found

Last updated 03/25/2022

Online Prescribing

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.  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.

“Professional relationship” means at a minimum a relationship established between a healthcare professional and a patient when:

  • The healthcare professional has previously conducted an in-person examination of the patient 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 professional 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.
  • A relationship established under rules of the Arkansas State Medical Board may be utilized for telehealth certification;
  • 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; or
  • The healthcare professional who is licensed in Arkansas has access to a patient’s personal health record maintained by a healthcare professional and uses any technology deemed appropriate by the healthcare professional, including the telephone, with a patient located in Arkansas to diagnose, treat, and if clinically appropriate, prescribe a noncontrolled drug to the patient.
  • For purposes of this subchapter, a health record may be created with the use of telemedicine and consists of relevant clinical information required to treat a patient, and is reviewed by the healthcare professional who meets the same standard of care for a telemedicine visit as an in-person visit

A professional relationship cannot be established only through:

  • An internet questionnaire
  • Email message
  • Patient generated medical history
  • Text messaging
  • Facsimile machine
  • Any combination of means listed above

See statute for additional avenues to establish the professional relationship.

SOURCE: AR Code 17-80-402 & 403 (Accessed Mar. 2022).

A physician-patient relationship must be established in accordance with Regulation 2.8 before the delivery of services via telemedicine. 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. See regulation for additional requirements.

A physician using telemedicine may NOT issue a prescription for any controlled substances defined as any scheduled medication under schedules II through V unless the physician has seen the patient for an in-person exam or unless a relationship exists through consultation or referral; on-call or cross-coverage situations; or through an ongoing personal or professional relationship.

SOURCE: AR Rules and Regulation. Sec. 060.00.16-005 (Accessed Mar. 2022).

When abortion-inducing drugs are used, the initial administration must occur in the same room and in the physical presence of the prescribing physician who prescribed, dispensed, or otherwise provided the drug or chemical to the patient.

SOURCE:  AR Code Annotated Section 20-16-603(b)(1). (Accessed Mar. 2022). 

Without a prior and proper patient-provider relationship, providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consultation, or a telephone consultation.

SOURCE: AR Code Annotated Sec. 17-92-1003(14)(B). (Accessed Mar. 2022).

Medical Marijuana Certification

“Telemedicine” does not include the use of audio-only electronic technology by a physician to renew a written certification that was previously issued to the same patient.

“Telehealth certification” means the electronic assessment of a patient by a practitioner in connection with an application for a registry identification card under § 5 of Arkansas Constitution, Amendment 98, also known as the “Arkansas Medical Marijuana Amendment of 2016”.

SOURCE: AR Code 17-80-402 (Accessed Mar. 2022)

Drug-induced, chemical and surgical abortions shall not be performed by telemedicine.

SOURCE: AR Admin Code 007 05.20-009 (Accessed Mar. 2022).

Drug-induced, chemical and surgical abortions shall not be performed by telemedicine.

When a physician or other licensed prescriber authorizes or provides new prescriptions or refill medications to a pharmacy that is not physically located in this state or to a pharmacy that utilizes common carriers to deliver medications through the mail for a new patient who has not previously received pharmacist services or prescriptions filled through that pharmacy, that pharmacy shall:

  • Establish a professional relationship between a pharmacist and the patient by telephone or telemedicine consult

See statute for additional requirements.

SOURCE: AR Code 17-92-120  (Accessed Mar. 2022).

Social Work

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.

“Professional relationship” does not include a relationship between a social worker and a client established only by the following:

  • An internet questionnaire;
  • An email message;
  • Patient-generated medical history;
  • Text messaging;
  • A facsimile machine; or
  • Any combination thereof.

See regulations for further requirements.

SOURCE: Rules and Regulations, Social Work Licensing Board, Sec. XIV, (Accessed Mar. 2022).

Licensed Counselor or Marriage Family Therapist

A licensed counselor or marriage and family therapists/client relationship must be established in accordance with Ark. Code Ann. §§ 17-80-402 & 403 and Section 12.3 & 12.4 before the delivery of services via telemedicine. A client’s completing a psychosocial history online and forwarding it to a licensed counselor or marriage and family therapist is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology. A licensed counselor or marriage and family therapist exhibits gross negligence if he or she provides and/or recommends any form of treatment via telemedicine without first establishing a proper licensed counselor or marriage and family therapist/client relationship.

“Professional relationship” does not include a relationship between a licensed counselor or marriage and family therapist and a client established only by the following:

  • An internet questionnaire;
  • An email message;
  • Patient-generated medical history;
  • Text messaging;
  • A facsimile machine; or
  • Any combination thereof.

See regulations for further requirements.

SOURCE: Rules and Regulations, Board of Examiners in Counseling, Rule XII, Sec. 12.2, (Accessed Mar. 2022)

Last updated 03/25/2022

Professional Board Standards

For all medical professionals, see the ‘Appropriate Use of Telemedicine’ standards in statute.

SOURCE:  AR Code 17-80-404, (Accessed Mar. 2022).

AR Board of Examiners in Speech-Language Pathology and Audiology

SOURCE: Rules and Regulations Board of Examiners in Speech-Language Pathology and Audiology, Sec. 12). (Accessed Mar. 2022). 

AR Board of Physical Therapy

SOURCE: Rule 007.36.20. (Accessed Mar. 2022). 

AR Board of Nursing: Advanced Practice Registered Nurse

SOURCE: Rule 67.00.17-005, Sec 14. (Accessed Mar. 2022).

Arkansas Social Work Licensing Board

SOURCE: Rules and Regulations, Social Work Licensing Board, Sec. XIV, (Accessed Mar. 2022).

AR Board of Examiners in Counseling

SOURCE: Rules and Regulations, Board of Examiners in Counseling, Rule XII, Sec. 12.1, (Accessed Mar. 2022)