Ohio Telemedicine: Laws, Rules, Regulations, and Policies

Posted by Michael Hsu on 6/12/20 9:00 AM
Michael Hsu

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Ohio has a somewhat ambivalent outlook on telemedicine. The State of Ohio does embrace it, even to a greater extent than most other states. Ohio’s definition of telemedicine includes behavioral therapy, school-based speech therapy, and pharmacological management.

At the same time, Ohio has yet to enact a parity law. The parity law was proposed several years ago for both private insurance and Medicaid, but it did not pass. Nevertheless, a good number of insurance companies cover telemedicine services even though they are not obliged to do so by law. 

Another curiosity regarding telemedicine in Ohio is the fact that it’s not a member of the Interstate Medical Licensure Compact, but it is simultaneously quite lenient toward out-of-state telemedicine and telehealth providers. 

Telemedicine in Ohio isn’t exclusively limited to healthcare providers licensed to practice medicine in the state. Ohio offers special permits to out-of-state providers that enable them to provide remote healthcare services to Ohioans. 

Ohio telemedicine definition

The policies, rules, and regulations regarding telemedicine in Ohio were first introduced by the State Medical Board of Ohio in response to a large number of inquiries the Board received from both providers and patients.

Technological advancements and innovations have made it possible for healthcare professionals to provide medical care to patients remotely. Upon meeting with interested parties, the Board considered remote services as a viable alternative to in-person medical care and sought to provide a framework for practicing telemedicine.

In 2012, the State Medical Board of Ohio concluded that telemedicine is a “potentially useful tool” that could provide various benefits to patients in the state. These benefits include:

  1. Improved accessibility of healthcare
  2. Higher utilization of specialty expertise
  3. Increased availability of patient medical records
  4. Potential cost reduction of patient care

The Board defines telemedicine as the practice of medicine in the State of Ohio through any type of communication—be it oral, written, or electronic—by a physician located outside of the state. 

The wording may be a bit confusing at first, given that it emphasizes that remote healthcare services are provided by a physician located outside of Ohio. At first glance, it may appear that the State of Ohio views telemedicine as a way to combat the shortage of medical staff—primarily specialists—and that Ohioan healthcare providers still have to deliver the services in person.

That isn’t entirely true. The Board also states that physicians in Ohio can rely on telemedicine to examine and diagnose patients through oral, written, and electronic communication without having to obtain a special telemedicine certificate. 

Please note that the Board exclusively mentions physicians here, implying that other healthcare professionals are prohibited from leveraging telemedicine in Ohio. 

This was the original outlook on telemedicine in Ohio. Since 2012, multiple changes have been made to expand the use of telemedicine in the state, primarily by Medicare and Medicaid programs. Given that Ohio does not have a telemedicine parity law, we’ll take a look at the policies, rules, and regulations enforced by the Board and Medicaid, respectively. 

State Medical Board of Ohio telemedicine policy

The Board’s main concern regarding telemedicine is the quality of medical care provided. That’s why it highlights that all licensees practicing telemedicine in Ohio will be held to the same standards of care as those delivering medical aid in-person. The Board also warns that failure to comply with these standards may result in disciplinary measures.

To ensure patients receive adequate medical care when treated remotely, the Board has provided guidelines that all licensees practicing telemedicine in Ohio need to follow. 

The guidelines include:

  1. Staff training
  2. Licensee-patient relationship
  3. Examinations
  4. Prescriptions
  5. Medical records
  6. Licensure

Staff training

The Board states that healthcare facilities providing telemedicine services should ensure that their staff involved in this practice is properly trained and competent. 

The Board doesn’t give any recommendations regarding the types of solutions that should be used to deliver remote healthcare services, nor does it define the modalities of telemedicine. 

Given that the telemedicine definition provided by the Board includes all types of communication, it’s safe to assume that physicians can rely on whichever solution they deem fit to provide telemedicine services. This may include:

  1. Phone consultations
  2. Email
  3. Other forms of audio-only communication
  4. Live two-way video communication.

One thing to keep in mind is that, whatever form of communication you rely on to deliver remote healthcare services to patients, you have to ensure that it’s fully HIPAA compliant. This means you can’t simply use your practice’s Gmail account to share protected health information (PHI)—you must first sign a Business Associate Agreement (BAA) with Google and properly configure the email to ensure that the sensitive medical information is fully encrypted.

If you’re looking for a fully HIPAA compliant telemedicine solution that you can utilize in Ohio, Curogram is the perfect solution. Our platform comes with built-in safeguards and complies with all HIPAA rules, allowing you to communicate with patients, share PHI, and host virtual appointments in a 100% secure environment. 

Licensee-patient relationship

Once more, the wording by the State Medical Board of Ohio leaves its policy regarding licensee-patent open to interpretation. The Board does state that licensees must have a way of determining the identity of the patient prior to providing telemedicine services and that they need to maintain a complete medical record for every patient admitted remotely. 

This leaves it unclear whether a licensee-patient relationship established exclusively via telemedicine is considered valid. Initially, the Board only mentioned that licensees practicing telemedicine need to ensure a method of providing follow-up care. 

Looking at the bigger picture, it’s evident that the Board’s initial view of telemedicine was that it’s an alternative in the event that the patients could not come in for an in-person visit, or the medical care had to be provided by an out-of-state medical professional. This implied that physicians in Ohio had to have an existing relationship with the patients prior to providing telemedicine services. 

As more patients and healthcare providers in Ohio started embracing telemedicine, the Board gradually became more lenient. In 2017, it passed two rules—4731-11-09 and 4731-11-01, which enabled licensees to establish a doctor-patient relationship through telemedicine alone.

That said, licensees must obtain informed patient consent before providing any form of remote healthcare services to their patients. 

Examinations

The Ohio Medical Board states that proper examination is required prior to providing diagnosis or treatment via telemedicine. This does not mean the examination must be conducted in-person. 

If the technology is sufficient to gather the necessary medical information—for instance, the provider uses a two-way video communication platform like Curogram—the examination may be performed remotely. 

The Board also states that other examinations may be considered appropriate if the patient is in a medical facility where a licensed healthcare professional can provide physical findings to the licensee practicing telemedicine at a distant site. 

With that in mind, the Board cautions against relying solely on questionnaires for medical assessment and warns that this practice may be considered a violation of the law and is subject to discipline by the Board.

Prescriptions

In the first iteration of the policy, the Board explicitly stated that physical examination is necessary prior to issuing any prescriptions. This excluded the possibility of prescribing medication electronically, given that a licensee had to “make an informed medical judgment based on circumstances of the situation.” 

Following in the footsteps of other states that have loosened their telemedicine regulations in recent years, the State Medical Board of Ohio made an amendment to this rule. Rather than describing how a physical exam should be conducted remotely, the Board focused on documentation of the visit, informed patient consent, and follow-up care. 

In other words, the Board made it possible for physicians to prescribe non-controlled substances, provided that the licensee meets the following conditions:

  • Determining the patient’s identity and physical location
  • Obtaining informed patient consent
  • Conducting appropriate evaluation
  • Creating a diagnosis and treatment plan
  • Forwarding the patient’s medical record to their primary healthcare provider
  • Documenting the information in the patient’s medical record
  • Providing the required follow-up care
  • Making the medical record readily available to the patient
  • Ensuring the appropriate technology is used

Despite loosening their policy a bit, the Board still limits online prescriptions. Only licensed physicians are allowed to issue online prescriptions for non-controlled substances.

Medical records

Licensees practicing telemedicine in Ohio must update and maintain complete medical records of patient’s care in the same manner they would if the services were delivered in-person. The purpose of doing so is to document the diagnosis, treatment, and plan of care for future reference. 

The medical records must contain the evaluation of the patient’s symptoms, the medical care provided, and other components of the electronic professional interaction. This means that licensees providing telemedicine services in Ohio must enter all the relevant medical data in their electronic health record (EHR) following each remote visit. 

Doing so manually is tiresome and time-consuming. Rather than spending valuable time on treating patients, doctors and medical staff have to dedicate a good portion of their time to administrative tasks. 

That’s why we’ve made sure that Curogram integrates with over 700 EHRs. With our telemedicine solution, all the medical information is automatically updated after each virtual visit, so you can focus on providing care to your patients instead of having to spend a third of your shift dealing with paperwork. 

Curogram EHR integrations

eClinicalWorks

Athena

Epic

Cerner

DrChrono

NextGen

Practice Fusion

CareCloud

Kareo

OfficeAlly

See More Integrations Here

Licensure

The Board states that, in order to provide telemedicine services to Ohioans, medical professionals need to be licensed to practice medicine in the State of Ohio. This doesn’t mean that the practice must be located in Ohio, as long as telemedicine practitioners have a current, valid Ohio medical license. 

Ohio licensees that wish to diagnose and treat patients outside of the state should consult other states’ licensing boards before offering remote healthcare services.

Ohio Medicaid telemedicine policy

When it comes to telemedicine in Ohio, the state law fails to cover multiple areas, such as reimbursement and covered health services. Ohio’s Medicaid program fills in these blanks and provides a more detailed policy regarding providing telemedicine services to Medicaid members in the state.

If you are a member or intend to join Ohio’s Medicaid program, it’s vital to understand that Medicaid’s definition of telemedicine slightly differs from the one provided by the Medical Board. 

Under Medicaid’s definition, telemedicine only includes remote healthcare that’s provided through real-time, two-way video communication.

In other words, while the Board does consider phone and email consultations viable ways of delivering remote medical care, Medicaid will only reimburse for medical aid delivered through a video platform. While this doesn’t explicitly exclude the use of other forms of communication, they are treated as supporting areas for the primary services—virtual video appointments—and aren’t reimbursed individually.

Covered health services

Ohio’s Medicaid program provides a detailed list of covered telehealth services. 

These include:

  • Consultations provided by licensed physicians
  • Mental health assessment 
  • Behavioral health counseling and therapy
  • School-based speech therapy
  • Pharmacological management 
  • Community psychiatric supportive treatment service

Eligible healthcare providers

Apart from detailing which telemedicine services will be reimbursed, Ohio’s Medicaid provides a strict list of medical professionals who can provide said services, depending on whether the services are delivered at the originating site or at a distant site.

Ohio Medicaid Program eligible healthcare providers

Originating site

Distant site

  • Physician
  • Primary Care Clinic 
  • Outpatient Hospital 
  • Rural Health Clinic
  • Federally Qualified Health Center 
  • Professional Medical Group
  • Podiatrist
  • Optometrist
  • Physician
  • Psychologist
  • Federally Qualified Health Center—Medical and Mental Health

Location restrictions

Another thing the Ohio Medicaid participants need to be aware of is that the program enforces certain limitations regarding the physical location of the licensee and their patients. In order to be reimbursed for the telemedicine services provided, the licensee should deliver medical care only to patients at eligible originating sites that are less than five miles away from the telehealth provider. 

We’re unsure why this location restriction exists, given that it’s in direct contrast with what telemedicine is trying to accomplish—delivering medical care to patients regardless of their location.

Here’s a list of eligible originating sites (offices), according to Ohio’s Medicaid:

  • Physician 
  • Physician assistant
  • Psychologist
  • Clinical nurse specialist
  • Certified nurse practitioner
  • Certified nurse-midwife 
  • Licensed independent social worker
  • Licensed independent chemical dependency counselor
  • Licensed independent marriage and family therapist,
  • Licensed professional clinical counselor 
  • The patient’s home 
  • School 
  • Inpatient hospital 
  • Outpatient hospital 
  • Nursing facility 
  • Intermediate care facility for individuals with an intellectual disability 

Reimbursement for telemedicine in Ohio

Ohio state law does not provide any reference regarding reimbursement of healthcare services delivered via telemedicine. We’ve mentioned that a good number of private insurance companies cover remote healthcare services, so patients are advised to consult their health plan providers prior to receiving telemedicine services.

The lack of reimbursement policy within Ohio state law means that the rates for telemedicine remain undefined. Looking at policies from other states, we would recommend billing patients at the same rates as if the medical care was provided in-person. 

As far as Ohio Medicaid is concerned, the program only reimburses for live-video telemedicine services under the conditions we listed above. This means that store-and-forward technology and remote patient monitoring (RPM) are not reimbursed in the State of Ohio. 

Ohio’s response to the COVID-19 emergency

Facing the COVID-19 pandemic, the State of Ohio issued an emergency rule pertaining to the expansion of telehealth services. 

The most notable changes include expanding telehealth services to include telephone consultations, images transmitted via fax machines, and email communications. The state also provided a detailed list of eligible telehealth providers for the duration of the emergency, which you can find here

Ohio also issued an Appendix detailing reimbursable telehealth services during a state of emergency, further increasing the availability of remote medical care during these difficult times. 

Embrace telemedicine in Ohio with Curogram

If you’re looking for a telemedicine solution that complies with Ohio state law, HIPAA rules, and rules and regulations set forth by Ohio Medicaid Program, Curogram is the perfect solution.

Our telemedicine platform enables you to set up your virtual clinic and start treating patients remotely in just 24 hours! Curogram enables healthcare professionals to host virtual appointments, share PHI, discuss work-related topics with colleagues and partners, and communicate with patients—all from a single, web-based dashboard.

The main appeal of Curogram comes from its convenience. Our platform is extremely easy to use for both healthcare professionals and patients. The platform mimics your in-person workflows, integrates with your EHR, and enables you to effectively treat patients remotely. You can also send them automated appointment reminders via SMS, reducing no-shows by 75%! 

Patients love Curogram because it’s extremely straightforward. All they have to do is click the link in the text message you send them, and they’ll be automatically redirected to the waiting room. Here, they’ll be tended by your medical staff until an available doctor initiates the video appointment. 

After each visit, they’ll receive links for the visit summary and other relevant medical data, which they can access by downloading the Curogram patient app. This ensures that PHI is shared in a secure, fully HIPAA compliant environment, and prevents data breaches and unauthorized access to sensitive medical information.

Embracing telemedicine in Ohio has never been easier! Start your free Curogram trial and see why clinics, doctors, and patients love us. 

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.

Telemedicine by State in the US

Alabama

Indiana

Nebraska

South Carolina

Alaska

Iowa

Nevada

South Dakota

Arizona

Kansas

New Hampshire

Tennessee

Arkansas

Kentucky

New Jersey

Texas

California

Louisiana

New Mexico

Utah

Colorado

Maine

New York

Vermont

Connecticut

Maryland

North Carolina

Virginia

Delaware

Massachusetts 

North Dakota

Washington

Florida

Michigan

Ohio

West Virginia

Georgia

Minnesota

Oklahoma

Wisconsin

Hawaii

Mississippi

Oregon

Wyoming

Idaho

Missouri

Pennsylvania

 

Illinois

Montana

Rhode Island

 

Topics: telemedicine

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