NCAO26

Advisory Opinion NCAO: 26.00 Telehealth Advanced Practice Nursing Care Services 3 Laws and Rules The nursing statutes and regulations do not reference the delivery of telehealth nursing services. This advisory opinion is intended as a broad statement on telehealth and is not meant to encompass all practice settings and related laws and rules. The terms “telehealth” and “telemedicine” are often used interchangeably to refer to the use of digital technology to deliver health care. The nursing laws and rules currently do not define these terms. There are many definitions used in laws and rules, by the public, institutions, professional organizations, regulatory bodies, and others to define these terms. Examples include: • RCW 43.70.495 Telemedicine Training for Health Care Professionals • RCW 70.41.020 Hospital Licensing and Regulation - Definitions (Telemedicine) • RCW 48.43.735 Reimbursement of Health Care Services Provided through Telemedicine or Store and Forward Technology • WAC 182-531-1730 Health Care Authority Physician-Related Services • WAC 246-335-610 Hospice Definitions (Telehealth and Telemedicine) • WAC 246-915-187 Physical Therapists and Physical Therapy Assistants Definition (Telehealth) Nurse Licensure The person practicing as an ARNP must have the appropriate Washington State license/credential to provide telehealth services to individuals/patients located in Washington. The ARNP providing telehealth services to an individual/patient located in another state or country must check with that state or country to determine if they need a license or credential in that state or country. RCW 18.79.240 defines exceptions that might apply. Chapter 70.15 RCW allows exceptions in emergencies for practitioners registered with the Department of Health ( Healthcare Providers Emergency Volunteers Practice Act Information and Resources). RCW 43.70.117 Health Care Professionals Licensed in another state or United States Territory or the District of Columbia - In-State Practice on a Limited Basis - Requirements - Limitations allows in-state practice on a limited voluntary (uncompensated) basis up to thirty days per calendar year. Telemedicine Training Requirement On or after January 1, 2021, RCW 43.70.495 requires any licensed, registered or certified health care provider (excluding physicians or osteopathic physicians) to take approved telemedicine training if they are performing these functions. The law defines “telemedicine” as: “The delivery of health care services using interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment. It does not include the use of audio-only telephone, facsimile, or email.” The training must include information on current state and federal law, liability, informed consent, and other criteria outlined by the Washington State Telehealth Cooperative . Alternative training offered by an employer continuing education courses or training developed by a health care professional board or commission must include similar components of the Telemedicine Training developed by the Washington State Telehealth Collaborative. The ARNP must sign and retain an attestation of completion but does not need to send this to the NCQAC unless requested. In addition, please see NCQAC FAQs on telemedicine training requirements. Discipline

Advisory Opinion NCAO: 26.00 Telehealth Advanced Practice Nursing Care Services 6 2. Cannabis authorization https://app.leg.wa.gov/rcw/default.aspx?cite=69.51A.030 3. Department of Health. (2018). Definitions-In Home Services-Hospice. Retrieved May 7, 2020, from https://app.leg.wa.gov/wac/default.aspx?cite=246-335-610 4. Reimbursement- RCW 48.43.735(8)(d) and 48.43.735(4) 5. Store and forward http://app.leg.wa.gov/RCW/default.aspx?Cite=74.09.325 6. Telemedicine law https://app.leg.wa.gov/RCW/default.aspx?cite=18.71&full=true 7. US Code of Federal Regulations. (2018). Healthcare Practitioners Practicing via Telehealth. Retrieved September 17, 2020, from https://www.govregs.com/regulations/title38_chapterI_part17_subjgrp207_section17.417 8. Washington Health Care Authority (HCA) https://apps.leg.wa.gov/wac/default.aspx?cite=182-531- 1730 9. Washington State Legislation (2020). Reimbursement of health care services provided through telemedicine or store and forward technology. Retrieved May 11, 2020, from https://app.leg.wa.gov/rcw/default.aspx?cite=48.43.735 Guidelines 1. Advanced Registered Nurse Practitioner, https://www.doh.wa.gov/portals/1/Documents/6000/ARNPLinks.pdf 2. AMD Telemedicine Services( 2014). School-Based Telemedicine Webinar Question and Answer Summary. Retrieved September 16, 2020, from https://www.amdtelemedicine.com/wp- content/uploads/2020/08/School-BasedTelemedicineWebinarQASessionSummary.pdf 3. American Academy of Ambulatory Care Nursing https://www.aaacn.org/professional- development/telehealth-nursing-practice 4. American Telehealth Association https://thesource.americantelemed.org/viewdocument/state- medicaid-best-4. 5. American Telemedicine Association: FAQs https://www.americantelemed.org/about/telehealth- faqs (2020) from https://www.americantelemed.org/resource/learning-development/ American Telemedicine Association. Practice Guidelines & Resources. ( 2018). Retrieved May 6. Center for Medicaid and Medicare Services-https://www.cms.gov/Medicare/Medicare-General- Information/Telehealth/ 7. Health Services Resource Administration (2020). Telehealth Programs. Retrieved September 16, 2020, from http://www.hrsa.gov/rural-health/telehealth 8. HIPAA Compliance Checklist 2020 9. NCQAC Telehealth FAQs