(a) In this section, the following words and terms
have the following meanings:
(1) Electronic means--Live, synchronous, interactive
treatment program services delivered using telecommunications or information
technology by a health professional licensed, certified, or otherwise
entitled to practice in this state and acting within the scope of
the health professional's license, certification, or entitlement to
a patient at a different physical location than the health professional.
This term includes services delivered using synchronous audiovisual
technology or synchronous audio-only technology but does not include
pre-recorded videos.
(2) Existing clinical relationship--A relationship
that occurs when a person has received at least one in-person or synchronous
audiovisual treatment service from the same provider within the six
months prior to the initial service delivered by synchronous telephone
(audio-only) technology.
(3) Synchronous audio-only technology--An interactive,
two-way audio telecommunications platform, including telephone technology,
that uses only sound and meets the privacy requirements of the Health
Insurance Portability and Accountability Act of 1996 (HIPAA).
(4) Synchronous audiovisual technology--An interactive,
two-way audio and video telecommunications platform that meets HIPPA
privacy requirements.
(5) Verbal consent--The spoken agreement of a client
or a client's legally authorized representative to participate in
treatment services through electronic means.
(b) Except as provided under §448.801 of this
chapter (relating to Screening) and §448.803 of this chapter
(relating to Assessment), only a licensed outpatient chemical dependency
treatment program may provide treatment program services through electronic
means.
(c) The program providing treatment services through
electronic means may provide treatment services to adult and adolescent
clients to the extent allowed by the facility's license and shall
comply with all requirements of this section.
(d) The program shall ensure only the following individuals
provide services through electronic means under this section:
(1) a qualified credentialed counselor (QCC); or
(2) a counselor intern who has more than 2,000 hours
of supervised work experience or a supervised work experience waiver
under §140.408(b) of this title (relating to Requirements for
LCDC Licensure) and who has passed the chemical dependency counselor
licensing exam.
(e) The program's physical location shall be equipped
to provide in-person, face-to-face treatment services with an individual
at the individual's request.
(f) The program shall ensure all treatment sessions
shall have the following two forms of access control:
(1) all contact between a QCC and clients via electronic
means shall begin with a verification of the client through a name,
password or pin number; and
(2) security as detailed in HIPAA.
(g) A facility shall implement adequate security and
encryption measures to ensure all patient communications, recordings
and records are protected and adhere to federal and state privacy
laws, including HIPAA and Texas Health and Safety Code Chapters 181,
464, and 466 (relating to Medical Records Privacy; Facilities Treating
Persons with a Chemical Dependency, and Regulation of Narcotic Drug
Treatment Programs).
(h) A program shall maintain compliance with HIPAA
and Code of Federal Regulations (CFR) Title 42, Part 2 (relating to
Confidentiality of Substance Use Disorder Patient Records).
(i) A program shall not use e-mail communications containing
client identifying information.
(j) A program shall use synchronous audiovisual technology,
except as provided in subsection (k) of this section.
(k) A program may provide outpatient individual and
group counseling to clients using synchronous audio-only technology
only when all the following criteria are met:
(1) the client and provider have an existing clinical
relationship;
(2) the provider receives the client's verbal consent
before each session; and
(3) the provider documents in the client's record the
specific reason why the provider provided outpatient counseling services
using synchronous audio-only technology.
(l) A program shall ensure timely access to individuals
qualified in the technology as backup for systems problems.
(m) A program shall develop a contingency plan and
maintain alternate means of communication for clients when technical
problems occur during the provision of services.
(n) A program shall provide individuals and clients
with a description of all services offered.
(o) A program shall provide developed criteria, in
addition to the Diagnostic and Statistical Manual of Mental Disorders,
to assess clients for appropriateness of utilizing services through
electronic means.
(p) A program shall provide appropriate referrals for
clients who do not meet the criteria for services.
(q) A program shall develop a grievance procedure and
provide the website and phone number to the Texas Health and Human
Services Commission (HHSC) for filing a complaint.
(r) Prior to clients engaging in services through electronic
means, a program shall describe and provide in writing the potential
risks to clients. The risks shall address at a minimum the following
areas:
(1) clinical aspects;
(2) security; and
(3) confidentiality.
(s) In a HIPAA-compliant manner, a program shall document
and maintain in a client's record the client's verbal consent to participate
in services provided through electronic means. The program shall provide
the verbal consent documentation to HHSC upon request.
(t) A program shall explain to the client or the client's
legally authorized representative what verbal consent means and to
what the client or client's legally authorized representative is consenting.
The verbal consent a client provides when electing to participate
in a treatment service delivered through electronic means only applies
to one treatment service at a time. A program shall obtain the client's
verbal consent before the client receives each service through electronic
means.
(u) If the program does not obtain verbal consent for
a treatment service through electronic means, the program shall provide
the service to the client in-person and face-to-face.
(v) A program shall inform a client who chooses to
receive services through electronic means that the program will:
(1) monitor services for evidence of fraud, waste,
and abuse;
(2) determine whether the client needs additional social
services or supports;
(3) ensure the provider documents, in writing and in
the client's record, the client's verbal consent to participate in
services provided through electronic means; and
(4) adhere to HIPPA, including using HIPAA-compliant
technology for services provided through electronic means.
(w) A program shall create safeguards to ensure adolescents
receive treatment services separately from adults and verify a client's
identity and the identity of any authorized participant.
(x) A program shall provide clients with information
to access online or a copy of the current version of the following
chemical dependency treatment facility (CDTF) rules, statutes, and
federal regulations to notify clients of applicable rules and laws
regarding CDTFs:
(1) This chapter;
(2) Texas Health and Safety Code Chapter 464; and
(3) 42 CFR Part 2.
(y) A program shall provide the program's emergency
contact information to the client.
(z) A program shall maintain resource information for
the local area of the client.
(aa) A program shall provide reasonable Americans with
Disabilities Act of 1990 (ADA) accommodations for clients upon request.
(bb) A program shall be located and perform services
in Texas.
(cc) HHSC maintains the authority to regulate the program
regardless of the location of the client.
(dd) The facility shall provide the facility's emergency
contact information to the client.
(ee) The facility shall maintain resource information
for the local area of the client.
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Source Note: The provisions of this §448.911 adopted to be effective September 1, 2004, 29 TexReg 2020; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8842; amended to be effective March 3, 2022, 47 TexReg 655; amended to be effective February 22, 2024, 49 TexReg 871 |