Telehealth - Providing Behavioral Health Care via Telehealth During the COVID-19 Pandemic (BHC )

What are the requirements for providing behavioral health care services via telehealth during the COVID-19 Pandemic ?

Any examples are for illustrative purposes only.

Credentialing requirements for Telehealth providers
The Joint Commission’s requirements that address credentialing verification of telehealth providers are found in the Human Resource Management (HRM) chapter of the Comprehensive Accreditation Manual for Behavioral Health Care (CAMBHC) at HRM.01.02.01. Note: HRM.01.02.01 includes credentialing requirements for ALL staff who provide care, treatment, or services for the organization, including those receiving pay (for example, permanent, temporary, and part-time personnel, as well as contract employees), volunteers, and behavioral health profession students. When employed by the organization, licensed independent practitioners are considered staff.  CAMBHC does not include specific requirements on credentialing during a disaster, therefore, the requirements outlined in HRM. 01.02.01 would apply.

Licensed Independent Practitioners (LIP) CURRENTLY credentialed and privileged by the organization, who would now provide the same services via a telehealth link to patients, would not require any additional credentialing or privileging. The medical staff or leadership determines which services would be appropriate to be delivered via a telehealth link. There is no requirement that ‘telehealth’ be delineated as a separate privilege. Behavioral Health Providers are expected to practice within the scope of their license/certification or registration and comply with state laws and regulations for providing telehealth services during the emergency or disaster as required by HRM.01.01.03 EP 2. and LD.04.01.01 EP 2. 

Telehealth  products that may be utilized
During the COVID-19 Nationwide Public Health Emergency, covered health care providers may use non-public facing applications that allow for using telecommunications technology for two-way, real-time interactive communication.  Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications. Public facing applications (such as Facebook Live or Tik Tok), should NOT be used in the provision of telehealth by covered health care providers.

Telehealth services that can be provided by remote telehealth communications  
Services that a covered health care provider, in their professional judgement, believes can be provided through telehealth in the given circumstances of the current emergency may be provided.  This includes and is not limited to diagnosis or treatment of COVID-19 related conditions, Mental Health Counseling for individual or groups, Psychiatric consultations, Psychological evaluations, adjustment of prescriptions, among many others.

Audio-Only Telehealth for Certain Services (update from CMS 04/29/20):
CMS is waiving the requirements for interactive (two-way, real-time) telecommunications systems to furnish telehealth services, to the extent they require use of video technology, for certain services. This waiver allows the use of audio-only equipment to furnish services described by the codes for audio-only telephone evaluation and management services, and behavioral health counseling and educational services (https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes). Unless provided otherwise, other services included on the Medicare telehealth services list must be furnished using, at a minimum, audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner. 

For new OTP patients that are treated with methadone, the requirements of an in-person medical evaluation will remain in force.  Patients with opioid use disorder starting methadone are also not permitted to receive escalating doses for induction as take-home medication.

Joint Commission requirements for Behavioral Health organizations that change their settings to include telehealth services during the state of emergency or disaster
The Standard Applicability Process (SAP) chapter in the CAMBHC lists standards that apply to various setting(s), service(s), and program(s), and specific population(s). During the state of emergency or disaster:
  • the only setting standards that apply to organizations which are CLOSED during the disaster and SOLELY providing Telehealth services directly to patients at home, are the Technology-Based setting standards.  In addition, organizations are required to comply with all the standards that apply to various service(s), and program(s), that are operational and as listed on their electronic application. 
  • the organizations providing Telehealth services to patients at one or more of their locations by a practitioner who is at a location remote from the patient and is communicating with the health care professional who is treating the patient using telecommunication system, are required to comply with all the standards that apply to various setting(s), service(s), and program(s), that are operational and as listed on their electronic application in addition to standards that apply to Technology-Based setting.
The organizations should notify their Account Executive of any such change no later than 60 days after the state of emergency or disaster has ended.

Licensure requirements for providers who use telehealth
Licensing for telehealth varies from state to state. According to HealthIT.gov, most states require a provider to be licensed to practice in the originating organization’s state, while others require the healthcare provider to have a valid license in the state where the individual served/patient is located.
CMS announced a waiver allowing doctors to furnish telehealth and other services using communications technology wherever the patient is located, including at home, even across state lines.
However, it’s only legal to practice across state lines if the state where the patient resides has also waived restrictive practice acts limiting transfer of license. The Federation of State Medical Boards provides a list of the states that have modified in-state licensure requirements for telehealth in response to COVID-19.

Telehealth Licensing and Scope of Practice Resources: Telehealth COVID-19 Resources:
Additional Resources:
Coronavirus (COVID-19) Guidance and Resources


 
Last updated on September 10, 2020
Manual: Behavioral Health
Chapter: Human Resources Management HRM

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