Transcript Skype Update 2012: The Good, The Bad & the Ugly TeleMental

Innovative Interjurisdictional
Practice Models
Marlene M. Maheu, Ph.D.
[email protected]
Executive Director
TeleMental Health Institute
Disclaimer
• I am an MFT and clinical psychologist, not an attorney,
physician or Information Technology specialist. My
goal is educational only. The information I present is
my best attempt to bring you timely and relevant
information in a rapidly evolving area. I therefore make
no warranty, guarantee, or representation as to the
accuracy or sufficiency of the information
contained in my training.
• My goal is to outline the issues and alert you to what's
happening, including legal, ethical and other risk
management issues. You are encouraged to seek
specific advice related to your circumstance from your
qualified authorities.
AASCB Slides & References
http://telehealth.org/aascb
We are retooling
2014
Telehealth vs. Distance Counseling
(working model not to scale)
Telehealth
Regional
Health
Information
Sharing
Health
Professions
Education
Administration
Behavioral
Telehealth
Disciplines, including
Distance Counseling,
Training &
Supervision
Consumer
Education
(and Selfmanagement)
Evaluation
Research
Public
Health
Homeland Security
What are the Current
Models for Distance Services
in Counseling and Other
Disciplines?
Traditional Behavioral Telehealth Model
Traditional Behavioral Telehealth Model
• Hub-and-spoke model
– Only work with previously identified clients/patients
who have had an in-person assessment
– Detailed and documented referral requests
– Detailed health record at fingertips of clinician
– Client/patient is at the “originating site”
– Clinician is at the “distant” site
– Community collaborator is available
• Client/patient is pre-trained by staff
• Technology is stable
– IT staff is available during entire time of connection to
client/patient
Online Norm vs. Traditional Behavioral
Telehealth (or Telemental Health)
Traditional Online Therapy
• Mostly Email & Chat
• Anonymity
• Accept self-referral online
• Disclaim Responsibility w/
Website Disclaimers
• No Clear Channels for
Mandated Reporting
• No Patient Records
2014
Traditional Behavioral Telehealth
• Video
• Verify clients/patients
• Rely on referrals from clinical
offices
• Use informed consent
processes/documentation
• Engage in mandated reporting
• Document as required by law
Online Norm vs. Traditional Behavioral
Telehealth (or Telemental Health)
Traditional Online Therapy
• No Contact with Other
Treating Clinicians
• No Authentication of
Consumer / Professional
• No Emergency Backup
Procedures
•
•
2014
Misunderstanding of
Clinical Processes (suicide)
Scant Research for
Unsupervised Settings
Traditional Telemental Health
• Obtain signed releases and
collaborate
• Verify identify of both
Consumer and Professional
• Establish emergency backup
plan and personnel prior to
delivering care
Levels of Security
General
Telepractice
Licensure Issues
2014
Inter-jurisdictional
Practice
Licensing Boards that may
assert jurisdiction:
• The one in the
professional’s state(s)
of licensure
• The one in the
client/client’s state of
location at time of call
• Both
Safest Practice:
• Provide services only
where licensed
• Require client to attest
to his or her location on
2014 every call
Inter-jurisdictional
Practice (cont.)
Special telehealth and in many cases,
“telemedicine” laws have led the way
• Prescription-writing initiatives led to
development of laws in the 90’s
• Reimbursement practices for
Medicare 7 Medicaid
• 32 states now mandate in-person
assessment prior to distance contact
• Special informed consent laws also
rapidly evolving
• Regulatory Case
• Oklahoma case of Dr. Trow
• No in-person
assessment
• No informed consent
• No HIPAA-compliant
technology (he used
2014
Skype)
Licensure Requirements for Professional Counselors – 2014
What’s New for 2014
(page 4)
Licensure Requirements for Professional Counselors – 2014
What’s New for 2014 (page 4)
Levels of Security
Specific
Telepractice
Licensure Models
2014
Special Telehealth Licenses or Certificates
Licenses could allow an out of state provider
to render services via technology in a foreign
state, or it allows a clinician to provide
services via telehealth into a state if certain
conditions are met (such as agreeing that
they will not open an office in that state.)
http://www.fsmb.org/pdf/grpol_telemedicine_licen
sure.pdf
States with Laws Mandating Private Insurance Coverage of Telemedicine
Special Telehealth Licenses or Certificates
•
•
•
•
•
Alabama
Louisiana
Minnesota
Montana
Nevada
•
•
•
•
•
New Mexico
Ohio
Oregon
Tennessee
Texas
http://www.fsmb.org/pdf/grpol_telemedicine
_licensure.pdf
Innovative Models
• National Council of State Boards of Nursing
(NCSB)
• Federation of State Medical Boards (FSMB)
• Association of State and Provincial Psychology
Boards (ASPPB)
History of Licensure Portability
• 1996
– Telecommunications Act of 1996 - Congress urged
the health care industry to develop multi-state
licensure models
– US Federal Communications Commission
• 2000
– National Council of State Boards of Nursing
(NCSBN) instituted the Nurse License Compact
(NLC)
Nurse Compact
• Developed upon the water rights precedent
shared by states.
• Within states that have signed the compact,
any licensed nurse can apply for a multistate
license and practice nursing in all of the
included states.
Association of State and Provincial Psychology Boards
(ASPPB) (continued)
Preferred Model Seem to be Compact
• Association of State and Provincial Psychology
Boards (ASPPB)
– Received $350k grant for 3 years
– Decided on “E.Passport” model
– Running into difficulties
– Now are working with other groups to develop a
collaborative model across disciplines
Levels of Security
Collaborative
Model
2014
Collaborative Effort
• Movement toward collaboration was inspired and is
being organized by Bill Hatherill, CEO of Federation of
Boards of Physical Therapy
• Organizing CEOs of regulatory associations to approach states to help
work with states
• Working with National Governors Association
• ASPPB is meeting in January with Federation of
Association of Regulatory Boards (FARBS) and other
groups
• Focus of ASPPB Meeting:
– What does it take to establish a compact?
– How to best move in conjunction with other disciplines to
approach state boards?
Collaborative Effort
• Talking about compacts and endorsement programs
– Endorsement--Where individual practitioner shows they
have meet the standard and then convince states to accept
credential
– Compacts – reciprocal
– Nursing – no real way to work around disciplining model
– Follow rules in state of citizen, have to agree with comply
with hearing and a both boards will impose fine, and
practitioner would lose e.passport everywhere
– Can’t take base license away
– Up to home state to impose other sanctions on
practitioner for base license
Levels of Security
Licensure
Portability
Legislation
2014
Federal Proposals
• State Boards are Active
• Federal (proposals recognize
that Congress has power to
regulate interstate health
commerce.)
1. STEP ACT (2011): allows
DoD providers with a
single state license to
deliver services across
state lines for the military
STEP ACT
STEP ACT is the
Servicemembers’
Telemedicine & E-Health
Portability Act, which
expanded the already
existing DOD state licensure
exemption for health care
professionals treating DOD
clients.
TELEmedicine for MEDicare Act, 2013
• HR 3077, the “TELE-MED Act” was introduced
Sept. 10 in the House by Reps. Devin Nunes,
R-Calif., and Frank Pallone, D-N.J. Nicknamed
the TELE-MED Act, seeks to update current
licensure laws for Medicare beneficiaries, the
number of whom is expected to rise to 81
million by 2030
TELEmedicine for MEDicare Act, 2013
• In the case of a Medicare participating physician or practitioner who
is licensed or otherwise legally authorized to provide a health care
service in a State, such physician or practitioner may provide such a
service as a telemedicine service to a Medicare beneficiary who is in
a different State, and any requirement that such physician or
practitioner obtain a comparable license or other comparable legal
authorization from such different State with respect to the provision
of such health care service by such physician or practitioner to such
beneficiary shall not apply.
• If passed, the bill will give licensing or authorizing states
enforcement powers and require the Secretary of the Department
of Health & Human Services to solicit input from “relevant
stakeholders” in order to provide telemedicine guidance for states.
Levels of Security
Resources
2014
TMHI News
http://telehealth.org/newsletter-signup/
TeleMental Health
Institute, Inc.
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