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Posts Tagged ‘Telemedicine’

Telehealth Certification In Wisconsin Mental Health Programs

Tuesday, August 11th, 2015

Process for Telehealth Certification In Wisconsin

Only certified mental health and/or substance abuse programs, or agencies planning to be certified as a mental health and/or substance abuse provider, may apply for telehealth certification. The first step in the process is for the agency to write a plan addressing each section in the attached template. The plan is then sent to the Behavioral Health Certification Section of the Division of Quality Assurance.

Provider’s must demonstrate compliance with their approved plan to the Division of Quality Assurance surveyor(s) during a site review or other unannounced focus visits.

Requirements for Telehealth Certification

There are several requirements that must be met in order to maintain certification.  Many of these requirements will need to be reflected in compliance policies and made operational as part of the telehealth program. These requirements fall in the following areas subject to additional detail in each area:

  • applicable regulatory requirements for the provider’s specific program (Administrative Code DHS 34, 35, 36, 40, 41, 61, 63, and 75)
  • requirements related to clinical supervision/collaboration for program staff who provide treatment services via telehealth, background checks, maintenance of professional liability insurance, documentation into the consumer’s record in a timely manner, and other requirements.
  • requirements regarding the locations for staff other than the main office of certified program or a certified branch office. Patients must receive the telehealth services at the main office or a certified branch office of the certified program.
  • Restriction against providing the telehealth services to consumers who are in-home or in-community.
  • minimum transmission standards established by the American Telemedicine Association (see http://www.americantelemed.org/resources/telemedicine-practice-guidelines/telemedicine-practice-guidelines)
  • compliance with vendor requirements for the telehealth hardware/software to ensure that the telehealth service is of high quality and as close to a face to face visit as possible.
  • orientation and ongoing training to staff on the use of the telehealth equipment, the clinical application of telehealth, safety and security during telehealth visits, privacy and confidentiality, back-up procedures if there is equipment failure, and consumer preparation for telehealth.
  • Assuring that patients are informed about the provision of services provided through telehealth, the history of telehealth, success rate of telehealth services, how telehealth sessions are conducted, and the extent to which the program is able to provide treatment services face-to-face versus via telehealth.
  • an ongoing method for obtaining consumer satisfaction on telehealth visits and evaluating the results of this survey process for quality assurance purposes
  • patient choice of having a face to face visit with a professional or seeing this person via telehealth, to the extent feasible.
  • workspaces must be secure, private, reasonably soundproof, and have a lockable door to prevent unexpected entry.
  • Efforts to ensure privacy so provider discussion cannot be overheard by others outside of the room where the service is provided.
  • If other people are in either the patient or the professional’s room, both the program staff and the consumer must be made aware of the other person and agree to their presence.
  • Program staff must verify for the consumer the identity of the staff member who is providing the treatment services via telehealth and verify for the staff member providing the treatment services theconsumer’s identity.
  • policy/procedure for technology breakdown that causes a disruption of the session.
  • System to Ensure secure upload and download with the vendor’s server.  At least 128 bit encryption software must be used.
  • assure that no information from a transmission of a telehealth services is stored on the vendor’s servers.
  • use of HIPAA Business Associate Agreement if information is transmitted via the vendor’s servers.

How Does Wisconsin Medicaid Reimburse for Telehealth?  Check Out The Article Here: Telemedicine Reimbursement Mental Health Programs

New Memorandum On Telehealth In Mental Health and Substance Abuse Programs

Tuesday, August 11th, 2015

 

On August 5, 2015 the  the Wisconsin Division of Quality Assurance (DQA), issued new DQA Memo 2015-011 (the “Telehealth Memorandum”) to provide background information and update a previous memo (Memo #2004-14, issued in September 2004) on the use of telehealth in certified mental health and substance abuse treatment programs/services in the State of Wisconsin.

Recognizing that significant technological advances have been made since the earlier memo, the DQA details revisions to the minimum requirements for telehealth certification by mental health and substance abuse programs in the State of Wisconsin.  The new standards for certification purport to permit use of hardware and software that may be less costly and easier to use.  This may result in facilitating broader use of telehealth to benefit patients with the state of Wisconsin.

The Telehealth Memorandum outlines basic certification requirements and references the application form for Mental Health and Substance Abuse Telehealth certification for additional detail.  Specific requirements are outlined  that certified mental health and substance abuse treatment programs must follow in order to use telehealth technology as a means of service provision for counseling, psychotherapy, medication management or related clinical consultation.  Services may include outpatient services, crisis services, community support services, comprehensive community services, day treatment programs, inpatient, and other services.

Some of the requirements that must be met in order to achieve certification of a telehealth program in Wisconsin include the following:

  • All staff employed by these programs may provide services using telehealth technologies provided they have received the necessary training and meet program and telehealth certification standards.
  • The certified program should identify specific staff providing the services in its telehealth plan and policies as required in the certification process.
  • Telehealth services cannot be provided in Wisconsin by narcotic treatment services certified under Chapter DHS 75.15 or mental health inpatient services certified under Chapter DHS 61.71 and Chapter DHS 61.79.
  • Telehealth technology cannot be used in lieu of the face-to-face assessment for continuing use of the restraint/seclusion in an inpatient setting.
  • Telehealth equipment may be used for the purpose of clinical supervision and clinical collaboration.
  • All the requirements for supervision and collaboration continue to apply such as transmission quality, ensuring that the transmitted information is not stored, and other requirements and restrictions outlined in DQA guidance.
  • The memo cautions providers regarding the use of telehealth equipment for clinical supervision for substance abuse counselors which require at least one in-person meeting per month.

New Paper On Credentialing of Telemedicine Providers

Monday, April 21st, 2014

I have published a new “Blue Paper” covering credentialing of telemedicine providers.  This issues has emerged over the past several years are telemedicine is growing in usage.  The article covers the relatively new CMS regulations regarding the credentialing process and provides some useful tips to providers who are actively engaging in telemedicine.

You can find the new Blue Paper at the following ling:  Telemedicine Credentialing Article

Distant Site Telemedicine Credentialing Conditions

Thursday, April 17th, 2014

Reliance On Distant-Site Hospital or Telemedicine Entity Credentialing

Reliance On Distant Site for Telemedicine Credentialing

The 2011 CMS regulation modified conditions of the participation for hospitals and critical access hospitals to permit the hospital to have its medical staff rely on the distant-site hospital credentialing decisions when making recommendations on privileges for individual physicians and practitioners providing telemedicine services. However, this process is only permitted when a number of conditions are met:

  • The telemedicine services must be provided pursuant to a written agreement with the Medicare participating distant-site hospital or qualifying distant-site telemedicine entity.
  • The agreement must specify that it is the responsibility of the governing body of the distant-site hospital to meet the existing requirements for credentialing of providers who are providing telemedicine service.
  • The distant-site hospital providing the telemedicine services must be another Medicare participating hospital or a “telemedicine entity.”
  • The distant-site physician or other practitioner must have been privileged at the distant-site hospital providing telemedicine services and the distant-site hospital must provide a current list of telemedicine physicians and practitioners who are privileged there and their current privileges at the distant-site hospital or entity to the hospital or CAH.
  • The distance site practitioner must hold a license that is recognized by the state in which the hospital whose patients are receiving telemedicine services is located
  • The hospital must have evidence of an internal review of the distant-site physician’s or practitioner’s performance under telemedicine privileges and must send this information to the distance site hospital for use in the distant-site hospital’s periodic appraisal of the distant-site physician’s provision of telemedicine services.
  • Information sent for use in the periodic appraisal must at a minimum have included all adverse events that resulted or could have resulted from telemedicine services provided by the distance site provider to the originating hospital’s patients and all complaints received by the originating hospital with respect to the distance site physician or practitioner.

Credentialing Rules for Telemedicine Providers

Thursday, April 17th, 2014

Telemedicine Credentialing CMS Credentialing Rules

Credentialing Telemedicine providersAt the present time, CMS conditions of participation are the primary regulatory source governing the process of credentialing telemedicine providers.  The Joint Commission has revised its requirements to be consistent with CMS rules.  In regulations dated May 5, 2011 (effective July 5, 2011), CMS provided final regulations that somewhat streamline the credentialing process and which comply with the Medicare Conditions of Participation.  CMS regulations give providers some options regarding credentialing of telemedicine including:

  • Retaining complete credentialing of all telemedicine providers using the credentialing process that is applicable to all other medical staff members.  The direct credentialing option is still the safest route for hospital’s to take from a liability standpoint.
  • Rely on the credentialing decision of another Medicare certified hospital when granting telemedicine privileges, subject to certain specific conditions including entering into a written agreement with the other facility.
  • Rely on the credentialing decisions of other “telemedicine entities” when granting telemedicine privileges, subject to certain conditions including entering into a written agreement.

In short, provided that all of the specific requirements contained in CMS regulations are met, a receiving hospital is permitted for purposes of Medicare participation to rely on the credentialing decisions that have been made by the “distant-site” telemedicine provider.  Note, however, that when the other facility is located out of state, the provider will still need to independently verify licensure under Wisconsin law.  The credentialing process conducted in a different state may not be a reliable source of assuring Wisconsin licensure.  In most cases, the distant-site provider will require full Wisconsin licensure to perform and permit billing for the applicable service.

ATA Issues Telemedicine Protocols for Mental Health Services

Tuesday, March 26th, 2013

ATA Proposed Telemedicine Protocols – Mental Health Video Services

telemedicine video mental healthThe American Telemedicine Association just issues a request for public comment on a draft policy that it released relative to video-based mental health services. The proposed ATA policies are intended to “detail best-practices for online mental health providers delivering video-based services through personal computers and mobile devices” according to the ATA release.

You can access the ATA proposed practice guidelines at: www.americantelemed.org/standards

You can comment to the proposed practice protocols at the following link:
www.americantelemed.org/comments

For more information regarding legal and regulatory issues affecting telemedicine and telehealth programs, contact John H. Fisher at the Ruder Ware Health Care Focus Group through the contact information on this page.

Telemedicine Resources On The Internet

Tuesday, February 12th, 2013

Sources of Telemedicine Information on the World Wide Web

Because telemedicine is a developing field, many of the legal issues regarding telemedicine are

undeveloped. As courts and legislatures attempt to tackle these issues, experts will want to stay informed of these developments. Fortunately, there are a number of useful World Wide Web sites that address telemedicine and the attendant legal issues. Some of the most useful and informative sites are:

 US Government Resources

Federal Telemedicine Gateway

http://www.tmgateway.org/

Office for the Advancement of Telehealth

US Department of Health & Human Services

http://telehealth.hrsa.gov/

Telemedicine-Related Activities Report

US Food and Drug Administration

http://www.fda.gov/cdrh/telemed.html

Telemedicine Report to Congress, January 31, 1997

US Department of Commerce and Department of Health & Human Services http://www.ntia.doc.gov/reports/telemed/cover.htm

US Department of Defense Telemedicine

http://www.matmo.org/

 

Telemedicine Associations

American Telemedicine Association – atawiki – contains an abundance of telemedicine services in Wiki format.

American Medical Informatics Association

http://www.amia.org/

American Telemedicine Association

http://www.atmeda.org

MedWeb Plus: Telemedicine (1999).

http://www.medwebplus.com/subject/Telemedicine.html

 

Telemedicine Publications

Telehealth Magazine

http://www.telemedmag.com

Telemedicine Information Exchange

http://208.129.211.51/

http://tie.telemed.org

Telemedicine Today, http://www.telemedtoday.com

Telemedicine and Telehealth Networks, http://www.telemedmag.com

Indian Health Service http://www.ihs.gov

Telemedicine Links, http://www.jma.com.au/telelink.htm#networks

Telemedicine Information Exchange, http://208.129.211.51/

United States Department of Commerce and United States Department of Health and Human Services (1997).

State Telemedicine Programs and Resources

East Carolina University School of Medicine’s Telemedicine Page

http://www.telemed.med.ecu.edu/

Emergency Medicine and Primary Care Home Page

http://www.embbs.com/

MedWeb: Telemedicine Emory University

http://WWW.MedWeb.Emory.Edu/MedWeb/

Telemedicine Links John Mitchell & Associates

http://www.jma.com.au/telelink.htm#networks Includes links to telemedicine networks, telemedicine projects, telemedicine organizations, telematics, telemedicine journals, books, articles, bibliographies, terminology.

Rural Alabama Health Alliance Telemedicine

http://www.tmgateway.org/gateway/agencies/rus/501/

University of Iowa’s Virtual Hospital

http://vh.radiology.uiowa.edu/

University of Kansas Telemedicine

http://www2.kumc.edu/telemedicine/index.asp

University of Vermont Telemedicine

http://www.vtmednet.org./telemedicine/

Health Information Tennessee

http://web.utk.edu/~chrg/hit/index.htm

Other Useful Links

Prevention

http://www.cdc.gov/cdc.html

Healthcare on the Internet Index/Abstract

http://www.personal.psu.edu/faculty/e/p/epd103/hci/

National Center for Injury Prevention and Control

http://www.cdc.gov/ncipc/osp/mortdata.htm

Sig Med Pulse, ASIS Medical Informatics Newsletter

http://www.asis.org/SIG/SIGMED/newsletter/pulsev1n3.html

Telemedicine Report to Congress, January 31, 1997, http://www.ntia.doc.gov/reports/telemed/

United States Food and Drug Administration (1997).

Telemedicine-Related Activities Report, http://www.fda.gov/cdrh/telemed.html

United States Government (1998)

The Federal Telemedicine Gateway, http://www.tmgateway.org/gateway/

Online Telemedicine Resource Links

Telemedicine Resources • Http://telehealth.hrsa.gov (OAT)

• http:www.atmeda.org (Am. Telemedicine Assn.)

 • http://telehealth.hrsa.gov/jwgt/jwgt.htm

http://transition.fcc.gov/wcb/tapd/ruralhealth/

 http://www.rurdev.usda.gov/UTP_DLTResources.html

Telemedicine Credentialing By Proxy

Tuesday, February 12th, 2013

Telemedicine Credentialing By Proxy and Hospital Policies

telemedicine policies credentialing telehealthProvider Credentialing requirements raise important considerations in any telemedicine arrangement. The facility where care is received, renders a diagnosis, or otherwise provides clinical treatment to a patient, must assure that a telemedicine practitioner is appropriately credentialed and privileged in compliance with their credentialing process, CMS rules, and the requirements of applicable accreditation organizations.  The process for credentialing telemedicine providers should be addressed by the governing body and reflected in medical staff bylaws and formal credentialing policies.

Credentialing standards have been somewhat streamlined since CMS adopted new regulations that were effective in June of 2011.  CMS rules now permit “credentialing by proxy” provided that several conditions are met.  It remains the responsibility of the board to determine when or if it wishes to rely on “credentialing by proxy” or whether it should apply full credentialing requirements on remote providers of telemedicine services.  Even though the process has been simplified, credentialing of providers who perform telemedicine services to patients of a hospital is still an extremely important responsibility of the hospital board.

John H. Fisher

Health Care Counsel
Ruder Ware, L.L.S.C.
500 First Street, Suite 8000
P.O. Box 8050
Wausau, WI 54402-8050

Tel 715.845.4336
Fax 715.845.2718

Ruder Ware is a member of Meritas Law Firms Worldwide

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