in the state they are visiting before engaging in a telemental health session with a client. The National Association of Social Workers (NASW, 2021a) advises clinicians to follow the laws of both jurisdictions (where the client is located and where the professional is located) that apply to their service provision. Most jurisdictions have adopted the position that electronic social work practice takes place in both the jurisdiction where the client is receiving such services (irrespective of the location of the practitioner) and in the jurisdiction where the social worker is licensed and located at the time of providing such electronic services (irrespective of the location of the client). In some states, face-to-face assessments have been required within six months of initial contacts and on a yearly basis. However, there are still temporary Medicare changes that allow patients to receive telehealth services in their home and remove the requirements for in-person appointments. Some COVID-19 practices have transitioned to permanent Medicare changes for telemental health, including no geographical restrictions for originating site, the ability to receive telemental health in the home, and the allowance of audio-only communication platforms (telehealth policy changes). Clinicians should ensure that they comply with the federal HIPAA regulations and the Health Information Technology for Economic and Clinical Health Act (HIPAA Rules for Telehealth Technology). Staff providing telemental health sessions must be trained before providing services. This is not unique to telemental health—all licensed individuals must be trained in the therapy they are providing or must receive training, consultation, and/or supervision when delivering a new service. In addition, many agencies require verifications of credentialing before allowing individuals to provide telemental health services (Johnson, 2014; Lustgarten, 2017). Some organizations, such as Distance Certified Counselors, the American Distance Counseling Association, the American Telemedicine Association, the International
Society for Mental Health Online, and the Office for the Advancement of Telehealth, offer certifications and guidance for practitioners who want to receive training (Swenson et al., 2016). Practitioners should be aware of the parameters of local licensure and practice jurisdiction. At this time, providers in most states have limitations on routinely delivering care to individuals outside of the states in which they are licensed, with the exception of working in a federal capacity that allows for licensure in any state. However, licensure regulations are evolving. Some states with large rural and/or underserved populations are starting to have licensing reciprocity across state lines to allow providers in other states to practice within state lines (Psychology Interjurisdictional Compact), and many states are developing practices for interstate telemental health such as telepsychology via PSYPACT (Psychology Interjurisdictional Compact). Practitioners who use telemental health services have the same duty to care for their clients as if they had face-to-face sessions. However, issues related to legal liability and malpractice have not been thoroughly studied (Daniel & Sulmasy, 2015). Many professional organizations are only now developing professional ethical guidelines for clinicians who have telemental health practices, as discussed in greater detail later in the course. Agencies often establish memoranda of understanding and service agreements between locations before implementing telemental health services. In addition, an agency may want to include a privacy officer or technology expert in the staffing plan, especially if telemental health services are provided frequently. Box 1 provides an example of a memorandum of understanding between the distant and originating sites providing telemental health services. Before a client comes to an agency’s office to receive telemental health, the two agencies should develop a memorandum of understanding that outlines the specific responsibilities of each agency. In such an agency-to-agency agreement, there would be further agreements related to liability risks (e.g., insurance agreements and other liabilities).
Box 1: Memorandum of Agreement between ABC Agency and XYZ Agency This agreement is made by and between ABC agency and XYZ agency. The purpose of this agreement is to increase the accessibility of mental health services for persons who have limited access to services by establishing an outpatient mental health service via teletherapy, facilitate the referral and delivery of outpatient mental health services, coordinate the services, and define the responsibility of ABC agency and XYZ agency for shared clients. The provision of treatment and services in this agreement is conditioned on the receipt of authorization for preauthorization required by third-party payers. Mental Health Clinic Services ABC agrees to provide mental health services to shared clients, including but not limited to the following: ● Individual and/or group psychotherapy. ● Intake evaluations and diagnostic assessments. ● Development and monitoring of the individual treatment plan (ITP). ● Referral to other services/professionals as deemed medically prudent by the psychiatrist and treatment team, including targeted case management, psychiatric rehabilitation, residential rehabilitation, and supported employment. ● Collaboration with members of the service team. ● Collaboration with other partners, including XYZ agency and continued psychiatric services and medication management services from XYZ agency. ● Emergency and crisis intervention. ● Clients may choose teletherapy services through ABC agency and continue their psychiatric services and medication management services from XYZ agency. ● ABC agency agrees to provide teletherapy services to eligible clients weekly for psychotherapy. With the new client, the therapist will schedule an intake interview and make appropriate referrals to XYZ agency for psychiatric evaluations and medication management. If XYZ agency receives a new client referral, the psychiatrist will refer the client to ABC agency for teletherapy services. ● ABC agency shall accept and serve insurance-eligible clients who are not presently covered but have current proof of eligibility.
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Book Code: PCUS1525
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