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House Keeping Items1. Today’s webinar is 1 hour including Q&A.2. All participants will be muted during the webinar.3. Polls will used during the presentation. Please answerto be part of the discussion.4. Please use the Q&A function vs. chat. We will monitorquestions throughout and answer as many as possibleat the end.5. This webinar is being recorded and will be postedwithin 24 hours atwww.beaconhealthoptions.com/coronavirus/ so youhave continued access to the information andresources.PLEASE NOTE: This presentation provides some general information that is subject to changeand updates. It should not be construed as including all information pertinent to your particularsituation or providing legal advice. We encourage you to consult with your legal counsel regardingthe topics raised in this presentation.2
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Telehealth Documentation 101: Bridging the virtual gapAnxietyDepressionJob lossWorkingremotely4
Today’s speakersNeLina Moffett, Ed.D, LPCProvider Quality ManagerLori O’Connor, M.ED, LMHCProvider Quality ManagerCarin Skapars, MS, LMHC,CPHQVice President of ClinicalQuality5
Why are we discussing this topic in relation toCOVID-19?Provider Concerns Providers have expressed concerns regarding telehealth documentation, i.e. obtaining consent,conducting intake/assessments etc.Remaining HIPAA Compliant For many providers, telehealth is a new concept. It seems that many providers transitionedovernight to meet needs during this climate.Expectations for Documentation Although documentation may seem straight forward, due to COVID-19 some policies andprocedures may vary from state to state. Not to mention there are some practices we should all bedoing when documenting our telehealth visits.Quality and Safety Resources to measure clinical outcomes and ensure quality of care is being delivered.6
What we will discuss today Privacy in telehealthQuality concerning telehealth documentationQuality and Safety ExpectationsMeasuring OutcomesOther available resources7
Chapter01DOCUMENTATIONAND TELEHEALTH8
As COVID-19 evolves so do telehealth standardsBut documentation standards have notchanged during COVID-19 Adhere to privacy and protection laws Stay attuned to specific requirements of a particular regulator orhealth plan Watch for any directives from licensing boards in the state(s) whereservices are being delivered Check in with your malpractice insurance carrier for any instructions9
Privacy: HIPAA, 42 CFR Part 2, State Laws,Licensing Board Requirements, and MoreBeacon’s expectation is that providers remain compliant with HIPAA and all other privacy laws andrequirements and continue to deliver the same high quality of care using telehealth as wouldoccur face to face. Telehealth and telephonic services should be documented as any other health careservices would be, making sure to include any stated or observed details that may be pertinent.1Ensure virtual conferencing platforms are compliant with HIPAA and all other privacy standards.2The “minimum necessary” standard still applies to ensure appropriate and limited distribution of PHI.Healthcare professionals must ensure that any permitted PHI disclosure is limited to the minimumnecessary information to achieve the purpose for which the information is being disclosed.310
Electronic Medical Records allow for an easiertransition to telehealthBeacon recommends that HIPAA compliant platforms be selected; however, itdoes not make recommendations around specific technology vendors orplatforms to use.Some EMR’s allow for “client portals” that give clinicians the ability to senddocumentation securely. This not only allows for a safe place to hold and sharedocumentation, but a place to keep ongoing documentation, progress notes,treatment plans, etc.11
Obtaining ConsentUSPS Mail (Snail Mail)Verify that intakepacket/release ofinformation are sent todesignated signee.EmailFaxVerbalIn personWhen the clinician would otherwise obtain informed consent, tailor the informed consent process toprovide information on telehealth, its limitations and the distinctive features of telehealth and otherpossible treatment options.3Note: Beacon Health Options is not offering any legal advice. A lawyer should be consulted with anylegal questions.12
Chapter02QUALITY ANDSAFETYEXPECTATIONS13
Establishing a Quality Improvement Programwithin your practice in a COVID-19 worldPolicy andProceduresUpdate toinclude deviationfrom standardpolicy4DocumentationMonitoringToolNeed to rednessIncludes crisissupportEvidenceBasedTreatmentDocument How are thesebeing respondedto duringCOVID-1914
Quality expectations begin prior to first sessionBefore the session starts:InformedRisk/BenefitsConsentDiscuss risks/benefits of telehealth and obtain signed informed consent including telehealth fromclient or legal rep.4Back-up PlanDiscuss and have a back-up plan in case of technical difficulties or crisis situation. Have quickaccess to local resources available for client.BillingDiscuss billing for sessions, late, or missed appointments, including any changes to usual processduring the pandemic.MinorsDecide where parent/guardian will be during session.IdentityVerificationDiscuss password/code word for identify verification (particularly important with phone onlysessions).COVID-19State/federal telehealth requirements applicable during COVID-19 crisis may change once the crisisperiod ends and so discuss telehealth treatment modality post-COVID-19.15
Quality and safety requirements during telehealthsessionE Risk/BenefitsConfirmachConfirmAlertsState RequirementsSeDocumentationDocumentationssIT supportIT SupportioCOVID-19n Confirm the client’s identity, physical location, telephone number andthat no one will record the session.4 Client and provider should both turn off notifications on devices. Check state telehealth requirements. If client is traveling, be aware thatsome states do not allow cross-state practice and so licensure in statewhere client is receiving services may be needed. Include platform used and if anything unusual happened. Do you have IT Support should systems go down? Review state/federal requirements frequently, if there are changespractice may need to change to be in compliance.16
Chapter03MEASURINGCLINICALOUTCOMES17
Screening Tools in ActionModify sAssessmentTreatmentPlanning18
Use screenings to inform treatment plans, evaluaterisk, and measure progress.General AnxietyDisorder(GAD)5Columbia-SuicideSeverity Beck DepressionInventory (BDI)6,7PTSD SymptomScale919
Wrap upReview HIPAA and all federal and state privacy laws applicable toyour licensure.Review established quality guidelines and ensure compliance.Know the telehealthguidelines forimplementation anddocumentation inyour licensing andpracticing state.Adapt clinical outcomes tools for telehealth to monitor progress.Note: Beacon Health Options is not offering any legal advice. A lawyer should be consultedwith any legal questions.20
Chapter04REFERENCES&ADDITIONALRESOURCES21
References1. Myers, K. and Cain, S. (2008). Practice Parameter for Telepsychiatry with Children and Adolescents. Journal of theAmerican Academy of Child and Adolescent Psychiatry, 47(12), 8b4e132. Substance Abuse and Mental Health Services Administration. (2020, March 19). COVID-19 Public Health EmergencyResponse and 42 CFR Part 2 Guidance. 9-42-cfr-part-2guidance-03192020.pdf3. Rutgers Biomedical and Health Sciences. (2020, March 25). HIPAA and Social Media Reminders Amid d-covid-194. Telehealth Certification Institute. (2020, May 18). Telehealth Ethics Along the Continuum of Care in a PandemicEnvironment. http://www.telementalhealthtraining.com.5. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A Brief Measure for Assessing Generalized AnxietyDisorder: The GAD-7. Archives of internal medicine, 166(10), 10926. American Psychological Association. (n.d). Depression Assessment Instruments. /22
References7. National HIV Curriculum. (n.d.). Patient Health Questionnaire-2. /phq-28. National Suicide Prevention Lifeline. (2009, January 14). Columbia-Suicide Severity Rating Scale SSRS-LifelineVersion-2014.pd9. American Psychological Association. (n.d). PTSD Assessment Instruments. https://www.apa.org/ptsdguideline/assessment23
Refer to Beacon’s COVID-19 webpage for the most up-to-dateinformationCoronavirus Provider Resources (Link)Provider Webinars (Link)Upcoming Provider Webinars1. June 17, 2020 - Social determinantsof Health: Treatment Implications2. June 24, 2020 – COVID-19:Exposure to secondary trauma andprovider resiliency3. July 1, 2020 - Suicide: Preventionand care during the COVID-19pandemic and beyond24
ResourcesTelehealth ResourcesAmerican Society of Addition Medicine (ASAM) “Support Access to Telehealth for Addiction Services: Regulatory Overview and General Practice nal Consortium of Telehealth Resource Centers “Telehealth Resources to Address g/covid-19-resources/Telehealth Certification Institute TeleMental Health Training st Telehealth Resource Center “COVID-19 and Telehealth”https://netrc.org/COVID-19/Official US Government Website for Medicaid “Medicaid State Plan Fee-For-Service Payments for Services Delivered via bstance Abuse and Mental Health Services Administration (SAMHSA) “COVID – 19 Public Health Emergency Response and 42 CFR Part 2 les/covid-19-42-cfr-part-2-guidance-03192020.pdf “Use of Telemedicine While Providing Medicated Assisted Treatment (MAT)” via the Department of Drug Enforcement /files/programs campaigns/medication assisted/telemedicine-dea-guidance.pdf25
ResourcesBeacon /Business-support-FAQs-for-providers.pdfCrisis ResourcesSuicide Hotline 1-800-273-8255Disaster Distress Helpline 1-800-985-5990Crisis Text TEXT HELLO to 741741Quality de #filter .general-use.english26
Chapter05QUESTIONS27
Thank YouThis presentation will be posted atwww.beaconhealthoptions.com/coronavirus/CONTACT US:Beacon’s National Provider Services Line800-397-1630 (Monday-Friday, 8 a.m.-8 p.m. ET) or contact your Provider Relationscontact28
Telehealth Documentation 101: Bridging the virtual gap . 5 Today’s speakers Lori O’Connor, M.ED, LMHC . Beacon Health Options is not offering any legal advice. A lawyer should be consulted with any legal questions. 13 . guidance-03192020.pdf 3. Rutgers Biomedical and Health Science
