774W - How Can I Legally Practice Telehealth Over State Lines and International Borders?

These slides are used for the TBHI LIVE event about the legal practice of telehealth over state lines. For more information visit telehealth.org

1. Practicing Across State lines and International Border? Optimizing Telehealth Podcast Episode 4 Marlene Maheu, PhD Shawna Wright, PhD

2. Telebehavioral Health Institute (TBHI) CME and CE Training, Consultation & Staffing

3. Shawna Wright PhD Dr. Shawna Wright is the Associate Director of KU's Center for Telemedicine & Telehealth. She is a licensed psychologist who established an independent telepsychology practice in 2011. Dr. Wright has expertise with treating rural and underserved populations, and regularly advocates for telehealth expansion to increase behavioral health access and equity in her home state of Kansas. She serves on several statewide committees as a telehealth expert. Dr. Wright enjoys telehealth training and consultation with a wide variety of professional groups.

4. Marlene Maheu PhD For almost thirty years, Dr. Maheu’s focus has been on telehealth legal and ethical risk management & compliance. She has served on a dozen professional association committees, task forces and work groups related to advancing telebehavioral health as well as establishing standards and guidelines for telebehavioral health. She has written 40+ of peer-reviewed telehealth book chapters and journal articles and is the lead author of five telehealth textbooks. She enjoys giving telehealth keynotes, training, consulting and helping organizations meet their staffing needs.

5. And there’s you! Please introduce yourself with state, profession and specialty …

6. Today’s Program Slide and recording access 24/7 for 6 months. Login is required. Please respect our copyright. Sound will be muted during the initial training to limit uncontrollable distractions. Please interact in chat box at designated times. It is not mandatory to keep camera on, but if possible, please show yourself to support the group process and learn from each other. Copyright 2021 Telebehavioral Health Institute, LLC All rights reserved.

7. Today’s Program LIVE CME or CE if you arrived within 15 min. of start , stay the entire time , interact AND complete the post-test today. Otherwise, you will receive a course completion that awards you asynchronous course credit hours. Ask short questions as we speak. Interactive, discussion format. Copyright 2021 Telebehavioral Health Institute, LLC All rights reserved.

8. Today’s Program To get 1 CME or CE, complete the course evaluation and post-test that are in left side-bar, underneath the yellow button that you clicked to enter this room. You are automatically enrolled into our in-house community news mailings. Lock your door, turn off your phone/email, and strap yourself in 🡪 we are about to get focused on Optimizing Telehealth ! Copyright 2021 Telebehavioral Health Institute, LLC All rights reserved.

9. 1 CME or CE Credit Hour Learning Objectives Identify at least five telehealth issues regulated differently by different state boards. Name the various groups who define if and how you can legally practice over state lines. Identify a free, federally funded resource to help you identify current and future state laws related to interjurisdictional practice.

10. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

11. Dr. Jones Works at a college counseling center and sees approximately 10-15 students per week. Transitioned all of his clients/patients to telehealth services during COVID All students were also transitioned to the university’s online learning platform. While many of the students in Mr. Jones’s care returned to living with their families in state, about 10% of his clients/patients moved out of state to be with their families. Due to the highly stressful nature of the COVID-19 Pandemic, most students wanted to maintain counseling services through telehealth regardless of their physical location. Dr. Jones only maintains a license to practice in his state of residency.

12. Coalition for Technology in Behavioral Science (CTiBS) An Interprofessional Framework for Telebehavioral Health Competencies (2018) Copyright 2021 Telebehavioral Health Institute, LLC All rights reserved. Website: CTiBS.org

13. CTiBS TBH Competency Domains (We will look at 3 today) Clinical Telepresence Technical mHealth Ethical & Evidence-Based Legal & Regulatory Practice Development C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved. 7 Domains An Interprofessional Framework for Telebehavioral Health Competencies

14. What is interjurisdictional practice? Licensing Boards/Colleges that may assert jurisdiction: The one in the professional’s state(s) / province(s)of licensure The one in the client/patient’s state/province of location at the time of contact Safest Practice: Provide services only where licensed Require patient to attest to his or her location at every contact

15. What licensing and regulation issues should mental health providers keep in mind before practicing over state lines? Adhere to federal, state, county & city laws Regulations impact all your actions as a professional Read the licensing rules for your discipline in your state(s) of practice Check with your board – get response in writing Examples

16. Licensing Rules Do Not Change with Different Technologies Telephone Video Email Apps Remote Patient Monitoring Text Messaging

17. What are licensing boards doing to support telehealth? Actively researching telehealth now Issues are complex Many haven’t yet decided how to proceed Legislative limitations Budgetary limitations

18. How can behavioral health professionals advocate for telehealth with their licensing boards? Write your licensing board directly Collaborate with your state-level professional organizations Boards don’t know what you need if you don’t tell them COVID-19 implications

19. Available as a PDF at: https://www.socialworkers.org/includes/newIncludes/homepage/PRA-BRO-33617.TechStandards_FINAL_POSTING.pdf C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved. NASW, ASWB, CSWA & CSWE Technology Standards

20. Social Work Technology Standards, Standard 2.06 Competence C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

21. Does practicing over state lines affect my malpractice insurance? Write to your malpractice carrier and describe your proposed service Notify your carrier of every state you “enter” to deliver care Can be nullified if practitioner is practicing criminally For benefits to apply, must have a formal client agreement for clinician to be considered as providing professional service

22. Can you recommend some risk management strategies? Check with an informed, local attorney who specializes in telehealth. Verify that your telepractice is in compliance with law in all relevant state(s) Conduct practice set-up sessions

23. How do I establish my client’s location? Opening protocol: Ask client/patient to “attest” to location Document their response Informed consent If not in your state(s) / province(s) of licensure, ask about whether it is an emergency Use an emergency protocol

24. Interjurisdictional Practice Models Psychologists: The Association of State and Provincial Psychology Boards (ASPPB) 🡪 Psychology Interjurisdictional Compact (PSYPACT). For information:  https://psypact.site-ym.com/ ? Counselors: Leadership shown by the American Mental Health Counselor’s Association (AMHCA) Psychiatrists: Federation of State Medical Boards (FSMB) C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

25. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

26. www.cchpca.org C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

27. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

28. What should I know about mandated reporting when I practice interjurisdictionally? Duty to report/warn Inform clients/patients of your remote safety policies in your informed consent process National Conference of State Legislators – Duty to Warn Differences Across States http://www.ncsl.org/research/health/mental-health-professionals-duty-to-warn.aspx

29. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

30. https://www.ncsl.org/research/health/mental-health-professionals-duty-to-warn.aspx

31. Copyright 2021 Telebehavioral Health Institute, LLC All rights reserved. https://www.cchpca.org/ US Federal & State Issues

32. Copyright 1994-2021 Telebehavioral Health Institute, LLC All rights reserved. https://www.cchpca.org/resources/covid-19-related-state-actions

33. Copyright 2021 Telebehavioral Health Institute, LLC All rights reserved. https://www.cchpca.org/resources/covid-19-related-state-actions

34. Copyright 2021 Telebehavioral Health Institute, LLC All rights reserved.

35. Kentucky State Board Affidavit to practice in Kentucky during COVID-19 🡪 Search for state board websites in your profession Copyright 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

36. How Do You Document Practicing Over State/Provincial or International Borders w/o a License? Do you document within the progress note? Beneficence vs. maleficence

37. International Issues

38. International Practice Where you will be and who you will serve? In U.S. and serving another country? In another country and serving U.S.? C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

39. International Practice Does your profession have a licensing board in the foreign country? Speak to your regulatory association Contact the U.S. embassy for the intended country C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

40. International Practice Will you try to collect reimbursement while your feet are on foreign soil? Allowed by some insurance companies Not allowed by Medicare C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

41. Tech Talk Time Tech-Talk Time Which technologies or products are related to today’s episode?

42. https://www.ebglaw.com/telemental-health-laws-app/

43. FindingLicensing Information Look at the regulatory board website for your profession Also write to the regulatory association for your profession: ASPPB.org – Psychology AASCB.org – Counseling FSMB.org – Medical (Psychiatry) ASWB.org – Social Workers AMFTRB – MFTs NCSBN - Nursing C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

44. Finding Licensing Information C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved. Visit websites; read licensure information with an eye to telehealth, even if the word is not mentioned; write to all involved state, provincial and national licensing boards to get requirements ( www.statename.gov )

45. How to Get Telehealth Licensing Information Contact your professional association (ethical or legal office) C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

46. How to Find Licensure Information Write to your malpractice carrier to ask about your telehealth coverage. C 1994-2021 Telebehavioral Health Institute, LLC All rights reserved.

47. Dr. Jones Dr. Jones reviewed the Center for Connected Health Policy website for background and direction for addressing his clients’ needs and to avoid abandonment during the pandemic. Dr. Jones identified the states where his students were residing during the pandemic and reached out to their licensing boards. Dr. Jones updated his telehealth informed consent form to include details about the importance of identifying/verifying the client’s location at every session and the limits of telehealth availability based on state law. Dr. Jones contacted his university’s legal office for input and guidance about his informed consent procedure. Dr. Jones developed and implemented an standard opening protocol that he now uses with every telehealth session.

48. Keep in touch! ☺ Telehealth.org [email protected] 619-255-2788