Telehealth Jobs from Home.pptx

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1. Telehealth Jobs from Home: Legal & Ethical Considerations/ Opportunities © 1994-2023 Telehealth.org, LLC All Rights Reserved.

2. Consulting, Staffing, Credentialing and Professional Training (CEs) in Ethically – Required Competencies www.telehealth.org Telehealth.org, LLC 2

3. WHO WE ARE: We are licensed healthcare professionals, attorneys and other consultants. TELEHEALTH.ORG GOAL: Our goal is educational only. No warranty, guarantee, or representation is made as to the accuracy or sufficiency of the information contained in our training for your specific circumstance. YOUR PART: You are encouraged to seek practice-specific advice from your own legal, regulatory, ethical and liability authorities before offering any telehealth services or programs to consumers/clients/patients. Obtain all such opinions in writing , and have your informed, trusted, local, legal counsel review those written responses for their full significance. Disclaimer 3

4. Learning Objectives 4 Intelligently discuss the broad pros and cons of working from your home telehealth practice Identify three specific ethical issues that are of relevance when working from your home List two legal issues that are of relevance with a telehealth job from home Outline how to deal with payors who may choose to list your home-based office address on their website or unexpectedly visit your home to conduct an inspection of your "office“

5. Learning Objectives 5 Describe how to deal with family issues with your home telehealth practice Name at least three areas in which job opportunities are available for clinicians who want to work from home Name three independent authorities to inform regarding your home telehealth practice to minimize risk Outline at least seven evidence-based models for treating specific populations with a home telehealth practice

6. Intelligently discuss the broad pros and cons of working from your home as a clinician

7. Location vs. Modality 7 Practitioners have traditionally been free to practice from their homes, but cautioned to exercise good clinical judgment Practitioners have a history of reimbursement denials for written correspondence, telephone, video, email, text-messaging

8. List two legal issues that are of relevance when you work from your home

9. 9 Insurance companies may ask legal questions: Your office address ? State of licensure ? Does your home have zoning regulations against commercial or other business entities? Do you have a business license for your address? They may also ask you to attest to other non­-telehealth or home-based requirements: Have parking lot? Handicap accessible? Have Medicare sign in your window? Health Insurers

10. 10 Insurance companies may ask legal questions (cont.): Their forms may also ask you to attest to non-­telehealth or home-based requirements: Have parking lot? Handicap accessible? Have Medicare sign in your window? Some insurance companies require you to be on US soil if you are billing for services delivered to their recipients (Medicare) Health Insurers

11. 11 Billing inaccurately (insurance fraud) Wrong licensure (prac tici ng without a license) Prac t icing anonymously (precludes manda t ed reporting) No continuity of care Wrong technology (privacy, security, data integrity) HIPAA and HITECH) Other Telehealth Legal Errors

12. How to handle? 12 Realize that employer, insurance company and other forms are legal declarations Always tell the truth Look for employers/payors who appreciate your professionalism Always inform your malpractice carrier

13. Name two common technical mistakes made by professionals when working from their homes

14. 14 Commercial vs. residential connect ivity Differences in bandwidth Bandwidth speed can also differ by time of day. After school is often a high traffic time and internet speed can be significantly slower. Variations in Connectivity

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19. Name two common clinical mistakes made by professionals when working from their homes

20. 20 You may forget to notify family and friends of your professiona l appointment schedule - they may unknowingly interrupt your professional time You may be flustered when dealing with an emergency because you have not practiced coping with crisis through technology, and are "practicing” on your clients and patients Boundaries Are Key

21. 21 Always to start session with an opening protocol That protocol includes formal procedures to secure both ends of the meeting Ask your client/patient to identify where they are, but you do not need to do the same Ask them to scan room with camera if needed Procedures Are Also Key

22. 22 Develop a non-verbal, fail-proof system to notify family or friends when you are in session Lock your home office door “Do no disturb" note on door Note on kitchen counter Text message others Face camera away from the door Procedures Are Also Key

23. 1. HIPAA, HITECH and Other Federal Regulations

24. 24 Most federal laws are silent about home-based professional offices – check your states of licensure to know for sure

25. 2. State Privacy Laws

26. 26 Most state privacy laws are silent about home-based professional offices

27. 3. State Licensing and Other Regulations

28. Licensing Boards 28 Licensing laws are in flux. To be in compliance with licensing law in most US states and Canadian provinces, you must be licensed in the state (or province) where your client/patient is at the time of the contact, regardless of where you live or work.

29. What if you are traveling out of your state(s) of licensure? 29 Licensing laws are in flux. To be in compliance with licensing law, you must be licensed in the state (or province) where your client/patient is at the time of the contact, regardless of where you live or work. Some state however mandate that you be licensed in their state when you deliver services from that state. (Florida, Alaska)

30. 30 Telepsychology 50-State Review https://www.apaservices.org/practice/advocacy/state/telehealth-slides.pdf

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33. 33 Most state licensing laws are silent about home-based professional offices

34. 4. Professional Association Ethical Codes

35. Identify three specific ethical issues that are of relevance when working from your home

36. Telebehavioral Health Standards & Guidelines 36 American Medical Association American Counseling Association American Mental Health Counselors Association American Psychological Association American Telemedicine Association Australian Psychological Society British Psychological Society Canadian Psychological Association

37. Telebehavioral Health Standards & Guidelines 37 Federation of State Medical Boards National Association of Social Workers New Zealand Psychological Psychologists Boar Ohio Psychological Association For specific documents see: http://telehealth.org/ethical-statements

38. 38 Boundaries of Competence Technical Legal Ethical Clinical

39. 39 BOUNDARIES: You may inadvertently violate your own boundaries Noises / sounds (spouse yelling at children) Personal items visible in background Children / adults in background, seen through windows, doors Home-Based Ethical Issues

40. 40 Informed Consent

41. 41 IC is Not Directly Relevant in Home-­Based Te lehealth Delivery IC is a legal as well as ethical issue Most state laws and ethical codes do not ask you to describe where you are at any given time when using telehealth If you mention it however, you will need to deal with consequences as a therapeutic boundary issue Informed Consent Issues

42. 42 http://www. counseling.org/Resources/aca-code-of-ethics.pdf

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46. 46 Most professional association ethical codes and guidelines are silent about home-based professional offices

47. 6. Malpractice Carriers

48. 48 Think back to your malpractice renewal applications Did the application include any questions about whether or not your office is home-based? Has anyone heard of a professional being dropped from a malpractice policy because of having a home-­ based office? Malpractice Insurance Renewal Applications?

49. 49 Working from your home may increase your liability under any circumstance, both in-person and with video Speaking with your malpractice carrier and getting their opinion in writing is suggested Malpractice Carriers

50. 50 Most malpractice carriers are silent about home-based professional offices

51. 7. Many Reimbursement Sources

52. 52 Insurance companies may send someone to your home to do a site inspection in the day you decide to wash the dog Someone in a suit can ring your doorbelI and want to take a look around Payer may accidentally publish your home address on their provider network website, although they collected your PO box or other office address Health Insurers

53. 53 Some payers require that you work from a "designa t ed telehealth site" which means a professional office Your home can be such an office (Medicare, Medicaid or 3 rd Party) slides Must meet all local, state and federal laws Contact them to get their determination in writing Health Insurers

54. 54 If you are on provider panels, look back to your credentialing and re­creden tial ing applications Did the application include questions about whether or not your office is home-based? Again, contact them if unsure Managed Care Credentialing Applications?

55. 55 Many payers (Medicare, Medicaid, 3 rd Party) are silent about home-based offices – but some may prohibit home-based care.

56. 8. Employers

57. 57 If you are employed, your employer is the only one who may have a policy for or against your working from home as a telepractitioner .

58. Name at least 5 areas in which job opportunities are available for clinicians who want to work from home

59. 59 1. Nursing Homes

60. 60 2. Employee Assistance Programs (EAPS)

61. 61 3. Rural Hospitals

62. 62 4. Schools

63. 63 5. Specialty, Schools, Residential, Treatment, Hospitals

64. 64 Companies do client/patient recruiting for you Physician or nurse is on site / or employer has records Patient is delivered to your desktop Companies choose a technology vendor and maintain that relationship/paperwork Companies help you with credentialing Companies pay you Evidence-based treatment protocols Telehealth.org Model “Commonalities”

65. 65 6. Migration Model

66. 66 7. Private Companies Serving Consumers Online

67. Online Employer Questions? 67 Legal & Ethical Online Therapy Jobs? 35 Easy Questions to Ask Online Therapy Employers Go to: https://blog.telehealth.org/online-therapy-jobs/

68. 68 8. Home Health

69. 69 9. College Counseling Center

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