Behavioral health professionals have hastened their adoption of telehealth services in order to meet the needs of patients in the time of COVID-19. This rapid transition has required providers to quickly obtain an understanding of telehealth policies, procedures, and best practices within a shifting regulatory landscape. This article shares a few helpful tips to assist psychiatrists with transitioning to delivering care through telemedicine during the COVID-19 pandemic.

Understand Telepsychiatry Policies and Procedures

Policies as they relate to telepsychiatry are changing rapidly. On March 13, 2020, the COVID-19 pandemic was declared a national emergency. Following this declaration, regulations related to providing telepsychiatry services were loosened. However, it is important to note that regulations are likely to tighten again following the public health emergency.

The declaration of a national emergency authorized the Health and Human Services Secretary to temporarily waive certain Medicare and Medicaid requirements as they relate to Section 1135 of the Social Security Act in order to ensure that healthcare services are available to meet the needs of patients who receive care through these programs. As mentioned previously, telepsychiatry is a rapidly changing landscape, with the information presented in this section relevant as of April 10, 2020.

Here Are Some Highlights

  • Generally speaking, psychiatrists must be licensed in the state where a patient is physically located at the time of the telepsychiatry appointment. Exceptions to this policy include medical licensure exemptions as they relate to federally supported entities such as the Department of Defense, Veterans Affairs Hospitals, and Indian Health Service.
  • As psychiatrists are treating patients within a national state of emergency, requirements for to hold licenses in the state in which they provide services have been waived with respect to Medicare and Medicaid services.
  • Typically, commercial payers require psychiatrists that provide telepsychiatry services have a license in the state in which the patient is located at the time services are provided. However, this area is also rapidly evolving. Please consult the Federation of State Medical Boards for further information: https://www.fsmb.org/siteassets/advocacy/pdf/states-waiving-licensure-requirements-for-telehealth-in-response-to-covid-19.pdf
  • The Ryan Haight Act, which requires that a physician conduct an initial, in-person examination before electronically prescribing a controlled substance, has been suspended.

It is still important to use a HIPAA compliant platform when delivering telepsychiatry services. That being said, the Office of Civil Rights has indicated they will exercise discretion for HIPAA violations as they relate to psychiatrists treating patients in good faith through non-HIPAA compliant platforms such as FaceTime or Skype during the national state of emergency. But, one should attempt to create telepsychiatry workflows using a HIPAA compliant platform first.

  • Billing codes and documentation requirements are the same for telepsychiatry services as for in-person services. Modifier 95, when added to the bill, indicates the services were provided via telepsychiatry.
  • Obtain and document consent for services through telepsychiatry.

Adopt Best Practices for Telepsychiatry

  • The standard of care in telepsychiatry is the same as in-person visits.
  • Encourage your patient to find a private, well-lit area of the home to receive service.
  • A workflow should be established for psychiatric emergencies. When engaging in telepsychiatry, you should determine where the patient is located and note an alternative method to contact the patient.
  • If a patient requires immediate intervention, be sure to contact emergency serves where the patient is located. When you call 911, this will be a local call and not necessarily where the patient is located.
  • For higher risk patients, consider requesting contact information for a for a "patient support person" (PSP) such as a family member or friend of the patient that may be alerted in the case of an emergency. You may also obtain consent from the patient to include the PSP in the appointments, as needed.
  • Continue to obtain self-report rating scales to optimize patient care.
  • During telepsychiatry appointments, you will have the privilege of seeing patients at home which will provide you with valuable information and assist with developing the treatment plan. Consider asking your patients to show you around their room or home. I've found this to be especially enlightening for adolescent patients.
  • Set up your camera for success by placing the camera on top of your computer. I recommend your head take up most of the screen. You may need to more actively inquire about patients' feelings and be slightly more animated to demonstrate your feelings over telepsychiatry.
  • Younger children may be more difficult to engage through telepsychiatry. You may consider drawing together and sharing the pictures during the appointment. Caregivers will provide essential help to guide younger children through the session.

Additional Resources

American Psychiatric Association: https://www.psychiatry.org/psychiatrists/practice/telepsychiatry/blog/apa-resources-on-telepsychiatry-and-covid-19

American Telemedicine Association: https://www.integration.samhsa.gov/operations-administration/practice-guidelines-for-video-based-online-mental-health-services_ata_5_29_13.pdf

American Telemedicine Association Guidelines for Working with Children and Adolescents: https://www.cdphp.com/-/media/files/providers/behavioral-health/hedis-toolkit-and-bh-guidelines/practice-guidelines-telemental-health.pdf?la=en