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Telepsychiatry and COVID-19

Tuesday, March 17, 2020  
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APA Update on Telehealth Restrictions in Response to COVID-19

On March 6, 2020, the Coronavirus Preparedness and Response Supplemental Appropriations Act was signed into law. This statute gives the Secretary of Health and Human Services (HHS) the authority to waive geographic and originating site Medicare telehealth reimbursement restrictions for mental health services overall, during certain emergency periods. However, there are two stipulations:

  • In order to be eligible for telehealth encounter while located in ("seen") in the home, the patient must have been seen by the provider (e.g., billed to Medicare) within the last three years, up to the date of the initial telehealth encounter.
  • If the patient intends to see a new provider for a telehealth encounter, the patient must have been seen by a provider from the same medical practice, operating under the same Tax Identification Number (TIN), within the last three years.

Please note: That while the legislation above grants the HHS Secretary the authority to make these changes, Secretary Azar has not yet announced whether or when it plans to do so. We are notifying you of these possible changes so that you can prepare. APA is monitoring the situation and will keep its members notified of any progress.

What You Can Do

If you are considering transitioning patients to telepsychiatry in place of in-person appointments, the APA's Telepsychiatry Toolkit is a good place to start. The Toolkit contains 60+ individualized pages with guidance on topics related to telepsychiatry, such as clinical considerations, administrative and technical requirements for software issues, and reimbursement.

For those looking to get started right away, the APA and the American Telemedicine Association co-published a guide for doing so, which can be accessed here: Best Practices in Videoconferencing-Based Telemental Health.

Getting Started: Technical Specifications

Telemedicine is the use of live videoconferencing to facilitate a patient encounter. For Medicare, Medicaid, and most private insurers, this does not include telephone alone; an encounter must be live video and audio paired together. Further, any software you choose must be HIPAA-compliant. While the APA cannot specifically recommend or endorse a software solution for your practice, we can offer you a place to start. First, be sure to visit our Telepsychiatry Toolkit's page Platform & Software Requirements. This will help you understand what you need to look for when shopping around for telepsychiatry software.

Be aware that you will need to sign a Business Associate Agreement (BAA) with any software company you partner with in order to ensure HIPAA compliance. Not all videoconferencing companies will do so (for instance Apple's FaceTime will not, and thus is not HIPAA-compliant). Based on anecdotal member feedback provided to the APA, members have signed BAA's with, and are using Zoom for HealthcareMegaMeeting TelemedicineVSee, and doxy.me. Again, while APA is not endorsing nor explicitly recommending these solutions for your practice, they are a good place to start when researching what will work for your own practice needs.

Physicians providing telepsychiatry services will need a license in the state in which the patient is located at the time services are provided.

But What about Telephone Calls?

Reimbursement issue aside, there is wide variability of interpretations about whether standalone phone calls are HIPAA-compliant. All of this, of course, depends on how the telephone system you’re using, whether a traditional landline, mobile device, Voice over Internet Protocol (VoIP—i.e., a phone that uses the internet to make calls), or the use of a third party phone call system embedded in a mobile application, handles Protected Health Information (PHI) under HIPAA. There is no quick and easy answer for this question.

The APA recommends you contact your malpractice carrier before engaging with a patient over the phone without video (e.g., not true telemedicine) to gauge their official, legal position.

Contacting Third Party Payers and Medicaid Directors

Given the increased need for telemedicine and telephone encounters with patients, the APA would like to help you to advocate for these services to be covered by private insurance and Medicaid for when patients are unable to come into the office for their regular appointments. You can use this sample letter to send to the private insurers and Medicaid Directors that provide coverage to your patients. Please let APA know if you receive a response.

If you have additional questions about any of the above issues, APA members may contact the Practice Management Help Line.