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Telehealth & TeleMental Health: The New Standard
The Ultimate Resource Page for
Ethical, Legal, Clinical, Technological, & Practice Considerations
Resources & Updates for Psychotherapists, Counselors,
Marriage & Family Therapists, Social Workers, Psychiatrists and Other Mental Health Professionals
This page is part of an Online Course, Telehealth: The New Standard
Ethical, Legal, Clinical, Technological, and Practice Considerations
CE Credits for Psychologists,
LMFTs, LPCCs, LEPs & LCSWs (BBS) Social
Workers (ASWB),
Counselors (NBCC, NAADAC, CALPCC), Nurses (BRN) & More
Telehealth, e-therapy, online therapy, online counseling, tele-medicine, e-counseling, or tele-mental health: all refer to the use of digital technology to provide clinical services, such as assessment and treatment. Telehealth activities may include providing clinical services by telephone, email, chats, interactive televideo communications technology such as Skype, or via virtual reality (VR) such as Second Life (SL), to individuals in conjunction with face-to-face (f2f) therapy or with no in-person contact. States and organizations vary in their definitions of telehealth.
U.S. Department of Health and Human Services on Telehealth
 Visit the website of the U.S. Department of Health and Human Services' Health Resources and Services Administration. This useful site provides a report on telehealth licensure requirements and trends for many health professions across the country. By clicking on Publications you then have access to their Telemedicine Licensure Report, the document "Telemental Health: Delivering Mental Health Care at a Distance," and a number of other useful documents and links.
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Organizations That Provide Platforms for Online Therapy, E-Therapy, or "Tele-Mental Health"
 Make sure to verify that the platform you choose to use is HIPAA compliant and complies with your state, federal, and your state and national professional organizations rules, codes of ethics, laws, and/or regulations.
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Use of Skype in Telehealth
The use of Skype in telehealth has been proliferated in recent years. While most expert seem to be satisfied with Skype level of security and view it to be HIPAA compliant, some still question it. Some argue that Skype-to-Skype voice, video and instant message conversations are likely to be more secure that conventional landlines or cellular phone conversation, which are not encrypted. The fact that Skype can and has given information and access to law enforcement means they have access to the encryption key, which probably means they must serve as Business Associate. However Skype neither provides BA Agreement nor claims to be HIPAA Compliant. Following are some resources that discuss whether Skype is a secure and/or HIPAA compliant format.
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Use of E-Mails in Traditional f2f Therapy and in Telemental Health
Hushmail and other secure email services are a good idea, but many, if not most, clients balk at the extra hassle involved in using them to communicate with their therapists, and may choose to use the familiar and free, but unsecured, emails after being informed of the risk by their therapists (via an Informed Consent and e-mail signature.)
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Use of Text in Traditional f2f Therapy and in Telemental Health
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Telehealth Across State Lines
- Zur, 2011: http://www.zurinstitute.com/ telehealth_across_state_lines-zur.html
- A video on a Colorado Psychiatrist who practiced across state lines: This is a unique case that has served as the 'poster child' for concerns regarding practicing across state lines. For video, click here.
- A different view on practicing cross states' line than the CO case above is Prince v. Urban (1996) 49 Cal.App.4th 1056 [57 Cal.Rptr.2d 181]: http://law.justia.com/cases/ california/caapp4th/49/1056.html
- For an excellent analysis of risk management of across state lines issues that is realistic, informed, intelligent, and not fear-based, go to: Harris, E & Younggren, J. N. (2011). Risk management in the digital world. Professional Psychology: Research and Practice, 42 (6), 412-418. For Abstract: http://psycnet.apa.org/journals/pro/42/6/412/
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Use of FaceTime in TeleMental Health
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Assessing a Person's Suitability for Online Therapy
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 Second Life & Virtual Realities
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Cloud Storage & HIPAA
 The use of cloud storage of medical records has proliferated in recent years.
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Insurance, Billing, Reimbursement & CPT Codes in Online Therapy, E-Therapy & TeleMental Health
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Malpractice Insurance for Telemental Health or Online Therapy
Reviewing online insurance policies and the literature on the topic, it is my general understanding that the following insurance companies will cover telemental health, e-therapy or online therapy if the insured practices legally, within the scope of his/her profession, and within the scope of his/her expertise (call your insurance company to verify your coverage):
- American Psychological Association Insurance Trust (APAIT) generally covers licensed psychologists. Gerry Koocher, Ph.D. a Trustee for APAIT, posted the following on 1/15/13: "The professional liability policy provided by The Trust is a broad-based policy and would cover any policyholder for civil liability or board complaints arising out of provision of telepsychology services in the same way it provides coverage for other claims and complaints. No provider of professional liability coverage, however, will cover claims of criminal liability."
- American Professional Agency covers psychologists and other mental health professionals. In response to my inquiry regarding their coverage of telemedicne and telemental health in Jan. 2013, I received the following response on on 1/16/13: "Please be advised, that while this activity would be covered under the policy there are some factors you should take into consideration. First, if you do not hold a license in the state where your patient resides and one is required, you may not be covered by the policy. Second, you must be HIPPA compliant, which includes, but is not limited to, using
a secure site to avoid any breach of a patient's rights. Being non-compliant, could put you at risk to fines and penalties, as well as having a suit or complaint being brought against you for breach of confidentiality."
- NASW Assurance Services which covers social workers, posted An Important Caution for Social Workers Practicing Online Therapy, which includes these statements: "The Social Work Professional Liability Insurance policy sponsored by NASW Assurance Services provides coverage worldwide, as long as the claim is made and the suit is brought in the United States, its territories, possessions, Puerto Rico or Canada. Therefore, it's not necessary to purchase another policy for internet, phone/telecommunication practice... There may be different requirements and/or licensure in the various states in which you may be practicing. As stated in VI. EXCLUSIONS under item Q. of the insurance policy, coverage would be excluded for a wrongful act committed while you did not have a license as required by law. You must be practicing legally for the policy to afford coverage."
- CPH covers CA MFTs and other mental health professionals. CPH states on its web site regarding coverage for E-therapy or Internet Therapy: "Yes - provided such practice is authorized or allowable under the scope of your license in the state where you practice and provided you are performing such services lawfully. Contact your state licensing board if you are unsure."
- TelMed is affiliated with American Telemedicine Association (ATA).
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Telehealth Technologies & Related Matters
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Psychotherapists' Professional Associations on Telehealth
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Professional Telehealth Associations
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Telemedicine Reimbursment Handbook
By The California Telemedicine & eHealth Center (CTEC)
60 page document at http://www.nrtrc.org/wp-content/uploads/Telemedicine-Reimbursement-Handbook1.pdf
TABLE OF CONTENTS
- The Impact of State Legislation on Telemedicine Reimbursement
- Understanding Telemedicine Legal and Regulatory Issues
- Privacy and Security
- Credentialing and Privileging of Providers
- Provider Licensing
- Patient Consent
- Major Payors for Telemedicine Reimbursement
- Federal and State Programs
- Medicare
- Federally Qualified Health Centers
- Medicaid (Medi-Cal)
- Healthy Families
- California Children’s Services
- County Medical Services Program
- Commercial or Private Insurance
- Blue Cross of California
- Appendices
- Appendix A – Listing of HPSAs for Medicare Coverage
- Appendix B – Listing of CPT Codes by Payer
- Glossary of Terms
- References
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State TeleHealth Laws & Licensing Boards
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Federal Resources, Laws, and Regulations
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University Centers for Telemedicine
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Online Telehealth Publications and Journals
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Miscellaneous Resources
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Psychology of the Web & Telehealth
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 Bibliographies
Guidelines by Prominent Organizations on Telemental Health
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Telehealth Updates
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