My Next Telehealth Prediction: Attestations
By Barbara Griswold, LMFT (Oct 18, 2021)
Many of you have asked what I see coming next in the way of telehealth. One prediction is that insurance plans will require telehealth providers to sign a Telehealth Attestation provided by the plan. By having providers sign Attestations, plans attempt to ensure their telehealth policies are being followed, and limit liability. Some plans required these prior to the COVID-19 pandemic.
Sound straightforward? A closer read of these attestations may contain some surprising agreements and require you to make some changes in how you are treating your clients. We’ll view the Telehealth Attestation of one plan and see how this may help us to prepare for what may be requested by other plans in the months to come.
In some parts of the country, Beacon Health Options sent an email stating they were “working on a strategy to permanently contract providers for telehealth services” and stated “if you are interested in continuing telehealth treatment post-pandemic please sign and return the attached telehealth attestation,” giving an email and fax number (to view the email and attestation sent, click here).
No surprise, the attestation asks the provider to meet state and federal telehealth requirements, document that services were provided via telehealth, and check the client’s telehealth benefits. It also requires the provider to utilize a HIPAA-compliant telehealth platform, which would not include platforms like FaceTime, Skype and the free version of Zoom.
However, I found some points of interest, including:
- That Beacon does not consider phone counseling to be telehealth, since it is not an interactive telecommunication system (this will vary by health plan and possibly state definitions of telehealth).
- The first visit may need to be in-person “where required by state and/or federal laws” (be sure to check on this when checking coverage for your client)
- Parental consent is needed when treating minors, so a parent must participate in some of the first session.
- “The member must be informed of the location of the provider rendering services” (What?Why? I’d want to ask more about that one! Is stating “therapist may be at their home” in an informed consent enough? Emails from this author to Beacon with this question have yet to be answered).
Informed consent: The Attestation states that before doing telehealth, the client must give informed consent, and be made aware of their right to refuse, and of treatment alternatives (such as face-to-face therapy) and the pros and cons of each. [This may also be required by law: For example, while this requirement had been previously relaxed, as of October 1, 2021, California therapists are again required to obtain and document written or verbal consent prior to treating clients via telehealth.]
I highly recommend a written consent, which can cover a host of issues, including helping clients consider how to set up a more confidential space, addressing privacy/security issues, that they should notify you when they leave the state, how emergencies will be handled, etc. [Note: I have a Sample Telehealth Informed Consent in my Practice Forms Packet, click here]
Policies and Procedures Document: Beacon (and many other health plans) want telehealth providers to have a written Telehealth Policies and Procedures, separate from their informed consent. This is an internal practice document outlining how you will handle issues such as
- how you will assess and document that clients are appropriate for telehealth treatment — and what you do if they aren’t
- details of a contingency plan when there is a transmission failure
- crisis client management. For example, Beacon states “acutely ill members should not be managed via telehealth. If necessary, the provider should make themselves … or another contracted clinician available to conduct a face-to-face assessment.” Your procedures for emergencies and availability for in-person sessions should be reviewed with the client prior to providing telehealth.
- protocols to ensure that the services meet the requirements of state and federal laws
It is important to note that these Policies and Procedures document may be requested for review by the health plan. But why write one yourself? A sample Policies and Procedures form is now available in my online store — click here
Further questions remain
- Beacon stated in the email “the provider must hold an independent license in the state in which he/she is performing the service.” So, if you are seeing a client who is in another state, and you have the permission of that state to see the client temporarily — it is still possible that insurance plans might require you to be licensed where the client is located.
- This email was addressed to Beacon providers. The situation for out-of-network therapists who are seeing Beacon clients — and whether they need to sign an attestation — would need to be checked for each client account.