Telehealth Policies and Regulations Clinicians Should Know About

Psych Congress Elevate Steering Committee member Edward Kaftarian, MD, CEO of Orbit Health Telepsychiatry, Encino, California, discusses the important elements surrounding policy, licensing, and regulations that clinicians using telehealth and telemedicine should keep in mind. Dr Kaftarian also shares helpful resources for more information on these topics.

More Insights From Dr Kaftarian:

• Telepsychiatry Reduces Barriers and Increases Mental Health Care Access
• Telehealth is “Here to Stay,” Says Dr Edward Kaftarian

Edward Kaftarian, MD is a nationally recognized psychiatrist and leader in the field of telepsychiatry and healthcare technology. Trained at the Johns Hopkins Hospital, he is board-certified in Psychiatry, Forensic Psychiatry and Addiction Medicine. Dr Kaftarian has served in a variety of executive roles within the California prison system, including chief psychiatrist, senior psychiatrist, medical director, and director of pharmacy. He is the founder of California’s Statewide Prison Telepsychiatry Program, which is the largest correctional telepsychiatry program in the world. Dr Kaftarian is currently the Chairman and CEO of Orbit Health Telepsychiatry, a company that provides telepsychiatry services to jails and prisons.

Read the transcript:

Hi, I'm Dr Edward Kaftarian, psychiatrist and CEO of Orbit Health Telepsychiatry. I'm here to talk to you about the rules and regulations around telehealth. Now, disclaimer, I'm not an attorney, so if you want official legal advice, you should retain an attorney. Still, I want to give you an overview of some of the important topics you want to consider when you're doing telehealth sessions.

The first one is every state has its own definitions of telehealth and telemedicine. Some of them don't have a definition, but a lot of them actually do. And so, you want to be aware of what qualifies as telemedicine. Often, texting and emailing do not count as telemedicine, so you want to be careful.

Now, when we're talking about telemedicine, are we talking about a different standard of care?

Well, some states have different standards for telemedicine, but a lot of them treat it the same way as in-person care. The standard is typically the same. So, if you were going to follow up with laboratory studies, or any other thing that you want to do with a patient in order to achieve standard of care, you're going to have to do that with telemedicine.

There are some limitations and I think that it's fair to expect and build them into the standard of care, but you don't want to make it so limited that you are below the standard of care.

Another important consideration is licensing.

In the vast majority, almost every state, you need a license to practice medicine for the state where the patient is located in. So it's where the patient is, not necessarily where you are, that is the most important factor when it comes to whether you're qualified to practice medicine. There are some exceptions, but for the most part, that's the rule of thumb.

There are special telemedicine permits and licenses that you can get, but they're limited. They are not like the full license; it’s a limited license that allows you to practice telemedicine in that state. But what I want to advise you on is some of these limitations are really extreme. In certain states, if you get a telemedicine license, you can't see your patient in that state, you can't open up an office in that state. So let's say that you're at a conference and you run into a patient. That's not permitted. In certain states, if you have a telemedicine license, you can't check up on your patient and see them in a clinic while you're in that state.

There are all sorts of other potential restrictions when it comes to telemedicine license. For example, if you're a psychiatrist and practicing medicine for the state of Texas, the telemedicine permit does not allow you to supervise nurse practitioners, so you need to get the full license for that. So just be careful to read the fine print about the restrictions that the telemedicine license offers.

Another consideration is: some states have really bizarre policies when it comes to telemedicine. For example, in Indiana, if someone walks past the patient, either behind the camera or in front of the camera, then the patient has technically given up their confidentiality. They've waved their confidentiality. That's strange. There are some other states that require that you have special telemedicine policies in hospitals in order to practice medicine.

Another bizarre policy is some states require you to have specific malpractice insurance for telemedicine, or to make sure that you're covered. Sometimes they require the patient to have health insurance coverage. This may seem a little intrusive, and these are often not requirements that have been outside of telemedicine. And so be aware of some of these more bizarre policies.

What you want to do is you want to go to the medical board in the state, go to the website and research. There's also other resources like the ‘telehealth resource centers.’ There are several telehealth resource centers that are grouped regionally, and you can go to their website. You can go to the American Psychiatric Association (APA), you can go to the Orbit Health website and get information about policies, but there are all sorts of policies that you need to think about.

There's also the issue of malpractice.

We touched on this earlier, but you want to have your malpractice carrier be aware that you're providing telemedicine because in some cases they may not be aware. In this case, you may need to have a rider on your current policy. You also might need a completely new policy.