7 Ways to legally and Ethically Expand Your Services with ......7 Ways to legally and Ethically Expand Your ... physician, information technology specialist or billing agent. The information

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7 Ways to legally and Ethically Expand Your

Services with Evidence-Based Telehealth

Presented by Marlene Maheu, PhD

January 11, 2017

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Thomas Durham, PhD

Director of Training

NAADAC, the Association for Addiction Professionals

www.naadac.org

[email protected]

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Produced By

NAADAC, the Association for Addiction Professionals

www.naadac.org/webinars

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www.naadac.org/telehealth

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Cost to Watch:Free

CE Hours Available:1.5 CEs

CE Certificate for

NAADAC Members:Free

CE Certificate for Non-members:

$20

To obtain a CE Certificate for the time you spent watching this webinar:

1. Watch and listen to this entire webinar.

2. Pass the online CE quiz, which is posted at


3. If applicable, submit payment for CE certificate or join NAADAC.

4. A CE certificate will be emailed to you within 21 days of submitting the quiz.

CE Certificate

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Using GoToWebinar – (Live Participants Only)

Control Panel

Asking Questions

Audio (phone

preferred)

Polling Questions

7 Ways to legally

and Ethically Expand

Your Services with

Evidence-Based

Telehealth

Telebehavioral Health

Institute, Inc.

Marlene M. Maheu, PhD

Executive Director

[email protected]

619-255-2788

NAADAC

Copyright © 2017 Telebehavioral Health Institute All rights reserved.

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Copyright 2012 TeleMental Health Institute, Inc. All rights reserved.

Consulting,

Staffing,

Credentialing

and Professional

Training (CEs)

in Ethically -

Required

Competencies

www.Telehealth.org

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Disclaimer

I am a licensed psychologist and MFT, not an attorney,

physician, information technology specialist or billing

agent. The information I present is my best attempt to

bring you timely and relevant information in a rapidly evolving area. I therefore make no warranty, guarantee,

or representation as to the accuracy or sufficiency of the information contained in any of my training.

My goal is educational only. I seek to outline the issues

and alert you to what's happening, with a keen eye

toward legal, ethical and other risk management issues.

You are encouraged to seek specific advice related to your circumstance from your qualified authorities.

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Optimizing Your Learning

You may want to turn off your cell phone,

close your email & lock your door

I often take questions as I go instead of

only at the end of the webinar. Just type

them into our interface as those questions

occur to you


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Learning

Objectives


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Learning Objectives Name two telehealth-related competencies

Compare and contrast definitions of at least three

different terms referring to “telehealth” in the

behavioral disciplines

Name three differences between traditional “online

therapy” and evidence-based telehealth

Name 2 legal issues of importance to telehealth

Name 2 ethical issues of importance to telehealth


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① Practice

Evidence-

Based Telehealth


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Understand Definitions Behavioral Telehealth

Telehealth

eHealth

Telemedicine/Telepsychiatry

Telemental Health

Telebehavioral Health

Telepsychology

Distance Counseling

Online Therapy

mHealth

E-Therapy

Telehealth vs.

Technology?


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Online Therapy vs. Standard of Care

Mostly Email / Chat vs. Video

Anonymity / No Patient Records

Avoid Responsibility w/ Website

Disclaimers

No Clear Channels for Mandated

Reporting


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Online Therapy vs. Standard of Care

No Contact with Other Treating Clinicians

No Authentication of Consumer / Professional

No Emergency Backup Procedures Misunderstanding of

Clinical Processes (suicide)

Operating w/o Needed Research for Unsupervised Settings


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② Follow Your

Ethical Code(s)

All Existing Ethics

Apply


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Relevant Professional Association

Standards & Guidelines American Counseling Association (2014)

2014 ACA Code of Ethics

American Psychological Association (2013)Guidelines for the Practice of Telepsychology

American Telemedicine Association (2013)Practice Guidelines For Video-Based Online Mental Health Services

National Association of Social Workers (2017)Predicted publication date will be summer

NAADAC/NCC Code of Ethics (2016)http://www.naadac.org/code-of-ethics


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http://www.naadac.org/code-of-ethics

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Copyright © 2016 All rights reserved.

INSERT

NAADAC

ETHICS CODE

POLLING

QUESTION HERE

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Informed

Consent


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Client/Patient Training

Email /Texting/Telephone/Video

Social networking – social media policy

File exchange

Computer repair

Clinical records

Insurance

Reports

Lateness / Missed sessions

Non-compliance/Avoidance

Safety plan (e.g. firearms, alcohol, drugs, children)


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Multicultural Issues &

Diversity


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③ Follow the Law

All Existing Laws

Apply

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HIPAA

Three Rules:

Transmission

Privacy

Security

Three HIPAA

Rules:

• Transmission

• Privacy

• Security


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HIPAA Privacy Rule

Data are “individually identifiable” if they include

any of the 18 types of identifiers, listed below, for

an individual or for the individual’s employer or

family member, or if the provider or researcher is

aware that the information could be used, either

alone or in combination with other information, to

identify an individual:

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HIPAA Privacy Rule (cont.)1. Name

2. Address (all geographic subdivisions smaller than state, including street address, city, county, zip code)

3. All elements (except years) of dates related to an individual (including birth date, admission date, discharge date, date of death and exact age if over 89)

4. Telephone numbers

5. Fax number

6. Email address

7. Social Security number

8. Medical record number

9. Health plan beneficiary number

10. Account number

11. Certificate/license number

12. Any vehicle or other device serial number

13. Device identifiers or serial numbers

14. Web URL

15. Internet Protocol (IP) address numbers

16. Finger or voice prints

17. Photographic images

18. Any other characteristic that could uniquely identify the individual


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Privacy vs. Confidentiality Privacy is the client

or patient's legal right to express themselves selectively.

Confidentiality is a health care professional's legal duty to protect a client or patient's right to privacy.


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Privacy

Increased hacking of Private Healthcare

Information (PHI) and devices

Increased privacy concerns by consumers

as they get more info-engaged

Greater number of audits in 2016 of

professionals and how they deal with PHI

ICD-10 audits

HIPAA audits


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HIPAA Documentation Risk Analysis

Define scope Define your systems – tablet, Gmail, look for vulnerabilities in

equipment, threats can be accidentally disclosing power outages that can happen

Rate risk as low, medium or high Example Risk: High risk is that laptop doesn’t have security, your

practice is to leave your laptop in your car when running errands Solution: Put encryption and firewall on your laptop

Document Risk Examine how all systems are working together Make you more efficient Save money

Should be re-upped every years Validate what’s been done, review any new risks (clients,

technologies) Calendar issues you will address throughout year, document

progress


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Copyright 2012 TeleMental Health Institute, Inc. All rights reserved.

• All Business Associates in

health care must sign an

agreement stating their

adherence to HIPAA

standards

• Transactions

• Security

• Privacy

• True for any service you hire

• It is now enforced by the

HITECH ACT

HIPAA, Business Associates &

HITECH

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INSERT SKYPE

POLLING

QUESTION

HERE

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HIPAA requires an “audit trail.” Skype doesn‘t

provide audit trails – and isn’t obligated to ….

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HIPAA requires “breach notification

tools.” Skype doesn‘t provide…

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Email HIPPA Omnibus Act

allows us to have email contact without meeting usual HIPAA standards when risks are fully disclosed in

Be aware of inherent problems with soliciting email contact from websites and directories.


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Where to find HIPAA-

compliant technology?

http://telehealth.org/

directory


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Jurisdictional Issues

Consumer Protection

• Training• Licensing (practicing

over state lines)• Privacy & Confidentiality• Interjurisdictional

Practice

• Record Keeping

• Advertising

• Mandated Reporting

• Collaborating with Other

professionals

• Technologies to Be Used

• Fees


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Practicing Over

State Lines

• Get licensed or registered everywhere you wish to practice


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④ Decide Which

Clients

/Supervisees to

Serve

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Choice of Clients / Supervisees

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⑤ Develop Clinical

Skills Related to

the Technology

You Choose

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Which technologies are legal and

ethical to use?

Videoconferencing

Telephones

Biotech test results (genomic testing?)

Apps

Social media

Newer technologies

Email

Text messaging

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NAADAC Code of Ethics

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Videoconferencing

Most video-based practice models have

not changed much in the past 10 years.

They stick to the fundamentals, which

work exceedingly well when delivered

according to evidence-based protocols.


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Telephones

State laws differ regarding the inclusion of

telephones in telehealth definitions and

statutes. (Some states exclude

telephones.)

Many telephone-based practice models

have not changed much in the past 10

years - some things simply get paid, and

will continue to do so.


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Technology Evolution

Consumer devices

Dedicated

hardware

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Internet Speeds

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⑥ Code Correctly

for

Reimbursement

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http://www.americantelemed.org/policy/state-policy-resource-center#tracker

Reimbursement

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⑦ Responsibly Find

Clients /

Employment

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Getting a Job in Telehealth

Develop competencies (certified training)

Consider employers

Review their offerings, both in terms of services offered and compensation

Review their requirements

Carefully read their policies and procedures and look at them from the perspective of a licensing board

Apply and see if they deliver what they promise

Challenge them on asking you to do anything illegal or unethical

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① Nursing

Homes

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③ Rural

Hospitals

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④ Schools

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.⑤ Specialty

Schools,

Residential

Treatment,

Hospitals

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⑥ Migration Model

⑥ Migration

Model

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⑦ Private

Companies

Serving

Consumers &

Healthcare

Systems*

• Register for

employment with

these companies

here:

WWW.PROVIDERPANEL.COM

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Health

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⑨ Correction

al Facilities

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Migration Model⑩ Military & Veteran’s

Administration

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11. College

Counseling

Centers

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12. Rehabilitation

counselors and

psychologists work

in a variety of state-

funded settings,

such as hospitals,

substance use

settings, transitional

homes, agencies…

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Telephone

services (EAP),

text-messaging

systems, patient

portals, social

media, social

support

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What’s the process for

getting fully trained

and credentialed in

telehealth?

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Certification in Telebehavioral

Health

State requirements – any licensing issues,

complaints?

Ethical requirements – did you complete a

competency-based training program?

Clinical expertise – do you know how to

conduct clinical work?

Malpractice coverage – do you have

proof of coverage for telehealth?

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Competencies

Knowledge attainment is the basic

requirement in all ethical codes

Have you been professionally trained?

Course completion certificate

Additionally, can you demonstrate the

proper attitudes and skills required for a

new area of practice?

CTiBS.org

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Credentialing

Impacts your ability to find legal and

ethical employment

Medical – related to hospitals

Is required for reimbursement

Professional – related to clinical expertise

In telehealth for behavioral disciplines, a

certification requires a minimum of 9-12 hours

minimum / 39 hours for private practitioners

maximum

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Learning Objectives Names two type of required competencies

Compare and contrast definitions of at least three

different terms referring to “telehealth” in the

behavioral disciplines

Name three differences between traditional “online

therapy” and evidence-based telehealth

Name 2 legal issues of importance to telehealth

Name 2 ethical issues of importance to telehealth

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Questions?

Marlene M. Maheu, Ph.D.Telebehavioral Health Institute, Inc.

Phone: 619-928-2627

Email: [email protected]

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Cost to Watch:Free

CE Hours Available:1.5 CEs

CE Certificate for

NAADAC Members:Free

CE Certificate for Non-members:

$20

To obtain a CE Certificate for the time you spent watching this webinar:

1. Watch and listen to this entire webinar.

2. Pass the online CE quiz, which is posted at


3. If applicable, submit payment for CE certificate or join NAADAC.

4. A CE certificate will be emailed to you within

21 days of submitting the quiz.

CE Certificate

©

.

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Upcoming Webinars


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by Douglass Weiss

January 25, 2017

NAADAC Code of Ethics, Part 1

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7 Ways to legally and Ethically Expand Your Services with ......7 Ways to legally and Ethically Expand Your ... physician, information technology specialist or billing agent. The information