N.Y. Comp. Codes R. & Regs. Tit. 14 § 596.6 - Requirements for Telehealth Services
(a) General requirements.
(1) The distant/hub site telehealth
practitioner must:
(i) possess a current,
valid license, permit, or limited permit to practice in New York State , or is
designated or approved by the Office to provide services;
(ii) directly render the telehealth
service;
(iii) abide by the laws
and regulations of the State of New York including the New York State Mental
Hygiene Law and any other law, regulation, or policy that governs the
assessment or treatment service being provided;
(iv) adhere to the same laws, rules, and
regulations and exercise the same standards of care and competencies required
for in-house in-person delivered services;
(v) utilize evidence-based telehealth
practice guidelines and standards of practice, to the degree they are
available, to ensure recipient safety, quality of care, and positive outcomes;
and
(vi) deliver services from a
secure site/location which ensures the minimum standards for privacy for
recipient- telehealth practitioner interaction are met . Telehealth
practitioners may deliver services from a site located within the United States
or its territories, which may include the practitioner's place of residence,
office, or other identified space approved by the Office of Mental Health and
in accordance with guidelines established by the Office.
(2) The telehealth practitioner must not be
terminated, suspended, or barred from the Medicaid or Medicare
program.
(3) If the
originating/spoke site is a hospital, the telehealth practitioner at the
distant/hub site must be credentialed and privileged by such hospital, as
necessary and consistent with applicable accreditation standards.
(4) Telehealth services must be rendered
using telehealth technologies. A provider of services approved to offer
telehealth services shall adopt and implement technology in a manner that
supports the standard of care to deliver the services, the features of which
include at least:
(i) The technology and
equipment utilized in the provision of telehealth services must be of
sufficient quality, size, resolution and clarity where applicable such that the
provider of services can safely and effectively provide the telehealth
services;
(ii) The technology and
equipment utilized in the provision of telehealth services or the use of audio
or video telephone communication must be compliant with the Health Insurance
Portability and Accountability Act (HIPAA).
(5) Telehealth practitioners must verify the
identity of the recipient before commencing each telehealth
encounter.
(6) A notation must be
made in the clinical record that indicates that the service was provided via
telehealth and indicating whether audio only services were provided which
specifies the time the service was started and the time it ended.
(7) Telehealth services provided to
recipients under age 18 may include staff members of the originating/spoke site
in the room with the recipient. Such determinations shall be clinically based,
consistent with Guidelines issued by the Office.
(8) For the purposes of billing , telehealth
services shall be considered face-to-face contacts when the service is
delivered in accordance with the provisions of the plan approved by the Office
pursuant to section
596.5
of this Part. Providers should refer to the program specific guidelines
established by the Office to determine authorized use of telehealth
services.
(9) Culturally competent
interpreter services shall be provided in the recipient's preferred language
when the recipient and telehealth practitioners do not speak the same
language.
(10) The telehealth
practitioner providing telehealth services at a distant/hub site shall be
considered an active part of the recipient's treatment team and shall be
available for discussion of the case or for interviewing family members and
others, as the case may require. Such telehealth practitioner shall prepare
appropriate progress notes and securely forward them or directly enter them in
to the originating/spoke provider health record as a condition of
reimbursement.
(11) Telehealth
services shall not be used:
(i) for purposes
of seeking a court order for treatment over objection; or
(ii) restraint or seclusion, as defined in
section
526.4 of
this Title.
(12)
Telehealth services may be used to satisfy specific statutory examination,
evaluation, or assessment requirement necessary for the involuntary removal
from the community, or involuntary retention in a hospital pursuant to section
9.27 of the Mental Hygiene Law, if such
services are utilized in compliance with the following:
(i) The telehealth practitioner must be a physician
and licensed to practice in New York.
(ii) Telehealth services can only be utilized to
fulfill one of the three physician-required activities in a removal or
retention action, i.e., either one of the two certifying physicians at the
emergency hospital site, or the confirming physician at the receiving hospital
site, can perform their required examination, evaluation, or assessment through
telehealth technology.
(iii) The
individual must be asked to consent to the use of telehealth technology for the
purposes of the examination, which can be embedded within the hospital's
general consent for treatment. If the individual refuses or is not able to give
consent to treatment, the effort to obtain consent must be documented in the
clinical record, and the examination may proceed.
(iv) All three physicians must sign the form at
whatever location they are at the time of the examination, regardless of
whether they are at the originating/spoke site or the distant/hub site. If the
telehealth practitioner is one of the examining physicians, a copy of his or
her signed Form OMH 471 must be received in the emergency hospital site before
the individual is transported to the receiving hospital. The telehealth
physician may sign their form electronically as permitted by the Electronic
Signature and Records Act (ESRA). The transmission of the form may be
electronically received, as long as in both instances the transmission is
securely made over an encrypted line or network.
(v) When telehealth services are used as part of a
9.27 retention action, forms amended by the Office of Mental Health to account
for the use of such services shall be utilized.
(vii) Telehealth consultation. Nothing herein shall
preclude the additional use of telehealth services in retention actions on a
consultative basis, rather than as a means of partially fulfilling a statutory
requirement for any Mental Hygiene Law Article 9 evaluation. The responsibility
for signing the commitment papers remains with the physician who actually
conducted the evaluation of the individual at the facility, not the
psychiatrist who provided the telehealth consultation.
(13) Telehealth services may be used to
satisfy specific statutory examination, evaluation, or assessment requirement
necessary for the immediate observation, care and treatment in a hospital,
pursuant to section
9.39 of the Mental Hygiene Law, if such
services are utilized in compliance with the following:
(i) The telehealth practitioner must be a physician and licensed
to practice in New York.
(ii)
Telehealth services can only be utilized to fulfill one of the two
physician-required activities in a removal or retention action, i.e., either
the certifying physician or confirming staff psychiatrist at the emergency
hospital site, can perform their required examination, evaluation, or
assessment through telehealth technology.
(iii) The individual must be asked to consent
to the use of telehealth technology for the purposes of the examination, which
can be embedded within the hospital's general consent for treatment. If the
individual refuses or is not able to give consent to treatment, the effort to
obtain consent must be documented in the clinical record, and the examination
may proceed.
(iv) All physicians
must sign the form at whatever location they are at the time of the
examination, regardless of whether they are at the originating/spoke site or
the distant/hub site. If the telehealth practitioner is the examining
physician, a copy of their signed Form OMH 474 must be received in the
emergency hospital site before the individual is transported. The telehealth
physician may sign their form electronically as permitted by the Electronic
Signature and Records Act (ESRA). The transmission of the form may be
electronically received, as long as in both instances, the transmission is
securely made over an encrypted line or network.
(v) When telehealth services are used as part of a 9.39 retention
action, forms amended by the Office of Mental Health to account for the use of
such services shall be utilized.
(vii) Telehealth consultation. Nothing herein shall
preclude the additional use of telehealth services in retention actions on a
consultative basis, rather than as a means of partially fulfilling a statutory
requirement for any Mental Hygiene Law Article 9 evaluation. The responsibility
for signing the commitment papers remains with the physician who actually
conducted the evaluation of the individual at the facility, not the
psychiatrist who provided the telehealth
consultation.
(b) Protocols and Procedures. A provider of
services approved to utilize telehealth Services must have written protocols
and procedures that address the following:
(1) Each recipient for whom the provision of
telehealth services may be offered must be evaluated to determine whether the
telehealth modality is appropriate, given the recipient's treatment
needs.
(2) Informed Consent:
Protocols must afford persons receiving services the opportunity to provide
informed consent to participate in any services utilizing telehealth services,
including the right to refuse these services and to be apprised of the
alternatives to telehealth services, including any delays in service, need to
travel, or risks associated with not having the services provided by
telehealth, and risks associated with receiving telehealth services in an
off-site location. Such informed consent may be incorporated into the informed
consent process for in-person care, or a separate informed consent process for
telehealth services may be developed and used.
(i) The recipient must be provided with basic
information about telehealth services, including both benefits and risks, and
shall provide his or her informed consent to participate in services utilizing
this technology. For recipients under age 18 for whom informed consent cannot
be obtained pursuant to Mental Hygiene Law Section 33.21, such information
shall be shared with and informed consent obtained from the recipient's parent
or guardian.
(ii) Recipients, or a
minor recipient's parent or guardian, shall be informed how to verify a
telehealth practitioner's professional license.
(iii) The recipient has the right to refuse
to participate in telehealth services, in which case services must be conducted
in-person by appropriate clinicians.
(iv) Telehealth sessions shall not be
recorded without the recipient's consent, which shall be documented in the
clinical record .
(3)
Confidentiality: Protocols and procedures must be maintained as required by
Mental Hygiene Law Section 33.13 and HIPAA at 45 CFR Parts 160 and 164 and
shall apply to both the originating/spoke site and the distant/hub site. Such
protocols shall ensure that:
(i) All current
confidentiality requirements and protections that apply to written
clinical/medical records shall apply to services delivered by telehealth
technologies, including the actual transmission of the service, any recordings
made during the time of transmission, and any other electronic
records.
(ii) The spaces occupied by
the recipient at the originating/spoke site , where non-residential, and the
practitioner at the distant/hub site must meet the minimum standards for
privacy expected for recipient-clinician interaction at a single Office of
Mental Health licensed expected for recipient-clinician interaction at a single
Office of Mental Health licensed location.
(4) All telehealth services must be conducted
via telehealth technologies that meet minimum federal and state requirements,
including but not limited to 45 C.F.R. Parts 160 and 164 (HIPAA Security
Rules), and which are consistent with guidelines of the Office. Transmissions
must employ acceptable authentication and identification procedures by both the
sender and the receiver.
(5)
Psychiatric emergencies: All telehealth service sites must have a written
procedure detailing the availability of in-person assessments in an emergency
situation.
(6) Prescribing
medications via telehealth: Procedures for prescribing medications through
telehealth must be identified and must be in accordance with applicable New
York State and federal law , including but not limited to the federal Ryan
Haight Act (21 U.S.C. section
823(f), New York State
Education Law sections 6902(3)(a)(ii), 7606, 7708, and 8407; and regulations of
the New York State Department of Health at 10 NYCRR Part 80.
(7) Recipient rights: Recipient rights
policies must ensure that each individual receiving telehealth services:
(i) is informed and made aware of the role
and license information of the telehealth practitioner at the distant/hub site,
as well as staff at the originating/spoke site , where non-residential, who are
responsible for follow-up or on going care;
(ii) is informed and made aware of the
location of the distant/hub site and all questions regarding the equipment, the
technology, etc., are addressed;
(iii) has the right to have appropriately
trained staff immediately available to him/her while receiving the telehealth
service to attend to emergencies or other needs;
(iv) has the right to be informed of all
parties who will be present at each end of the telehealth transmission;
and
(v) if the recipient is a
minor, the recipient and his or her parent or guardian shall be given the
opportunity to provide input regarding who will be in the room with the
recipient when telehealth services are provided.
(8) Quality of Care: All telehealth service
sites shall have established written quality of care protocols to ensure that
the services meet the requirements of New York State and federal laws and
established recipient care standards. A review of telehealth services shall be
included in the provider's quality management process.
(9) Contingency Plan: All telehealth service
sites must have a written procedure detailing the contingency plan when there
is a failure of the transmission or other technical difficulties that render
the service undeliverable.
(10)
Ownership and Maintenance of Records:
(i) The
program in which the recipient is admitted shall be responsible for obtaining
and maintaining a complete clinical record as if the recipient were seen
in-person at such site.
(ii) The
telehealth practitioner must have immediate access to the recipient health
record.
(iii) The distant/hub site
shall maintain copies of all documentation completed by the distant/hub
telehealth practitioner unless the telehealth practitioner records the
information directly within the originating/spoke site's electronic medical
record system.
(c) Guidelines of the Office.
The Office shall develop guidelines to assist providers in complying with the provisions of this Part and in achieving treatment goals through the use of telehealth Services. The Office shall post such guidelines on its public website.
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.