Preparing for the Telehealth World: Navigating Legal, Regulatory, Reimbursement, and Ethical Issues in an Electronic Age

Deborah C. Baker and Lynn F. Bufka American Psychological Association, Washington, DC

As technology advances, psychologists increasingly have the opportunity to engage with patients or other users of psychological services via less traditional methods. However, little guidance exists to prepare psychologists to navigate the legal, regulatory, reimbursement, and ethical issues that can arise when providing psychological services via technology. A review of relevant state and federal laws reveals inconsistencies even in the terminology used to describe provision of services via technology with some referring to “telehealth,” others to “telemedicine,” and others using additional terms. The following overview of laws, regulations, and existing guidelines in the area of telehealth and telemental health provides some preliminary guidance for psychologists as they attempt to meet the needs of their patients using available and emerging technologies. Specific issues addressed include the applicability of the HIPAA Privacy and Security Rules, informed consent and reimbursement by third party payers.

Keywords: telehealth, telemental health, privacy, security, reimbursement, technology

With the proliferation of wireless devices such as smart phones and PDAs, and the availability of Internet-based videoconferenc- ing and social networking, health care providers are able to con- nect easily and virtually with patients without requiring face-to- face encounters. Whether the communications are limited to scheduling appointments or involve providing psychological inter- ventions remotely, using this technology for delivery of health care services has raised unique issues relating to how these services are coordinated and delivered virtually. While using technology to

provide virtual services can enhance and increase access to care, such as for rural populations or linguistic minorities, the technol- ogy itself creates new challenges and potential risks that psychol- ogists need to carefully consider. Not only are psychologists eth- ically obligated to attain and maintain competency in specific practice areas and/or in working with specific populations, psy- chologists who use telehealth technology must also be competent in using the technology. Psychologists, like other health care providers, confront a lack of uniformity and clear guidance on legal, regulatory, and ethical requirements regarding reimburse- ment policies, privacy and security issues, and even best practices for using this technology to provide psychological services.

This lack of uniformity begins with the threshold issue of what we should call this particular area of practice. Various terms such as “telehealth,” “telemedicine,” “e-health,” and even “m-health” are used by the provider community, legislators, policymakers, and payers. Telehealth is often used as the broader term to describe electronic information and telecommunications technology used to support and improve clinical health services, health administration, patient information, public health, and professional education and supervision. Telemedicine is often used to refer to the narrower category of delivery and support of clinical services. However, the terms are frequently used interchangeably as there is yet no uni- versal definition or term used by legislators, policymakers, gov- ernment agencies, and payers. Within the realm of behavioral health, terms such as “telemental health,” “e-mental health,” “te- lepsychology,” or “telepsychiatry” are often used. Telepsychology is further complicated in that this term is sometimes used to describe all psychological services, including those outside of health care, that are delivered via technology. For purposes of this article, telehealth is used to define the delivery of clinical health care services via technology. Telemental health is used when specifically referring to behavioral health care services delivered through technology.Prior to beginning work on this discussion, please watch the Virtual Clinic  (Links to an external site.) video and review the Guidelines for the Practice of Telepsychology (2013). Be sure to also read Baker and Bufka (2011), Preparing for the Telehealth World: Navigating Legal, Regulatory, Reimbursement, and Ethical Issues in an Electronic Age, Harris and Younggren (2011), Risk Management in the Digital World, Luxton et al. (2014), Best Practices for Remote Psychological Assessment Via Telehealth Technologies, and Gros et al. (2013), Delivery of Evidence-Based Psychotherapy via Video Telehealth articles.
In your initial post, provide an evaluation of the efficacy of using telehealth with mild, moderate, and severe mental health disorders. As part of your evaluation, assess the integration of evidence-based practices into the telehealth trend in psychotherapy. Consider the population, specialty, and treatment preferences you identified in the Week One Creating a Specialist Website interactive assignment, and assess the appropriateness of using telephone, text-based, virtual clinics, and/or video telehealth given your client focus, specialty, and treatment preference(s). Analyze ethical and professional issues you might encounter and explain the risks and benefits of using these delivery methods with your identified treatment.

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Baker, D. C., & Bufka, L. F. (2011). Preparing for the telehealth world: Navigating legal, regulatory, reimbursement, and ethical issues in an electronic age. Professional Psychology: Research and Practice, 42(6), 405-411. doi:10.1037/a0025037

Harris, E., & Younggren, J. N. (2011). Risk management in the digital world. Professional Psychology: Research and Practice, 42(6), 412-418. doi:10.1037/a0025139

Luxton, D. D., Pruitt, L. D., & Osenbach, J. E. (2014). Best practices for remote psychological assessment via telehealth technologies. Professional Psychology: Research and Practice, 45(1), 27-35. doi:10.1037/a0034547