In 2018, the American Psychiatric Association (APA), in conjunction with the American Telemedicine
Association (ATA) developed: - best practices for providing videoconferencing-based telepsychiatric
care-guidelines inform the technical considerations and administrative requirements needed to provide
these services
best practices for providing videoconferencing-based telepsychiatric care: - -Use of a designated
technology platform. Telesessions should not be conducted using alternate platforms; however, an
alternate plan, such as a telephone call, may be used in case of technology failure.
-Provisions for the verification of confidential and secure client information. -Sufficient bandwidth to
provide clear, appropriate video and audio quality.
-Device compliance with Health Insurance Portability and Accountability Act of 1996 (HIPAA) and state
requirements.
During telepsychiatry sessions, both the provider and client locations should be treated as a -
Confidential space
During telepsychiatry sessions, provisions must be taken to ensure: - -the discussion cannot be
overheard by other-adequate lighting and ambiance is provided that is appropriate to the session -place
the camera so that the eyes and face of the participants are visible
Telepsychiatry Legal and Regulatory Considerations: Best practices - -Malpractice insurance-Licensure
requirements-Federal and state prescribing guidelines -Reimbursement
Telepsychiatry Legal and Regulatory Considerations: Malpractice insurance - Malpractice insurance is
required and some policies require additional policies for telehealth.
Telepsychiatry Legal and Regulatory Considerations: Licensure requirements - Licensure requirements
differ from in-person practice.-Providers must hold a license to practice in the state where the client
resides.-The PMHNP is responsible for following standards for the state in which they are practicing.
, Telepsychiatry Legal and Regulatory Considerations: Federal and state prescribing guidelines - Federal
and state prescribing guidelines differ for telepsychiatry.-The Ryan Haight Online Pharmacy Consumer
Protection Act of 2008 governs the prescribing of controlled substances via teleconferencing.• To safely
prescribe, the provider must conduct an in-person medical evaluation at least once every 24 months and
comply with all federal and state prescribing guidelines.
Telepsychiatry Legal and Regulatory Considerations: Billing and Reimbursement - -Reimbursement varies
by state and insurance provider.• Currently, 48 states provide Medicaid reimbursement for
telepsychiatry services.-pt made aware of any and all financial charges that may arise from the services
prior to the commencement of initial services
Best practices for determining the appropriateness of telepsychiatry services include consideration of
the following: - -cognitive capacity of the client-client history and medical status -geographic distance to
emergency facilities -client support system
Best practices related to special populations: Forensic and Correctional - -follow applicable standards of
consent in terms of client's legal status and rights -develop clear, site-specific protocols
Telemental health Children and Adolescents: environment - should facilitate the assessment by
providing an adequate room size, furniture arrangement, toys, and activities that allow the youth to
engage with the accompanying parent, presenter, and provider and demonstrate age-appropriate skills
best practices related to special populations: Children and Adolescents - follow the same guidelines
presented for adults•modify care based on developmental status (motor functioning, speech and
language capabilities, relatedness, and relevant regulatory issues)-include family as appropriate-
Providers should consider how the presenter's involvement can affect service delivery -Appropriateness
for telemental care shall consider safety of the youth, the availability of supportive adults, the mental
health status of those adults, and ability of the site to respond to any urgent or emergent situations.
Best practices related to special populations: Geriatric - -include family as clinically appropriate-adapt
care for cognitive or sensory impairment
best practices related to special populations: Military and Veteran - -be familiar with federal and
organizational structures and guidelines -be familiar with military cultural competence
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