Telehealth/Telemedicine Services

 

Standard of Care (13:34-32.3)

 

Telehealth services will be provided via APN and/or Medical Doctor, Clinical Director, and Credentialed Interns only (The Multidisciplinary Treatment Team).

 

All staff providing telemedicine or engaging in telehealth while providing health care services to the clients will be: (1) validly licensed certified or registered pursuant to Title 45 of the Revised Statutes, to provide such services in the State of New Jersey; (2) remain subject to regulation by the appropriate New Jersey State licensing board or other New Jersey State professional regulatory entity; (3) act in compliance with existing requirements regarding the maintenance of the liability insurance (4)  remain subject to the New Jersey jurisdiction if either the patient or the provider is located in New Jersey at the time services are provided.

 

Prior to providing services through telemedicine or telehealth, the Treatment Team will determine whether providing those services through telemedicine or telehealth would be consistent with the standard of care applicable for those services when provided in-person. If the Treatment Team determines, either before or during the provision of professional counseling that services cannot be provided through telemedicine or telehealth in a manner that is consistent with in-person standards of care, the Treatment Team shall not provide or supervise services through telemedicine or telehealth.

In determining the suitability and appropriateness of telehealth for a given client the Treatment Team will assess and determine if the client’s accessibility, symptomatology, and risk of harm to self and/or others are suitable for telehealth. In addition, they will be considering client characteristics, technical capabilities, clinical diagnosis, emergency probability with each client. The Treatment Appropriateness Assessment will be completed on each client and placed in their clinical chart. Each client determined to be suitable and appropriate for telehealth will be explained the purpose, scope, process, benefits, and components involved in telehealth services.

Some reasons that a client would be considered unsuitable for telehealth:

1. The client was hesitant to use telehealth.

2. There was a high risk that the client would not engage with therapy, so a practitioner would visit in person to help build strong rapport. 

3. If the client was not progressing with telehealth sessions, a practitioner would attend the session in-person to assess whether extraneous factors were limiting progress (such as the relationship between the client and another practitioner present during the session. 

Treatment Team Member-Client Relationship (13:34-32.4)

 

Prior to providing services through telemedicine or telehealth, the Treatment Team member will establish a licensee-client relationship by:

 

1) Identifying the client with, at a minimum, the client’s name, date of birth, phone number, and address. A licensee may also use a client’s assigned identification number, Social Security number, photo, health insurance policy number, or other identifier associated directly with the client; and

 

2) Disclosing and validating the licensee’s identity, license, title, and, if applicable, specialty and Committee certifications.

 

Prior to initiating contact with a client for the purpose of providing services to the client using telemedicine or telehealth, a Treatment Team member will:

 

1) Review the client’s history, including medical history, provided by the client and any other records provided by the client;

 

2) Determine as to each unique client encounter whether he or she will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person; and

 

3) Provide the client the opportunity to sign a consent form that authorizes the licensee to release client records of the encounter to the client’s primary care licensee or other healthcare provider identified by the client.

 

Telemedicine or telehealth without a proper Treatment Team member-client relationship if the provision of professional counseling or rehabilitation counseling, as applicable, is:

 

1) For informal consultations with another healthcare provider performed by a licensee outside the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;

 

2) During episodic consultations by a healthcare specialist located in another jurisdiction who provides consultation services, upon request, to a licensee in this State;

 

3) Related to healthcare assistance provided in response to an emergency or disaster, provided that there is no charge for the medical assistance; or

 

4) Provided by a substitute licensee acting on behalf and at the designation of an absent licensee in the same specialty on an on-call or cross-coverage basis.

 

Prior to providing services through telemedicine or telehealth, the Treatment Team member will determine the client’s originating site and record this information in the client’s record. If, during the session, contact with the client is interrupted, once contact is reestablished, the Treatment Team member shall reverify the client’s location.

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Provision of Telehealth Counseling/Telemedicine (13:34-32.5)

 

Telemedicine services shall be provided using interactive, real-time, two-way communication technologies. Counseling- Center of Hope will use asynchronous store and forward technology to allow for electronic transmission of images, diagnostics, data, and medical information; except that Counseling- Center of Hope may use interactive, real-time, two-way audio in combination with a asynchronous store and forward technology, without video capabilities, if, after accessing and reviewing the patients’ medical records, we determine that we are able to meet the same standards of care as if the healthcare services were being provided in person. Counseling- Center of Hope will be utilizing Doxy.me for the EHR software.

 

The identity, professional credentials and contact information of all staff providing telemedicine and or telehealth services shall be made available to the patient during and after the provision of services. The contact information will allow the client to contact the Counseling- Center of Hope as well as the individualized staff member who conducted the telehealth or a telemedicine service for at least 72 hours following the provision of services.

 

The APN and/or Medical Doctor, Clinical Director, and/or Credentialed Interns must review the medical history and any medical records provided by the client or referring agency. For an initial encounter with the client, the respective staff shall review the patient's medical history and medical records prior to initiating contact with the client, as pursuant to paragraph (3) of subsection a. of P.L. 2017, c117 (C.45:1-63). In the case of a subsequent telemedicine or telehealth encounter conducted pursuant to an ongoing provider-patient relationship, the respective staff may review the information prior to initiating contact with the client or contemporaneously with the telemedicine or telehealth encounter.

 

Following the provision of services using telemedicine or telehealth, the client’s medical information shall be made available to the client upon their request, and with the client’s affirmative consent, forwarded directly to the client's primary care provider or healthcare provider of record, or, upon request by the client to other healthcare providers. For clients without a primary care provider or health care provider of record, Counseling- Center of Hope maybe advise the client to contact a primary care provider, and, upon request by the client, assist them with locating a primary care provider or other in-person medical assistance that, to the extent possible, is located within reasonable proximity to the client. Counseling- Center of Hope will also refer the client o appropriate follow up care where necessary, including making appropriate referrals for emergency or complementary care, if needed. Consent may be oral, written or digital in nature, provided that the chosen method of consent is deemed appropriate under the standard of care but must be documented in the client’s chart.

 

Records (13:34-32.6)

 

All services through telemedicine or telehealth will be maintained in a record of the care provided to a client. The records will comply with the requirements at N.J.A.C. 13:34-18.1 or 27.1, as applicable, and all other applicable State and Federal statutes, rules, and regulations for recordkeeping, confidentiality, and disclosure of a client’s records.

 

Counseling- Center of Hope will ensure that the same standards of care or practice standards are applicable to in-person settings. If telemedicine or telehealth services would not be consistent with the standard of care, Counseling- Center of Hope will direct the patient to seek in person care.

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Privacy and Notice to Clients (13:34-32.8)

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a) The licensees who communicate with clients by electronic communications other than telephone or facsimile will establish written privacy practices that are consistent with the Federal standards set forth at 45 CFR Parts 160 and 164, which are incorporated herein by reference, as amended and supplemented, relating to privacy of individually identifiable health information.

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b) Written privacy practices required at (a) above shall include privacy and security measures that assure confidentiality and integrity of client-identifiable information. Transmissions, including client email, prescriptions, and laboratory results must be password protected, encrypted electronic prescriptions, or protected through substantially equivalent authentication techniques.

c) A licensee who becomes aware of a breach in confidentiality of client information, as defined at 45 CFR 164.402, shall comply with the reporting requirements at 45 CFR 164.

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d) The licensees, or their authorized representatives, will provide a client, prior to evaluation or treatment, with copies of written privacy practices and shall obtain the client's written acknowledgment of receipt of the notice.

 

e) The licensees who provide services through telemedicine or telehealth, or their authorized representatives, will, prior to providing services, give clients notice regarding telemedicine and telehealth, including the risks and benefits of being treated by telemedicine or telehealth and how to receive follow-up care or assistance in the event of an adverse reaction to the treatment, or in the event of an inability to communicate as a result of a technological or equipment failure. A licensee will obtain a signed and dated statement indicating that the client received this notice.

 

 f) When telemedicine or telehealth is unable to provide all pertinent clinical information that a licensee exercising ordinary skill and care would deem reasonably necessary to provide care to a client, the licensee will inform the client of this prior to the conclusion of the provision of care through telemedicine or telehealth and will advise the client regarding the need for the client to obtain an additional in-person medical or mental health evaluation, as applicable, reasonably able to meet the client's needs.