Best Practices for Telehealth During COVID-19 Public Health Emergency
Updated March 19, 2020
National Council for Behavioral Health members are on the front lines providing critical mental health and substance use treatment during an unprecedented public health emergency. Congress and the Trump Administration have changed federal guidelines so that more practitioners may use telehealth during the COVID-19 outbreak.
This document is intended to provide you with the background and resources necessary to help you begin or expand your use of telehealth. This list is not exhaustive and guidance from the Trump Administration or future legislation may change the current situation at any time. Please reach out to use if we can be of help during this period. For technical assistance, contact your Telehealth Regional Center here.
HHS Office of Civil Rights has issued a "Notification of Enforcement Discretion" for telehealth remote communications during the public health emergency. HHS will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers during the COVID-19 nationwide public health emergency.
Key Things to Know
Be strategic in your considerations: Work with your team to think strategically about where opportunities for expanding telehealth are. Consider which services/programs already have virtual options that could be expanded, which populations or clients would most easily adapt to virtual platforms, and which services or populations would pose the greatest challenges. With things moving quickly, all of these factors are important to streamlining implementation.
Take time to assess your needs: Understand what your current capacity is and where your gaps are in terms of equipment, staffing and patient resources. Ask yourself: What technology capacities do you already have? What equipment could you purchase quickly? Who on your staff could be a leader in utilizing technology and training other staff? What are the needs of individuals served by your organization? What technology capacities can you guestimate they have/need? ExL If your patients regularly access a patient portal, they likely have smart phones, if population is >60% over age 60 perhaps phone calls would be best, etc.
Communicate visit changes to your patients: Let your patients know that your organization's telehealth policies during COVID19 outbreak. If you will only be providing telehealth visits, post information to your website, consider changing your organizations phone script to include this information at the beginning of your recording, call patients with upcoming appointments and offer televisit. Consider targeted outreach to "high risk" patients.
Practice using technology first: Whatever application you decide to use, practice with other staff before you use with a patient. You may be able to recommend preferred video conferencing applications to patients and send them test links to make sure a connection is available before starting your session.
Create a backup plan: Establish protocols in case escalation of care is required or technology fails. Do you need to consult with another provider? What backup technology could you use?
Consider appropriate screening tools: If you are still offering in-person appointments, incorporate approaches for screening for COVID19 symptoms prior to arrival and protocols for shifting appointments to virtual should someone be presenting symptoms. If someone is displaying symptoms but is in crisis or requires immediate support, consider protocols and partnerships that can alert EMS/crisis response teams of symptoms consistent in advance.
Documentation and record keeping: Continue maintaining an electronic record for each patient and document to the highest of your capability based on your interaction, including any assessments or treatment plans. Ensure your staff are kept abreast of policy or billing changes as states adopt and expand access so that documentation is in compliance.
Check in with patients: find out where the trouble areas are for them and make changes where necessary. Check in during the visit and afterwards. Did they struggle with this type of communication? Could you switch to a different application? Are there tests you could do beforehand to check their internet or phone connection if that is a trouble area?Reach out if you need help: Contact the National Council for technical assistance. Additionally, there are regional telehealth centers (TRC) throughout the country. You can reach out to them with specific questions. Find your TRC here.
President & CEO
National Council for Behavioral Health
Direct: (202) 684-3749