PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following action:
Action taken:
Addition of Part 596; and repeal of section 599.17 of Title 14 NYCRR.
Statutory authority:
Mental Hygiene Law, sections 7.09, 31.02 and 31.04
Subject:
Telepsychiatry Services.
Purpose:
Establish basic standards to approve telepsychiatry in certain OMH-licensed programs; repeal unnecessary existing provisions.
Text of final rule:
1. Section 599.17 of Title 14 NYCRR is repealed.
2. A new Part 596 is added to Title 14 NYCRR to read as follows:
Part 596
TELEPSYCHIATRY SERVICES
§ 596.1 Background and intent.
(a) Telepsychiatry is defined as the use of two-way real-time interactive audio and video equipment to provide and support mental health services at a distance. Such services do not include a telephone conversation, electronic mail message or facsimile transmission between a provider and a recipient, or a consultation between two professional or clinical staff.
(b) Telepsychiatry can be beneficial to a mental health care delivery system, particularly when on-site services are not available or would be delayed because of distance, location, time of day, or availability of resources. The benefits of telepsychiatry can include improved access to care, provision of care locally in a more timely fashion, improved continuity of care, improved treatment compliance, and coordination of care.
(c) The Office of Mental Health supports the use of telepsychiatry as an appropriate component of the mental health delivery system to the extent that it is in the best interests of the person served and is performed in compliance with applicable federal and state laws and regulations and the provisions of this Part in order to address legitimate concerns about privacy, security, patient safety, and interoperability.
§ 596.2 Legal base.
(a) Section 7.09 of the Mental Hygiene Law grants the Commissioner of Mental Health the power and responsibility to adopt regulations that are necessary and proper to implement matters under his or her jurisdiction.
(b) Sections 31.02 and 31.04 of the Mental Hygiene Law authorize the Commissioner of Mental Health to set standards of quality and adequacy of facilities, equipment, personnel, services, records and programs for the rendition of services for persons diagnosed with mental illness, pursuant to an operating certificate.
§ 596.3 Applicability.
The provisions of this Part shall apply to any provider licensed pursuant to Article 31 of the Mental Hygiene Law who has been authorized by the Office under this Part to include the use of telepsychiatry as a means of rendering licensed services, provided, however, that telepsychiatry shall not be utilized in Personalized Recovery Oriented Services (PROS) programs subject to Part 512 of this Title or Assertive Community Treatment (ACT) programs approved pursuant to Part 551 of this Title.
§ 596.4 Definitions.
For purposes of this Part:
(a) Distant or “hub” site means the distant location at which the practitioner rendering the telepsychiatry service is located.
(b) Encounter means a telepsychiatry event involving patient contact, whereby the care of the patient is the direct responsibility of both the originating (spoke site) provider and the distant (hub site) provider.
(c) Encryption means a system of encoding data on a Web page or email where the information can only be retrieved and decoded by the person or computer system authorized to access it.
(d) Originating or “spoke” site means the site where the patient is physically located at the time mental health services are delivered to her/him by means of telepsychiatry.
(e) Nurse practitioner in psychiatry means a person currently certified as a nurse practitioner with an approved specialty area of psychiatry (NPP) by the New York State Education Department or who possesses a permit from the New York State Education Department.
(f) Physician means a physician currently licensed to practice medicine in New York State who (i) is a diplomat of the American Board of Psychiatry and Neurology or is eligible to be certified by that Board, or (ii) is certified by the American Osteopathic Board of Neurology and Psychiatry or is eligible to be certified by that Board.
(g) Practitioner means a physician or nurse practitioner in psychiatry who is providing telepsychiatry services from a distant or hub site in accordance with the provisions of this Part.
(h) Provider of services means a provider of mental health services licensed pursuant to Article 31 of the Mental Hygiene Law.
(i) Qualified mental health professional means a practitioner possessing a license or a permit from the New York State Education Department who is qualified by credentials, training, and experience to provide direct services related to the treatment of mental illness and shall include physicians and nurse practitioner in psychiatry, as defined in subdivisions (e) and (f) of this Section, as well as the following:
(1) Creative arts therapist: a person currently licensed as a creative arts therapist by the New York State Education Department or who possesses a creative arts therapist permit from the New York State Education Department.
(2) Licensed practical nurse: a person currently licensed as a licensed practical nurse by the New York State Education Department or who possesses a licensed practical nurse permit from the New York State Education Department.
(3) Licensed psychoanalyst: a person currently licensed as a psychoanalyst by the New York State Education Department or who possesses a permit from the New York State Education Department.
(4) Licensed psychologist: a person currently licensed as a psychologist by the New York State Education Department, or who possesses a permit from the New York State Education Department and who possesses a doctoral degree in psychology, or an individual who has obtained at least a master's degree in psychology who works in a federal, state, county or municipally operated clinic.
(5) Marriage and family therapist: a person currently licensed as a marriage and family therapist by the New York State Education Department or who possesses a permit from the New York State Education Department.
(6) Mental health counselor: a person currently licensed as a mental health counselor by the New York State Education Department or who possesses a permit from the New York State Education Department.
(7) Nurse practitioner: a person currently certified as a nurse practitioner by the New York State Education Department or who possesses a permit from the New York State Education Department.
(8) Physician: a person currently licensed as a psychiatrist by the New York State Education Department or who possesses a permit from the New York State Education Department.
(9) Physician assistant: a person currently registered as a physician assistant by the New York State Education Department or who possesses a permit from the New York State Education Department.
(10) Registered professional nurse: a person currently licensed as a registered professional nurse by the New York State Education Department or who possesses a permit from the New York State Education Department.
(11) Social worker: a person who is either currently licensed as a licensed master social worker or as a licensed clinical social worker (LCSW) by the New York State Education Department, or who possesses a permit from the New York State Education Department to practice and use the title of either licensed master social worker or licensed clinical social worker.
(j) Telecommunication system means an interactive telecommunication system that is used to transmit data between the originating/ spoke and distant/hub sites.
(k) Telepsychiatry means the use of two-way real-time interactive audio and video to provide and support clinical psychiatric care at a distance. Such services do not include a telephone conversation, electronic mail message, or facsimile transmission between a provider and a patient or a consultation between two physicians or nurse practitioners, or other staff, although these activities may support telepsychiatry services.
§ 596.5 Approval to Utilize Telepsychiatry Services.
(a) Telepsychiatry services may be authorized by the Office for assessment and treatment services provided by physicians or nurse practitioners, as defined in Section 596.4 of this Part, from a site distant from the location of a patient, where the patient is physically located at an originating/spoke site licensed by the Office, and the physician or nurse practitioner is physically located at a distant/hub site that participates in the New York State Medicaid program.
(b) A provider of services must obtain prior written approval of the Office before utilizing telepsychiatry services.
(c) Approval shall be based on receipt by the Office of the following:
(1) Sufficient written demonstration that telepsychiatry will be used for assessment and treatment services consistent with the provisions of this Part, and that the services are being requested because they are necessary to improve the quality of care of individuals receiving services;
(2) Submission of a written plan to provide telepsychiatry services that satisfies the provisions of this Part and includes:
(i) confidentiality protections for persons who receive telepsychiatry services, including measures to ensure the security of the electronic transmission;
(ii) informed consent of persons who receive telepsychiatric services;
(iii) procedures for handling emergencies with persons who receive telepsychiatric services; and
(iv) contingency procedures to use when the delivery of telepsychiatric service is interrupted, or when the transmission of the two-way interactions is deemed inadequate for the purpose of service provision.
(d) Requests for approval to offer telepsychiatry services shall be submitted to the Field Office serving the area in which the originating/spoke site is located. The request for approval shall be submitted by the originating site. Such Field Office may make an on-site visit to either or both sites prior to issuing approval.
(e) The Office shall provide its approval to utilize telepsychiatry services in writing. The provider of services must retain a copy of the approval document and shall make it available for inspection upon request of the Office.
(f) Failure to adhere to the requirements set forth in this Part may be grounds for revocation of such approval. In the event that the Office determines that approval to utilize telepsychiatry services must be revoked, it will notify the provider of services of its decision in writing. The provider of services may request an informal administrative review of such decision.
(1) The provider of services must request such review in writing within 15 days of the date it receives notice of revocation of approval to utilize telepsychiatry services to the Commissioner or designee. The request shall state specific reasons why such provider considers the revocation of approval incorrect and shall be accompanied by any supporting evidence or arguments.
(2) The Commissioner or designee shall notify the provider of services, in writing, of the results of the informal administrative review within 20 days of receipt of the request for review. Failure of the Commissioner or designee to respond within that time shall be considered confirmation of the revocation of deemed status.
(3) The Commissioner’s determination after informal administrative review shall be final and not subject to further administrative review.
§ 596.6 Requirements for Telepsychiatry Services.
(a) General requirements.
(1) The distant/ hub site practitioner must:
(i) possess a current, valid license to practice in New York State;
(ii) directly render the telepsychiatry 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) exercise the same standard of care as in-house delivered services; and
(v) deliver services from a site that is enrolled in the New York State Medicaid program.
(2) The distant/hub provider and originating/spoke site provider of service must not be terminated, suspended, or barred from the Medicaid or Medicare program.
(3) If the originating/spoke site is a hospital, the practitioner at the distant/hub site must be credentialed and privileged by such hospital, consistent with applicable accreditation standards.
(4) Telepsychiatry services must be rendered using an interactive telecommunication system.
(5) A notation must be made in the clinical record that indicates that the service was provided via telepsychiatry and which specifies the time the service was started and the time it ended.
(6) Telepsychiatry services provided to patients under age 18 may include staff that are qualified mental health professionals, as such term is defined in this Part, or other appropriate staff of the originating/spoke site in the room with the patient. Such determinations shall be clinically based, consistent with clinical guidelines issued by the Office.
(7) For the purposes of this Part, telepsychiatry 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.
(8) Culturally competent interpreter services shall be provided in the patient’s preferred language when the patient and distant/hub practitioners do not speak the same language.
(9) The practitioner providing telepsychiatry services at a distant/hub site shall be considered an active part of the patient’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 practitioner shall prepare appropriate progress notes and securely forward them to the originating/spoke provider as a condition of reimbursement.
(10) Telepsychiatry services shall not be used:
(i) for purposes of ordering medication over objection or restraint or seclusion, as defined in section 526.4 of this Title; or
(ii) to satisfy any specific statutory examination, evaluation or assessment requirement necessary for the involuntary removal from the community, or involuntary retention in a hospital pursuant to any of the provisions of Article 9 of the Mental Hygiene Law. Physicians conducting such examinations, evaluations or assessments may only utilize telepsychiatry on a consultative basis.
(b) Protocols and Procedures. A provider of services approved to utilize telepsychiatry services must have written protocols and procedures that address the following:
(1) Informed Consent: Protocols must exist affording persons receiving services the opportunity to provide informed consent to participate in any services utilizing telepsychiatry, including the right to refuse these services and to be apprised of the alternatives to telepsychiatry services, including any delays in service, need to travel, or risks associated with not having the services provided by telepsychiatry. Such informed consent may be incorporated into the informed consent process for in-person care, or a separate informed consent process for telepsychiatry services may be developed and used.
(i) The patient must be provided with basic information about telepsychiatry and shall provide his or her informed consent to participate in services utilizing this technology.
(ii) For patients under age 18, such information shall be shared with and informed consent obtained from the patient’s parent or guardian.
(iii) The patient has the right to refuse to participate in telepsychiatry services, in which case evaluations must be conducted in-person by appropriate clinicians.
(iv) Telepsychiatry sessions shall not be recorded without the patient’s consent.
(2) Confidentiality: Protocols and procedures should be maintained as required by Mental Hygiene Law Section 33.13 and the Health Insurance Portability and Accountability Act (HIPAA) at 45 CFR Parts 160 and 164. Such protocols shall ensure that all current confidentiality requirements and protections that apply to written clinical records shall apply to services delivered by telecommunications, including the actual transmission of the service, any recordings made during the time of transmission, and any other electronic records.
(i) All confidentiality requirements that apply to written medical records shall apply to services delivered by telecommunications, 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 patient at the originating/spoke site and the practitioner at the distant/hub site must meet the minimum standards for privacy expected for patient-clinician interaction at a single Office of Mental Health licensed location.
(3) Security of Electronic Transmission: All telepsychiatry services must be performed on dedicated secure transmission linkages 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.
(4) Psychiatric emergencies: Protocols should exist to address psychiatric emergencies, which may override the right to confidentiality to require the presence of others if, for instance, an individual receiving services is suicidal, homicidal, dissociated, or acutely psychotic during the evaluation or treatment service. In general this individual should not be managed via telepsychiatry without qualified mental health professionals present at the originating/spoke site, unless there are no adequate alternatives and immediate intervention is deemed essential for patient safety. All telepsychiatry sites must have a written procedure detailing the availability of in-person assessments by a physician or nurse practitioner in an emergency situation.
(5) Prescribing medications via telepsychiatry: Procedures for prescribing medications through telepsychiatry must be identified and must be in accordance with applicable New York State and federal regulations.
(6) Procedures for first evaluations for involuntary commitments: Under New York State law, physicians must conduct first evaluations for involuntary commitments of individuals. If these evaluators want additional consultation before rendering their decision, they may obtain consultation from psychiatrists via telepsychiatry. 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 telepsychiatric consultation.
(7) Patient rights: Patient rights policies must ensure that each individual receiving telepsychiatry services:
(i) is informed and made aware of the role of the practitioner at the distant/hub site, as well as qualified professional staff at the originating/spoke site who are going to be 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 telepsychiatry 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 telepsychiatry transmission; and
(v) if the patient is a minor, the patient and his or her parent or guardian shall be given the opportunity to provide input regarding who will be in the room with the patient when telepsychiatry services are provided.
(8) Quality of Care: All telepsychiatry 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 patient care standards. A review of telepsychiatry services shall be included in the provider’s quality management process
(9) Contingency Plan: All telepsychiatry 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.
(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 telepsychiatry. The Office shall post such guidelines on its public website.
§ 596.7 Reimbursement for Telepsychiatry Services.
(a) The originating/spoke site where the patient is admitted is authorized to bill Medicaid for telepsychiatry services.
(b) Under the Medicaid program, telepsychiatry services are covered when medically necessary and under the following circumstances:
(1) the person receiving services is located at the originating/spoke site and the practitioner is located at the distant/hub site;
(2) the originating/spoke site is the provider of services where the person receiving services is located;
(3) the distant/hub site is the site where the practitioner is located;
(4) the person receiving services is present during the telepsychiatry encounter or consultation;
(5) the physician/nurse practitioner is not conducting the telepsychiatry encounter consultation at the originating/spoke site;
(6) the request for telepsychiatry services and the rationale for the request are documented in the individual's clinical record;
(7) the clinical record includes documentation that the telepsychiatry encounter or consultation occurred and that the results and findings were communicated to the requesting provider of services;
(8) the practitioner at the distant/hub site is:
(i) licensed in New York State;
(ii) practicing within his/her scope of specialty practice;
(iii) providing services from a site that participates in New York Medicaid;
(iv) affiliated with the originating/spoke site facility; and
(v) if the originating/spoke site is a hospital, credentialed and privileged at the originating/spoke site facility.
(c) If the person receiving services is not present during the provision of the telepsychiatry service, the service is not eligible for Medicaid reimbursement and remains the responsibility of the originating/spoke facility.
(d) The following interactions do not constitute reimbursable telepsychiatry services;
(1) telephone conversations;
(2) video cell phone interactions;
(3) e-mail messages.
(e) The originating/spoke site may bill for administrative expenses only when a telepsychiatric connection is being provided and a physician or nurse practitioner is not present at the originating/spoke site with the patient at the time of the encounter.
(f) Reimbursement for services provided via telepsychiatry must be in accordance with the rates and fees established by the Office and approved by the Director of the Budget.
(g) If a telepsychiatry service is undeliverable due to a failure of transmission or other technical difficulty, reimbursement shall not be provided.
§ 596.8 Contracts for the Provision of Telepsychiatry Services.
(a) Nothing in this Part shall be deemed to prohibit a provider of services from providing assessment and treatment services, consistent with applicable regulations of the Office, as a distant/hub site via telepsychiatry pursuant to contract with an originating/spoke site provider that is not licensed or operated by the Office, but which is enrolled in the New York State Medicaid program.
(b) Although prior approval of the Office is not required before entering into such contracts, notice of such contracts or agreements shall be provided by the distant/hub provider of services within 30 days after execution of such contract to the Field Office serving the area where such provider of services is located.
(c) Reimbursement for telepsychiatry service shall be pursuant to such contracts and are not separately billable by the distant/hub site.
(d) Providers of service shall not engage in distant/hub telepsychiatric services that violate the provisions of paragraph (10) of subdivision (a) of Section 596.6 of this Part.
Final rule as compared with last published rule:
Nonsubstantive changes were made in sections 596.1(a), (b), 596.3, 596.5(a), (d), 596.6(a)(1)(v), (6), (b)(1), (7)(v), 596.7(b)(2), (8)(iii), (e) and 596.8(a).
Text of rule and any required statements and analyses may be obtained from:
Jessica Kircher, NYS Office of Mental Health, 44 Holland Avenue, Albany, NY 12229, (518) 474-1331, email: Jessica.Kircher@omh.ny.gov
Revised Regulatory Impact Statement, Regulatory Flexibility Analysis, Rural Area Flexibility Analysis and Job Impact Statement
A revised Regulatory Impact Statement, Regulatory Flexibility Analysis, Rural Area Flexibility Analysis and Job Impact Statement are not required because the changes made to the last published rule do not necessitate revision to the previously published documents. The changes to the text are not substantial, do not change the meaning of any provision and therefore do not change any statements in the document.
Initial Review of Rule
As a rule that does not require a RFA, RAFA or JIS, this rule will be initially reviewed in the calendar year 2021, which is no later than the 5th year after the year in which this rule is being adopted.
Assessment of Public Comment
The Office of Mental Health has received public comments from five stakeholder entities, including providers and provider organizations. All of the comments were reviewed, assessed and taken into consideration. Below are the collective responses to each of the issues presented.
1. Comment: Several comments suggested that the range of licensed clinicians authorized to provide services remotely be expanded to include those outside of psychiatry. The definition of “practitioner” was brought into question due to the fact that it currently limits those authorized to provide these services to psychiatrists and nurse practitioners.
Response: These comments address issues beyond the intended scope of the regulation, and no changes were made to the proposed regulation in response to them. However, the Office will take these comments under advisement as it continues to evaluate and develop the use of technology in the delivery of mental health services.
2. Comment: Locations outside of OMH-licensed programs should have the ability to receive telepsychiatry services, such as in-home” telepsychiatry.
Response: The use of telepsychiatry in settings not licensed by OMH, such as in-home settings, implicates significant challenges such as emergency situations, privacy and confidentiality, and security of data OMH is not prepared to amend the regulations to accommodate this comment at this time. However, the Office will take these comments under advisement as it continues to evaluate and develop the use of technology in the delivery of mental health services.
3. Comment: The regulation should specify that when a minor is receiving telepsychiatry services, the minor and his/her parents/guardian may choose who they would like to have present in the room.
Response: The regulations have been clarified to reflect this comment. This provision now reads: (v) if the patient is a minor, the patient and his or her parent or guardian shall be given the opportunity to choose who will be in the room with the patient when telepsychiatry services are provided. 596.6 (b)(7)(v).
4. Comment: A suggestion was made to establish a procedure for prescription refills and the reporting/addressing of side effects of such medication in between telepsychiatry sessions.
Response: This is not a telepsychiatry regulatory issue. These types of issues should be managed consistent with the agency policy/practice for medication orders and renewals and documenting side effect, etc.
5. Comment: Adding to the list of telepsychiatry benefits a decrease in the cost of overall services.
Response: No changes to the regulations were made as a result of this comment. This regulation is not being proposed as a vehicle for cost savings.
6. Comment: It was suggested that the regulation expand the use of telepsychiatry to allow for ordering medication over objection or restraint or seclusion.
Response: These comments address issues beyond the intended scope of the regulation, some of which require statutory change, and no changes were made to the proposed regulation in response to them. However, the Office will take these comments under advisement as it continues to evaluate and develop the use of technology in the delivery of mental health services.
7. Comment: The issue of consent for telepsychiatry was raised by several commenters, who recommended that specific consent should not be deemed necessary for this type of service.
Response: No changes to the proposed regulation were made as a result of these comments. Obtaining informed consent for services delivered via telepsychiatry is considered a “best practice” and is recommended by groups such as the American Telemedicine Association. Providers have flexibility in either expanding the information provided in the consent process for in-person care, or in developing a separate consent for telepsychiatry. Informed consent for telepsychiatry incorporates issues that are different than in-person care. For example, technical issues like encryption or the potential for technical failure should be addressed. Other key topics include confidentiality and the limits to confidentiality in electronic communication; an agreed upon emergency plan, process by which patient information will be documented and stored; and the potential for technical failure.
8. Comment: OMH was asked to clarify the language detailing who determines if “all or part” of the telepsychiatry service is undeliverable.
Response: In response to this comment, language in subdivision (g) of Section 596.7 has been clarified such that it now reads: “If a telepsychiatry service is undeliverable due to a failure of transmission or other technical difficulty, reimbursement shall not be provided.”
9. Comment: A few comments expressed that telepsychiatry services should also be utilized by Assertive Community Treatment (ACT) programs and Personalized Recovery Oriented Services (PROS) programs.
Response: These comments address issues beyond the intended scope of the regulation, and no changes were made to the proposed regulation in response to them. However, the Office will take these comments under advisement as it continues to evaluate and develop the use of technology in the delivery of mental health services.
10. Comment: Concerns were raised about the OMH approval process for the use of telepsychiatry services. It was thought to be an unnecessary extra layer of approval for the delivery of mental health care. Additionally, commenters speculated about a possible delay in services that may come from this approval process.
Response: No changes to the regulations were made to address this comment. First, the ability to offer telepsychiatry services is an optional choice for providers – they are not required to offer this service. Second, the approval process established in the regulations is essential in order to ensure standards regarding equipment and technology are in place, which are essential to safeguard privacy. This administrative process is local (through the regional office) abbreviated and OMH anticipates requests for approval will be issued in a timely manner.
11. Comment: Some commenters had issue with the requirement of the distant/hub site practitioner to be enrolled in New York Medicaid. Much like the requests for expansion of services, it was thought by some that telepsychiatry should be available in non-Medicaid settings. One comment suggested that both the distant/hub site and the originating/spoke site be able to bill Medicaid, as is the case with Medicare.
Response: The regulations were not changed in response to this comment. Enrollment in the New York State Medicaid program does not preclude the ability to serve persons who are not Medicaid beneficiaries. There are numerous reasons for requiring Medicaid enrollment (e.g., Medicaid enrollment is a prerequisite for participation in the NYS Medicaid Electronic Health Records (EHR) Incentive Program), and physicians or providers ordering/referring services provided under the state plan or under a waiver of the state plan must enroll in Medicaid.
12. Comment: Clarification was requested regarding the term “affiliated” and what would be required to document an “affiliation”.
Response: No changes to the regulation are required in light of this question. Clarification regarding the affiliation requirement will be provided in guidelines of the Office.
13. Comment: One comment suggested removing the restriction on the use of video cell phone interactions in order to achieve optimal access and maximal participation for both patients and providers.
Response: No changes to the regulations were made to address this comment. The restriction on cell phone interactions is designed to address legitimate concerns regarding patient confidentiality and security of transmission.
14. Comment: Several questions were raised regarding the billing for telepsychiatry services, specifically asking for clarification as to which providers can bill for clinical or administrative fees (hub or spoke?).
Response: No changes to the regulations is necessary to address this comment. The regulations direct OMH to develop guidelines to assist in implementation. Questions with respect to billing issues will be addressed in this guidance.
15. Comment: An additional billing question was presented requesting detailed guidance to providers on the billing and reimbursement for telepsychiatry services.
Response: No changes to the regulations is necessary to address this comment. The regulations direct OMH to develop guidelines to assist in implementation. Questions with respect to billing issues will be addressed in this guidance.
16. Comment: One comment suggested removing the phrase “and referring physician” from § 596.7(b)(2) as there are important circumstances in which the patient has not been referred by a physician.
Response: In response to this comment, OMH has removed the phrase “and referring physician” from § 596.7(b)(2).
17. Comment: There was a request to modify § 596.6(b)(6) to allow the telepsychiatric consultant to complete one of the two Physician Certificates in support of involuntary admission (9.27) with the remaining two signatories (Applicant, other Physician Certificate) present at the facility with the patient.
Response: These comments address issues beyond the intended scope of the regulation, and no changes were made to the proposed regulation in response to them. However, the Office will take these comments under advisement as it continues to evaluate and develop the use of technology in the delivery of mental health services.
18. Comment: One commenter recommended that the definition of telepsychiatry include a consultation between two physicians or nurse practitioners, or other staff when directly related to the treatment of an individual.
Response: No revisions or changes to the regulation are necessary to address this comment. The regulations do not preclude administrative use of telepsychiatry, although billing for administrative use is not permitted.
