14 CRR-NY 830.5NY-CRR
14 CRR-NY 830.5
14 CRR-NY 830.5
(1) Telepractice services, as defined in this Part, may be authorized by the office for the delivery of certain addiction services provided by practitioners employed by, or pursuant to a contract or memorandum of understanding (MOU) with a program certified by the office.
(2) The office supports the use of telepractice as an appropriate component of the delivery of certain addiction services to the extent that it is in the best interests of the person receiving services; 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; and does not replace the preferred option of an in-person exchange between patient and practitioner.
(3) Services may be provided via telepractice by a practitioner from a site distant from the location of the patient, provided both practitioner and patient are located in sites approved by the office pursuant to a plan submitted by a certified program in application for a telepractice designation.
(4) Telepractice does not include an audio or video telephone conversation, electronic mail message, or facsimile transmission between a program and a patient or a consultation between two practitioners, although these activities may support telepractice services.
(5) An office certified program must obtain prior written authorization from the office pursuant to this section before implementing telepractice services; services shall be limited to those authorized and approved by the office and may include the following:
(i) admission assessments, direct transfers;
(ii) psycho-social evaluations and mental health consultations;
(iii) medication assisted treatment prescribing and monitoring; and
(iv) counseling (individual and group);
(v) other services as approved by the office.
(1) Requests for designation to provide telepractice services shall be in the form of a written proposed plan and attestation, found in Telepractice Standards for OASAS Designated Providers posted on the agency website, and submitted by a certified provider to the office bureau of certification and the field office serving the area in which the applicant site is located. Such field office may make an on-site visit to either or both linked sites prior to final approval and designation which will be issued by the Bureau of Certification.
(2) Office approval and operating certificate designation will be based on review of the written proposed plan and attestation addressing the following criteria, including but not limited to:
(i) telepractice services must be conducted via telecommunication systems employing acceptable authentication and identification procedures by both the sender and the receiver; applicant must document a relationship with a credible technology service provider;
(ii) meet Federal and State confidentiality requirements including, but not limited to, 42 C.F.R. part 2, and 45 C.F.R. parts 160 and 164 (HIPAA Security Rules);
(iii) confidentiality requirements applicable to written medical records shall apply to telepractice services including the actual transmission of the service, any recordings made during the transmission, and any other electronic records;
(iv) spaces occupied by the patient and the practitioner must both meet minimum privacy standards consistent with patient-practitioner interaction and confidentiality at a single OASAS certified location;
(v) culturally competent translation services must be provided when the patient and practitioner do not speak the same language;
(vi) a written procedure detailing the availability of face-to-face assessments by medical staff in an emergency situation;
(vii) written procedures for a contingency plan in the event of a transmission failure or other technical difficulties which may render the service undeliverable;
(viii) when applicable, a written and executed contract or MOU between an applicant provider and an individual practitioner or a corporate entity encompassing multiple practitioners regarding the above criteria and including billing, payment, record sharing, background checks, and any other relevant details necessary for implementation;
(ix) a practitioner must be licensed or credentialed to practice in New York State and be in good standing with the appropriate licensing or credentialing authority, and be physically located in the USA when providing services via telepractice.
(x) proposals to provide buprenorphine prescribing and monitoring via telepractice must comply with applicable State and Federal laws and regulations; guidance may be found in Telepractice Standards for OASAS Designated Providers posted on the agency website.
(3) Subsequent changes to an approved plan must be submitted in writing and approved by the office prior to implementation.
(1) The patient shall be admitted to, or seeking admission to only one of the two connected sites.
(i) if the patient is admitted to or seeking admission to a program, the practitioner shall prepare appropriate admission or progress notes and, if appropriate, securely forward them to the designated program as a condition of reimbursement;
(ii) if telepractice services are a regular part of an admitted patient’s treatment/recovery plan, the practitioner must coordinate with the responsible professional at the patient’s designated program to prepare and update the treatment/recovery plan to permit the patient’s program to be reimbursed for continuing services;
(iii) the patient must be provided basic information about telepractice including alternatives, possible delays in service, possible need to travel to an approved originating site to receive services, risks associated with not having the services provided; the patient must acknowledge in writing having received such information;
(iv) the patient may refuse to receive services via telepractice; and
(v) patients and prospective patients must have at least one in-person evaluation session with clinical staff prior to participation in a telepractice session to determine if telepractice is appropriate; additional evaluations may be required for medication assisted treatment using controlled substances.
(2) Telepractice services must be included in a provider’s quality review process.
(3) The distant site practitioner must directly render the telepractice service.
(4) If the distant site is a hospital, the practitioner must be credentialed and privileged by such hospital, consistent with applicable accreditation standards.
(5) Telepractice sessions shall not be recorded without the patient’s written consent.
(6) Unless otherwise required, persons receiving services via telepractice may be accompanied by a staff member during the session or may be alone. If the initial evaluation or a subsequent treatment plan recommends that the patient be accompanied during telepractice sessions, the person must be accompanied for the session to be reimbursed by Medicaid or Medicaid managed care.
(7) Failure to maintain minimum standards for designation, implementation and reimbursement may result in disciplinary action against a provider’s operating certificate. In the event the office determines that approval to utilize telepractice must be revoked, the office will notify the provider in writing. The provider may request an administrative review of such decision pursuant to this paragraph.
(i) the provider must request such review in writing within 15 days of receipt of the notice of revocation of designation to utilize telepractice. The request shall state the reasons the provider considers the revocation of designation incorrect and shall include any supporting documentation;
(ii) the commissioner shall notify the provider, in writing, of the results of the administrative review within 20 days of receipt of the request for review. Failure to notify the provider within 20 days shall be deemed confirmation of revocation of a designation to utilize telepractice;
(iii) the commissioner’s determination after administrative review shall be final and not subject to further administrative review.
(d) Medicaid reimbursement.
(1) For purposes of billing for Medicaid reimbursement, both the practitioner and/or facility employing the practitioner, and the designated program must be Medicaid enrolled and in good standing. For Medicaid reimbursement the practitioner, as defined in this Part, must be defined as a telehealth provider in subdivision two of Public Health Law section 2999-cc.
(2) For purposes of this subdivision, telepractice services shall be considered face-to-face contacts.
(3) To be eligible for Medicaid reimbursement, telepractice services must meet all requirements applicable to assessment and treatment services of Part 841 and the part pursuant to which the designated program operating certificate is issued and must exercise the same standard of care as services delivered on-site or in-community.
(4) Telepractice services will be reimbursed at the same rates for identical procedures provided by practitioners on-site or in-community; an additional administrative fee for transmission may be billed pursuant to applicable rules or directives issued by the NYS Department of Health.
(5) The designated program is the primary billing entity; reimbursement for practitioners at a distant/hub site must be pursuant to a contract or MOU. Delivery of services via telepractice are covered when medically necessary and under the following circumstances:
(i) the patient is located at an originating/spoke site and the practitioner is located at a distant/hub site;
(ii) the patient is located at another designated program, an additional location of a designated program or at an in-community location approved by the office; and the practitioner is located in another designated program;
(iii) the patient is present during the telepractice session;
(iv) the request for a telepractice session and the rationale for the request are documented in the patient's case record; or
(v) the case record includes documentation that the telepractice session occurred and the results and findings were communicated to the designated provider.
(6) If the person receiving services is not present during the telepractice service, the service is not eligible for third party reimbursement and any incurred costs may remain the responsibility of the designated provider.
(7) Telepractice services may only be delivered via technological means approved by the Federal Center for Medicaid and Medicare Services (CMS), provided such means are compliant with Federal confidentiality requirements.
(8) If all or part of a telepractice service is undeliverable due to a failure of transmission or other technical difficulty, reimbursement shall not be provided.
(e) Contracts or memorandum of understanding (MOU) for the provision of telepractice services.
(1) Prior approval of the office is not required before entering into such contracts or MOU; however, notice of such contracts or agreements must be provided by the OASAS certified provider to the Office Bureau of Certification within 30 days after execution of such contract or MOU or as part of the proposed plan and attestation required for designation.
(2) The designated OASAS program is the default billing entity. Reimbursement of practitioners for telepractice services shall be pursuant to such contract or MOU; services are not separately billable by the practitioner unless agreed to in writing in advance of any service delivery.
(3) Designated programs or approved practitioners shall not engage in any services via telepractice not authorized by the office.
(4) Practitioners under contract or MOU with a certified and designated program must comply with the provisions of Part 805 of this Title related to criminal history information reviews or provide documentation that such security checks have been conducted and satisfied.
(5) Designated programs shall notify the Office Bureau of Certification of any change in practitioners pursuant to a contract or MOU and compliance with provisions of Part 805 of this Title.
The office shall post standards on its public website to assist in compliance with the provisions of this Part and in achieving treatment goals through the provision of telepractice. Such standards shall include, but not be limited to:
(1) Technology guidelines, including:
(i) the minimum technology thresholds (i.e., equipment, bandwidth, videoconferencing software, network specifications, carrier selection, hub/bridge, and security specifications), which shall be updated as new technology is approved; and
(ii) the form or format regarding the technology and communications to be used.
(2) Clinical standards for the prescribing of medication assisted treatment (MAT), including controlled substances, via telepractice.
(g) Policies and procedures.
A program designated to deliver services via telepractice must have written policies and procedures consistent with the plan and attestation submitted by the program for designation approval, and the applicable requirements of this Part.
(h) Medication assisted treatment.
Induction and prescribing of addiction medications must be done in accordance any and all applicable Federal rules and regulations; guidance may be found in the Telepractice Standards for OASAS Designated Providers posted on the OASAS website.
14 CRR-NY 830.5
Current through December 31, 2020
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