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Telehealth Jobs
from Home:
Legal & Ethical
Considerations/
Opportunities
© 1994-2023 Telehealth.org, LLC All Rights Reserved.
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
Consulting, Staffing, Credentialing and
Professional Training (CEs) in Ethically –
Required Competencies
www.telehealth.org
Telehealth.org, LLC
2
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
• WHO WE ARE: We are licensed healthcare professionals, attorneys and other consultants.
• TELEHEALTH.ORG GOAL: Our goal is educational only. No warranty, guarantee, or
representation is made as to the accuracy or sufficiency of the information contained in our
training for your specific circumstance.
• YOUR PART: You are encouraged to seek practice-specific advice from your own legal,
regulatory, ethical and liability authorities before offering any telehealth services or
programs to consumers/clients/patients. Obtain all such opinions in writing, and have your
informed, trusted, local, legal counsel review those written responses for their full
significance.
Disclaimer
3
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
Learning
Objectives
4
• Intelligently discuss the broad pros and cons of
working from your home telehealth practice
• Identify three specific ethical issues that are of
relevance when working from your home
• List two legal issues that are of relevance with a
telehealth job from home
• Outline how to deal with payors who may choose to
list your home-based office address on their website
or unexpectedly visit your home to conduct an
inspection of your "office“
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
Learning
Objectives
5
• Describe how to deal with family issues with
your home telehealth practice
• Name at least three areas in which job
opportunities are available for clinicians who
want to work from home
• Name three independent authorities to inform
regarding your home telehealth practice to
minimize risk
• Outline at least seven evidence-based models
for treating specific populations with a home
telehealth practice
Intelligently discuss the broad
pros and cons of working from
your home as a clinician
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
Location
vs.
Modality
7
• Practitioners have traditionally been free to
practice from their homes, but cautioned to
exercise good clinical judgment
• Practitioners have a history of
reimbursement denials for written
correspondence, telephone, video, email,
text-messaging
List two legal issues that are of
relevance when you work from your
home
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
9
• Insurance companies may ask legal questions:
• Your office address?
• State of licensure?
• Does your home have zoning regulations against commercial or
other business entities?
• Do you have a business license for your address?
• They may also ask you to attest to other non-telehealth or home-
based requirements:
• Have parking lot? Handicap accessible?
• Have Medicare sign in your window?
Health Insurers
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
10
• Insurance companies may ask legal questions (cont.):
• Their forms may also ask you to attest to non-telehealth or home-
based requirements:
• Have parking lot? Handicap accessible?
• Have Medicare sign in your window?
• Some insurance companies require you to be on US soil if you are
billing for services delivered to their recipients (Medicare)
Health Insurers
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
11
• Billing inaccurately (insurance fraud)
• Wrong licensure (practicing without a license)
• Practicing anonymously (precludes mandated
reporting)
• No continuity of care
• Wrong technology (privacy, security, data integrity)
HIPAA and HITECH)
Other Telehealth Legal Errors
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
How to handle?
12
• Realize that employer, insurance company and
other forms are legal declarations
• Always tell the truth
• Look for employers/payors who appreciate
your professionalism
• Always inform your malpractice carrier
Name two common technical
mistakes made by professionals when
working from their homes
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
14
• Commercial vs. residential connectivity
• Differences in bandwidth
• Bandwidth speed can also differ by time of day. After school is
often a high traffic time and internet speed can be significantly
slower.
Variations in Connectivity
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
15
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
16
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
17
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
18
Name two common clinical mistakes
made by professionals when working
from their homes
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
20
• You may forget to notify family and friends of your
professional appointment schedule - they may unknowingly
interrupt your professional time
• You may be flustered when dealing with an emergency
because you have not practiced coping with crisis through
technology, and are "practicing” on your clients and patients
Boundaries Are Key
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
21
• Always to start session with an opening protocol
• That protocol includes formal procedures to secure both ends
of the meeting
• Ask your client/patient to identify where they are, but you
do not need to do the same
• Ask them to scan room with camera if needed
Procedures Are Also Key
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
22
• Develop a non-verbal, fail-proof system to notify family or friends
when you are in session
• Lock your home office door
• “Do no disturb" note on door
• Note on kitchen counter
• Text message others
• Face camera away from the door
Procedures Are Also Key
1. HIPAA, HITECH and
Other Federal
Regulations
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
24
Most federal laws are silent about home-
based professional offices – check your
states of licensure to know for sure
2. State Privacy
Laws
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
26
Most state privacy laws are silent
about home-based professional
offices
3. State Licensing
and
Other Regulations
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
Licensing
Boards
28
• Licensing laws are in flux.
• To be in compliance with licensing law in
most US states and Canadian provinces,
you must be licensed in the state (or
province) where your client/patient is at the
time of the contact, regardless of where
you live or work.
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
What if you are
traveling out of
your state(s) of
licensure?
29
• Licensing laws are in flux.
• To be in compliance with licensing law, you
must be licensed in the state (or province)
where your client/patient is at the time of the
contact, regardless of where you live or work.
• Some state however mandate that you be
licensed in their state when you deliver
services from that state. (Florida, Alaska)
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
30
Telepsychology 50-State Review
https://www.apaservices.org/practice/advocacy/state/telehealth-slides.pdf
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
31
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
32
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
33
Most state licensing laws are silent
about home-based professional
offices
4. Professional
Association
Ethical Codes
Identify three specific ethical
issues that are of relevance
when working from your home
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
Telebehavioral
Health Standards
& Guidelines
36
• American Medical Association
• American Counseling Association
• American Mental Health Counselors Association
• American Psychological Association
• American Telemedicine Association
• Australian Psychological Society
• British Psychological Society
• Canadian Psychological Association
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
Telebehavioral
Health Standards
& Guidelines
37
• Federation of State Medical Boards
• National Association of Social Workers
• New Zealand Psychological Psychologists Boar
• Ohio Psychological Association
• For specific documents see:
http://telehealth.org/ethical-statements
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
38
Boundaries of Competence
• Technical
• Legal
• Ethical
• Clinical
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
39
BOUNDARIES:
• You may inadvertently violate your own boundaries
• Noises / sounds (spouse yelling at children)
• Personal items visible in background
• Children / adults in background, seen through
windows, doors
Home-Based Ethical Issues
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
40
Informed Consent
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
41
IC is Not Directly Relevant in Home-Based Telehealth
Delivery
• IC is a legal as well as ethical issue
• Most state laws and ethical codes do not ask you to
describe where you are at any given time when
using telehealth
• If you mention it however, you will need to deal with
consequences as a therapeutic boundary issue
Informed Consent Issues
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
42
http://www.counseling.org/Resources/aca-code-of-ethics.pdf
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
43
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
44
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
45
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
46
Most professional association ethical
codes and guidelines are silent about
home-based professional offices
6. Malpractice
Carriers
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
48
• Think back to your malpractice renewal applications
• Did the application include any questions about
whether or not your office is home-based?
• Has anyone heard of a professional being dropped
from a malpractice policy because of having a home-
based office?
Malpractice Insurance Renewal
Applications?
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
49
• Working from your home may increase your liability
under any circumstance, both in-person and with video
• Speaking with your malpractice carrier and getting their
opinion in writing is suggested
Malpractice Carriers
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
50
Most malpractice carriers are silent
about home-based professional
offices
7. Many Reimbursement
Sources
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
52
• Insurance companies may send someone to your home
to do a site inspection in the day you decide to wash the
dog
• Someone in a suit can ring your doorbelI and want
to take a look around
• Payer may accidentally publish your home address
on their provider network website, although they
collected your PO box or other office address
Health Insurers
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
53
• Some payers require that you work from a
"designated telehealth site" which means a
professional office
• Your home can be such an office (Medicare,
Medicaid or 3rd Party) slides
• Must meet all local, state and federal
laws
• Contact them to get their determination
in writing
Health Insurers
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
54
• If you are on provider panels, look back to
your credentialing and recredentialing
applications
• Did the application include questions
about whether or not your office is home-
based?
• Again, contact them if unsure
Managed Care Credentialing
Applications?
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
55
Many payers (Medicare, Medicaid, 3rd
Party) are silent about home-based
offices – but some may prohibit home-
based care.
8. Employers
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
57
If you are employed, your employer is the
only one who may have a policy for or
against your working from home as a
telepractitioner.
Name at least 5 areas in which job
opportunities are available for clinicians
who want to work from home
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
59
1. Nursing Homes
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
60
2. Employee
Assistance
Programs (EAPS)
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
61
3. Rural Hospitals
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
62
4. Schools
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
63
5. Specialty, Schools,
Residential,
Treatment, Hospitals
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
64
• Companies do client/patient recruiting for you
• Physician or nurse is on site / or employer has records
• Patient is delivered to your desktop
• Companies choose a technology vendor and maintain
that relationship/paperwork
• Companies help you with credentialing Companies pay
you
• Evidence-based treatment protocols
Telehealth.org Model “Commonalities”
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
65
6. Migration Model
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
66
7. Private Companies
Serving Consumers
Online
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
Online Employer
Questions?
67
Legal & Ethical Online Therapy Jobs?
35 Easy Questions to Ask Online Therapy
Employers
Go to:
https://blog.telehealth.org/online-therapy-jobs/
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
68
8. Home Health
©
1994-2023
Telehealth.org,
LLC
All
Rights
Reserved.
69
9. College Counseling
Center
Telehealth.org
contact@telehealth.org
619-255-2788
Keep in touch! ☺

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