As an Applied Behavior Analysis therapist, you may be considering telehealth as a way to see your clients in light of the Coronavirus outbreak in the United States. Many mental and behavioral health therapists are seeing an increased demand for telehealth services and many are making — or considering — a transition to telehealth.
However, the challenge of implementing telehealth services for ABA therapy can seem daunting. ABA therapists are currently thinking over the ethical considerations of transitioning to telehealth, understanding the technology requirements and regulations, and working to keep up with insurance company policies that are affecting the use of telehealth during this fast-changing situation.
In this article, we’ll shed light on some of the issues that you may be thinking about as you consider implementing telehealth during the current healthcare crisis.
The Council of Autism Service Providers has released a set of recommendations that address some of the considerations of using telehealth for ABA therapy. The major relevant points with regards to the current pandemic are as follows:
Many providers are unsure about how to implement direct services via telehealth. What kinds of therapy can I practice over telehealth? How can I create a safe and effective therapeutic environment with telehealth? What about the informed consent of the client? We’ll be covering these issues in more depth in the second article of this series, which will be based on our Facebook Live stream events with ABA expert Dr. Joyce Pollard, CEO of the Behavior Change Institute.
Regulations will vary by state, but the following resources can help you research and understand the telehealth regulations that may affect you.
eVisit State Telemedicine Legislation – Provides information about state legislation via a clickable, virtual map.
American Telemed’s State Policy Resource Center and State Toolkits – Publishes detailed reports on telehealth regulations and policies by state. Policies are tracked in real-time to ensure that it’s up-to-date.
CCHPCA State Laws and Reimbursement Policies and their State Telehealth Laws and Reimbursement Policies (April 2017) – Helps you stay current on telehealth regulations and policies and Medicare/Medicaid program by state.
ABA therapists will need to protect the privacy and confidentiality of their clients by choosing secure technologies. According to CASP, providers should comply with the regulations imposed by the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act.
For technology, providers will need:
All sessions should be conducted through a secure Internet connection with adequate bandwidth so that the session is not interrupted.
Protecting your client’s private health information is the number one priority. Private health information, if compromised, can cause the client economic harm, embarrassment, and discrimination. Medical information can also be many times more valuable than a credit card number on the black market.
During the Coronavirus pandemic, the federal government has temporarily lifted the restrictions on non-HIPAA compliant technology to allow therapists to use telephones and unencrypted video conferencing technology like Apple Facetime or Skype to conduct sessions (but never public facing platforms such as Facebook Live, Twitch, or TikTok). Some insurance companies may loosen the restrictions as well. However, using non-HIPAA compliant technology is not recommended since protecting your client’s privacy is paramount, and many users have seen that these platforms are crashing due to the serious demand that comes with so many users seeking virtual conferencing options.
Insurance companies will have different requirements for the provision of telehealth services and it’s informed by state laws (which will vary by state). We are seeing many insurance companies temporarily amending their rules to adapt to the current situation. Here are some major points:
As an ABA therapist, you can contact your funding sources to secure any authorizations that are needed to provide services via telehealth and follow the guidelines that they provide you with. This may mean sending in forms or applying online. Some questions to ask your funding source:
Since insurance companies are temporarily amending some rules as a response to COVID-19, it’s also important to check on the date of when the amended rules will no longer be effective.