Consent Requirements

The referring health care practitioner must obtain written consent from the eligible Georgia Medicaid member prior to rendering service. The consent must state that the member agrees to participate in the telehealth-based service. Copies of this form (refer to Appendix A) should be in the medical record of both the originating and distant site providers. The consent form must include a description of the risks, benefits and consequences of telehealth and be included in the member’s medical record. Providers may utilize a consent form other than the one attached to this guide; however, it must, at a minimum, contain the same requirements, standards and information listed on the member consent form in Appendix A.

If the member is a minor child, a parent/guardian must present the child for telehealth services and sign the consent form unless otherwise exempted by state or federal law. The parent/guardian need not attend the telehealth session unless attendance is therapeutically appropriate.

There will be no dissemination of any member images or information to other entities without written consent from the member.

For CBHRS, the Telehealth Member Consent Form for each member is outlined in the Telehealth Guidance Document and must be utilized.Special considerations in the use of electronic-facilitated treatment must include informed consent of the individual served, authorization through the process of Individualized Recovery Plans, educational components in assessment and service delivery which indicates ongoing agreement with the treatment method and under what circumstances electronic communications may and may not be used.

Prior to an initial telehealth service, the practitioner who delivers the service to a GA Medicaid Member shall ensure that the telehealth member consent form is provided to the member and signed.  See manual for specific requirements.

In school-based settings, the parent or legal guardian of the client provides consent prior to the service being provided.

SOURCE: GA Dept. of Community Health GA Medicaid Telehealth Guidance Handbook, p. 6, 8-9, 15, 22 & 26 (Apr. 1, 2025).  GA Dept. of Community Health, GA Medicaid Community Behavioral Health and Rehabilitation Services, p. 42 (Apr. 1, 2025).  (Accessed Jun 2025).

Prior to an initial telehealth service, the rendering provider must obtain a signed consent form from the GA Medicaid Member.

The member must be aware of their otpions to refuse the telehealth service at any time without affecting the right to future care or treatment and without risking the loss of covered Medicaid services.

SOURCE:  GA Medicaid Telemedicine Guidance Presentation (Dec. 18, 2024).  (Accessed Jun. 2025).

Comprehensive Supports Waiver Program (COMP) & New Options Waiver Program

Adult Occupational Therapists, Adult Physical Therapists, Speech and Language Therapists, Adult Nutrition providers, Behavior Support Service providers and Supported Employment providers wishing to use telehealth modalities to deliver evaluation or treatment services must obtain valid signed consent from the individual or the legal decision-maker.

SOURCE: GA Dept of Community Health, Division of Medicaid, New Options Waiver Program, (Apr. 1, 2025) & GA Dept. of Community Health, New Options Waiver Program (NOW) (Apr. 1, 2025).  (Accessed Jun. 2024).