Health care providers must inform the patient prior to the initial delivery of telehealth services about the use of telehealth and obtain verbal or written consent from the patient for the use of telehealth as an acceptable mode of delivering health care services.
If a health care provider, whether at the originating site or distant site, maintains a general consent agreement that specifically mentions use of telehealth as an acceptable modality for delivery of services and includes the required information, as explained below, then this is sufficient for documentation of patient consent and should be kept in the patient’s medical file. Providers also need to document when a patient consents to receive services via audio-only prior to initial delivery of services.
The consent shall be documented in the patient’s medical file and be available to DHCS upon request. Providers are required to share additional information with beneficiaries regarding:
- Right to in-person services
- Voluntary nature of consent
- Availability of transportation to access in-person services when other available resources have been reasonably exhausted
- Limitations/risks of receiving services via telehealth, if applicable
- Availability of translation services
Consent requirements may be found in Business and Professions Code, Section 2290.5 [b] and Welfare and Institutions Code, Section 14132.725 [d]. Model patient consent language may be found on the DHCS website.
FQHCs and RHCs are directed to refer to the above on consent requirements
SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Jan. 2023), Pg. 5., CA Department of Health Care Services (DHCS). Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual. Jan. 2023. Pg. 13. (Accessed Feb. 2023).
Applies to Healthcare Providers including FQHCs/RHCs
In addition to any existing law requiring beneficiary consent to telehealth, including, but not limited to, subdivision (b) of Section 2290.5 of the Business and Professions Code, all of the following shall be communicated by a health care provider, FQHC, and RHC to a Medi-Cal beneficiary, in writing or verbally, on at least one occasion prior to, or concurrent with, initiating the delivery of one or more health care services via telehealth to a Medi-Cal beneficiary:
- An explanation that beneficiaries have the right to access covered services that may be delivered via telehealth through an in-person, face-to-face visit;
- An explanation that use of telehealth is voluntary and that consent for the use of telehealth can be withdrawn at any time by the Medi-Cal beneficiary without affecting their ability to access covered Medi-Cal services in the future;
- An explanation of the availability of Medi-Cal coverage for transportation services to in-person visits when other available resources have been reasonably exhausted; and
- The potential limitations or risks related to receiving services through telehealth as compared to an in-person visit, to the extent any limitations or risks are identified by the provider, FQHC, or RHC.
The provider, FQHC, or RHC shall document in the patient record the provision of this information and the patient’s verbal or written acknowledgment that the information was received.
The department shall develop, in consultation with affected stakeholders, model language for purposes of the communication described in this subdivision.
This subdivision does not apply to Medi-Cal covered services delivered by providers via any telehealth modality to eligible inmates in state prisons, county jails, or youth correctional facilities.
SOURCE: Welfare and Institutions Code 14132.725 & Welfare and Institutions Code 14132.100, as amended by SB 184 (2022 Session). (Accessed Feb. 2023).
Indian Health Services, Memorandum of Understanding Agreement (IHS-MOA)
Refer to fee-for-service policy. All consent for homeless patients must be documented.
SOURCE: CA Department of Health Care Services (DHCS). Indian Health Services, Memorandum of Agreement (MOA) 638, Clinics Manual. Jan. 2023. Pg. 8. (Accessed Feb. 2023).
Providers must include a record of the written or verbal request for the consultation by the referring provider or other source in the medical record. Verbal and written informed consent from the patient or the patient’s legal representative is required if the consulting provider has ultimate authority over the care or primary diagnosis of the patient.
SOURCE: CA Department of Health Care Services, Vision Care: Professional Services Manual. (Oct. 2022), Pg. 5. (Accessed Feb. 2023).
Local Education Agency Services
The health care provider at the originating site must first obtain oral consent from the student’s parent or legal guardian prior to providing service via telehealth. Written consent to telehealth services is not required.
If oral consent from the student’s parent or legal guardian is received, the health care provider must document oral consent in the student’s medical record, including the following:
- A description of the risks, benefits and consequences of telehealth
- The student’s parent or legal guardian retains the right to withdraw the student from services via telehealth at any time
- All existing confidentiality protections apply, including HIPAA requirements
- The student’s parent or legal guardian has access to all transmitted medical information
- No dissemination of any student images or information to other entities without further written consent
SOURCE: CA Department of Health Care Services (DHCS). Local Education Agency (LEA) Telehealth. Oct. 2022. Pg. 4. (Accessed Feb. 2023).
Providers must document in the patient’s medical chart that the patient has given a written or verbal consent to the audio-only telemedicine encounter.