Consent Requirements

Communication Technology-Based Services:  Brief Communication Technology-Based Service, Remote Evaluation of Pre-Recorded Patient Information, Interprofessional Internet Consultation

Consent is required.  It can be verbal and noted in the beneficiaries’ medical record. It is only necessary to obtain consent once annually.

SOURCE: CY 2019 Final Physician Fee Schedule. CMS, p. 31-40 & CY 2020 Final Physician Fee Schedule. CMS, p. 435, (Accessed Feb. 2023).

Chronic Care Management

Get the patient’s written or verbal consent for CCM services before you bill for them. This helps ensure patients are engaged and aware of their cost sharing responsibilities. This also helps prevent duplicate practitioner billing. You must also inform the patient of these items and document it in their medical record:

• Availability of CCM services
• Possible cost sharing responsibilities
• Only 1 practitioner can furnish and bill CCM services during a calendar month
• Patient’s right to stop CCM services at any time (effective the end of calendar month)

Patients need to provide informed consent only once unless they switch to a different CCM practitioner.

SOURCE:  CMS MLN Booklet Chronic Care Management Services (Sept. 2022), p. 7. (Accessed Feb. 2023).

Virtual Check-In

The patient verbally consent to the virtual check-in, and the provider documents consent in the medical record. The provider may get one consent for a year’s worth of these services.

SOURCE:  CMS Your Medicare Coverage, Virtual Check-Ins.  (Accessed Feb. 2023).

Physician is and must obtain prior consent from the recipient before services are rendered, this will count as part of each recipient’s benefit limit of 14 annual physician office visits currently allowed.

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Service (ch. 28, p. 17). Jan. 2023. (Accessed Feb. 2023).

Providers enrolled in Medicaid with specialty type 931, offering Applied Behavior Analysis and Positive Behavior Support (PBS) Services must must obtain prior consent from the recipient before services are rendered. A sample recipient consent form is attached to the Telemedicine Service Agreement(see manual for more details).

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis), (Ch. 37, p. 16). Jan. 2023. (Accessed Feb. 2023).

Remote Patient Monitoring (RPM) Services

A practitioner must obtain patient consent before furnishing or billing RPM services. Consent may be verbal or written but must be documented in the medical record, and includes informing them about:

• The availability of RPM services and applicable cost sharing
• That only one practitioner can furnish and be paid for RPM services during a calendar month
• The right to stop RPM services at any time (effective at the end of the calendar month)

Informed patient consent by the recipient or caregiver, when appropriate, must be obtained prior to rendering RPM services or if the patient chooses to change the practitioner who will render the services.

SOURCE: AL Medicaid Management Information System Provider Manual, Remote Patient Monitoring (Ch. 111, Pg. 3), Jan. 2023. (Accessed Feb. 2023).

For Rehabilitative Services — ASD, DMH, DHR, DYS, DCA —  the treatment provider who delivers the service to a recipient shall ensure that the following written information is provided to the recipient in a form and manner which the recipient can understand, using reasonable accommodations when necessary, that:

• S/he retains the option to refuse the telehealth service at any time without affecting the right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the recipient would otherwise be entitled;
• Alternative options are available, including in-person services, and these options are specifically listed on the recipient’s informed consent statement;
• All existing confidentiality protections apply to the telemedicine consultation (this applies to physicians only);
• All existing confidentiality protections apply to the telehealth treatment services provider by treatment providers;
• S/he has access to all medical information resulting from the telemedicine consultation/telehealth treatment services as provided by law for patient access to his/her medical records;
• The dissemination of any recipient identifiable images or information from the telemedicine consultation/telehealth treatment services to anyone, including researchers, will not occur without the written consent of the recipient;
• S/he has a right to be informed of the parties who will be present at each end of the telemedicine consultation/telehealth treatment services and s/he has the right to exclude anyone from either site; and
• S/he has a right to see an appropriately trained staff or employee in-person immediately after the telemedicine consultation/telehealth treatment service if an urgent need arises, or to be informed ahead of time that this is not available.

The treatment provider providing the telehealth treatment service, or staff at the recipient site, shall retain the signed statement and the statement must become a part of the recipient’s medical record. A copy of the signed informed consent must also be given to the recipient and documented in the medical record.

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA(105, p. 11-12).  Jan. 2023 & AL Medicaid Management Information System Provider Manual, Rehabilitative Services (ASD) – DMH (Ch. 110, p. 16).  Jan. 2023. (Accessed Feb. 2023).

Family Planning

For any telephonic encounter a verbal consent is required. A recipient consent for services must be obtained at each Family Planning visit.

SOURCE:  AL Medicaid Management Information system Provider Manual, Appendix C Family Planning, Jan. 2023, C-1, (Accessed Feb. 2023).

No Reference Found

Informed consent standards for Telehealth services shall adhere to all applicable statutes and policies governing informed consent, including A.R.S. § 36-3602.

SOURCE: AZ Health Care Cost Containment System. Telehealth and Telemedicine Ch 300, (320-I pg. 4), Approved Apr. 2022. (Accessed Jan. 2023).

Before a provider delivers health care via telehealth, informed consent, written or verbal, is required to be obtained from a member or the member’s Health Care Decision Maker. Exceptions to this consent requirement include:

• If the telehealth interaction does not take place in the physical presence of the member,
• In an emergency situation in which the member, or when applicable, the member’s Health Care Decision Maker is unable to give Informed Consent, or
• Transmission of diagnostic images to a health care provider serving as a consultant or the reporting of diagnostic test results by that consultant.

SOURCE: AZ Health Care Cost Containment System. AHCCCS General and Informed Consent, Ch. 320-Q. pg. 4. 07/01/20. (Accessed Jan. 2023).

Healthcare services provided by telemedicine, including without limitation a prescription through telemedicine, shall be held to the same standard of care as healthcare services provided in person. A healthcare provider providing telemedicine services within Arkansas shall follow applicable state and federal laws, rules and regulations regarding:

• Informed consent;
• Privacy of individually identifiable health information;
• Medical record keeping and confidentiality, and
• Fraud and abuse.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190. Updated Jan. 1, 2022, (Accessed Jan. 2023).

Occupational Therapy, Physical Therapy and Speech-Language Pathology Services

Parental or guardian consent is required prior to telemedicine service delivery

SOURCE: AR Medicaid Provider Manual. Section II Occupational Therapy, Physical Therapy and Speech-Language Pathology Services, Rule 214.600. Updated Jan. 1, 2022, (Accessed Jan. 2023).

Provider-Led Arkansas Shared Savings Entity (PASSE) Program

Virtual and telehealth services are provided in lieu of providing the same services at a practice site or provided at the individual’s place of residence. Therefore, these services must have patient consent, be documented in the patient integrated medical records, and submitted as a claims or encounter from a contracted provider as medically necessary service. The provision of virtual care can include an interdisciplinary care team or be provided by individual clinical service provider.

SOURCE: PASSE Program, p. II-8, (1/1/23).  (Accessed Jan. 2023).

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).

Vision Care

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 shall give all first-time patients a written statement that includes the following:

• The patient may refuse telemedicine services at any time without affecting the patient’s right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the patient would otherwise be entitled;
• All applicable confidentiality protections shall apply to the services;
• The patient shall have access to all medical information resulting from the services, under state law.

SOURCE: CO Revised Statutes 25.5-5-320. (Accessed Jan. 2023).

Providers must document the member’s consent, either verbal or written, to receive telemedicine services.

The Medicaid requirement for face-to-face contact between provider and member may be waived when treating the member through telemedicine. In-person contact between a health care provider and a member is not required for services delivered through telemedicine that are otherwise eligible for reimbursement.  Prior to treating the member through telemedicine for the first time, the provider must furnish each member with all of the following written statements, which must be signed (electronic signatures will be accepted) by the member or the member’s legal representative:

• The member retains the option to refuse the delivery of health care services via telemedicine at any time without affecting the member’s right to future care or treatment and without risking the loss or withdrawal of any program benefits to which the member would otherwise be entitled.
• All applicable confidentiality protections shall apply to the services.
• The member shall have access to all medical information resulting from the telemedicine services as provided by applicable law for client access to his or her medical records.

These requirements do not apply in an emergency.

SOURCE: CO Department of Health Care Policy and Financing.  “Telemedicine Billing Manual” 10/22. (Accessed Jan. 2023).

Covered telemedicine services must be provided only after the member’s consent, either verbal or written, to receive telemedicine services is documented.

SOURCE: CO Adopted Rule 8.095.4.A. (Accessed Jan. 2023).

Effective Now Until June 30, 2024

Notwithstanding the provisions of section 19a-906 of the general statutes, as amended by this act, if a telehealth provider provides a telehealth service to a patient during the period beginning on May 10, 2021 and ending on June 30, 2024, the telehealth provider shall, at the time of the telehealth provider’s first telehealth interaction with a patient, inform the patient concerning the treatment methods and limitations of treatment using a telehealth platform, including, but not limited to, the limited duration of the relevant provisions of this section and sections 3 to 7, inclusive, of public act 21-9, as amended by this act, and, after providing the patient with such information, obtain the patient’s consent to provide telehealth services. The telehealth provider shall document such notice and consent in the patient’s health record. If a patient later revokes such consent, the telehealth provider shall document the revocation in the patient’s health record.

During the period beginning on May 10, 2021 and ending on June 30, 2024, each telehealth provider shall, at the time of the initial telehealth interaction, ask the patient whether the patient consents to the telehealth provider’s disclosure of records concerning the telehealth interaction to the patient’s primary care provider. If the patient consents to such disclosure, the telehealth provider shall provide records of all telehealth interactions during such period to the patient’s primary care provider, in a timely manner, in accordance with the provisions of sections 20-7b to 20-7e, inclusive, of the general statutes.

During the period beginning on May 10, 2021 and ending on June 30, 2024, any consent or revocation of consent under this section shall be obtained from or communicated by the patient, or the patient’s legal guardian, conservator or other authorized representative, as applicable.

SOURCE: HB 5596 (2021 Session), Sec. 1 & SB 2 (2022 Session), Sec. 32. (Accessed Feb. 2023).

Permanent Statute

At the time of the telehealth provider’s first telehealth interaction with a patient, the telehealth provider shall inform the patient concerning the treatment methods and limitations of treatment using a telehealth platform and, after providing the patient with such information, obtain the patient’s consent to provide telehealth services. The telehealth provider shall document such notice and consent in the patient’s health record. If a patient later revokes such consent, the telehealth provider shall document the revocation in the patient’s health record.

Consent must be obtained by the parent or the patient’s legal guardian as applicable.

SOURCE: CT Gen. Statutes Sec. 19a-906(b)(2)&(e). (Accessed Feb. 2023).

Providers must obtain informed consent in writing from each member before providing telehealth services and annually thereafter. The provider must ensure each patient is aware they can opt-out or refuse telehealth services at any time.

SOURCE: CT Medicaid Assistance Program Provider Bulletin 2020-09 (March 2020), p. 6. (Accessed Feb. 2023).

Recipient must provide written consent to use telemedicine. It must be obtained by either the referring, consulting, or distant provider.  An exception is made for involuntary detention and commitment. An exception applies when a DMAP recipient is detained or committed to a facility for care.

The client has the right to refuse these services at any time and must be made aware of any alternatives, including any delays in service, need to travel, or risks associated with not having services provided via telemedicine. The format used by the consulting provider to obtain written consent is left to the provider but must be maintained in the client’s records and must identify that the covered medical service was delivered by telemedicine.

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 10/28/22. Ch. 16.5.5.1, 16.6 & 16.7 Telemedicine, pg. 75-76, & Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. p. 10-13  (Accessed Feb. 2023).

Participants may provide written or verbal consent to receive telemedicine services in lieu of in-person healthcare services. A provider must appropriately document the beneficiary’s written or verbal consent and comply with any other applicable consent requirements, including but not limited to Section 3026 of Title 5-E of the District of Columbia Municipal Regulations if providing telemedicine services at a District of Columbia Public School (DCPS) or District of Columbia Public Charter School (DCPCS).

SOURCE: DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.5-6. (Accessed Feb. 2023).

Participants must provide written or verbal consent to receive telemedicine services in lieu of in-person healthcare services, consistent with all applicable District laws. A provider shall document the beneficiary’s consent to receive telemedicine services in writing. Written consent includes any method that documents in writing the beneficiary’s agreement to receive the service via telemedicine, including but not limited to an e-mail, text message, or signed PDF. If verbal consent is obtained, a detailed service note that describes the beneficiary’s verbal consent is required.

SOURCE: Department of Health Care Finance – Telemedicine Provider Guidance, Jan. 7, 2022, pg. 2., Physicians Billing Manual.  DC Medicaid.  (Jan. 2023) Sec. 15.2. P. 51-52, Clinic Billing Manual, DC Medicaid (Jan. 2023), Sec. 15.2, P. 49, FQHC Billing Manual, DC Medicaid 15.2 P. 51. (Jan. 2023), Behavioral Health Billing Manual (Jan. 2023) 14.2, p. 67., Outpatient Hospital Billing Guide, 16.2, p. 75 (Jan 2023), Inpatient Hospital Billing Guide, 11.2, p. 60 (Jan. 2023), Long-Term Care Billing Manual, 15.2, p. 51 (Jan 2023).  (Accessed Feb. 2023).

No Reference Found

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.

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. 8, 10, 53 & 59-60 (Jan 2023). (Accessed Jan. 2023).

Comprehensive Supports Waiver Program (COMP)

Adult Occupational Therapists 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, GA Medicaid, Comprehensive Supports Waiver Program, (Jan. 1, 2023), p. XIII-19., XIV-7, XV-13, XVI-7, XVIII-12.  (Accessed Jan 2023).

No reference found.

Any written information must be provided to the participant before the telehealth appointment in a form and manner which the participant can understand using reasonable accommodations when necessary. The participant must be informed and consent to the delivery models, provider qualifications, treatment methods, or limitations and telehealth technologies. The rendering provider at the distant site must also disclose to the participant their identity, current location, telephone number and Idaho license number. If the participant (or legal guardian) indicates at any point that he wants to stop using the technology, the service should cease immediately and an alternative (in-person) appointment should be scheduled. The partial, interrupted service is not reimbursable.

SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. Nov. 18, 2022, Section 10.9 p. 128.  (Accessed Feb. 2023).

No Reference Found

The provider must obtain appropriate consent from the member prior to delivering services, and must maintain documentation as described in the Telehealth Documentation Standards section.

Patient consent for receiving a service through telehealth should be documented. Patient consent may be received verbally or by electronic signature, and should be documented as such. Documentation must be maintained by the provider to substantiate the services provided and that consent was obtained. Documentation must indicate that the services were rendered via telehealth, clearly identify the location of the provider and the patient, and be available for postpayment review.

SOURCE:  Indiana Health Coverage Programs, Provider Reference Module, Telehealth and Virtual Services (Sept. 27, 2022), p. 1, 3.  (Accessed Feb. 2023).

Appropriate consent from the member must be obtained by the provider prior to delivering services.

SOURCE: Indiana Health Coverage Programs (IHCP) Bulletin, BT202142, June 8, 2021, (Accessed Feb. 2023).

A health care provider may not be required to obtain a separate additional written health care consent for the provision of telehealth services.

SOURCE: IN Code 16-36-1-15 (Accessed Feb. 2023)

Skills Training and Development Rendered Via Telehealth

Client must have documented acknowledgement of receipt of informed consent about risks/benefits of the telehealth modality.

SOURCE: IHCP Expands and Clarifies Telehealth Coverage, Bulletin BT202297 (Nov. 8, 2022), p. 2.  (Accessed Feb. 2023).

No reference found

Signed member consent for telehealth home services is required.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, Home Health Agency, p. AIII-19 (Jan. 2023) (Accessed Feb. 2023).

Except when otherwise prohibited by any other provision of law, when the patient consents and has a primary care or other treating physician, the person providing telemedicine services will send within three business days a report to such primary care or other treating physician of the treatment and services rendered to the patient in the telemedicine encounter.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-31 (Jan. 2023). (Accessed Feb. 2023).

The cabinet, in consultation with the Division of Telehealth Services within the Office of Inspector General is required to promulgate administrative regulations to establish minimum requirements for the proper use and security of telehealth, including requirements for confidentiality and data integrity, privacy and security, informed consent, privileging and credentialing, reimbursement, and technology, among other things.

SOURCE: KY Statute Sec. 211.334, (Accessed Feb. 2023).

Health care providers performing a telehealth or digital health service shall obtain patient informed consent.

SOURCE: KY 900 KAR 12:005 (Accessed Feb. 2023).

No Reference Found

A patient may provide verbal, electronic or written consent for telehealth and telemonitoring services under this section.

SOURCE: ME Statute Sec. 22:855.3173-H, Sub. Sec. 6, (Accessed Jan. 2023).

Recently Passed Legislation

No later than January 1, 2023, the Department of Health and Human Services shall amend its rules in 14-193 C.M.R. Chapter 6, Licensing of Mental Health Facilities, and 14-118 C.M.R. Chapter 5, Regulations for Licensing and Certifying of Substance Abuse Treatment Programs, to allow a facility licensed under the Maine Revised Statutes, Title 5, section 20005, subsection 6, paragraph B or Title 34-B, section 1203-A to obtain consent through verbal, electronic or written means from a person during a public
health emergency in accordance with Title 22, section 51. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A.

SOURCE: ME Revised Statutes Annotated, Title 22, Ch. 1, Subchapter 2. §51 as enacted by L.D. 1758 (2022 Session). (Accessed Jan. 2023).

Prior to the provision of any Telehealth Service, the Health Care Provider shall document that it has provided the educational information to the Member or authorized representative and obtain the Member’s written informed consent to the receipt of Telehealth Services and/or to Store-and-Forward Telehealth Services, Remote Consultation, Virtual Check-In, or Telephone Evaluation and Management. A copy of the signed informed consent shall be retained in the Member’s medical record and provided to the Member or the Member’s legally-authorized representative upon request.

This information should be in a format and manner that the Member is able to understand and include the following:

• Description of the telehealth services and what to expect;
• Explanation that the use of telehealth for this service is voluntary and that the member is able to refuse the telehealth visit at any time without affecting the right to future care or treatment or loss or withdrawal of MaineCare benefit;
• Explanation that MaineCare will pay for transportation to a distant appointment if needed;
• Explanation that the Member will have access to all information resulting from the telehealth service provided by law;
• The dissemination, storage or retention of an identifiable Member image or other information shall comply with federal and state laws and regulations requiring confidentiality.
• Informed of all parties who will be present at the receiving and originating site and have the right to exclude anyone from either site; and
• Member has the right to object to videotaping or other recording of a telehealth consultation.

Written or verbal Member consent for each Remote Consultation must be documented in the Member’s medical record. Billing for interprofessional services is limited to those practitioners who can independently bill Medicaid for evaluation and management services.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. p. 6 & 10-11. (June 15, 2020). (Accessed Jan. 2023). 

Member’s record must document consent for Assistive Technology-Remote Monitoring.

SOURCE: MaineCare Benefits Manual, Home and Community Benefits for the Elderly and for Adults with Disabilities, 10-144 Ch. II, Sec. 19, p. 23 (May 2, 2021). (Accessed Jan. 2023).

Prior to the provision of telemonitoring services, the Health Care Provider shall document that it has provided the member with choice and educational information obtained the member’s written informed consent to the receipt of telemonitoring services. The Health Care Provider shall retain a copy of the signed informed consent in the member’s medical record and provide a copy to the member or the member’s legally authorized representative upon request.

SOURCE:  Mainecare Benefits Manual. Ch. 11. Home Health Services. Sec. 40.08. p. 24. (Aug 11, 2019). (Accessed Jan. 2023).

The originating site must obtain consent from the patient prior to engaging in telehealth and be documented in the medical record. If the participant is unable to provide consent, the medical record must contain in writing an explanation as to why the participant was unable to consent to services rendered via telehealth.

SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. Updated April 2020. p. 1, (Accessed Jan. 2023).

Consent is required unless there is an emergency.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.05. (Accessed Jan. 2023).

Consent may be given verbally by the participant.

SOURCE: MD Medical Assistance Program. Professional Services Provider Manual, p. 74. Updated Jan. 2022. (Accessed Jan. 2023).

Mental Health

An individual must voluntarily consent to telemental health services, which must be documented in the individual’s medical record.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.21.30.05. (Accessed Jan. 2023).

Remote Patient Monitoring

The participant consents to remote patient monitoring services and has the capability to utilize the monitoring tools and take actions to improve self-management of the chronic disease.

SOURCE: Code of Maryland Admin Regs, Sec. 10.09.96.05(A)(2). (Accessed Jan. 2023).

A provider is required to determine that it is clinically appropriate to deliver such service via telehealth, including the telehealth modality and technology employed, including obtaining member consent.

Providers must obtain the member’s consent to receive services via telehealth and inform the member

• of any relevant privacy considerations and
• that the member may revoke their consent to receive services via telehealth at any time.

Note: MassHealth will continue to analyze telehealth’s impacts on utilization, quality of care, and access to care. Based on its analysis of these and other relevant factors, MassHealth will continue to evaluate its policy, with no significant changes anticipated before October 1, 2023.

SOURCE: MassHealth All Provider Bulletin 355, Oct. 2022. (Accessed Nov. 2022).

Health care services provided via telehealth shall conform to the standards of care applicable to the telehealth provider’s profession and specialty. Such services shall conform to applicable federal and state health information privacy and security standards, as well as standards for informed consent.

SOURCE: Massachusetts General Laws, Part I, Title XVII, Ch. 118E, Sec. 79. (Accessed Nov. 2022).

SOURCE: Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021. (Accessed Nov. 2022).

Targeted Case Management

The person receiving targeted case management or the person’s legal guardian has the right to choose and consent to the use of interactive video under this subdivision and has the right to refuse the use of interactive video at any time.

SOURCE: MN Statute Sec. 256B.0625, Subdivision 20b(b). (Accessed Jan. 2023).

Signed consent for using telehealth is required.

SOURCE: MS Admin. Code 23, Part 225, Rule 1.6(A). (Accessed Mar. 2023).

The Division of Medicaid defines physician verbal orders as physician orders that are verbally communicated by telephone, telehealth or face-to-face to authorized medical personnel regarding medications, treatments, interventions or other beneficiary care.

SOURCE: MS Admin Code, Title 23, Part 203, Rule 1.11, (Accessed Mar. 2023).

Prior to the provision of telemedicine [or telehealth as its referred to in rural health clinic manual] services in a school, the parent or guardian of the child shall provide authorization for the provision of such service.  Such authorization shall include the ability for the parent or guardian to authorize services via telemedicine in the school for the remainder of the school year.

SOURCE: MO Revised Statute. XII Public Health and Welfare. Ch. 208, Sec. 208.677;  MO HealthNet, Rural Health Clinic, 13.14.A p. 166 (Feb. 6, 2023); MO HealthNet, Physician Manual, Telehealth Services, 13.26.A p. 286-287 (Feb. 3, 2023) & MO HealthNet, Provider Manual, Behavioral Health Services, 13.22.A p. 210 (Feb. 6, 2023). (Accessed Mar. 2023).

A provider shall follow consent and patient information protocols consistent with the protocols followed for in-person visits.

SOURCE: Montana Code Annotated 53-6-122 (Accessed Jan. 2023).

READ LESS

Written or email consent required before initial service delivery. Must include this information:

• A list of alternative care options, including in-person services;
• All existing laws and protections including: confidentiality protections, patient access to all medical information from the consult, and dissemination of client identifiable information;
• Whether the telehealth consultation will be recorded;
• The identification of all the parties who will be present at each telehealth consultation, and a statement indicating that the client has the right to exclude anyone from either the originating or the distant site; and
• The written consent form becomes a part of the client’s medical record and a copy must be provided to the client or the client’s authorized representative.

For each adult client or for a client who is a child but who is not receiving telehealth behavioral health services, a safety plan must be developed, should it be needed at any time during or after the provision of telehealth; Special rules apply for a child who is receiving telehealth behavioral health services;

If the client is a child or otherwise unable to sign the consent form, the client’s legally authorized representative shall provide the consent.

Sample patient consent form available in Manual Appendix.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.04, Ch. 1, & Appendix, 471-000-10 Instructions for Completing NE Medicaid Telehealth Patient Consent Form.  (Accessed Mar. 2023).

Written information must be provided to the patient.  See statute for specific requirements of written information.

The patient shall sign a statement prior to or during an initial telehealth consultation, or give verbal consent during the telehealth consultation, indicating that the patient understands the written information provided and that this information has been discussed with the health care practitioner or the practitioner’s designee. The signed statement may be collected by paper or electronic signature and shall become a part of the patient’s medical record. If the patient gives verbal consent during the initial telehealth consultation, the signed statement shall be collected within ten days after such telehealth consultation.

If the patient is a minor or is incapacitated or mentally incompetent such that he or she is unable to sign the statement or give verbal consent, such statement shall be signed, or such verbal consent given, by the patient’s legally authorized representative.

Does not apply in an emergency situation in which the patient is unable to sign the statement or give verbal consent and the patient’s legally authorized representative is unavailable.

SOURCE: NE Revised Statutes Sec. 71-8505, (Accessed Mar. 2023).

A state plan amendment shall include a provision prohibiting the state from requiring a person to obtain prior authorization that would not be required if a service were provided in person or through other means, establish a relationship with a provider of health care or provide any additional consent to or reason for obtaining services through telehealth as a condition to paying for services as described in paragraph (a). The State Plan for Medicaid may require prior authorization for a service provided through telehealth if such prior authorization would be required if the service were provided in person or through other means.

SOURCE: NV Revised Statute 422.2721, (Accessed Feb. 2023).

With written consent of the patient receiving medication assisted treatment through telehealth services provided under this section, the health care provider shall provide notification of the patient’s medication assisted treatment to the doorway, as defined in RSA 167:4-d, II(c), within the region where the patient resides.

SOURCE: NH Revised Statutes Annotated, 167:4-d, (Accessed Feb. 2023).

Consumers must provide informed consent to participate in any service utilizing telepsychiatry. Should a client choose not to participate, they must be made aware of other face to face options and services. If they choose to participate, the clients must be informed and aware of the location of the psychiatrist/APN providing the telepsychiatry service.

SOURCE: NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013. (Accessed Dec. 2022).

Medical Ethics

The provision of consultation, recommendation, or treatment during a face-to-face telehealth encounter online, using standard videoconferencing technology, where a medical history and informed consent are obtained and a medical record generated by the practitioner, and a physical examination is:

• Recorded as appropriate by the practitioner, or a practitioner such as a physician, a physician or anesthesiologist assistant, or an advanced practice nurse, with the results communicated to the telehealth practitioner; or
• Waived when a physical examination would not normally be part of a typical physical face-to-face encounter with the patient for the specific services being provided.

SOURCE: NM Administrative Code 16.10.8.8 (6). (Accessed Feb. 2023).

MAD covers service plan updates through the participation of interdisciplinary teams.

The six elements of teaming may be performed by using a variety of media (with the person’s knowledge and consent) e.g., texting members to update them on an emergent event; using email communications to ask or answer questions; sharing assessments, plans and reports; conducting conference calls via telephone; using telehealth platforms conferences; and, conducting face-to-face meetings with the person present when key decisions are made. Only the last element, that is, conducting the final face-to-face meeting with the recipient present when key decisions that result in the updates to the service plan, is a billable event.

SOURCE: NM Administrative Code 8.321.2.9 (L) & (L)(3c). (Accessed Feb. 2023).

The practitioner shall provide the member with basic information about the services that he/she will be receiving via telehealth and the member shall provide his/her consent to participate in services utilizing this technology. Telehealth sessions/services shall not be recorded without the member’s consent. Culturally competent translation and/or interpretation services must be provided when the member and distant practitioner do not speak the same language. If the member is receiving ongoing treatment via telehealth, the member must be informed of the following patient rights policies at the initial encounter.  See guidance for patients rights policy.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 6-7. (Accessed Feb. 2023).

Mental Health

Telehealth services may be provided only where clinically appropriate and with informed consent by the recipient. Where the recipient is a minor consent shall also be provided by the parent/guardian or other person who has legal authority to consent to health care on behalf of the minor. The recipient may withdraw consent at any time. A provider may not deny services to an individual who has a preference to receive services in-person.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.1(b), as amended by Final Rule and Notice Of Adoption. (Accessed Feb. 2023).

Part of obtaining approval for telehealth services is obtaining informed consent and may be incorporated into the informed consent process for in-person care.  See regulation for specific requirements.

SOURCE: NY Code of Rules and Regs.  Title 14, Sec. 596.5(b)(c) & 596.6., as amended by Final Rule and Notice Of Adoption. (Accessed Feb. 2023).

Must obtain and document informed consent to utilize telemental health to deliver services.  See guidance for details.

SOURCE: NY Office of Mental Health, Telemental Health Services Guidance, 2019, pg. 4, (Accessed Feb. 2023).

Teledentistry

Services provided by means of telehealth must be in compliance with the Health Insurance Portability and Accountability Act (HIPAA) and all other relevant laws and regulations governing confidentiality, privacy, and consent

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2022, page 85 (Accessed Feb. 2023).

Provider(s) shall obtain and document verbal or written consent. In extenuating circumstances when consent is unable to be obtained, this must be documented.

Outpatient Behavioral Health Services manual applies the same requirement to telephonic services specifically.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 6, Oct. 1, 2022 & NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, p. 7, Sept. 1, 2021. (Accessed Feb. 2023).

Outpatient Behavioral Health

At the time of the initial service, the provider shall obtain the written consent from the legally responsible person for treatment for beneficiaries of all ages.

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, p. 15, Sept. 1, 2021. (Accessed Feb. 2023).

No Reference Found

Behavioral Health

Prior to providing services to a client by telehealth, an eligible provider of the service to be provided as listed in rule 5122-29-30 of the Administrative Code shall describe to the client the potential risks associated with receiving telehealth services, telehealth and document that the client was provided with the risks and agreed to assume those risks.

SOURCE: OAC 5122-29-31. (Accessed Mar. 2023).

There will be no dissemination of any member images or information to other entities without written consent from the member or member’s parent or legal guardian, if the member is a minor.

In order for OHCA to reimburse medically necessary telehealth services provided to SoonerCare members in a primary or secondary school setting, all of the telehealth requirements must be met, with the exception of the requirement that a parent or legal guardian being there to present the child, as well as all of the requirements shown below, as applicable.

Advance parent or legal guardian consent for telehealth services must be obtained for minors, in accordance with 25 O.S. §§ 2004 through 2005.  Additional consent requirements shall apply to school-based services.

For telehealth medical services provided in a primary or secondary school setting, the telehealth practitioner must provide a summary of the service, including, but not limited to, information regarding the exam findings, prescribed or administered medications, and patient instructions, to: (1) The SoonerCare member, if he or she is an adult, or the member’s parent or legal guardian, if the member is a minor; or (2) The SoonerCare member’s primary care provider, if requested by the member or the member’s parent or legal guardian.

Even though physical therapy, occupational therapy, and/or speech and hearing services are not subject to the notification requirements of OAC 317:30-3-27(d)(2), said services must still comply with all other State and Federal Medicaid requirements, in order to be reimbursable by Medicaid.  Accordingly, for those physical therapy, occupational therapy, and/or speech and hearing services that are provided in a primary or secondary school setting, but that are not school-based services (i.e., not provided pursuant to an IEP), providers must adhere to all State and Federal requirements relating to prior authorization and prescription or referral.

SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Dec. 2022).

If the member is a minor, the provider must obtain the prior written consent of the member’s parent or legal guardian to provide services via telehealth, that includes, at a minimum, the name of the provider; the provider’s permanent business office address and telephone number; an explanation of the services to be provided, including the type, frequency, and duration of services. Written consent must be obtained annually, or whenever there is a change in the information in the written consent form, as set forth above. The parent or legal guardian need not attend the telehealth session unless attendance is therapeutically appropriate. The requirements of subsection OAC 317:30-3-27(c)(5), however, do not apply to telehealth services provided in a primary or secondary school setting.  If the member is a minor, the telehealth provider shall notify the parent or legal guardian that a telehealth service was performed on the minor through electronic communication whether a text message or email.

For telehealth medical services provided in a primary or secondary school setting, the telehealth practitioner must provide a summary of the service, including, but not limited to, information regarding the exam findings, prescribed or administered medications, and patient instructions, to:

• The SoonerCare member, if he or she is an adult, or the member’s parent or legal guardian, if the member is a minor; or
• The SoonerCare member’s primary care provider, if requested by the member or the member’s parent or legal guardian.

SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Dec. 2022).

Prior to the delivery of services via a telemedicine or telehealth modality, a member’s written, oral, or recorded consent to receive services using a telemedicine or telehealth delivery method in a language that the member understands must be obtained by the health system, clinic, or provider and documented in the member’s health record. Consent must include an assessment of member readiness to access and participate in telemedicine or telehealth delivered services, including conveying all other options for receiving the health care service to the member. Consent must be updated at least annually thereafter. For members and their families with LEP or hearing impairments, providers must use qualified or certified health care interpreters, when obtaining patient consent.

SOURCE: OR OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telehealth Service and Reimbursement. (Accessed Mar. 2023).

Prior to the delivery of services via a telemedicine or telehealth modality, a client or member’s written, oral, or recorded consent to receive services using a telemedicine or telehealth delivery method in the language that the client or member understands must be obtained and documented by the health system, clinic or provider in the client or member’s health record. Consent must include an assessment of client or member readiness to access and participate in telemedicine or telehealth delivered services, including conveying all other options for receiving the health care service to the client or member. Consent must be updated at least annually thereafter. For clients or members who experience LEP or hearing impairment clients , providers must use qualified or certified health care interpreters when obtaining client or member consent.

SOURCE: OR OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Mar. 2023).

Teledentistry

A patient receiving services through teledentistry shall be notified of the right to receive interactive communication with the distant dentist and shall receive an interactive communication with the distant dentist upon request. This must be reflected in the patient’s chart documentation.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Mar. 2023).

School Based Health Services

Providers billing Medicaid for SBHS health related services via telehealth must obtain the child’s/student’s parent or guardian’s written or verbal consent to receive the services via telehealth technologies, prior to the delivery of health-related services to an eligible child/student with disabilities using a telehealth modality. Verbal consent must be documented/noted in the child’s plan of care by the practitioner. Consent must be obtained and documented annually or with change in services on the child/students plan of care.

SOURCE: OR OAR 410-133-0080, Health Systems Division: Medical Assistance Programs, School-Based Health Services, Coverage (Accessed Mar. 2023).

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Informed Consent for Telemedicine

It will be necessary that, prior to receiving telemedicine or telehealth services, all patients sign an informed consent form expressing their agreement to receive the services. If the patient does not agree to the use of telemedicine or telehealth services, the doctor or health professional must not provide the services, nor bill any type of charge for the patient refusing the consultation.

The patient maintains the option to accept or deny the service at any time, without affecting the right to receive any other type of medical or health care or attention through telemedicine or telehealth. In the event that the patient is a minor, or a person declared legally incompetent, this Article shall apply to their custodian, guardian or legal representative.

This consent may be electronic and must be documented in the patient’s file. In addition, the consent must include the risk of loss of confidentiality inherent in the use of technology.

Before starting the consultation, you must ensure that your patient consents to receive the service through the telemedicine modality. Develop a specific format for telemedicine:

• Check that your patient understands the risks, benefits and alternatives of Telemedicine
• Discuss with your patient the benefits, such as safer access or convenience, versus the risks and limitations of using telemedicine, despite all measures taken.
• Analyze the patient’s ability to use technology and to consent to the use of Telemedicine.
• Prior to the consultation, I sent the consent to be signed by the patient by a means that allows secure electronic communication and request that it be returned signed by the same means.
• If you cannot send the consent via email or your patient cannot return it signed, consider asking the patient to confirm via text message that the consent was discussed, that they understood it and if they authorize it.
• Include in the medical record a copy of the consent form that you used as evidence of the points discussed.
• In the event that the patient does not consent to the use of Telemedicine, they must document in the file that the service was offered and that the patient did not agree.
• Document that the patient gave their consent prior to providing the service and that they accepted the use of Telemedicine, as well as the disclosure of their information, even understanding the risks and limitations when communicating through electronic means.
• In the case of minors or disabled, request the written authorization of the parents or guardian.
• As with all visits with a patient, you should document the visit and the means by which it was conducted. The requirements are the same as for a face-to-face meeting where you need to document relevant history.
• Make sure you are seeing the right patient.

SOURCE: Telesalud. Departamento de Salud. (Accessed Mar. 2023).

No Reference Found

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No Reference Found

Privacy policies must be reviewed with the individual before beginning a telehealth assessment and the review must be documented in the patient record.  The patient must be informed about privacy policies and given an opportunity to request an in-person assessment before receiving a telehealth assessment.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care.  p. 49-50, (2017) (Accessed Dec. 2022).

The individual being evaluated via telehealth must be informed of the process and given an opportunity to request an in-person face-to-face assessment before conducting a telehealth assessment. This should be documented in his/her record.

Explanation of the process shall include a statement that services will not be withheld if the telehealth encounter is refused and the individual may terminate the telehealth assessment at any time.

Documentation must contain a statement that the telehealth process was explained to the individual and whether or not an objection was raised.

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services Telecommunications Guidelines, p. 8, (2012) (Accessed Dec. 2022).

A parent or legal guardian must provide written or verbal consent to the distant site provider to allow any other individual, other than the health professional as required by Texas Government Code §531.0217(c-4)(4) for school-based telemedicine, to be physically present in the distant or patient site environment during a telehealth or telemedicine service with a child.

An adult client must also provide written or verbal consent to the distant site provider to allow any other individual to be physically present in the distant or patient site environment during a telehealth or telemedicine service.

Provider must obtain informed consent from the client, client’s parent, or the client’s legally authorized representative prior to rendering a behavioral health service through a synchronous audio-only technology platform; except when doing so is not feasible or could result in death or injury to the client. Verbal consent is permissible and must be documented in the client’s medical record.

The distant site provider must obtain informed consent to treatment from the patient, patient’s parent, or the patient’s guardian prior to rendering a telemedicine medical service.

If a patient has a primary care provider who is not the distant site provider and the patient or their parent or legal guardian provides consent to a release of information, a distant site provider must provide the patient’s primary care provider with the following information:

• A medical record or report with an explanation of the treatment provided by the distant site provider
• The distant site provider’s evaluation, analysis, or diagnosis of the patient

School-Based Setting

The parent or legal guardian of the client provides consent before the service is provided.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 5, 6, 8, 10,& 11  (Dec. 2022). (Accessed Dec. 2022).

If a patient receiving a telemedicine medical service has a primary care physician or provider and consents or, if appropriate, the patient’s parent or legal guardian consents to the notification, the commission shall require that the primary care physician or provider be notified of the telemedicine medical service for the purpose of sharing medical information.  In the case of a service provided to a child in a school-based setting as described by Subsection (c-4), the notification, if any, must include a summary of the service, including exam findings, prescribed or administered medications, and patient instructions.

If a patient receiving a telemedicine medical service in a school-based setting as described by Subsection (c-4) does not have a primary care physician or provider, the commission shall require that the patient’s parent or legal guardian receive:

• The notification required under Subsection (g); and
• A list of primary care physicians or providers from which the patient may select the patient’s primary care physician or provider.

SOURCE: TX Govt. Code Sec. 531.0217. (Accessed Dec. 2022).

Behavioral Analysts Program

A telehealth provider shall obtain client consent before services may be provided through telehealth.  If a client previously consented to in-person services, a telehealth provider shall obtain updated consent to include telehealth services.

SOURCE: TX Admin Code, Title 16, Sec. 121.71, (Accessed Dec. 2022).

Physical Therapy, Occupational Therapy, and Speech Therapy

• The provider should obtain informed consent for treatment from the patient, patient’s parent, or the patient’s legal guardian prior to rendering a telehealth service. Verbal consent is permissible and should be documented in the client’s medical record.

SOURCE: TX Medicaid Physical Therapy, Occupational Therapy, and Speech Therapy Services Handbook pg. 9 (Dec. 2022). (Accessed Dec. 2022).

No Reference Found

A qualified telemedicine and store-and-forward provider must provide appropriate informed consent in a language that the beneficiary understands (see rule for details).

SOURCE: VT Health Care Administrative Rules 13.174.003 (3.101.5), Telehealth, (Accessed Feb. 2023).

A health care provider delivering health care services or dental services through telemedicine must obtain and document a patient’s oral or written informed consent.  See law for special informed consent instructions third-party vendors, emergency situations, a psychiatrist’s examination and a patient receiving by store-and-forward means

SOURCE: VT Statutes Annotated, Title 18 Sec. 9361 (Accessed Feb. 2023).

Audio-Only Telephone

A health care provider delivering health care services by audio-only telephone shall obtain and document a patient’s oral or written informed consent for the use of audio-only telephone prior to the appointment or at the start of the appointment but prior to delivering any billable service.

The informed consent for audio-only telephone services shall be provided in accordance with Vermont and national policies and guidelines on the appropriate use of telephone services within the provider’s profession and shall include, in language that patients can easily understand:

• that the patient is entitled to choose to receive services by audio-
• only telephone, in person, or through telemedicine, to the extent clinically appropriate;

• that receiving services by audio-only telephone does not preclude the patient from receiving services in person or through telemedicine at a later date;

• an explanation of the opportunities and limitations of delivering and receiving health care services using audio-only telephone;

• informing the patient of the presence of any other individual who will be participating in or listening to the patient’s consultation with the provider and obtaining the patient’s permission for the participation or observation;

• whether the services will be billed to the patient’s health insurance plan if delivered by audio-only telephone and what this may mean for the patient’s financial responsibility for co-payments, coinsurance, and deductibles; and

• informing the patient that not all audio-only health care services are covered by all health plans.

For services delivered by audio-only telephone on an ongoing basis, the health care provider shall be required to obtain consent only at the first episode of care.

If the patient provides oral informed consent, the provider shall offer to provide the patient with a written copy of the informed consent.

Notwithstanding any provision of this subsection to the contrary, a health care provider shall not be required to obtain a patient’s informed consent for the use of audio-only telephone services in the case of a medical emergency.

A health care provider may use a single informed consent form to address all telehealth modalities, including telemedicine, store and forward, and audio-only telephone, as long as the form complies with the provisions of section 9361 of this chapter and this section.

SOURCE: 18 Vermont Statute Annotated Ch. 219, Sec. 9362, (Accessed Feb. 2023).

No reference found.

If a Provider, whether at the originating site or distant site, maintains a consent agreement that specifically mentions use of telehealth as an acceptable modality for delivery of services including the information noted above, this shall meet DMAS’s required documentation of patient consent.

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), (Oct. 2022) (Accessed Nov. 2022).

Consent for care via the modality used is required for documentation by the distant site.

Consent must be documented in the client record.

Written informed consent is obtained from the client that store and forward technology will be used and who the consulting provider is.

SOURCE: WA State Health Care Authority. Medicaid Provider Guide. Telemedicine Policy and Billing, p. 15, 20,22 (Jan. 2023) WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 336 (Jan. 2023). (Accessed Feb. 2023).

Informed consent documentation is required for remote patient monitoring services.

SOURCE: WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 340-341 (Jan. 2023). (Accessed Feb. 2023).

Managed Care and Behavioral Health Administrative Service Organizations

If a provider intends to bill a patient or a managed health care system for an audio-only telemedicine service, the provider must obtain patient consent for the billing in advance of the service being delivered. The authority may submit information on any potential violations of this subsection to the appropriate disciplining authority.

If the commissioner has cause to believe that a provider has engaged in a pattern of unresolved violations obtaining consent (as required above) the commissioner may submit information to the appropriate disciplining authority for action. Prior to submitting information to the appropriate disciplining authority, the commissioner may provide the provider with an opportunity to cure the alleged violations.  See text for additional information.

SOURCE: Revised Code of Washington 71.24.335 & 74.09.325. (Accessed Feb. 2023).

Member’s consent to receive treatment via Telehealth shall be obtained and may be included in the member’s initial general consent for treatment.

The provider who has the ultimate responsibility for the care of the patient must first obtain verbal and written consent from the recipient, including as listed below:

• The right to withdraw at any time
• A description of the risks, benefits and consequences of telemedicine
• Application of all existing confidentiality protections
• Right of the patient to documentation regarding all transmitted medical information
• Prohibition of dissemination of any patient images or information to other entities without further written consent.

If the member (or legal guardian) indicates at any point that he or she wishes to stop using the technology, the service should cease immediately and an alternative method of service provision should be arranged.

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17 Practitioner Services: Telehealth Services. (Effective Jan. 1, 2022) p. 4.; WV Dept. of Health and Human Svcs., Medicaid Provider Manual, Chapter 523: Targeted Case Management, p. 7 (Jul. 1, 2016); 521.9 Behavioral Health Outpatient Services. P. 9-10. (Jan. 15, 2018). p. 10. (Accessed Feb. 2023).

On at least an annual basis, providers should supply and document that:

• The member expressed an understanding of their right to decline services provided via telehealth.
• Providers should develop and implement their own methods of informed consent to verify that a member agrees to receive services via telehealth.
• These methods must comply with all federal and state regulations and guidelines.
• Providers have flexibility in determining the most appropriate method to capture member consent for telehealth services. Examples of allowable methods include educating the member and obtaining verbal consent prior to the start of treatment or telehealth consent and privacy considerations as part of the notice of privacy practices. Refer to Wis. Admin. Code § DHS 94.03(2m) for additional guidance.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth &ForwardHealth Update Dec. 2021 updated Oct. 2022, No. 2021-50. (Accessed Nov. 2022). 

If the patient and/or legal guardian indicates at any point that he/she wants to stop using the technology, the service should cease immediately and an alternative appointment set up.

The telehealth consent form is no longer required by Wyoming Medicaid. Consent must still be obtained by the provider from the client by one of the following methods:

• Verbally
• Email
• Text Message

This information must be properly documented by the provider and kept on file.

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 Provider Manual, p. 138 (Jan. 1, 2023), WY Division of Healthcare Financing Tribal Provider Manual, Ch. 6 Institutional/UB Common Billing Information, pgs. 146 & Ch. 7 CMS-1500 Common Billing Information, pg. 226 (Jan. 1, 2023) & Institutional Provider Manual pg. 143.  (Jan. 1, 2023). (Accessed Jan. 2023).

To obtain Medicaid reimbursement for services delivered through the telehealth modality, the following standards must be observed:

• Telehealth consent must be obtained if the originating site is the student’s home.

SOURCE: WY Division of Health Insurance, School Based Services Manual, (Jan. 1, 2023). (Accessed Jan. 2023).