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 Mar. 2024).

As a flexibility for the COVID-19 PHE, annual beneficiary consent for virtual check-ins may be obtained at the same time as the services are furnished for both new and established patients. Post PHE—virtual check-ins may only be furnished to established patients.

The flexibility to obtain annual beneficiary consent for virtual check-ins at the time of service was made permanent in the CY 2021 PFS Final Rule. At the end of the PHE, virtual check-ins may only be furnished to established patients.

SOURCE: Centers for Medicare and Medicaid Services, Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19, 11/6/23, (Accessed Mar. 2024).

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 Mar. 2024).

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 Mar. 2024).

Consent for Care Management & Virtual Communication Services 

We require patient consent for all services, including non-face-to-face services. You may get patient consent at the same time you initially provide the services. Direct supervision isn’t required to get consent. In general, auxiliary personnel under general supervision of the billing practitioner can get patient consent for these services. The person getting consent can be an employee, independent contractor, or leased employee of the billing practitioner.

SOURCE: Centers for Medicare and Medicaid Services (CMS), Telehealth Services MLN Fact Sheet, Feb. 2024, (Accessed Mar. 2024).

We require patient consent for all services, including non-face-to-face services. You may get patient consent at the same time you initially provide the services. Direct supervision isn’t required to get consent. In general, auxiliary personnel under general supervision of the FQHC practitioner can get patient consent for these services.

SOURCE: Centers for Medicaid and Medicare Services, Medicare Learning Network Booklet 6397, Federally Qualified Health Centers, Jan. 2024, & MLN Booklet 6398, Rural Health Clinics, Mar. 2024, (Accessed Mar. 2024).

Providers must obtain prior written or verbal consent from the recipient before services are rendered.

Telemedicine services provided to minors under the age of medical consent must have a parent or legal guardian attend the telemedicine visit.

SOURCE: AL Medicaid Management Information System Provider Manual, Telemedicine Services, Ch. 112, Jan. 2024, pg. 3, (Accessed Feb. 2024).

For ABA therapy or PBS services listed above provided via telemedicine, enrolled providers are eligible to participate in the Telemedicine Program to provide medically necessary telemedicine services to Alabama Medicaid eligible recipients. In order to participate in the telemedicine program: …

• Providers must obtain prior consent from the recipient before services are rendered. A sample recipient consent form is attached to the Telemedicine Service Agreement.

SOURCE: AL Medicaid Management Information System Provider Manual, Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis), (Ch. 37, p. 16). Jan. 2024. (Accessed Feb. 2024).

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. 2024. (Accessed Feb. 2024).

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. 2024, C-1, (Accessed Feb. 2024).

What type of informed consent is required when providing services via telehealth?

Alaska Medicaid requires providers to obtain consent for delivering services through a telehealth modality prior to services being rendered. Receipt of consent must be documented in the member’s file and may be obtained for a period of time agreed upon between the member/member representative and provider or may be for a single visit. Both written and verbal consent is acceptable for the purposes of telehealth.

• Verbal Consent: Consent may be obtained verbally in most scenarios. The patient’s clinical record must confirm that the member consented to a telehealth mode of delivery.
• Written Consent: Some services, regardless of the mode of delivery, may require written consent. Providers should refer to their scope of practice requirements for any written consent requirements.

SOURCE: Alaska Medicaid Frequently Asked Questions Coverage of Telehealth Modalities, Sept. 19, 2023, (Accessed Feb. 2024).

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. 5), Approved 8/29/23. (Accessed Feb. 2024).

For telehealth services, in addition to the requirements set forth in section of Universal Requirements for informed consent of this Policy, before a provider delivers health care via telehealth, verbal or written informed consent from the member, or when applicable, the member’s HCDM, shall be obtained as specified in AMPM Policy 320-I, A.R.S. §36-3602, and A.A.C. R9-21-206.01.

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 HCDM 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. 3. Effective 10/1/23. (Accessed Feb. 2024).

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 Feb. 2024).

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 Feb. 2024).

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 Feb. 2024).

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. Mar. 2024. Pg. 14. (Accessed Apr. 2024).

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 Apr. 2024).

State law requires the  health care provider initiating the use of telehealth to obtain written or verbal consent once before the initial delivery of telehealth services. Medi-Cal has developed Telehealth Patient Consent Language,​ which includes language outlining a beneficiary’s right to in-person services, the voluntary nature of consent, the availability of transport to access in-person services if needed, and potential limitations/risks of receiving services via telehealth. Providers are not required to use DHCS model language but rather can be utilized as a resource. Patient consent can be completed verbally or in writing. Patients who consent to synchronous video must separately consent to synchronous audio-only services.

Health care providers may document consent either by having the beneficiary sign a paper or electronic form that can be included in the patient’s medical record or by having the provider note consent in the patient’s medical record. Group practices need to obtain and document a patient’s initial consent for purposes of telehealth services prior to the initiation of health care services via telehealth.  If consent is documented by the group practice, it is not necessary for each provider rendering health care services via telehealth to document consent.

Minors who receive confidential care, including sexual health, reproductive health, mental health under the Minor Consent Program, may consent to receive the same services via telehealth that are appropriate for telehealth. More information is available ​on the Minor Consent Program​​.

SOURCE: CA Department of Health Care Services. Telehealth FAQs. (Accessed Apr. 2024).

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 Apr. 2024).

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 Apr. 2024).

Local Education Agency Services

All of the following shall be communicated by a health care provider 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 the 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 inperson 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.

Documentation of written or verbal consent to receive services via telehealth must be maintained in the student’s file. Consent requirements outlined in the Local Educational Agency provider manual section related to accessing public benefits or insurance or releasing medical information in personally identifiable form from the student’s education record must also be followed.

SOURCE: CA Department of Health Care Services (DHCS). Local Education Agency (LEA) Telehealth. Jun. 2023. Pg. 7. (Accessed Apr. 2024).

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. 2024).

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” 1/24. (Accessed Jan. 2024).

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. 2024).

All consent for telemedicine services could be verbal during the PHE. Providers must obtain written consent prior to the first visit post-PHE, as described in the Waiving the Face-to-Face Requirement & Required Disclosure Statements section of the Telemedicine Billing Manual.

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 Apr. 2024).

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 Apr. 2024).

Informed Consent

In a method as determined by providers, informed consent must be obtained in writing (electronic consent is acceptable) from each HUSKY Health member before providing telehealth services and annually thereafter. DSS is not requiring the use of a specific form and providers may use their own form or format for obtaining informed consent. In addition, the provider must ensure each HUSKY Health member is aware they can optout or refuse telehealth services at any time.

Services Rendered to Minors

If the HUSKY Health member is a minor child under age 18, a parent or legal guardian must be present for services to the same extent as it would be required for comparable in-person services unless exempted by state or federal law. In addition, informed consent for telehealth services must be obtained by the parent or legal guardian prior to the provision of such services and obtained annually thereafter.

SOURCE: CT Medicaid Assistance Program Provider Bulletin 2023-38 (May 2023), p. 3. (Accessed Apr. 2024).

Verbal consent obtained during the PHE, as evidenced by a documentation in the medical record, may remain in effect for up to six months after the end of the PHE, after which, providers must obtain informed consent per the terms found in Provider Bulletin 2023-38 (cited above).

SOURCE: CT Medicaid Assistance Program Telehealth FAQ (May 2023), p. 2. (Accessed Apr. 2024).

Consent is required to assure that the patient is a willing participant in the telehealth delivered service and to assure that the recipient retains a voice in their treatment plan. The patient must be informed and given an opportunity to request an in-person assessment before receiving a telehealth assessment. This consent must be documented in the patient’s record and must identify that the covered medical service was delivered by telehealth.

Where a DMAP recipient is involuntarily detained or committed to a facility for care, obtaining member consent may be impracticable. In these instances, delivery of care via telehealth should continue to meet all other telehealth policy requirements and all normal DMAP criteria for member safeguards and confidentiality. Exceptions to consent end upon the discharge of the recipient from any facility where the individual was involuntarily detained

SOURCE: DE Medical Assistance Program. Practitioner Provider Specific Manual, 1/12/24. Ch. 16.4.1, 16.4.3, pg. 75-76. (Accessed Apr. 2024).

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: Adult Behavioral Health Service Certification and Reimbursement. Dec. 1, 2016. Sec. 1.8. p. 10-13 (Accessed Apr. 2024).

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 Mar. 2024).

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. 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. 2023, pg. 2., Physicians Billing Manual.  DC Medicaid.  (Jan. 2024) Sec. 15.2. P. 51-52, Clinic Billing Manual, DC Medicaid (Sept. 2023), Sec. 15.2, P. 49, FQHC Billing Manual, DC Medicaid 15.2 P. 51. (Oct. 2023), Behavioral Health Billing Manual (Feb. 2024) 14.2, p. 68, Inpatient Hospital Billing Guide, 11.2, p. 60 (Jan. 2024), Long-Term Care Billing Manual, 15.2, p. 51 (Sept. 2023). (Accessed Mar. 2024).

SOURCE: Outpatient Hospital Billing Guide, 15.8.2, p. 74 (Sept. 2023). (Accessed Mar. 2024).

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. 13, 15, 50 & 59-60 (Jan. 1, 2024). (Accessed Jan 2024).

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, GA Medicaid, Comprehensive Supports Waiver Program, (Jan. 1, 2024),   & GA Dept of Community Health, Division of Medicaid, New Options Waiver Program, (Jan. 1, 2024). (Accessed Jan 2024).

The U.S. Department of Health and Human Services Office for Civil Rights expects that patients should not receive telehealth services in public or semi-public settings, absent patient consent or exigent circumstances.

For audio-only – For services furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in their home, interactive telecommunications may include two-way, real-time audio-only communication technology if the distant site physician or practitioner is technically capable to use an interactive telecommunications system as defined in the previous sentence, but the patient is not capable of, or does not consent to, the use of video technology.

SOURCE: HI Med-Quest Memo, QI-2338/FFS 23-22/CCS-2311.  (Accessed Feb. 2024).

The participant must be informed and consent to the delivery models, any applicable cost-sharing, provider qualifications, treatment methods, or limitations and virtual care technologies and provided adequate training on how to use the technology. The rendering provider at the distant site must also disclose to the participant their identity, current location, telephone number and Idaho license number. Providers can deliver virtual care services from any location in the United States. Providers must meet all applicable licensure requirements required by the State of Idaho. If the participant (or legal guardian) indicates at any point that they want to stop using the technology, the service should cease immediately, and an alternative (in-person) appointment should be scheduled. Providers are subject to all applicable state and federal laws regarding protected health information and personal privacy.

The individual treatment record must include written documentation of evaluation process, the services provided, participant consent, participant outcomes, and those services were delivered via virtual care. The documentation must be of the same quality as is originated during an in-person visit, including but not limited to, billing the CPT® or HCPCS code with the number of minutes closest to the actual time spent providing the service, service type, amount, frequency, duration and time spent with the participant. If the code is a timed code of 15-minute increments, it must be billed with a number of units as described in the Billing 15-Minute Timed Codes section of the General Billing Instructions, Idaho Medicaid Provider Handbook. These documentation requirements are specific to delivery via virtual care and are in addition to any other documentation requirements specific to the area of service (i.e., IEP requirements for school-based services).

SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. (Jan. 30, 2024), Section 9.12, 9.12.2, p. 133-134. (Accessed Feb. 2024).

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 (must be within the United States), telephone number and Idaho license number. If the participant (or legal guardian) indicates at any point that they want to stop using the technology, the service should cease immediately, and an alternative (in-person) appointment should be scheduled.

SOURCE: ID MedicAide May 2023.  (Accessed Feb. 2024).

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 (Nov. 1, 2023), p. 1, 3.  (Accessed Mar. 2024).

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 Mar. 2024).

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 Mar. 2024)

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 Mar. 2024).

Division of Mental Health and Addiction: Adult Mental Health Habilitation Services

Client must have documented acknowledgement of receipt of informed consent about risks/benefits of the telehealth modality. AMHH provider agencies must maintain the actual documentation with signatures or verification that attestation was obtained via telehealth in the clinical record.(p. 64, 127)

SOURCE: Division of Mental Health and Addiction, Adult Mental Health Habilitation Services Module (Oct. 3, 2023), p. 64, 127. (Accessed Mar. 2024).

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 (Feb. 2024). (Accessed Mar. 2024).

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. A person licensed, registered, certified, or otherwise authorized to practice by the Behavioral Sciences Regulatory Board will not be required to comply with the provisions of this requirement.

SOURCE: KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 2-32 (Jan. 2024). (Accessed Mar. 2024).

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 Mar. 2024).

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

SOURCE: KY 900 KAR 12:005 (Accessed Mar. 2024).

Behavioral Health Services

Assessments, evaluations, individual psychotherapy, family psychotherapy, and medication management services [CPST allowed in Rehabilitation Services section and services allowed within intensive outpatient or outpatient treatment may be provided in Addiction Services section] may be reimbursed when provided via telecommunication technology when the following criteria is met: …

• The member’s record includes informed consent for services provided through the use of telehealth;

Informed consent to deliver telemedicine/telehealth services. The consent form must include the following:

• Rationale for using telemedicine/telehealth in place of in-person services;
• Risks and benefits of the telemedicine/telehealth, including privacy-related risks;
• Possible treatment alternatives and those risks and benefits; and
• Risks and benefits of no treatment.

Rights to confidentiality must be reviewed, signed by, and given to the member and/or responsible party, if applicable.

SOURCE: LA Dept. of Health and Hospitals, Behavioral Health Services, Chapter Two of the Medicaid Svcs. Manual, Section 2.3, p. 113, 171, 199 & 301 (As issued 1/12/24 (dates vary)). (Accessed Feb. 2024).

Supports Waiver

When using virtual delivery, providers will follow these guidelines: …

• Providers need the consent of the beneficiary and the beneficiary’s parent or legal guardian (and their contact information) prior to initiating a telemedicine/telehealth service with the beneficiary if the beneficiary is 18 years old or under;
• Beneficiary must be informed of all persons who are present and the role of each person;
• Beneficiaries may refuse services delivered through telehealth

SOURCE: LA Dept. of Health, Support Services, Ch. 43.4, (As issued on 8/21/23), (Accessed Feb. 2024).

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 Feb. 2024).

The department may not require a licensed facility to obtain written informed consent from a person receiving mental health services or substance use disorder treatment from the licensed facility during a public health emergency. A licensed facility shall obtain consent from a person receiving mental health services or substance use disorder treatment during a public health emergency; such consent may be obtained through verbal, electronic or written means.

SOURCE: ME Statute Title 22, Subtitle 1, Ch. 1, Subchapter 2, Sec. 51, (Accessed Feb. 2024).

Before providing a Telehealth Service to a Member, a Health Care Provider shall ensure and document that the following information is provided to the Member or authorized representative in a format and manner that the Member is able to understand:

• Description of the telehealth services and what to expect;
• An explanation that use of Telehealth Services is voluntary. The Member shall have the option to refuse the Telehealth Services at any time without affecting the right to future care or treatment and without risking the loss or withdrawal of a MaineCare benefit to which the Member is entitled;
• An explanation that MaineCare will pay for the Member’s transportation to MaineCare Covered Services pursuant to Section 113, Non-Emergency Transportation Services, of the MBM;
• An explanation that the Member shall have access to all information resulting from the Telehealth Service as provided by law;

Prior to the provision of any Telehealth Services, the Health Care Provider shall obtain the Member’s written, electronic, or verbal informed consent to receive services via Telehealth Services, to Store-and-Forward Telehealth Services, Remote Consultation, Virtual Check-In, or Telephone Evaluation and Management.

A copy of the 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.

Health Care Providers shall comply with federal and Maine state laws and regulations regarding individual health care data confidentiality when disseminating, storing, or retaining an identifiable Member image or other information from a Telehealth Service;

At the onset of the Telehealth Service, the Health Care Provider shall inform the Member of the persons present at the Receiving (Provider) Site, and the Member shall have the right to exclude any person from either site during the service; and

The Member shall have the right to object to the audio and/or visual recording of a Telehealth Consultation.

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. p. 9-10. (Nov. 6, 2023). (Accessed Feb. 2024).

The member’s record must document the member’s consent and commitment to the Assistive Technology plan elements including all assistive communication, environmental control and safety components.

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 Feb. 2024).

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 Feb. 2024).

SOURCE: MD Medicaid Synchronous Telehealth Policy Guide, p. 1-2, 4. Updated Aug. 2023. (Accessed Feb. 2024).

The provider shall obtain the participant’s consent to services via telehealth, unless there is an emergency that prevents obtaining consent, which shall be documented in the participant’s medical record.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.04. (Accessed Feb. 2024).

Consent may be given verbally by the participant.

SOURCE: MD Medical Assistance Program. Professional Services Provider Manual, p. 78. Updated Jan. 2023. (Accessed Feb. 2024).

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 Feb. 2024).

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 Feb. 2024).

Under this telehealth policy, providers must always obtain the member’s consent to receive services via telehealth. This ensures that members will have the choice to decide between receiving services in-person or via telehealth. Under M.G.L. c. 118E, § 79(d), MassHealth members have a choice to decline to receive services via telehealth in order to receive such services in person. The availability of telehealth modalities does not mitigate the provider responsibility to accommodate member choice for in-person services (i.e., this language does not affect network adequacy standards for managed care plans).

Providers must adhere to the following best practices when delivering services via telehealth.   Providers are encouraged to have documented policies and procedures that incorporate these best practices.  …

• Providers must follow consent and patient information protocol consistent with those followed during in-person visits.
• Providers must obtain the member’s consent to receive services via telehealth and inform the member (a) of any relevant privacy considerations, and (b) that the member may revoke their consent to receive services via telehealth at any time.
• Providers must inform patients of the location of the provider rendering services via telehealth (i.e., distant site) and obtain the location of the patient (i.e., originating site).
• The provider must inform the patient of how the patient can see a clinician in-person in the event of an emergency or as otherwise needed.

SOURCE: MassHealth All Provider Bulletin 379, Oct. 2023. (Accessed Apr. 2024).

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 Apr. 2024).

Home Health Agency

Providers must obtain verbal consent from a member, and the member’s caregiver/legal guardian if applicable, before beginning home health services via telehealth. Providers must also document the consent in the member’s record. In obtaining the member’s consent, MassHealth home health agencies must provide the member with a statement explaining

• what a telehealth visit involves;
• what is expected from the member, as well as the home health provider;
• any relevant privacy considerations; and
• that the member may revoke, at any time, their consent for the rendering of services via telehealth.

SOURCE:  MassHealth Home Health Agencies, Bulletin 87, Jul. 2023, (Accessed Apr. 2024).

Adult Foster Care

Providers must get verbal consent from a member, and the member’s caregiver/legal guardian if applicable, before beginning AFC/GAFC services via telehealth. Providers must also document the consent in the member’s record.

In obtaining the member’s consent, providers must provide the member with a statement explaining

• what telehealth involves;
• what is expected from the member, as well as the AFC/GAFC provider;
• any relevant privacy considerations; and
• that the member may revoke, at any time, their consent to receive services via telehealth.

STATUS: MassHealth Adult Foster Care, Bulletin 29, Apr. 2023, (Accessed Apr. 2024).

Therapy

Live video telehealth must be used, with the member’s consent, to conduct the comprehensive evaluation or reevaluation under 130 CMR 430.601(A)(9) for members receiving therapy.

Providers must get verbal consent from a member, and the member’s caregiver or legal guardian if applicable, before starting telehealth and must document the consent in the member’s record. When requesting the member’s consent, MassHealth therapy providers must provide the member with a statement explaining

• what a telehealth visit entails;
• what is expected from the member and the therapy provider;
• any relevant privacy considerations; and
• that the member may take back their consent for telehealth services at any time.

Information provided to members should be given in their preferred method of delivery and must be documented within the member’s record.

STATUS: MassHealth Rehabilitation Center Bulletin 16, Apr. 2023; Therapist Bulletin 18, Apr. 2023; Speech and Hearing Center Bulletin 16, Apr. 2023, (Accessed Apr. 2024).

SOURCE: MI Dept. of Health and Human Services, Medicaid Provider Manual, p. 2144, Jan. 1, 2024 & Medical Services Administration (MSA) Bulletin 21-24 Aug. 2021 (Accessed Jan. 2024).

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 Feb. 2024).

Signed consent for using telehealth is required.

SOURCE: MS Admin. Code 23, Part 225, Rule 1.6(A). (Accessed Apr. 2024).

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 Apr. 2024).

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, 1.14 p. 9 (9/1/23); MO HealthNet, Physician Manual, Telehealth Services, Sec. 2.67, p. 112 (9/1/23) & MO HealthNet, Provider Manual, Behavioral Health Services, Sec. 1.19 p. 59 (9/1/23). (Accessed Jan. 2024).

Distant Site on School Grounds

Distant site services provided on school grounds should be billed with place of service 03 and a GT modifier.

The provider must get consent from the parent or guardian to provide telemedicine services. The parent or guardian may authorize services via telemedicine for a whole school year.

SOURCE: MO HealthNet Telemedicine Billing PPT, Education and Training Unit, Revised July 2022, (Accessed Jan. 2024).

Telemedicine/Telehealth Requirements

• To the extent possible, providers must ensure members have the same rights to confidentiality and security as provided during traditional office visits.
• Providers must follow consent and patient information protocol consistent with those followed during in-person visits.
• Telemedicine/telehealth does not alter the scope of practice of any healthcare provider; or authorize the delivery of healthcare services in a setting or manner not otherwise authorized by law.
• Record keeping must comply with Administrative Rules of Montana (ARM) 37.85.414.
• Enrolled providers delivering services via telemedicine/telehealth must submit claims using the appropriate CPT or HCPCS code, place of service, and modifier for the services rendered.

SOURCE:  MT Medicaid, All Provider Notice, Coverage and Reimbursement for Telemedicine/Telehealth Services, Mar. 21, 2023, (Accessed Feb. 2024).

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 Feb. 2024).

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.

Sample patient consent form available in Manual Appendix.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.04, Ch. 1, & Sample Consent form: Appendix, 471-000-10 Instructions for Completing NE Medicaid Telehealth Patient Consent Form.  (Accessed Apr. 2024).

Once the PHE ends on May 11, 2023: …

• Informed consent prior to providing treatments or services will again be required, and this consent must be kept in the member’s medical record.

SOURCE: NE Medicaid Program, Bulletin 23-08:  Guidance on Telehealth, Mar. 23, 2023, (Accessed Apr. 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 Apr. 2024).

A state plan amendment shall include a provision 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) or (b). 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 Mar. 2024).

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 Mar. 2024).

The recipient has consented to using telehealth, including teledentistry, as a method of receiving services.

Each participating medical provider shall: … Ensure the patient’s informed consent to the use of telehealth and advise members of any relevant privacy considerations.

The provider shall present the patient with basic information about the services that the patient will be receiving via telehealth.

The patient shall provide his or her consent to participate in services utilizing this technology.

Telehealth sessions shall not be recorded without the patient’s consent.

Culturally competent translation or interpretation services shall be provided when the patient and the distant provider do not speak the same language.

Documentation in the patient’s medical record shall reflect that the patient was informed of the patient’s rights policies which include the following:

• The right to refuse to participate in services delivered via telehealth;
• The role of the provider at the distant site and the professional staff at the originating site who shall be responsible for follow up or ongoing care;
• The city and state of the distant site provider and all questions regarding the equipment and the technologies are addressed;
• The right to be referred to in-person emergency care when clinically appropriate;
• The right to be informed of all the parties who shall be present at each end of the telehealth transmission; and
• The right to know how an emergency would be handled by the provider during a telehealth visit.

Source: NH Admin Rules, HE-C 5004.02, 07, (Accessed Mar. 2024).

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 Feb. 2024).

In regard to NJ Medicaid or a managed care organization contracted with the Division reimbursing a local education agency for behavioral health services delivered in-person or via telehealth, under a system to submit Medicaid claims for such covered behavioral health services, the system shall include the requirement for a local education agency to obtain parental or guardian consent prior to billing Medicaid for any service provided under this section.

SOURCE: NJ A3334 (2023 Session). (Accessed Feb. 2024).

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. 2024).

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)(3c). (Accessed Feb. 2024).

The practitioner shall confirm the identity of the NYS Medicaid member and provide the NYS Medicaid member with basic information about the services that they will be receiving via telehealth. Written consent by the NYS Medicaid member is not required, but the provider must document informed consent in the chart of the patient before or during the first visit in which telehealth services are provided. Telehealth sessions/services shall not be recorded without the consent of the NYS Medicaid member.

Informed consent means that telehealth practitioners provide members with sufficient information and education about telehealth to assist them in making an informed choice to receive telehealth services. This must include the following:

1. The telehealth provider must confirm that the NYS Medicaid member is aware of the potential advantages and disadvantages of telehealth, be given the option of not participating in telehealth services and information regarding their right to request a change in service delivery mode at any time.
2. The telehealth provider must inform NYS Medicaid members that they will not be denied services if they do not consent to telehealth devices or request to receive services in-person.
3. Where the NYS Medicaid member 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.

Informed consent shall be obtained through a process of communication between the telehealth provider and NYS Medicaid member. Although some providers may choose to document informed consent to receive telehealth services using a form, it is not necessary to use a specific form. Informed consent processes should be specified in the policies and procedures of the provider.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 7-8. (Accessed Mar. 2024).

Mental Health

Mental health services guidance requires the same informed consent process as above and additionally states that:

• Informed consent must be obtained before or during the first visit in which Telehealth Services are provided and documented in the case record
• Individuals, or a minor individual’s parent or guardian, should be informed how to verify a Telehealth Practitioner’s professional license.

SOURCE: NY Office of Mental Health. Telehealth Services Guidance for OMH Providers. April 2023, p. 11. (Accessed Mar. 2024).

Virtual Check-Ins

The patient must consent to receive virtual check-in services and the provider must document the consent of the patient in their chart at least once annually while the patient receives virtual check-in services.

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 39, Number 3, February 2023, p. 13. (Accessed Mar. 2024).

eVisits

The provider shall obtain verbal or written consent for communication-based technology services (CBTS) annually. Written consent is not required, but the provider must document informed consent for CBTS in the chart of the patient before an eVisit can occur.

SOURCE: Medicaid Update Vol. 39, No. 13, Aug. 2023. (Accessed Mar. 2024).

eConsults

The treating/requesting provider shall provide the NYS Medicaid member with information about the eConsult and obtain consent from the patient prior to each eConsult. A single instance of patient consent cannot apply to multiple eConsults across different specialties. Written consent is not required; however, the provider must document informed consent in the chart of the patient before the eConsult. Patients have the right to refuse an eConsult and see a consultative provider in-person if they wish to do so.

SOURCE: NY State Medicaid Update January 2024 Volume 40, Number 1. (Accessed Mar. 2024).

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 Mar. 2024).

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 Mar. 2024).

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 2024, page 64. (Accessed Mar. 2024).

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, Jun. 1, 2023 & NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, Nov. 1, 2023. (Accessed Mar. 2024).

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 Feb. 2024).

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.

School Based Settings – 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.

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.

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.

The member retains the right to withdraw at any time.

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 Mar. 2024).

Audio-Only Services

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 audio-only telecommunications, that includes, at a minimum, the name of the provider; the provider’s permanent business office address and telephone number; and 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 audio-only telecommunications session unless attendance is therapeutically appropriate.

SOURCE: OK Admin. Code Sec. 317:30-3-27.1. (Accessed Mar. 2024).

Prior to the delivery of services using 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;

Consistent with ORS 109.640, provision of birth control information and services using a telemedicine or telehealth modality shall be provided to any person regardless of age without consent of parent or legal guardian;

Consistent with ORS 109.640, provision of any other medical or dental diagnosis and treatment using a telemedicine or telehealth modality shall be provided to any person 15 years of age or older without consent of parent or legal guardian;

See rule for additional requirements.

SOURCE: OR OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telehealth Service and Reimbursement. (Accessed Mar. 2024).

Prior to the delivery of services using 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 shall be obtained and documented by the health system, clinic or provider in the client or member’s health record. Consent shall 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 shall be updated at least annually thereafter. For clients or members who experience LEP or hearing impairment clients, providers shall use qualified or certified health care interpreters when obtaining client or member consent;

Consistent with Oregon Revised Statute (ORS 109.640), provision of birth control information and services using a telemedicine or telehealth modality shall be provided to any person regardless of age without consent of parent or legal guardian;

Consistent with ORS 109.640, provision of any other medical or dental diagnosis and treatment using a telemedicine or telehealth modality shall be provided to any person 15 years of age or older without consent of parent or legal guardian;

Consistent with ORS 109.675, provision of outpatient diagnosis or treatment of a mental or emotional disorder or a chemical dependency using a telemedicine or telehealth modality shall be provided to any person 14 years of age or older without consent of parent or legal guardian;

Consistent with ORS 109.610, provision of diagnosis or treatment of certain sexually transmitted infections using a telemedicine or telehealth modality shall be provided to a person regardless of age without consent of parent or legal guardian;

See rule for additional requirements.

SOURCE: OR OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Accessed Mar. 2024).

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.

The member’s chart Documentation shall reflect notification of the right to interactive communication with the distant site dentist.

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Accessed Mar. 2024).

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. 2024).

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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 incapable, 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, understood, 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: Guidelines & Protocols for Telehealth in Puerto Rico & Department de Salud: Telehealth: Informed Consent for Telemedicine. (Accessed Mar. 2024).

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Remote Patient Monitoring

The provider must obtain consent from the recipient to furnish RPM services.

SOURCE: SD Medicaid Billing and Policy Manual: Telemedicine, p. 6 (Feb. 2024), (Accessed Apr. 2024).

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 Jan. 2024).

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 Jan. 2024).

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.

Documentation of the written or verbal consent must be maintained in the client’s medical record. (In CSHCN Manual).

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 4-5  (Jan. 2024).  TX Medicaid CSHCN Services Program Provider Manual Telecommunication Services (Dec 2023), p. 4.  (Accessed Jan. 2024).

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.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 6  (Jan. 2024). (Accessed Jan. 2024).

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.

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

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 8, 12 (Jan. 2024). (Accessed Jan. 2024).

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

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 11  (Jan. 2024). (Accessed Jan. 2024).

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. 10  (Jan. 2024). (Accessed Jan. 2024).

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., [repealed eff. Apr. 1, 2025],(Accessed Jan. 2024).

Conditions for telemedicine medical services provided in a primary or secondary school-based setting.

For a child receiving telemedicine medical services in a primary or secondary school-based setting, advance parent or legal guardian consent for a telemedicine medical service must be obtained.

The patient’s primary care physician or provider must be notified of a telemedicine medical service, unless the patient does not have a primary care physician or provider.

• The patient receiving the telemedicine medical service, or the patient’s parent or legal guardian, must consent to the notification.
• For a telemedicine medical service provided to a child in a primary or secondary school-based setting, the notification must include a summary of the service, including:
  • exam findings;
  • prescribed or administered medications; and
  • patient instructions.

If a child receiving a telemedicine medical service in a primary or secondary school-based setting does not have a primary care physician or provider, the child’s parent or legal guardian must be offered:

• the information in subparagraph (B)(ii) of this paragraph; and
• a list of primary care physicians or providers from which to select the child’s primary care physician or provider.

Telemedicine medical services provided in a school-based setting by a physician, even if the physician is not the patient’s primary care physician or provider, are reimbursed if:

• the physician is enrolled as a Medicaid provider;
• the patient is a child who receives the service in a primary or secondary school-based setting; and
• the parent or legal guardian of the patient provides consent before the service is provided.

SOURCE: TX Admin Code, Title 1, Part 15, Sec. 354.1432, (Accessed Jan. 2024).

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 Jan. 2024).

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 (Jan. 2024). (Accessed Jan. 2024).

Managed Care (also applies to START Kids and STAR Health)

When an MCO conducts a change in condition assessment using audio-visual communication, verbal consent must be obtained and documented, and a HIPAA-compliant audio-visual communication product must be used.

If verbal consent for audio-visual communication is not received, the MCO must use in-person communication.

The MCO must inform members who utilize audio-visual communication for change in condition assessments that the member’s services will be subject to the following:

• The MCO must monitor services for fraud, waste, and abuse.
• The MCO must determine whether additional social services or supports are needed.
• The MCO must ensure that verbal consent to use telecommunications is documented in writing.

See rules Sec. 1604-1506 for additional requirements for each program.

SOURCE: Title 1, Part 15, Sec. 353.1503, (Accessed Jan. 2024).

No Reference Found

Qualified telemedicine and store and forward providers shall: …

Provide appropriate informed consent, in a language that the beneficiary understands, consistent with 18 VSA § 936l(c)(l) to include:

• Identifying the beneficiary, the provider, and the provider’s credentials,
• The types of services permitted using telemedicine technologies,
• A statement that the provider determines whether the conditions being diagnosed and/or treated are appropriate for a telemedicine encounter,
• Details on security measures taken with the use of telemedicine technologies,
• Disclosure to the beneficiary that information may be lost due to technical failures,
• A statement that the provider will follow all applicable federal and state legal requirements of medical and health information privacy, and
• Circumstances under which consent is not required.

SOURCE: VT Health Care Administrative Rules 13.174.003 (3.101.5), Telehealth, (Accessed Mar. 2024).

A health care provider delivering health care services or dental services through telemedicine shall obtain and document a patient’s oral or written informed consent for the use of telemedicine technology prior to delivering services to the patient.  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 Mar. 2024).

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 Mar. 2024).

No reference found.

• A description of the telehealth service(s);
• That the use of telehealth services is voluntary and that the member may refuse the telehealth service(s) at any time without affecting the right to future care or treatment and without risking the loss or withdrawal of the member’s benefits;
• That dissemination, storage, or retention of an identifiable member image or other information from the telehealth service(s) shall comply with federal laws and regulations and Virginia state laws and regulations requiring individual health care data confidentiality;
• That the member has the right to be informed of the parties who will be present at the distant (Provider) site and the originating (member) site during any telemedicine service and has the right to exclude anyone from either site; and
• That the member has the right to object to the videotaping or other recording of a telehealth consultation.

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 Assistance Svcs., Medicaid Provider Manual Supplement-Telehealth Services, (1/10/24) (Accessed Apr. 2024).

To receive payment for an audio-only telemedicine service, a provider must obtain client consent before delivering the service to the client. The client’s consent to receive services via audio-only telemedicine must:

• Acknowledge the provider will bill the agency or the agency’s designee, including an agency-contracted managed care entity (managed care organization or behavioral health administrative services organization) for the service; and
• Be documented in the client’s medical record.

A provider may only bill a client for services if they comply with the requirements in WAC 182-502-0160.

 SOURCE: WAC 182-501-0300(6)(a). (Accessed Mar. 2024).

For audio-only telemedicine, providers must obtain consent before rendering the service per RCWs 74.09.325 and 71.24.335. 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. 21, 23 (Apr. 2024), WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 345 (Mar. 2024). (Accessed Mar. 2024).

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. 99 (Mar. 2024). (Accessed Mar. 2024).

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 Mar. 2024).

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. 2024).

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.

SOURCE: WI ForwardHealth Online Handbook. Topic #22738: Interprofessional Consultations (E-Consults), (Accessed Apr. 2024).

Providers must obtain member consent for telehealth services, including informing the member of any applicable copay or cost sharing that may apply. This includes patient-initiated virtual check-in and e-visit services. For more information regarding telehealth consent guidelines, refer to the Telehealth topic (#510) of the ForwardHealth Online Handbook.

Additionally, providers are responsible for communicating with members how the delivery of a service may potentially vary between an in-person and a telehealth delivery. This includes informing a member of any potential changes they may anticipate in how a service is delivered when the temporary telehealth policy and PHE flexibilities expire and permanent policy is effective.

SOURCE: WI ForwardHealth Update: Expanded Coverage for Permanent Telehealth Policy, No. 2023-01, Jan. 2023, (Accessed Apr. 2024).

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. 139 (Jan. 2, 2024), WY Division of Healthcare Financing Tribal Provider Manual, pg. 137 & 216 (Jan. 2, 2024) & Institutional Provider Manual pg. 137-138. (Jan. 2, 2024). (Accessed Jan. 2024).

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.

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.

SOURCE: WY Division of Health Insurance, School Based Services Manual, pg. 17, (Jan. 2, 2024). (Accessed Jan. 2024).