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 Oct. 2021).

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

SOURCE: AL Medicaid Management Information System Provider Manual, Physician Service (ch. 28, p.17). Oct. 2021. (Accessed Oct. 2021).

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

SOURCE: AL Medicaid Management Information System Provider Manual,Therapy (Occupational, Physical, Speech, and Applied Behavior Analysis), (ch. 37, p. 16). Oct. 2021. (Accessed Oct. 2021).

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

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

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

SOURCE: AL Medicaid Management Information System Provider Manual, Rehabilitative Services – DMH, DHR, DYS, DCA(105, p. 11-12).  Oct. 2021. & AL Medicaid Management Information System Provider Manual, Rehabilitative Services (ASD) – DMH (Ch. 110, p. 18).  Oct. 2021. (Accessed Sept. 2021).

No Reference Found

Informed consent standards for telehealth services should adhere to all applicable statutes and policies governing telehealth.

SOURCE: AZ Health Care Cost Containment System. Telehealth and Telemedicine Ch 300, (320-I pg. 3), Oct. 2019. (Accessed Sept. 2021).

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

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

SOURCE: AZ Health Care Cost Containment System. AHCCCS General and Informed Consent, Ch. 320-Q. pg. 4. 07/01/20. (Accessed Sept. 2021).

A provider must obtain informed consent, as required by applicable state and federal laws, rules and regulations.

SOURCE: AR Medicaid Provider Manual. Section I General Policy.  Rule 105.190. p. 15 Updated Aug. 1, 2018. (Accessed Oct. 2021). & AR Admin. Rule 016.06.18. p. 7 (Accessed Oct. 2021).

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, documented in the patient integrated medical records, and submitted as a claims or encounter from a contracted provider as medically necessary service.

SOURCE: PASSE Program, p. II-9, (3/1/19).  (Accessed Oct. 2021).

Providers must inform the patient about the use of telehealth and obtain verbal or written consent from patients before utilizing telehealth.  If a healthcare provider at the originating or distant site maintains a general consent agreement that addresses the use of telehealth that is sufficient for documentation of patient consent and must be kept in the patient’s medical file.

SOURCE: CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. (Aug. 2021), Pg. 5. (Accessed Aug. 2021).

Federally Qualified Health Center (FQHC) & Rural Health Clinic (RHC)

Refer to fee-for-service policy.  All consent for homeless, homebound or migratory or seasonal workers (HHMS) must be documented.

SOURCE: CA Department of Health Care Services (DHCS).  Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHC) Outpatient Services Manual.  Aug. 2020. Pg. 11.  (Accessed Aug. 2021). 

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.  Aug. 2020. Pg. 8.  (Accessed Aug. 2021).  

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.  (Aug. 2020), Pg. 5.  (Accessed Aug. 2021). 

Local Education Agency Services

Oral consent must be obtained for the student’s parent or guardian.  The student’s written consent to telehealth is not required.

If oral consent from the student’s parent or legal guardian is received, the health care provider must document oral consent in the student’s medical record, including the following:

• A description of the risks, benefits and consequences of telehealth
• The student’s parent or legal guardian retains the right to withdraw the student from services via telehealth at any time
• All existing confidentiality protections apply, including HIPAA requirements
• The student’s parent or legal guardian has access to all transmitted medical information
• No dissemination of any student images or information to other entities without further written consent››

SOURCE:  CA Department of Health Care Services (DHCS).  Local Education Agency (LEA) Telehealth.  Aug. 2021. Pg. 4.  (Accessed Aug. 2021).

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 Aug. 2021).

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” 4/21.  (Accessed Aug. 2021).

Effective Now Until June 30, 2023

Notwithstanding the provisions of section 19a-906 of the general statutes, if a telehealth provider provides a telehealth service to a patient during the period beginning on the effective date of this section and ending on June 30, 2023, 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 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 the effective date of this section and ending on June 30, 2023, 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 the effective date of this section and ending on June 30, 2023, 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) (Accessed June 2021).

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.

SOURCE: CT Gen. Statutes Sec. 19a-906(b)(2).  (Accessed June 2021).

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.

SOURCE:  DE Medical Assistance Program.  Practitioner Provider Specific Manual, 5/20/21. Ch. 16.6 & 16.7 Telemedicine, pg. 81-82, & Adult Behavioral Health Service Certification and Reimbursement.  Dec. 14, 2016.  Sec. 1.8. p. 11-13  (Accessed July 2021).

A provider shall document the beneficiary’s consent to receive telemedicine services in writing.  Written consent required. 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. In emergency circumstances, a detailed service note that describes the beneficiary’s consent and the reasons why a separate written consent was not available at the time of the service is acceptable.

SOURCE: DC Department of Health Care Finance – Telemedicine Provider Guidance, July 2021, pg. 2.

Participants must provide written consent to receive telemedicine services in lieu of face-to-face healthcare services.

SOURCE: Physicians Billing Manual.  DC Medicaid.  Mar. 18, 2021, Sec. 15.9.2. P. 66, & DC Municipal Regulation. Title 29, Ch. 9, Sec. 910.5. (Accessed Aug. 2021).

No Reference Found

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.

SOURCE: GA Dept. of Community Health GA Medicaid Telehealth Guidance Handbook, p. 8 & 58-59 (Oct. 2021). (Accessed Oct. 2021).

QUEST Integration Health Plans & Community Case Management Agencies

Prior to using technology for an interaction, consent shall be obtained and documented from the member and documented in the member’s record.

SOURCE: Memo QI-2107A (April 29, 2021). (Accessed Sept. 2021).

An appropriate consent is required, which must disclose the delivery models, provider qualifications, treatment methods, or limitations and telehealth technologies.

SOURCE: Idaho Medicaid Provider Handbook. General Information and Requirements for Providers. June 9, 2021, Section 10.9 p. 126.  (Accessed Oct. 2021).

No Reference Found

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 Aug. 2021).

Providers should always give the member the choice between a traditional clinical encounter versus a telemedicine visit. Appropriate consent from the member must be obtained by the originating site and documentation maintained at both the distant and originating sites.

SOURCE: IN Medicaid Telemedicine and Telehealth Module, Oct. 1, 2019, published Mar. 30, 2021, p. 3. (Accessed Aug. 2021).

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, as amended by Senate Bill 3 (Accessed Aug. 2021).

No reference found

Signed beneficiary 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 (Aug. 2021) (Accessed Aug 2021).

The cabinet, in consultation with the Division of Telehealth Services within the Office of Health Data and Analytics 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: House Bill 140 (2021 Session), (Accessed Sept. 2021).

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

SOURCE: KY 900 KAR 12:005 Emergency Rule & Ordinary Rule. (Accessed Sept. 2021).

No Reference Found

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

SOURCE: ME Statute Sec. 22:855.3173-H, Sub. Sec. 6 as amended by LD 791 (2021 Session). (Accessed Aug. 2021).

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

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

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

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

SOURCE: MaineCare Benefits Manual, Telehealth, 10-144 Ch. 101, Ch. 1, Sec. 4. p. 6 & 10-11. (June 15, 2020). (Accessed Aug. 2021). 

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

SOURCE: MaineCare Benefits Manual, Home and Community Benefits for the Elderly and for Adults with Disabilities, 10-144 Ch. II, Sec. 19, p. 13 (May 2, 2021). (Accessed Aug. 2021).

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 Aug. 2021).

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

SOURCE: MD Medicaid Telehealth Program. Telehealth Provider Manual. Updated April 2020. p. 1, (Accessed Aug. 2021).

Consent is required unless there is an emergency.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.09.49.05. (Accessed Aug. 2021).

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 Aug. 2021).

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 Senate No. 2984. Section 40 (Accessed Sept. 2021)

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

For substance use disorder services, the member must have consented to receiving services over telemedicine.

SOURCE: MN Dept. of Human Svcs., Provider Manual, Substance Use Disorder Telemedicine, Oct. 19, 2017 (Accessed Sept. 2021).

Signed consent for using telehealth is required.

SOURCE: MS Admin. Code 23, Part 225, Rule 1.6(A). (Accessed Aug. 2021).

Prior to the provision of telehealth [or telemedicine as its referred to in Physician 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 telehealth 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, p. 166 (Nov. 25, 2020); MO HealthNet, Physician Manual, Telehealth Services, p. 290 (Jul. 2, 2021) & MO HealthNet, Provider Manual, Behavioral Health Services, p. 209 (Nov. 24, 2020). (Accessed Aug. 2021).

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

SOURCE: Senate Bill 357 (2021 Session), (Accessed Sept. 2021)

READ LESS

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

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

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

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

Sample patient consent form available in Manual Appendix.

SOURCE: NE Admin. Code Title 471 Sec. 1-004.04, Ch. 1, p. 8 & Appendix, 471-000-10 Instructions for Completing NE Medicaid Telehealth Patient Consent Form.  (Accessed Aug. 2021).

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 & Legislative Bill 400 (2021 Session), (Accessed Aug. 2021).

No Reference Found

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 Jul. 2021).

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 Jul. 2021).

Behavioral Health Services

To prescribe medication via telehealth, a prescribing clinician must obtain informed consent, obtain a medical history, and generate a medical record.

SOURCE: NM Human Services Dept. Behavioral Health Policy and Billing Manual for Providers Treating Medicaid Beneficiaries (2019) p. 31 (Accessed Jul. 2021).

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

SOURCE: NY Dept. of Health, Medicaid Update, Vol. 35, Number 2, February 2019, p. 6-7. (Accessed Jul. 2021).

Mental Health

Part of obtaining approval for telemental health 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) & 596.6. (Accessed Jul. 2021).

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

SOURCE: NY Office of Mental Health, Telepsychiatry Standards Guidance, 2020, pg. 3, (Accessed Jul. 2021).

Teledentistry

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

SOURCE: NY Dental Policy and Procedure Code Manual January 1, 2021, page 83 (Accessed Jul. 2021).

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

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

SOURCE: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telehealth, Virtual Communications and Remote Patient Monitoring, p. 6, Nov. 15, 2020 & NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 8C, Outpatient Behavioral Health Services, p. 7, Jan. 1, 2021. (Accessed Jul. 2021).

Outpatient Behavioral Health

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

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

No Reference Found

Behavioral Health

Prior to providing services to a client by telehealth, an eligible provider of the service to be provided 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 Jul. 2021).

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

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

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

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

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

SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Jun. 2021).

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

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

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

SOURCE: OK Admin. Code Sec. 317:30-3-27. (Accessed Jun. 2021).

Prior to the delivery of services via a telehealth modality, a patient oral, recorded, or written consent to receive services using a telehealth delivery method shall be obtained and documented annually. Consent must be updated at least annually thereafter.

SOURCE: OR OAR 410-141-3566, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Telehealth Service and Reimbursement. (Effective Jan. 1, 2021). (Accessed Jun. 2021).

Telehealth services must include patient-clinician agreement of informed consent, discussed with and agreed to by the patient and documented in the medical record.

SOURCE: Oregon Health Authority, Health Evidence Review Commission, Guideline Note Changes for the February 1, 2021 Prioritized List of Health Services, p. AD-3. (02/19/21). (Accessed Jun. 2021).

Prior to the delivery of services via a telehealth modality, a patient oral, recorded, or written consent to receive services using a telehealth delivery method in the language that the patient understands must be obtained and documented by Providers annually. Consent must be updated at least annually thereafter. For LEP and Deaf and hard of hearing patients and their families, providers must use qualified and certified health care interpreters when obtaining patient consent.

SOURCE: OR OAR 410-120-1990, Health Systems Division: Medical Assistance Programs, Telehealth. (Effective Jan. 1, 2021). (Accessed Jun. 2021).

Teledentistry

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

SOURCE: OR OAR 410-123-1265, Health Systems Division: Medical Assistance Programs, Oregon Health Plan, Teledentistry. (Effective Jan. 1, 2021). (Accessed Jun. 2021).

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 Jun. 2021).

Newborn Nurse Home Visiting Services – Effective Only During Governor-Declared or Authority-Declared public health emergency and up to 120 days after the emergency ends

All services provided by telehealth must be provided according to clinical and telehealth guidelines approved by the Authority. All services provided by telehealth must be provided in accordance with these rules except that:

• Screening for intimate partner violence may be delayed or omitted for safety reasons during a telehealth visit.
• Certified providers may obtain oral consent for services, as an alternative to written consent, prior to provision of services. Providers must document consent for services in the family’s record.

SOURCE: Oregon Administrative Rules Sec. 333-006-0170 (Accessed Jun. 2021).

No Reference Found

A patient’s written consent is required prior to the dissemination of any of their images or information to other entities.

A patient may withdraw from the use of telemedicine at any time.

SOURCE: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 30-31 (Feb. 2021) (Accessed Jun. 2021). 

No Reference Found

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

SOURCE: TN Dept. of Mental Health and Substance Abuse Services. Office of Crisis Services and Suicide Prevention. Minimal Standards of Care.  p. 49-50, (2017) (Accessed Jun. 2021).

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 Jun. 2021).

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 medical services, to be physically present in the distant or patient site environment during a telehealth or telemedicine medical 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 medical service.

Distant site providers that communicate with clients using electronic communication methods other than phone or facsimile must provide clients with written notification of the physician’s privacy practices prior to evaluation and treatment. Providers must make a “good faith effort” to obtain the client’s written acknowledgment of the notice, including by email response. A distant site provider should provide patients who receive a telemedicine medical service with guidance on the appropriate follow-up care.

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.

SOURCE: TX Medicaid Telecommunication Services Handbook, pg. 5-7  (Sept. 2021). (Accessed Sept. 2021).

Additional parental or guardian consent may be required if online or web-based screening tools are used that could result in client data being stored electronically in an outside database other than the provider’s electronic medical record system, or if the data is used for purposes other than THSteps screening. The provider should seek legal advice regarding the need for this consent.

SOURCE:  TX Medicaid Children’s Services Handbook, p. 175, (Sept. 2021), (Accessed Sept. 2021).

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. 531.001. (Accessed Sept. 2021).

Behavioral Analysts Program & Dyslexia Therapy 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. 121.70 & Sec. 121.71, (Accessed Sept. 2021).

No Reference Found

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

SOURCE: VT Health Care Administrative Rules 13.174.003 (3.101.5), Telehealth, (Accessed May 2021). 

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

SOURCE: VT Statutes Annotated, Title 18 Sec. 9361 (Accessed May 2021).

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, & Senate Bill 117 (2021 Session), (Accessed May 2021).

Before providing a telehealth service to a member, the Provider shall inform the patient about the use of telehealth and document verbal, electronic or written consent from the patient or legally authorized representative, for the use of telehealth as an acceptable mode of delivering health care services. See Telehealth Supplement for requirements.

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

SOURCE:  VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual Supplement-Telehealth Services (Available in multiple manuals, including physician/practitioner, see overview for full list), p. 5  (July 2021) (Accessed Sept. 2021).

Consent for care via the modality used is required for documentation.

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, Physician-Related Svcs./Health Care Professional Svcs., p. 92 & 94 (Jul. 2021). (Accessed Sept. 2021).

Newly Passed Legislation – 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 as revised by House Bill 1196 (2021 Session), (Accessed Sept. 2021).

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

SOURCE: WV Dept. of Health and Human Svcs. Medicaid Provider Manual, Chapter–519.17.2 Practitioner Services: Telehealth Services. (Revised Mar. 1, 2020) (Accessed Sept. 2021).

Provider must obtain patient’s (or legal guardian’s) written and verbal consent. The patient has the right to withdraw from telehealth services at any point for an alternative service. See manual for consent requirements.

SOURCE: 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). (Accessed Sept. 2021).

Providers must 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.

SOURCE: WI ForwardHealth Online Handbook. Topic #510 Telehealth. (Accessed Sept. 2021).

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

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

• Verbally
• Email
• Text Message

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

SOURCE: WY Dept. of Public Health Insurance, Medicaid, CMS 1500 ICD-10, p. 120-121 (Jul. 2021); Institutional Manual, pg. 115-116, (Jul. 2021); Tribal Provider Manual, pg. 186, (Jul. 2021), (Accessed Sept. 2021).