Colorado Medical Board
Evaluation and Treatment of the Patient: An appropriate medical evaluation and review of relevant clinical history, commensurate with the presentation of the patient to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided, should be performed prior to providing treatment, including issuing prescriptions, electronically or otherwise. Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional (encounter in person) settings. Treatment, including issuing a prescription based solely on an online questionnaire, does not constitute an acceptable standard of care.
Continuity of Care: Physicians should adhere to generally accepted standards of medical practice as it relates to continuity and coordination of care.
Referrals for Emergency Services: An emergency plan should be provided by the provider to the patient when the care provided using telehealth technologies indicates that a referral to an acute care facility or Emergency Department for treatment is necessary for the safety of the patient.
Medical Records: The medical record should include, if applicable, copies of all patient-related electronic communications, including patient-provider communication, prescriptions, laboratory and test results, evaluations and consultations, records of past care, and instructions obtained or produced in connection with the utilization of telehealth technologies. Informed consents obtained in connection with an encounter involving telehealth technologies should also be filed in the medical record. The patient record established during the use of telehealth technologies must be accessible and documented for both the provider and the patient, consistent with all established laws and regulations governing patient healthcare records.
Privacy and Security of Patient Records & Exchange of Information: Providers should meet or exceed applicable federal and state legal requirements of medical/health information privacy, including compliance with the Health Insurance Portability and Accountability Act (HIPAA) and state privacy, confidentiality, security, and medical record retention rules. Written policies and procedures should be maintained at the same standard as traditional in person encounters for documentation, maintenance, and transmission of the records of the encounter using telehealth technologies.
Parity of Professional and Ethical Standards: A provider’s professional discretion as to the diagnoses, scope of care, or treatment should not be limited or influenced by non-clinical considerations of telehealth technologies, and provider remuneration or treatment recommendations should not be materially based on the delivery of patient-desired outcomes (i.e. a prescription or referral) or the utilization of telehealth technologies.
Exemptions from Policy 40-27 Guidelines for the Appropriate Use of Telehealth Technologies in the Practice of Medicine: The Colorado Medical Board recognizes the challenges during a public health emergency. The Food and Drug Administration (“FDA”) guidelines for testing in times of a public health emergency shall guide Colorado policy for the purposes of Policy 40-27: Guidelines for the Appropriate Use of Telehealth Technologies in the Practice of Medicine.
SOURCE: The Colorado Medical Board Policies, 40-27, page 101-103. Guidelines for the Appropriate Use of Telehealth Technologies in the Practice of Medicine. 8/19/21. (Accessed Jan. 2024).
Colorado Mental Health Boards Teletherapy Policy
Evaluation and Treatment of the Patient: An appropriate mental health evaluation and review of relevant clinical history, commensurate with the presentation of the patient to establish diagnoses and identify underlying conditions, should be performed prior to providing treatment. Treatment and consultation recommendations made in an online setting will be held to the same standards of appropriate practice as those in traditional (encounter in person) settings.
Mandatory Disclosure Statement: Appropriate mandatory disclosure statement should be obtained for a teletherapy encounter including those elements required by law and generally accepted standards of practice.
Continuity of Care: Licensees, certificate holders, and registrants should adhere to generally accepted standards of mental health practice as it relates to continuity and coordination of care.
Referrals for Emergency Services: An emergency plan should be provided by the provider to the patient when the care provided using teletherapy technologies indicates that a referral to an Emergency Department for treatment is necessary for the safety of the patient.
Mental Health Records: The mental health record should include, if applicable, copies of all patient-related electronic communications, including patient-provider communication, evaluations and consultations, records of past care, and instructions obtained or produced in connection with the utilization of teletherapy technologies. Mandatory disclosure statements obtained in connection with an encounter involving teletherapy technologies should also be filed in the mental health record. The patient record established during the use of teletherapy technologies must be accessible and documented for both the provider and the patient, consistent with all established laws and regulations governing patient healthcare records.
Privacy and Security of Patient Records & Exchange of Information: Providers should meet or exceed applicable federal and state legal requirements of mental health information privacy, including compliance with the Health Insurance Portability and Accountability Act (HIPAA) and state privacy, confidentiality, security, and medical record retention rules. Written policies and procedures should be maintained at the same standard as traditional in-person encounters for documentation, maintenance, and transmission of the records of the encounter using teletherapy technologies.
Disclosures and Functionality for Providing Online Services: Disclosures and advertising should be made in accordance with state and federal law. Parity of Professional and Ethical Standards. There should be parity of ethical and professional standards applied to all aspects of a provider’s practice. A provider’s professional discretion as to the diagnoses, scope of care, or treatment should not be limited or influenced by non-clinical considerations of teletherapy technologies, and provider remuneration or treatment recommendations should not be materially based on the delivery of patient-desired outcomes or the utilization of teletherapy technologies.
Policy
When listed, certified, registered, or licensed and treating clients within the State of Colorado, it is at the discretion of the licensee, certificate holder, or registrant as to the type of modality of treatment format that is appropriate for the client. Regardless of the modality chosen, the licensee, certificate holder, or registrant must comply with all provisions as outlined in the Mental Health Practice Act, Title 12 Article 43.
Once a licensee, certificate holder, or registrant chooses to provide psychotherapy via electronic means, the licensee, certificate holder, or registrant is expected to carefully identify and address issues that involve:
- The agreed upon therapeutic means of communication between the client and the licensee, certificate, or registrant. (i.e. if/when will face-to-face contact be appropriate, what method(s) of electronic communication will be utilized, what is
the structure of the contractual relationship);
- Implementing consent form(s) and proper disclosure(s) including, but not limited to the client’s knowledge regarding security issues, confidentiality, structure, etc.;
- Ensuring that the therapeutic means of communication includes confidentiality and computer/cyber security;
- Determining the basis and ability for the licensee, certificate holder, or registrant to support the rationale for the decision to choose a particular therapeutic method;
- Ensuring that the licensee, certificate holder, or registrant is practicing within his/her scope of practice;
- Ensuring that the therapeutic means of communication that is chosen does not cause any potential harm to the client.
The licensee, certificate holder, or registrant may encounter specific challenges while providing psychotherapy through electronic means. The licensee, certificate holder, or registrant must realize that these challenges may include, but are not limited to:
- Verifying the identity of the client and determining if they are a minor;
- Providing the client with procedures for alternative modes of communication when there is possible technology failure;
- Assessing how to cope with potential misunderstandings when the visual cues that would normally occur during face-to-face visits do not exist;
- Assessing how to address crisis intervention when necessary;
- Ensuring that clients are knowledgeable with regard to encryption methods, firewall, and backup systems to help secure communication and educate clients on the risk of unsecured communications;
- Establishing a means to retain and preserve data;
- Upon request, have the ability to capture and provide client treatment notes, summaries or other information that is received via the electronic technology;
- Disclosing that health insurance coverage may not exist for psychotherapy service that is provided through technological means.
Disclaimer: This policy applies only to mental health professionals who are certified, registered, or licensed, and treating clients within the State of Colorado.
SOURCE: State Board of Psychologist Examiners Policies, 30-1, page 10-12. Teletherapy Policy – Guidance regarding Psychotherapy through Electronic Means. 2/2/18. (Accessed Jan. 2024).
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