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DDES Memo Series 2004-14

September 20, 2004

STATE OF WISCONSIN
Department of Health and Family Services
Division of Disability and Elder Services

To:
Area Administrators/Assistant Area Administrators
Bureau Directors
County Departments of Community Programs Directors
County Departments of Developmental Disabilities Services Directors
County Departments of Human Services Directors
County Departments of Social Services Directors
Grassroots Empowerment Project
Licensing Chiefs/Section Chiefs
Mental Health and AODA Coordinators
Mental Health and Substance Abuse Certified Programs
NAMI-Wisconsin
State Council on Alcohol and Other Drug Abuse
State Council on Mental Health
Tribal Chairpersons/Human Services Facilitators
WAODA
Wisconsin Family Ties
Interested Parties

From: 
Sinikka Santala
Administrator

Re:  Mental Health And Substance Abuse Telehealth – Criteria For Certification

Document Summary

The purpose of this memo is to provide background information on Mental Health and Substance Abuse Telehealth and share the attached Request for Approval to Use Telehealth. This request form outlines the specific requirements that certified mental health and substance abuse programs must follow if they want to use telehealth technology as a means of service provision with consumers.

The purpose of this memo is to provide background information on Mental Health and Substance Abuse Telehealth and share the attached Request for Approval to Use Telehealth. This request form outlines the specific requirements that certified mental health and substance abuse programs must follow if they want to use telehealth technology as a means of service provision with consumers. County agencies, providers, state staff, consumers and family members have reviewed and commented on this criterion and the Wisconsin County Human Service Association has endorsed the Template.

Mental Health and Substance Abuse Telehealth is generally described as the use of telecommunication equipment to link mental health and/or substance abuse providers and consumers in different locations. Telehealth is sometimes referred to as telepsychiatry, however treatment professionals other than psychiatrists may use telehealth. Psychologists, Master level therapists, AODA counselors, psychiatric nurses and other staff who are part of a certified program can provide Telehealth services. Telehealth technology allows for the provision of quality behavioral health services, including interactive consultation between a consumer and a professional, assessments, pharmacological management, clinical counseling and consumer screening, with greater access and frequency, and without the additional cost of staff travel or unnecessary consumer transport.

Telehealth has been used in the provision of mental health and substance abuse services in other states for a number of years. The first implementation of telepsychiatry was conducted in the early 1950s at the Nebraska Psychiatric Institute, where they investigated the potential of closed-circuit television as a teaching aid. Ten years later, the first telepsychiatry consultations were performed at the Institute. Telehealth is not new technology that we are testing in Wisconsin. This technology is widely used in Nebraska, Montana, Oregon, Texas, South Carolina, and other states with great success.

Telehealth has been proven to result in many benefits to consumers as well as treatment professionals and funding agencies. Some of the benefits include:

• increase access to child, geriatric, deaf, forensic and specialty staff;
• reduce travel costs, staff time, and per diem costs for consultants;
• increase elements of continuity of care and professional contact;
• increase urban to rural areas skill pools through information transfer;
• increase speed and accuracy of diagnosis and treatment; and,
• increase access to select skills such as sign language, diagnosis, treatment and consultation.

For example, a number of counties in rural Wisconsin have a difficult time recruiting psychiatrists, and when they do they often must pay the psychiatrist from the time they leave their home until they reach the county and begin to provide services. This means the county agency may use significant fiscal resources just for travel time without the psychiatrist even seeing a consumer. Telehealth will allow the county to more easily attract a qualified psychiatrist and pay only for the time the person is actually seeing consumers. In addition, if the consumer is in need of hospitalization, the psychiatrist may be more available, through telehealth consultation, to the admitting hospital, as well as with the other treatment professionals, family members, natural supports, etc.

Telehealth will also enhance the ability of small, remote, rural counties to access specialty services such as child and geriatric psychiatry. This technology should assist in better diagnostic services, correct medication determinations and more successful treatment planning for those individuals most in need.

Telehealth services can be provided to consumers involved in any certified mental health and/or substance abuse programs, such as outpatient services, crisis services, community support services, day treatment programs, inpatient, etc. All staff employed by these programs may provide services via telehealth, provided they have received the necessary training and meet program certification standards. Specific staff providing the services should be outlined in the plan, as required in the certification process.

Medicaid Reimbursement

The Division of Health Care Financing will reimburse for Medicaid-covered services provided via telehealth in the same way it reimburses for face-to-face contacts provided that the following requirements are met.

• The agency is a certified program under one of the following program standards: HFS 34, 36, 40, 61, 63, or 75 (except does not include 75.15), Wis. Admin. Code. Professional staff providing telehealth must be part of one of these certified programs.

• Medicaid will only accept claims for telehealth from providers that are certified under HFS 34, 36, 40, 61, or 75 (except does not include 75.15). Medicaid will not accept claims from individual professional staff.

• The HFS certified program is certified for telehealth by the Bureau of Quality Assurance.

• The service is a service that is covered under one of the Medicaid mental health or substance abuse benefits: outpatient mental health, outpatient substance abuse, pharmacologic management, mental health day treatment, substance abuse day treatment, crisis intervention, community support program, comprehensive community services, or child/adolescent day treatment services.

• The service is not group therapy.

• The provider indicates the "GT" modifier on the claim detail for the specific procedure code. The "GT" modifier definition is "Via interactive audio and video telecommunication systems."

• Providers must continue to follow all Medicaid coverage policies and all other requirements for each particular service.

If you have any questions regarding reimbursement, please contact Christine S. Wolf, LICSW, MH/SA Policy Analyst, Division of Health Care Financing, P. O. Box 7850, Madison, WI 53701, or email her at wolfcs@wisconsin.gov .

Insurance Reimbursement

For insurance billings for telehealth services the agency will need to check with individual policies to determine if telehealth is covered.

Only certified mental health and/or substance abuse services, or agencies planning to be certified as a mental health and/or substance abuse provider, may apply for telehealth certification. The first step in the process is for the agency to write a plan addressing each section in the attached template. Once the plan is completed it should be sent to the Bureau of Quality Assurance (BQA) Program Certification Unit, 2917 International Lane #300, Madison, WI 53704.

UPDATED ADDRESS AS OF 2013:

Attn: Sally Andrews
Behavioral Health Certification Section
Division of Quality Assurance
Department of Health Services
P.O. Box 2969
1 W. Wilson St.
Madison, WI 53701-2969

It is strongly suggested for agencies interested in using telehealth as a means of service provision to establish a stakeholder advisory committee, which should include consumers and family members. The purpose of this committee is to help write the plan for certification and to determine how and when telehealth will be used, and for which services.

Provider’s electing to utilize telehealth must demonstrate compliance with an approved plan to the Bureau of Quality Assurance during a site review or other unannounced focus visits.

There are several provisions in the attached template that are important for successful application of telehealth for mental health and/or substance abuse services. These include:

1. Certified services shall meet the requirements for the corresponding Administrative Code, e.g. HFS 75, HFS 34, HFS 61, etc
2. It is critical that agencies meet the minimum transmission standards to ensure that the telehealth service is of high quality and as close to a face to face visit as possible.
3. All staff using telehealth for service provision must receive orientation and ongoing training on the use of the equipment, the clinical application of telehealth, safety and security during telehealth visits, privacy and confidentiality, back-up procedures if there is equipment failure, and consumer preparation for telehealth.
4. Consumers must be educated about the provision of services provided through telehealth, the history of telehealth, success rate of telehealth services and how telehealth sessions are conducted.
5. The agency has an ongoing method for obtaining consumer satisfaction on telehealth visits and evaluating the results of this survey process.
6. Consumers are given the choice of having a face to face visit with a professional or seeing this person via telehealth.

Regional Office Contact: 
Area Administrator/Assistant Area Administrator

Central Office Contact: 
Area Administration
Office of Strategic Finance
Department of Health and Family Services
PO Box 7850 Room 633
Madison, WI 53707-7850
Telephone – 608-261-7812

MEMO WEB SITE: 
http://www.dhs.wisconsin.gov/partners/local.htm

Attachment:
Form DDE-2589 (fillable Word document) - renamed OQA-2589 (January, 2007)

cc:
Mark Hale, BQA
Chris Wolf, DHCF

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