Telemental Health Compliance Attestation Requirements – Prescriber

Action:

1. Review each requirement carefully and confirm you are able to meet each requirement
2. Go back to the Telemental Health page and complete the electronic Attestation (Step 4) or click here.

Attestation Requirements:

1. I have confirmed that the videoconferencing technology that will be used to deliver Telemental Health is compliant with HIPAA requirements as well as current American Telemedicine Association (ATA) minimum standards including: a minimum Internet connection bandwidth of 384 kilobits per second, a minimum live video display resolution of 640 x 360 pixels at 30 frames per second. The videoconference equipment conforms with applicable federal and state regulations.
   • Please note: You will also be required to provide the name of the video conferencing technology you will be using.
     
2. I am and will remain in compliance with all applicable laws, rules, regulations and state board requirements applicable to the delivery of Telemental Health, prescribing, coding requirements, and documented protocols (e.g., informed consent, emergency contact information).
3. I will provide Telemental Health in a private and secure environment. Rooms to be used for Telemental Health will have adequate lighting and will be reasonably soundproof for patient privacy.
4. I will ensure that all documents containing protected health information or personal health information, including prescriptions, are transmitted securely in accordance with all privacy rules including HIPAA.
5. I have the appropriate protocols in place and have trained my staff on protocols and procedures related to technical or other types of failure that may disrupt service delivery.
6. I understand and agree that I must hold and will only provide services when properly licensed according to state requirements for providing services within the state where the member is physically located at the time of the services.
7. I meet the prescriptive authority requirements and possess a valid DEA for each state in which I am licensed.
8. I and my staff are appropriately trained in, and will comply with, proper claim submission procedures, including use of GT modifier for Telemental Health.
9. My malpractice insurance carrier has been notified and has delivered the appropriate rider or proof of coverage for Telemental Health, as applicable to my scope of practice.

You will be asked if you have completed the ATA Delivering Online Video Based Mental Health Services online course─this is not required, however highly recommended.

Note: We encourage all providers who plan to deliver Telemental Health services to complete the American Telemedicine Association Delivering Online Video Based Mental Health Services online course prior to electronically signing the Telemental Health Attestation. It is a 3-hour course worth 3 CUs at a special negotiated rate of $50 discount off of the standard price ($149 vs. the standard $199) for Optum network providers.

Click here to review the course overview
Click here to complete the course.