Legal and Reimbursement Issues
Shabana Khan, MD

• Telepsychiatrists should consult federal and state laws, as well as the laws, regulations, and policies of their medical licensing board and the Drug Enforcement Administration (DEA) prior to initiating telepsychiatry services with youth.
• Many states require guardian consent, written and/or verbal, for telepsychiatry services in addition to the usual consent for care.
• Telepsychiatrists must consider that reporting requirements may vary by jurisdiction and ensure that relevant personnel at the distant (provider location) and originating (patient location) sites are informed of reporting requirements for youth.
• The Ryan Haight Online Consumer Pharmacy Protection Act of 2008 impacts the legitimate practice of child and adolescent telepsychiatry. The requirement for the initial in-person evaluation is a major barrier for telepsychiatry with youth and the exceptions to this requirement are narrow and do not apply to many telepsychiatry applications. 
• The Ryan Haight Act is also relevant to the increasing trend towards direct-to-consumer telepsychiatry as the home setting is not an approved site of service for prescribing controlled substances.
• Teletelepsychiatrists should comply with the AACAP Code of Ethics.
• In the absence of a comprehensive policy for delivering telemedicine services, individual states have proposed legislation to expand services in several ways, such reimbursing for school-based telepsychiatry services or repealing laws that mandate minimum distance requirements between distant and originating sites in order to receive reimbursement.
• The majority of states have telehealth commercial insurance coverage laws that require private insurers to cover telemedicine services similar to in-person care, however only a subset of these states have payment parity laws which require insurers to pay telemedicine providers the same amount as they would if that same service were provided in-person.
• Some states require coverage for telepsychiatry services for specific circumstances or disorders, such as the delivery of autism interventions.

References

1. Clinical update: Telepsychiatry with children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry.2017;56(10):875-893.
2. Ryan Haight Online Pharmacy Consumer Protection Act. In: L P, ed. No110, HR 6353; 2008.
3.  American Academy of Child & Adolescent Psychiatry. Code of ethics. Published September 2014. Accessed May 3, 2018.
4. Center for Connected Health Policy. Telehealth policy. Laws and reimbursement policies: Advanced search. Published 2018. http://www.cchpca.org/laws/list?field_area_of_law_tid[0]=99&field_status_tid[0]=127&items_per_page=10&page=1. Accessed 2 May, 2018.