Last updated 09/04/2024
Consent Requirements
Patient Consent
Informed consent procedure:
- The professional will explain to the patient how they will carry out services through Telehealth.
- The professional will take measures to protect the patient’s information and his giving his consent to the disclosure of your information to through Telehealth, you will be sure to demonstrate it through written informed consent.
- In the case of minor patients or people declared legally incapable, the written authorization from parents or legal guardian hold parental authority over the minor, or the authorization of the guardian appointed by the Court, as the case may be.
- The consent must warn about the risk of loss of confidentiality inherent to the use of the technology.
SOURCE: Departamento de Salud, Reglamento Para Regular La Ciberterapia en Puerto Rico, Numero 9517 (Dec. 2023), Article 5, Section 5.3 & Departmento De Salud, Reglamento Para El USO De La Telesalud En Puerto Rico, Numero 9518 (Dec. 1, 2023), Article 5, Section 5.3. (Accessed Sept. 2024).
Informed Consent for Telemedicine
Prior to receiving telemedicine or telehealth services, all patients must sign an informed consent form expressing their agreement to receive the services. If the patient does not agree to use telemedicine or telehealth services, the physician or health professional must not provide the services or charge any type of fee if the patient refuses the consultation.
The patient retains the option to accept or deny the service at any time, without affecting the right to receive any other type of medical or health care or attention through telemedicine or telehealth. In the event that the patient is a minor, or a person declared legally incapable, this Article shall apply to his or her guardian, tutor or legal representative.
This consent may be electronic and must be documented in the patient’s file. In addition, the consent must include the risk of loss of confidentiality inherent in the use of technology.
Before you begin the consultation, you must ensure that your patient consents to receive the service via telemedicine. Develop a specific format for telemedicine:
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- Make sure your patient understands the risks, benefits, and alternatives of Telemedicine
- Discuss with your patient the advantages, such as safer access or convenience, versus the risks and limitations of using telemedicine, despite all the measures taken.
- Analyze the patient’s capacity to use technology and to consent to the use of Telemedicine.
- Prior to the consultation, send the consent to be signed by the patient through a means that allows secure electronic communication and request that it be returned signed by the same means.
- If you are unable to send consent via email or your patient is unable to return it signed, consider asking the patient to confirm via text message that the consent was discussed, understood, and authorized.
- Include in the medical record a copy of the consent form you used as evidence of the points discussed.
- In the event that the patient does not consent to the use of Telemedicine, the patient must document in the file that the service was offered and that the patient did not agree.
- Document that the patient gave his/her consent prior to providing the service and that he/she accepted the use of Telemedicine, as well as the disclosure of his/her information, even understanding the risks and limitations of communicating through electronic means.
- In the case of minors or incapacitated persons, request written authorization from the parents or guardian.
- As with all visits with a patient, you must document the consultation and the means by which it was conducted. The requirements are the same as for a face-to-face encounter in that you need to document the relevant history.
- Make sure you are caring for the right patient.
SOURCE: Guidelines & Protocols for Telehealth in Puerto Rico & Department de Salud: Telehealth: Informed Consent for Telemedicine. (Accessed Sept. 2024).
Last updated 09/03/2024
Definitions
Telehealth: It means remote care that health professionals, beyond doctors, offer to their patients through the use of technologies, services electronics and telecommunications.
SOURCE: Departmento De Salud, Reglamento Para El USO De La Telesalud En Puerto Rico, Numero 9518 (Dec. 1, 2023), Article 1, Section 1.6. (Accessed Sept. 2024).
Cybertherapy: Refers to the individual-therapist interaction mediated by technological communication tools and information. These may include, but are not limited to a diagnostic services, evaluation, analysis, consultations, supervision, information, education, interpretation and intervention with the needs and expectations of the individual who receives them.
SOURCE: Departamento de Salud, Reglamento Para Regular La Ciberterapia en Puerto Rico, Numero 9517 (Dec. 2023), Article 1, Section 1.6 (Accessed Sept. 2024).
Telehealth – It means that healthcare professionals, other than doctors, provide remote care to their patients through the use of technologies, electronic services and telecommunications.
Telemedicine – It is the practice of remote medical care incorporating diagnosis, treatment and medical education through the use of technological resources to optimize health care services. They must include, but are not limited to, complementary and instant services to the care of a specialist; immediate diagnoses by a specialist doctor in a given area or region; remote education of students from schools of nursing schools, health and medicine professionals; digital archiving services for radiological examinations, ultrasounds, medical emergencies and others. In the case of Rehabilitation Centers, physical therapists, occupational therapists and speech therapists will be included for Telemedicine purposes.
SOURCE: Telesalud. Departamento de Salud. (Accessed Sept. 2024).
Telehealth is the use of communication technologies to provide health services at a remotely. Telehealth is a broad term that includes telemedicine, but also involves aspects such as: training for health professionals, coordination of medical care and related services such as mental health and pharmacy.
Telemedicine is the provision of clinical services by health professionals; through the use of technology and communication for the exchange of valid information for diagnosis, treatment, disease prevention, research and evaluation. All this with the aim of improving the health of communities.
Source: Telemedicina Y Telesalud. Departamento de Salud. (Accessed Sept. 2024).
Last updated 09/04/2024
Email, Phone & Fax
The consultation must be in real time, making the interaction is almost the same as a face-to-face consultation, ensuring that patients are evaluated and treated appropriately, with the only exception that the professional and patient are not in the same place.
SOURCE: Departamento de Salud, Reglamento Para Regular La Ciberterapia en Puerto Rico, Numero 9517 (Dec. 2023), Article 5, Section 5.1 & Departmento De Salud, Reglamento Para El USO De La Telesalud En Puerto Rico, Numero 9518 (Dec. 1, 2023), Article 5, Section 5.1. (Accessed Sept. 2024).
Last updated 09/04/2024
Live Video
Policy
Any professional certified to offer their services through Telehealth (Cybertherapy) will be able to bill health insurance companies and the Insurance Administration of Health (ASES) for the services provided, and they will be obliged to pay the same with the same rate established in the contract, as if it were a service provided in person. For these purposes, insurance companies of health and ASES, will have to provide the professionals who request it with the corresponding codes for billing for the services provided through Telehealth.
SOURCE: Departmento De Salud, Reglamento Para El USO De La Telesalud En Puerto Rico, Numero 9518 (Dec. 1, 2023), Article 7., Departamento de Salud, Reglamento Para Regular La Ciberterapia en Puerto Rico, Numero 9517 (Dec. 2023), Article 7. (Accessed Sept. 2024).
The Puerto Rico Medicaid delivery system is a subset of the larger public government healthcare delivery system for most of the island’s population. The Puerto Rico Department of Health is the single state agency, and they have a cooperative agreement with the Puerto Rico Health Insurance Administration (PRHIA) also known as Administracion de Seguros Salud de Puerto Rico (ASES) which implements and administers island-wide health insurance system. Approximately half of Puerto Rico’s 3.5 million residents have low incomes and depend upon the public health system for their medical care.
https://www.medicaid.gov/state-overviews/puerto-rico.html
The practice of Telemedicine must take into consideration those aspects as defined by the “Center for Medicare Services” (CMS), for the purposes of the “Act for the Use of Telemedicine and Telehealth in Puerto Rico ” [Law 168-2018, as amended] Rev. November 19, 2020, the consultations made may be considered for reimbursement by “Medicare”, “Medicaid” other medical plans.
Synchronous teleconsultations are carried out in real time (term most used in the international arena), involving the participation of both patients and health professionals in sending information, sometimes using sophisticated telecommunication technologies.
Telecare – Refers to equipment in the home that allows independent living and issues data and alerts to caregivers. Telecare is a monitoring system for the elderly or dependents. The innovative service consists of a wearable device hidden under the guise of a simple watch, connected 24×7 to a central control unit, which receives the user’s vital signs, location and signals. If an emergency situation is detected, we contact the user, family members and emergency care agencies if necessary.
Teleconsultation- Remote communication between patient and provider. It is a system that uses computers and telecommunications for the purpose of providing health care at the hands of specialized personnel.
SOURCE: Telesalud. Departamento de Salud. (Accessed Sept. 2024).
Synchronous: Synchronous Teleconsultation (face to face) is carried out in real time between the health professional and the patient requesting the service.
Source: Telemedicina Y Telesalud. Departamento de Salud. (Accessed Sept. 2024).
Eligible Services/Specialties
Any professional licensed and certified to offer their services through Cybertherapy, may bill health insurance companies and the Health Insurance Administration (ASES) for the services provided, and these they will be obliged to pay them as if it were a service provided in person. For these purposes, the health insurance companies and ASES, They will have to provide the professionals who request it with the corresponding codes for billing for services provided through Cybertherapy.
SOURCE: Departamento de Salud, Reglamento Para Regular La Ciberterapia en Puerto Rico, Numero 9517 (Dec. 2023), Article 7. (Accessed Sept. 2024).
Eligible Providers
The provisions of this Regulation apply to the following health professionals duly authorized to exercise their specialty who are interested in obtaining a certification for offer services using Telehealth:
- Audiologists
- Chiropractors
- Dentists
- Health Educators and Pharmacists
- Veterinary Doctors
- Podiatrists
- Doctors in Naturopathy and Naturopaths
- Nutritionists and Dietitians
- Optics
- Optometrists
- Those categories of nursing included in the Law No. 254 of December 31, 2015.
SOURCE: Departmento De Salud, Reglamento Para El USO De La Telesalud En Puerto Rico, Numero 9518 (Dec. 1, 2023), Article 1, Section 1.5. (Accessed Sept. 2024).
Cybertherapy
The provisions of this Regulation apply to all health professional duly authorized to practice practice of physical therapy, occupational therapy, speech-language therapy, psychology, professional counseling and counseling in rehabilitation, who is interested in obtaining a certification for offer services using Cybertherapy.
This regulation is promulgated with the purpose of promoting, facilitate and incorporate into our jurisdiction the advances technologies in the practice of physiotherapy, therapy occupational, speech-language therapy, psychology, counseling professional and rehabilitation counseling, in addition to having that every professional duly licensed and authorized to practice the practices described above, can invoice the services provided using Cybertherapy, as established in Law No. 48-2020, to health insurance companies and to the Health Insurance Administration (ASES).
SOURCE: Departamento de Salud, Reglamento Para Regular La Ciberterapia en Puerto Rico, Numero 9517 (Dec. 2023), Article 1, Section 1.3 & 1.5 (Accessed Sept. 2024).
Eligible Sites
No reference found.
Geographic Limits
No reference found.
Facility/Transmission Fee
No reference found.
Last updated 09/04/2024
Miscellaneous
Each examination board attached to the Office of Regulation and Certification of Health Professionals (ORCPS) of the Department of Health/ within the specialties regulated by the Law No. 168-2018, must adopt those regulations that understand essential for the good practice of the profession when offered services through Telehealth. Since the approval of the same, every applicant must comply with the requirements imposed for each board to obtain the certification authorized by Law No. 168-2018, including continuing education requirements, among others.
Each Board will issue the Certification for the practice of Telehealth to all audiologists, chiropractors, dentists, health educators, pharmacists, veterinarians, podiatrists, naturopathic doctors, naturopaths, nutritionists and dieticians, opticians, optometrists, and those within the nursing categories included in Law 254-2015, which thus request it and that they comply with the requirements established in the Article 2.2 of this regulation.
The Certification issued by the Board will authorize the professional to make your queries remotely using means technological, such as: telephones, video calls, applications or any other technological tool that is appropriate for each of the professions covered by the Law 168-2018. The Certification also authorizes consultations outside the geographical limits of Puerto Rico, but within the jurisdiction of the United States, provided that the professional meets the requirements established in the state or jurisdiction in which the patient is currently located of the consultation
SOURCE: Departmento De Salud, Reglamento Para El USO De La Telesalud En Puerto Rico, Numero 9518 (Dec. 1, 2023), Article 1, Section 1.5, Article 2, Section 2.1, 2.3 . (Accessed Sept. 2024).
Last updated 09/05/2024
Out of State Providers
Certification to practice in Puerto Rico required.
SOURCE: Law No. 68 of 2020 For the Use of Telemedicine in Puerto Rico. Regulation 9107 of August 20, 2019 Telemedicine Use in Puerto Rico (original law). (Accessed Sept. 2024).
Cybertherapy
Each examination board attached to the Office of Regulation and Certification of Health Professionals Health (ORCPS) of the Department of Health, within the specialties regulated by Law No. 48-2020, must adopt those standards that they consider essential for the good practice of the profession when offering services through Cybertherapy. Since the approval of the same, every applicant must meet the requirements taxes by each board to obtain certification authorized by Law No. 48-2020, including requirements for continuing education, among others. The present body of standards will not be applicable to the Social Work professionals in Puerto Rico. It recognizes the faculty of the Examination Board of Labor Professionals Social, attached to the Department of State of Puerto Rico, establish the standards that regulate this profession, including licensing, continuing education, among other requirements applicable to these professionals, under Law No. 171 of May 11, 1940, as amended.
SOURCE: Departamento de Salud, Reglamento Para Regular La Ciberterapia en Puerto Rico, Numero 9517 (Dec. 2023), Article 1, Section 1.5 (Accessed Sept. 2024).
Last updated 09/04/2024
Overview
Recently adopted regulations indicate that Puerto Rico Insurance Administration of Health (ASES) are obliged to pay the same rate for services covered in-person as they would had the service been provided via telehealth. ASES will need to provide professionals who request it corresponding codes for billing services delivered via telehealth. However, the services must be in real-time and almost the same as a face-to-face consultation.
NOTE: CCHP utilized Google translate for any information presented here in English. Some discrepancies may be caused in the translation process. Please access the “Source” link provided for the original Spanish version.
Last updated 09/04/2024
Remote Patient Monitoring
Remote monitoring: Facilitates remote self-care through the use of electronic equipment and systems (e.g. vital signs monitoring platforms).
Source: Telemedicina Y Telesalud. Departamento de Salud (Accessed Sept. 2024).
Tele-monitoring – Facilitates self-care with electronic equipment. The data is stored in a repository. It consists of measuring, observing and even modifying the course of one or more vital parameters of a patient through electronic means and remote communication. These parameters include, for example, pulse, respiration, blood pressure, blood glucose and oxygen, and many others.
Teleconsultation- Remote communication between patient and provider. This is a system that uses information technology and telecommunications to provide healthcare assistance from specialized personnel.
Source: Telemedicina Y Telesalud. Departamento de Salud (Accessed Sept. 2024).
The consultation must be in real time, making the interaction is almost the same as a face-to-face consultation, ensuring that patients are evaluated and treated appropriately, with the only exception that the professional and patient are not in the same place.
SOURCE: Departamento de Salud, Reglamento Para Regular La Ciberterapia en Puerto Rico, Numero 9517 (Dec. 2023), Article 5, Section 5.1 & Departmento De Salud, Reglamento Para El USO De La Telesalud En Puerto Rico, Numero 9518 (Dec. 1, 2023), Article 5, Section 5.1. (Accessed Sept. 2024).
Conditions
No reference found.
Provider Limitations
No reference found.
Other Restrictions
No reference found.
Last updated 09/04/2024
Store and Forward
Policy
Asynchronous – Asynchronous teleconsultation (by email or text messages) is carried out by sending clinical information, with advice provided later.
Source: Telemedicina Y Telesalud. Departamento de Salud. (Accessed Mar. 2024).
Referral requests to different specialties are received from general practitioners. An expert physician assesses the completeness of the data and sends the results for review and opinion by the specialist physician. Asynchronous teleconsultations are carried out by sending clinical information, and subsequent advice occurs later; a clear example of this type is teledermatology, where dermatological images are sometimes sent via email to refer consultations or share clinical cases; similarly, on websites such as the NHS in England, the patient is advised about the symptoms they present. One of the greatest advantages of asynchronous teleconsultation, generally called “store-and-forward” is that the parties involved do not have to be present during the transfer of information. Additionally, they have the capacity to capture and store static or moving images of the patient, as well as audio and text, which provides greater clinical information that is reflected in the quality of the diagnoses. These applications are widely used in teledermatology, teleophthalmology, teleneurology and otorhinolaryngology, and have the advantage of being economical, and ideal for high volume work and testing.
Source: Telemedicina Y Telesalud. Departamento de Salud. (Accessed Mar. 2024).
The consultation must be in real time, making the interaction is almost the same as a face-to-face consultation, ensuring that patients are evaluated and treated appropriately, with the only exception that the professional and patient are not in the same place.
SOURCE: Departamento de Salud, Reglamento Para Regular La Ciberterapia en Puerto Rico, Numero 9517 (Dec. 2023), Article 5, Section 5.1 & Departmento De Salud, Reglamento Para El USO De La Telesalud En Puerto Rico, Numero 9518 (Dec. 1, 2023), Article 5, Section 5.1. (Accessed Sept. 2024).
Eligible Services/Specialties
No reference found.
Geographic Limits
No reference found.
Facility/Transmission Fee
No reference found.
