1. Nature of Telehealth
Telehealth involves the use of secure audio and/or video communications to provide behavioral health services when you and your provider are not in the same location. Your provider will identify themselves with name, credentials, and appropriate state licensure at each visit. Telehealth will be used only when clinically appropriate.
2. Patient Location Requirement (STATE & CMS)
You must provide your physical location at each session. You may participate from any private, safe, confidential location for audio-video telehealth.
Park Valley Behavioral Health Care strongly prefers that patients attend telehealth sessions from their home to ensure safety and privacy, particularly for high-risk individuals. If this is not possible, another private, safe, and confidential location may be approved by your provider based on clinical judgment.
Telehealth services may be provided only when your provider is licensed or otherwise legally authorized to practice in the state where you are physically located at the time of the visit.
Audio-only telehealth services are subject to Medicare and state-specific location and coverage requirements, which may change over time.
3. Potential Benefits and Risks
Benefits include improved access, reduced travel, and continuity of care. Risks include technology failure, limited assessment, or potential loss of privacy.
4. Emergency Procedures
You must provide an emergency contact. Your provider may contact 911, mobile crisis, your emergency contact, or local first responders in a safety emergency. You agree to remain connected during an emergency unless instructed otherwise by emergency personnel. Telehealth is not a substitute for emergency care.
5. Privacy, Security, and Confidentiality
Telehealth uses secure, HIPAA-compliant technology. All federal and state-applicable confidentiality laws apply, including HIPAA, state privacy laws, and 42 CFR Part 2. You must inform your provider if anyone else is present during the session, and you agree not to record the session without permission.
6. Minor Patient Supervision Requirement
Patients under the age of eighteen (18) must be accompanied by a parent or legal guardian for behavioral health services, including telehealth encounters, unless otherwise permitted by law and clinically appropriate. Parental or guardian consent is required for treatment, and the parent or legal guardian must be available during the visit as required by the provider.
7. Medicare Requirements (CMS 11/20/2025 FAQ)
Medicare may allow behavioral health telehealth services from a patient’s home or other approved locations when all CMS coverage, documentation, and clinical requirements are met.
Some Medicare beneficiaries may be required to have periodic in-person visits in order to continue receiving certain telehealth services, as required by CMS and subject to change. Park Valley Behavioral Health Care will notify you if an in-person visit is required for continued telehealth eligibility.
8. Audio-Only Telehealth (CMS & STATE)
Audio-only behavioral health telehealth services may be provided only when permitted by CMS and applicable state law, and when your provider determines such services are clinically appropriate. CMS may require that you be located in your home and that video is unavailable or declined in order for audio-only services to be eligible for coverage, which is not guaranteed and depends on payer requirements.
9. Limitations of Telehealth
Telehealth may not be appropriate during severe crises, active suicidal or homicidal thoughts, psychosis, or substance intoxication. Your provider may require an in-person visit or a higher level of care.
10. Patient Responsibilities
You agree to participate from a private location, not while driving or operating machinery, and to maintain updated phone numbers, address, and emergency contact information.
Your signature indicates that you understand that your behavioral health services may be provided through telehealth using secure, HIPAA-compliant audio and/or video communication technology, including GoTo Meeting. You acknowledge that, in order to participate in telehealth appointments, it may be necessary for this practice to send you a telehealth session link via text message to the mobile phone number you have provided.
You understand that text messaging is not a fully secure form of communication and that there is a potential risk that messages may be accessed by unauthorized individuals. You agree to take reasonable steps to protect the privacy of your mobile device and communications. Standard text messaging and data rates may apply.
You understand that telehealth behavioral health services are governed by applicable state and federal laws, including HIPAA and state telehealth regulations, and that the same standards of confidentiality apply to telehealth services as to in-person services.
By signing this consent, you authorize this practice to communicate with you via text message for the limited purpose of sending telehealth appointment links and related scheduling communications, and you acknowledge that your signature constitutes your informed consent to receive telehealth session links via text message.
11. Billing and Insurance
Telehealth services are billed the same as in-person services. Co-pays are due prior to the telehealth visit. Insurance plan coverage varies. Park Valley will bill your insurance when applicable and you are responsible for any non-covered charges.
12. Right to Withdraw Consent
You may withdraw consent for telehealth at any time. Your provider may discontinue telehealth if it becomes clinically inappropriate or unsafe.