CurrentDelaware Department of Health and Social ServicesPolicy DSAMH040

Telemedicine in DSAMH Licensed and Certified Sites

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This policy governs the use of telemedicine by DSAMH-licensed, certified, operated, state-provider, and contracted programs. It establishes requirements for licensure, Medicaid enrollment, patient safety, consent, documentation, staffing, billing, privacy, provider credentials, and escalation to in-person or emergency services.

Policy Summary

PayerDelaware Department of Health and Social Services

PolicyTelemedicine in DSAMH Licensed and Certified Sites

Policy CodePolicy DSAMH040

Change TypeNo material change

Effective DateAug 5, 2022

Last ReviewJul 9, 2026

Next Review DateNot specified

Key ActionAt each service, verify the client’s identity using at least two identifiers, confirm location and psychological safety, and obtain appropriate consent.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

0%Telemedicine-only programs licensed or certified by DSAMH

2Minimum client identifiers per service

AnnualPolicy review frequency

Covered

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CurrentDelaware Department of Health and Social ServicesPolicy DSAMH040

Telemedicine in DSAMH Licensed and Certified Sites

Customize your policy alerts

Sign up for Delaware Department of Health and Social Services Policy DSAMH040 alerts

Get alerted when Policy DSAMH040 changes without checking for updates manually.

Monitor payer policy activity

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Policy Summary

PayerDelaware Department of Health and Social Services

PolicyTelemedicine in DSAMH Licensed and Certified Sites

Policy CodePolicy DSAMH040

Change TypeNo material change

Effective DateAug 5, 2022

Last ReviewJul 9, 2026

Next Review DateNot specified

Key ActionAt each service, verify the client’s identity using at least two identifiers, confirm location and psychological safety, and obtain appropriate consent.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

0%Telemedicine-only programs licensed or certified by DSAMH

2Minimum client identifiers per service

AnnualPolicy review frequency

Covered

Originating-site facility fee

Not coveredDistant-site facility fee

Telemedicine Eligibility and Restrictions

Telemedicine eligibility and operational requirements

A program may provide telemedicine only when all applicable program, clinical, legal, payer, and operational requirements are satisfied.

ALL of the following

The program is DSAMH-licensed, certified, operated, state-provided, or contracted and has a physical site with the capacity and intention to offer in-person services.
The program has the capacity to enroll in the Delaware Medical Assistance Portal (DMAP) when Medicaid certification or reimbursement applies.
Telemedicine is clinically appropriate and safe for the client. If it is unsafe or clinically inappropriate, the program provides or escalates the encounter to in-person treatment or an emergency response protocol.
A provider-patient relationship is established, including verification of the patient's location and identity to the extent possible, disclosure and validation of the provider's identity and credentials, appropriate consent, diagnosis using acceptable medical practices, discussion of diagnoses and treatment options, follow-up coverage, and a written visit summary.
Appropriate telemedicine consent and encounter-level verification are completed and documented, including confirmation that no unauthorized person is present, psychological safety, client location, identity using at least two identifiers, and verbal agreement to telemedicine at each service unless another legally permitted consent method applies.At least 2 client identifiers
Examples include the client's name and date of birth. Consent exceptions permitted by law, including certain involuntary-detention circumstances, must still meet all other telemedicine safeguards and confidentiality requirements.
The program maintains required policies and procedures for ADA access, privacy and HIPAA safeguards, emergency response, diversion prevention, medication consent, client suitability, staffing, credentialing, billing, and documentation.
The program follows applicable service-specific, payer, contractual, federal, Delaware, professional-board, SAMHSA, and DEA requirements, applying the higher standard when requirements conflict.

Telemedicine exclusions and restrictions

Telemedicine is restricted or unavailable in the following circumstances.

ANY of the following

The program seeks DSAMH licensure or certification while operating entirely through telemedicine without a qualifying physical site and the capacity and intention to offer in-person services.
DSAMH does not license or certify a program that seeks to practice 100% telemedicine at application or throughout the license or certification period.
Telemedicine is clinically inappropriate or unsafe for the client's circumstances, including circumstances requiring in-person treatment or emergency response.
A DSAMH certification or license, payer or contractual requirement, professional-board rule, federal or state law, or other applicable regulation requires direct in-person contact or prohibits telemedicine.

Operational Coding and Review Requirements

Client verification

MinimumAt least 2 client identifiers are required at each telemedicine service.

ExamplesIdentifiers may include the client’s name and date of birth.

TimingIdentity must be verified at the time of each service.

Policy review

Minimum frequencyReview telemedicine policies at least annually.

UpdatesUpdate policies as needed.

Policy lifespanThis policy will be reviewed annually.

Provider Responsibilities

Note

Comply With Governing Telemedicine Laws

Comply with all applicable telemedicine requirements. DSAMH-licensed and certified programs must comply with Delaware law, the law of the originating state when applicable, federal telemedicine law, and this policy. Telemedicine treatment and consultation must meet the same standard of care as comparable in-person services.

Apply requirements of Delaware Code Title 24, Chapter 60 and any applicable originating-state laws.
Follow federal requirements and any discipline-specific requirements established by the applicable professional board.
When requirements conflict, apply the higher standard and consult house counsel and DSAMH.

Billing Rule

Maintain DMAP and Physical-Site Capacity

Maintain DMAP enrollment capacity and a physical site capable of providing in-person services. DSAMH will only license or certify programs within its authority that can enroll in the Delaware Medicaid Assistance Portal (DMAP) and have the capacity and intent to offer in-person services. Programs may not be licensed or certified as 100% telemedicine programs at application or throughout the license or certification period.

Telemedicine Terms

Asynchronous

DefinitionStore-and-forward applications for client treatment that are not delivered through live telemedicine means.

DMAP limitationAsynchronous telemedicine does not meet the DMAP definition of telemedicine.

Manual referenceThe limitation is stated in relation to The Adult Behavioral Health Services DHSS Certification and Reimbursement Manual.

Certification

DefinitionDSAMH-issued Medicaid certification for programs that meet the minimum requirements in The Adult Behavioral Health Services DHSS Certification and Reimbursement Manual.

Enrollment approvalThe certification verifies DSAMH approval to enroll the provider in the Delaware Medical Assistance Portal (DMAP).

Policy Summary

PayerDelaware Department of Health and Social Services

PolicyTelemedicine in DSAMH Licensed and Certified Sites

Policy CodePolicy DSAMH040

Change TypeNo material change

Effective DateAug 5, 2022

Last ReviewJul 9, 2026

Next Review DateNot specified

Key ActionAt each service, verify the client’s identity using at least two identifiers, confirm location and psychological safety, and obtain appropriate consent.

SourceLink

On This Page

Maintain the capacity to enroll in DMAP and meet Division of Medicaid and Medical Assistance enrollment requirements.
Maintain a physical site with capacity and intent to provide in-person services for the life of the license or certification.
Monitor annual policy updates and changes to State and federal virtual-service requirements.
Ensure on-site staffing during scheduled business hours is sufficient for service needs and applicable licensure, certification, or contract requirements.

Denial Risk

Screen for Clinical Appropriateness and Safety

Screen every client and encounter for clinical appropriateness and safety. Maintain a triage process that explains the uses, limits, and benefits of telemedicine during admission and identifies circumstances in which telemedicine is unsafe or clinically inappropriate. Any clinically inappropriate scenario requires in-person treatment, and the program must safely escalate a telemedicine encounter to in-person care or an emergency response.

Do not provide telemedicine when it is unsafe or not clinically appropriate.
Assess client suitability, including barriers to accessing telemedicine services.
Maintain a process to place clients into an in-person program or begin in-person services when circumstances require it.
Ensure telemedicine care and recommendations meet the same standard of appropriate practice as in-person care.
For involuntarily detained or committed recipients when consent is impracticable, continue all other telemedicine, safeguard, and confidentiality requirements; the consent exception ends upon discharge from the facility.

Documentation Required

Maintain Telemedicine Policies and Safeguards

Establish and maintain telemedicine policies and safeguards. Written policies and procedures must support accessible, equitable, safe, confidential, and clinically appropriate telemedicine. Maintain ADA compliance and resource lists for staff serving people with disabilities, do not discriminate, and provide equal access through in-person or telemedicine services.

Define in-person requirements for each applicable level of care and minimum on-site staffing.
Define how telemedicine will meet the in-person standard of care and how client suitability and access barriers will be assessed.
Maintain procedures for safe transition to in-person services, client emergencies, telemedicine-specific diversion prevention, and informed medication consent covering changes, risks, benefits, alternatives, and needed after-appointment support.
Maintain HIPAA safeguards and policies addressing privacy problems, technical privacy breaches, and other telemedicine risks.
Maintain policies meeting minimum federal requirements, review them when federal law changes, and review telemedicine policies at least annually.

Documentation Required

Verify the Client and Obtain Encounter-Level Consent

Perform and document required checks and consent at every telemedicine service. Obtain telemedicine-specific informed consent with the client's signature unless law permits verbal or another method of consent, and obtain the client's verbal agreement to telemedicine at the time of each service.

Verify that no unauthorized person is present within the client's visual or hearing space.
Verify the client's psychological safety at the time of each service.
Verify the client's location at the time of each service to establish jurisdiction and enable emergency response.
Verify identity using at least two identifiers, such as name and date of birth, at the time of each service.
Document all consent and verification activities, while applying the limited involuntary-detention consent exception only when legally applicable.

Billing Rule

Document and Bill the Service Accurately

Document and bill telemedicine services distinctly and accurately. Maintain procedures that distinguish telemedicine from in-person services for both billing and clinical documentation. Maintain a process for responding to connection failures and other unforeseen treatment-delivery concerns, including escalation when the service cannot safely continue.

Document whether each service was delivered in person or by telemedicine, as applicable, and bill accordingly.
Address no-video, no-audio, other technical problems, and disconnection during a session.
Address human-driven privacy problems, technical privacy breaches, client emergency or decompensation, and provider emergency during a call.
Address illegal or unethical activity discovered during a call and the provider's ability to fulfill the duty to warn and protect.
Review and address unintended or unforeseen treatment-delivery concerns arising from telemedicine.

Prior Authorization

Verify Provider Licensure and Out-of-State Approvals

Verify all staff licenses and credentials before and during telemedicine practice. Maintain procedures to confirm required licenses, credentials, experience, and scope of practice, including any applicable exceptions, interstate compacts, or reciprocity processes.

Verify staff licensure and credentials and maintain annual training on applicable federal, State, and payer requirements.
For each out-of-state-licensed practitioner, document how the person's license and experience meet DSAMH requirements for the specific level of care and position.
Request written DSAMH approval from the Policy and Compliance Quality Assurance Administrator with the out-of-state licensing accrediting body, resume, and job description for the specific Delaware position.
Retain DSAMH's written approval accepting the out-of-state licensure and experience.
Ensure licensed prescribers regulated under Title 24, Chapter 1700 remain licensed and practice within scope and required regulations.

Note

Apply Higher and Service-Specific Requirements

Apply service-specific, payer, contractual, and higher regulatory requirements. Direct in-person contacts and service-specific requirements may apply to ACT, ACT Plus, Intensive Case Management, Mental Health Group Homes, Opioid Treatment, Residential Treatment, and other levels of care. Follow payer-source and contract requirements, and apply any more restrictive rule that prohibits telemedicine.

Complete required in-person contacts and service-specific activities, which may include initial assessments, recovery plans, medical assessments, toxicology activities, or medication administration.
For OTP services, maintain policies meeting current SAMHSA certification requirements and, where applicable, DEA licensure requirements; review and update them when those requirements change.
For Medicaid-certified programs, obtain DSAMH pre-certification.
For DSAMH-contracted programs, meet every element of the DSAMH contract.
Consult DSAMH and house counsel when regulatory, payer, or contractual requirements conflict.

Final accessFinal approval for access to taxonomies and billing codes is through the DMAP portal and its selected enrollment vendor.

Contracted Programs

DefinitionPrograms contracted with the Division of Substance Abuse and Mental Health.

Contracting authorityThe Division of Substance Abuse and Mental Health is the contracting division identified in this definition.

Program statusContracted Programs are among the programs covered when utilizing telemedicine.

Distant Site

DefinitionThe site where the physician or other licensed practitioner delivering the service is located when the service is provided through the interactive telecommunications system.

Provider enrollmentDistant-site consulting providers must be enrolled in DMAP or a DMAP MCO to be reimbursed for professional services.

Facility feeDistant-site facility fees are not covered.

DMAP

Full nameDelaware Medical Assistance Portal.

ManagementThe portal is managed by a contracted provider.

Selection authorityThe contracted provider is selected by DMMA.

DMMA

AbbreviationDMMA.

Full nameDivision of Medicaid and Medical Assistance.

Portal roleDMMA selects the contracted provider that manages the Delaware Medical Assistance Portal.

DSAMH

AbbreviationDSAMH.

Full nameDivision of Substance Abuse and Mental Health.

Program roleDSAMH issues behavioral health program licenses and Medicaid certifications and contracts with programs.

Facility

Physical areaThe physical area, grounds, buildings, fixtures, or portions thereof.

Relationship to entityThe facility may be owned, leased, operated, or used by an entity or program.

Covered elementsThe definition includes grounds, buildings, fixtures, and portions of those areas.

License

DefinitionApproval granted by the Division authorizing a program to provide treatment of behavioral health disorders.

Full licensureFull licensure is one type of license.

Other typesOther types include provisional licensure and temporary licensure.

Licensure

DefinitionThe act of conferring a license to a program to provide services.

Payer limitationIssuance of a DSAMH license or certification does not guarantee payer sources or contracts.

Contract limitationThe limitation applies to contracts with DSAMH or any other entity.

Originating Site

DefinitionThe facility where the Medicaid patient is located when the telemedicine service is furnished.

Provider enrollmentOriginating-site providers must be enrolled in DMAP or a DMAP MCO to be reimbursed for services.

Facility feeThe originating-site facility fee is covered.

Pre-certification

Provider statusThe provider has met the minimum requirements in The Adult Behavioral Health Services DHSS Certification and Reimbursement Manual.

DSAMH approvalPre-certification verifies DSAMH approval to enroll the provider in DMAP.

Final certificationFinal approval for access to taxonomies and billing codes is through the DMAP portal and its selected enrollment vendor.

Provider

DefinitionAll DSAMH-licensed, certified, or contracted programs utilizing telemedicine.

Licensed programsDSAMH-licensed programs utilizing telemedicine are providers under this definition.

Certified or contracted programsDSAMH-certified and DSAMH-contracted programs utilizing telemedicine are also providers.

Telehealth

DefinitionUse of information and communications technologies to support healthcare and related services.

TechnologiesExamples include telephones, remote patient monitoring devices, video, and other electronic means.

Supported functionsTelehealth supports clinical healthcare, provider consultation, health-related education, public health, and health administration.

Telemedicine

DefinitionA form or subset of telehealth that delivers clinical healthcare through real-time two-way audio, visual, or other telecommunications or electronic communications.

Audio-only servicesAudio-only conversations are included when the patient cannot access suitable broadband or other technology needed for an audio and visual connection.

Supported careTelemedicine may support assessment, diagnosis, consultation, treatment, education, care management, and self-management.