Cybertherapy: the plan must pay for remote therapy the same

Cybertherapy is what Act 48-2020 calls the remote practice of eight therapies, where the interaction between the person and the therapist is mediated by communication and information technology tools. It is not the same as the telemedicine of Act 168-2018, which is for physicians; this law is for therapists, psychologists, counselors and social workers. Two sentences of it get used the most: the plan must pay for it as if it were in person, and if you did not accept it they cannot charge you for it.

On the professional’s side, the law covers anyone licensed and authorized to practice in Puerto Rico physical therapy, occupational therapy, speech-language therapy, psychology, counseling, social work, rehabilitation counseling or educational therapy. On the side of the person receiving the service, the law sets no eligibility requirements: it sets a prior informed consent and the right to refuse without being billed. Students with disabilities registered in the Special Education Program are excluded from this authorization, except during emergency or disaster situations decreed by the Governor of Puerto Rico or by the President of the United States.

• For the professional: to be duly licensed and authorized to practice in Puerto Rico one of the eight disciplines the law names. If so, they do not need the Certification for the Practice of Cybertherapy.Verified against the official source
• For the professional licensed in the federal jurisdiction: to apply for and obtain from the Department of Health the Certification for the Practice of Cybertherapy in Puerto Rico. Anyone not licensed in the federal jurisdiction cannot receive it.Verified against the official source
• For the person receiving the service: to sign, before receiving it, an informed consent form expressing their agreement. If they are a minor or a person declared legally incapable, their custodian, guardian or legal representative signs it.Verified against the official source

• Informed consent form to receive cybertherapy services.

1. 1

   Step 1: The plan must pay for it as if it were in person

   This is the sentence that settles most disputes, and it is worth quoting whole. The law says the professional licensed in those eight disciplines “may bill the services provided using cybertherapy (…) to health insurance companies and to the Health Insurance Administration (ASES), which shall be obliged to pay for it as if it were a service rendered in person.” It does not say “may pay for it”: it says they shall be obliged to.

2. 2

   Step 2: And they must give the billing codes to whoever asks

   This is the practical detail that unblocks cases, because the usual argument is that “there is no code.” The same article continues: “To that end, health insurance companies and ASES must provide the professionals referred to here, who so request, the corresponding codes for billing the services rendered through the means established here.”

3. 3

   Step 3: If you did not accept it, they cannot bill you for it

   The law writes it in the negative and that is why it works as a defense. Before receiving cybertherapy an informed consent form must be signed, and “if the individual does not agree to the use of cybertherapy services, the service shall not be provided to them, nor shall any type of charge be billed to them.” It adds that the person “keeps the option to accept at any time, without affecting the right to receive any other type of attention, care or therapy.” Saying no today does not close the door tomorrow nor take away your right to in-person therapy.

4. 4

   Step 4: Who decides for a minor or an incapable person

   The law closes that article with a clear rule: “In case the patient is a minor, or a person declared legally incapable, this Article shall apply to their custodian, guardian or legal representative.” The consent and the right to refuse pass to that person.

5. 5

   Step 5: What the eight disciplines are

   It matters because outside that list this law does not apply. They are physical therapy, occupational therapy, speech-language therapy, psychology, counseling, social work, rehabilitation counseling and educational therapy. Physicians are not in this law: for them Act 168-2018 on telemedicine governs, and it has its own guide here.

6. 6

   Step 6: Certification: the one from outside needs it, the one from here does not

   It is the most common confusion among professionals. Someone licensed in Puerto Rico “may conduct their consultations at a distance by technological means, such as telephones, video calls, applications or any other technological tool available, without the need to obtain the certification.” Someone duly licensed and authorized to practice in the federal jurisdiction “must apply for the Certification for the Practice of Cybertherapy in Puerto Rico.” And someone not licensed in the federal jurisdiction “cannot receive the said certification.”

7. 7

   Step 7: How long the certification lasts and where the payment goes

   Two facts the law does set. The certification “shall be issued for a term of three (3) years and may be renewed, upon the Department’s approval, provided evidence is submitted of compliance with the standards established for the profession.” And on the money: “The amount of these fees shall not be returned to the applicant for having had their application disapproved,” and those fees “shall go to the University of Puerto Rico’s Technological Assistance Program.” The amount is set by the Secretary by regulation and we do not publish it because we did not read that regulation.

8. 8

   Step 8: Special Education: excluded, except in an emergency

   If your child receives therapies through Special Education, this is the part that concerns you. The law says that “excluded from the authorization to practice cybertherapy established here are those therapies given to students with disabilities registered in the Special Education Program, except in emergency or disaster situations duly decreed by the Governor of Puerto Rico or by the President of the United States of America.” During such an emergency, the law allows those students to “continue receiving their services through the practice of cybertherapy, to the extent it is possible for the specialist and the minor,” and adds that none of that prevents compensatory services in the areas where cybertherapy could have been given but access for the parent or the specialist did not allow it. Those compensatory services, however, “shall not be available for therapies that require mandatory in-person interaction, such as equine therapy, aquatic therapy or auditory processing therapy.”

9. 9

   Step 9: Your record and what happens if the therapist breaches

   The law refers record handling to Act 40-2012 and to the Puerto Rico Health Information Network, and adds an instruction of its own: “special caution shall be required in taking the measures necessary to protect the confidentiality of the records of the individuals receiving cybertherapies.” On breaches, anyone violating the law “shall be understood to be illegally practicing the corresponding profession” and is subject to the penalties of their profession’s organic act; in addition the Department of Health may impose an administrative fine of no more than five thousand dollars ($5,000). We did not read Act 40-2012 for this guide, so we do not explain here how to request a record.

The certification for professionals licensed in the federal jurisdiction is issued by the Department of Health, on the form the Department itself supplies and pursuant to the regulation the law orders it to adopt. If your problem is that the health plan will not pay for a remote therapy, the claim is against the insurer or against ASES depending on who covers your plan, and this law’s coverage article is what is worth citing. If your matter is a physician attending by video call and not a therapist, the applicable law is a different one and it has its own guide.

• Accepting that the plan pay less because it is virtual: the law requires paying for it as if it were a service rendered in person.
• Giving up when the insurer says no code exists: the law obliges it to provide the codes to the professional who requests them.
• Paying a bill for a cybertherapy you did not consent to: the law says that if you do not agree the service shall not be provided nor any charge billed to you.
• Believing that refusing it takes away your in-person therapy: the law says the opposite, and that you may accept at any time.
• Confusing this law with telemedicine: Act 168-2018 is for physicians and this one is for eight disciplines of therapy, psychology, counseling and social work.
• Thinking a therapist licensed in Puerto Rico needs an extra certification: the law says they do not.
• Assuming it applies to Special Education therapies: they are excluded except in an emergency or disaster decreed by the Governor or the President.

These are the government pages this guide is based on.

• Departamento de Salud de Puerto Rico

  Salud

  bvirtualogp.pr.gov