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Indian Healthcare Provider Series 1/2: Barriers & Innovations in Telebehavioral Health

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Read Time:69 Minute, 16 Second

Allow'' s see. Okay, well, we want
to invite you to this. This gathering, which which came out
of I wanted Melody to do the introductions because she is so
into real she as well as Lucy have been so associated with bringing this
together. And it appeared of a series of trainings that we did
in the spring that were a lot more extensively dedicated to
telebehavioral Health and wellness Training amongst area based suppliers
in the state of Washington. And Lucy with with her duty and also
connection stated, you know, gosh, it would be so nice if we could
do something similar to this that was especially intended at Indian
wellness care suppliers. As well as so that'' s just how this all transpired. And, as well as it ' s became this truly remarkable gathering of
individuals who are ready to share their experiences and also proficiency
therefore, so thanks to every one of the panelists as well as presenters for
being prepared to join us today.And thank you to
every one of you that
have actually joined us to pay attention in and also take part in this. So today
we'' re going to be speaking about dressing barriers, and
highlighting advancements as well as telebehavioral. Aid. Go to the
next slide please. And also just a little history on the
Behavioral Health And Wellness Institute at Harborview Medical Center at UW
Medicine, and the training workforce as well as policy Innovation
Center.The BHI is the center of quality where innovation study as well as clinical technique
integrated to improve psychological health as well as dependency therapy and also bhi establish first top priority programs which consist of improving take care of youth and young people with early psychosis, Behavioral Health and wellness Urgent Treatment strolling clinic, as well as the last 2 we
are focusing in on today expanded electronic as well as telehealth services and also Behavioral Health and wellness Training labor force and policy Technology Facility. Following slide please. I wish to introduce every one of our wonderful individuals today. So we have Dr. Chris Fore that is presently the Supervisor of the Indian Health And Wellness Solution telebehavioral Health and wellness Center of Excellence.He ' s a participant of the Choctaw Nation of Oklahoma. He obtained his doctorate in

youngster professional psychology from Oklahoma State University. In 2009. He developed the IHS Tella, behavior university hospital of excellence, and the mandate for the center ' s to check out the feasibility of telebehavioral Health within IHS, regionally and also country wide, boost accessibility to care, create
versions of treatment and to attend to sustainability.
We have wonderful Lucy Mendoza and Michael Longnecker from the Washington Healthcare Authority that every one of you I ' m sure know and also we ' ll be talking especially concerning billing as well as compensation with telehealth.Today, we have Dr. Megan
Balu, who is Cherokee as well as is'a scientific psycho therapist originally from Oklahoma. She ' s the present supervisor
of behavior health for the lummi nation in northwest Washington. Catherine akia, who is a specialist for the American Indian Health Compensation works mostly on Medicaid improvement tasks as well as the tribal behavior health and wellness system. Her experience includes over 17 years of social
justice job in public health, the justice system, and labor
organizing. And we additionally have Jen Olson, that ' s collaborated with Washington tribes for over twenty years on population based public health program. She is likewise an expert on Medicaid improvement makeover jobs with the American
Indian Health Commission. We have Melissa Hurt-Moran from camis course who presently holds a position of CD professional Supervisor for kalispel people of Indians. She has actually held her stdp reduce DDP qualification because 2005, and currently has SAP and NC air conditioner 11.
She has a master ' s in clinical mental health therapy with a. minor in dependencies counseling.And last however not the very least, we have
. Micah Woodard who is an lcsw W, as well as BCD. I don ' t really know. what BCD represents.
So he assisted to inform us when you.

talk and also he ' s at the Western Oregon. solution system and also acts as the behavioral health director at. Indian Health And Wellness Solution at the Western Oregon service system is. leader in the US Public Wellness Solution Commissioned. Corps. See, Dr. Woodard has offered in this function for over 10. years providing comprehensive school based wellness solutions,. integrated behavior wellness as well as program advancement
and also. planning. Got everybody So following slide. please.
And after that I ' ll transform it over to. Christina to discuss the Northwest MHTTC that has. partnered with us to supply this program today.
Great, thank you a lot. We are.
extremely, very recognized to be below as well as just wished to share a. little bit about the Northwest MHTTC My name is Christina. I ' m. among the CO directors as well as we are a fairly New two years.
in resource for the Northwest and area 10.
Therefore we. disseminate evidence based practices execute other. encouraging and ideal methods from other communities for. major psychological health problems right into our field, we work with a. range

of components of the field. So behavior health, key. care suppliers, institution people, as well as a variety of other settings.
Next slide. the MHTTC is a network in fact throughout the.
nation. As well as some of you might have become aware of the addiction.
modern technology transfer centers in your job. So they ' ve been going. for a whole lot longer than we have. But our factor is to distribute,.
you understand, sources and free training across the nation as well as.
across the area. Following slide. Our specific Northwest MHTTC. does have a web site, we have things like live webinars such.
as this, we have on-line courses, study as well as method briefs.
We. have a resource library on our website, and we have archived. webinars also. Exceptional. If you ' d like to keep in touch, we
. can place these points in the conversation later.But we do have a month-to-month. e-newsletter as well as we share things like this event.
As well as you can. email us with any kind of questions, we have some social
media, also. So we ' d love to learn through you.
And also currently we ' ll most likely to next slide. We constantly intend to be conscious concerning utilizing language that. advertises recovery and also as culturally'proper. And also just. likewise intend to advise individuals that this webinar is being recorded. So we just intend to make certain we aren ' t divulging recognizing. details.But we feel in one’s bones that this is a network slide that. turned up just recently. Therefore we simply'intend to be certain to remind.

, what we ' re what our goals are in these kind of.
events, when currently we have a couple of logistics relating to.
interaction throughout the session. Superb. So we ' ll.
evaluation quickly in the next pair slides, just how the webinar.
is established and also just how you can utilize the chat and q & a to communicate. with us and also what jobs and also how to do that.
So initially, in the. next slide, we have the conversation box&. Therefore you ' re
all using. that I believe, have been using that. And also I ' m sorry, there we go. Sorry, next slide.
The chat box.So our team as well as. the rest of the panelists might share details about. logistics, allow us understand if you ' re having technology issues you can share. with us. But it isn ' t a massive, noticeable point that we desire all. the concerns pertaining to. So'we ' ll go to the following slide.
since we intend to make certain we do obtain to your concerns. And so.
you can either type a question right into the q & a window, and also someone. may kind a response back to you or they could call on you. later to go over in the conversation part.
Or you could. raise your hand. And also that will certainly additionally alert everyone and after that. they can unmute you later on if we intend to do even more sound.
conversation. Exceptional. Lastly, Your responses is truly.
vital. Therefore like any kind of training center that obtains.
funds, our funders desire to see what we ' re.
doing.But a lot more notably, we want to recognize how we ' re doing and. if we ' re conference your needs, therefore we'considerably value your. responses. Next slide. After today ' s session, and also
during the. near the tail end, we ' ll be placing in a link. As well as so it ' s a. very brief study simply to inform us just how did it go. We ' d love to. feed that back to the presenters and also the panelists and all the. coordinators.
And it simply aids us actually plan future sessions. Just reminder, slides this recording and also resources will be. uploaded. However we do not have the capacity to certificates or see. us for this series.
Outstanding. All right. So currently I ' ll transform it. over.
And I leap in truly quick. in the past. Prior to we start.
I neglected I was mosting likely to run
a poll. after I did the introductions of all of you, I was going to ask.
our attendees to tell us that they are. So if you wouldn ' t. mind, I ' m going to run a poll and ask you all to click on who. you are.And then we ' ll we ' ll share the outcomes
with the group
. to make sure that our audio speakers understand that they ' re talking with today.
Appears like. Right now we have about half of the people have. voted and if you if you do mark, various other please do not hesitate to put.
into the chat. What you are if you ' re not a manager,. clinician behavioral'health and wellness medical professional, or recommending. medical professional I ' ll offer it simply a few even more.
secs. Oh,'great. We ' ve obtained a. telehealth program professional.
That ' s terrific. Care'Organizer at an MC Oh I'' ll go on as well as finish the. ballot now as well as share the results with you. And also as you can.
see, we have an equivalent number of managers as well as various other an EHR.
coordinator. And also we have the next biggest group is 23% are.
behavioral wellness clinicians, we have a number of scribing.
medical professionals and another medical professional who maybe is not a.
prescriber. So I will certainly stop sharing the results.If that box.

stays up on your screen, you just increase to the top right.
hand corner, as well as click on the X to obtain out of your method. All right, and I'' ll transform it over.
to Dr. For many thanks. Alright, , thanks,.
everyone. I appreciate this possibility. today. I was.
browsing the guests to see a couple of acquainted names in.
conversation. So it'' s great to talk with some people I sanctuary ' t touched. base with in a while. And also'today, I ' m gon na be chatting simply really. briefly concerning some of the important things you need to be taking note.
to if you intend to do telebehavioral within Indian.
nation. I'' ll be doing a much more in deepness talk on this following.
week, it'' ll be really deep dive. However this is a pretty general.
overview.And I will certainly say sorry up front, I placed October 17,. rather of September, I ' m just hopeful believing that we could.
surpass 2020. As well as with any luck 2021 we'' d be better.
However I ' m so. sorry for that typo there. Following slide, please. So one of the. points you all need to be knowledgeable about, if you are not.
already and also with any luck you are so I'' m not gon na invest a great deal of.
time on this. With the general public health and wellness emergency, there been.
whole lots of adjustments as well as waivers and also dispensations offered to attempt to.
reinforce tele wellness generally, as well as Tel Aviv or help additionally obtain some.
take advantage of this. So one point to be aware of this is all.
finishing October 24, I believe as well as now, and also it'' s not clear. which of these if any one of them may stay.So that is something.
we had a telephone call with CMS yesterday around this. And also so something a.
whole lot of people asking inquiries regarding initially one here, very same.
states licensure is no more called for. To ensure that is a large deal. for you that run tribal programs or IHS programs, this isn'' t a. large deal. Since you ' ve had this with any luck you understand that.
your suppliers that you use don'' t have actually to be accredited in the.
state where the individual is, which is great.This is actually a.
large deal for urban companions as well as for economic sector. Once more, we ' ll. need to see if this lingers after October However. presently, nobody doing telehealth has actually to have a. provider certificate in the exact same state as the patient. The following. one, a HIPAA demands are currently kicked back relating to. weapons video clip platforms. Basically, they have stated
you. can use almost anything, anything that ' s not Team, a. group platform, a team system would certainly be something like Twitch,. as an example, where it'' s even more of a broad customer program.
system, Facebook Messenger functions, FaceTime functions, Google.
Hangout jobs. All that HIPAA is saying, Yeah, proceed, as long.
as you act in excellent confidence is the terms that they utilize. So as lengthy.
as you'' re not intentionally attempting to share info, you can.
meet with your individuals on almost any type of video clip platform that.
you can imagine, which is great. It'' s truly opened it up a great deal. And also following slide please. Um, CMS and also some billing, and I recognize.
we'' ll have some billing folks on on board, and also we'' ll be speaking a. little bit later.But some telephone calls are now. billable.
That'' s something that ' s not typically a billable.
solution, but some online sign in that you can do. There are.
really details instances around what those are. So I'' m not going. to obtain off right into the weeds, however simply know that some of your.
telephone visits might be billable. As well as last but not least, on the.
four walls rule has been type of waived in that in house solutions.
are now can be reimbursed.It ' s a large modification and also'really useful. for us.
A great deal of our individuals aren'' t taking a trip, a great deal'of our. clinics aren ' t necessarily open therefore having the ability to see the. patient in their residence or recognize in an alternative setting as well as still.
get repaid is truly excellent and also very useful. Following slide. So when we discuss telehealth.
on the whole as well as telebehavioral, particularly, I'' m mosting likely to include. some things to this slide that as I was considering a little. bit later, I possibly ought to have placed in there. telehealth. The factor you make use of telehealth the primary factor is to supply.
access to care. That'' s really what telehealth is all about.
getting solutions in position into people who would certainly not otherwise.
have those services. That'' s truly the the toughness of. telehealth. And also I would certainly likewise say that there ' s a capacity. secondary factor to utilize telehealth which is to boost.
high quality of treatment if you can get some very educated companies. Some carriers who are may be extremely culturally experienced or.
culturally aware in match them up with the right set of.
patients.That that '

s an additional truly good reason that you why.
to make use of telehealth. The other point you desire to consider.
whenever you are assuming about telehealth up until a behavioral.
health and wellness especially, is what are your area needs. One of the.
things that I typically chat to people concerning is that telehealth.
normally isn'' t below to change a solution. That'' s not, in my. opinion, especially in Indian Country, there ' s a lot of job.
to walk around. So I believe telehealth is often below and is.
most productive in Indian country when it connects voids when.
you have a service that you desire as well as need, yet can'' t get it any type of.

other'way.So we ' re not talking regarding replacing your beaver. health and wellness program with tele beaver health, we'' re discussing.
getting you maybe a dependency psychiatrists a day, every various other.
week, since that'' s the solution that you need. You put on'' t have. the work to work with somebody, you wear'' t have the money to work with.
a person full-time as well as you wear'' t have that need.
However you actually. need that solution a day, a week or day every
other week, inform us. excellent for that. If you intend to run your whole program through tele,.
you can do that. But that obtains a great deal much more difficult. And that'' s. really not, in my viewpoint where the toughness of tele lie. So.
when we talk concerning telehealth until the beaverhead,.
especially, with all these new things that have actually happened as well as.
us needing to pivot very quickly right into seeing individuals outside of.
centers, I created these series circumstances and also this is.
what you require to be thinking of this whenever you'' re going. to deploy tele wellness up until it be rolled specifically.Because.

there'' s great deals of various permutations right here that impact.
exactly how things are mosting likely to look. So initially of all, where'' s your. company going to be and also where'' s the client mosting likely to be? The
. those are really the crucial concerns facility to center in our system.
in the IHS system is what used to be our most typical design that.
is no modification. But it'' s additionally the easiest to control. The service provider.
remains in an IHS facility, the individuals in an IHS facility or.
or maybe a tribal facility, as well as they attach that that'' s quite. simple. Um, let ' s say though, that'' s not how it ' s. mosting likely to take place. Currently, maybe your service provider needs to be
at residence to,. to self quarantine, for'instance.
So they ' re attaching from the. house, you ' ve obtained the patient in the center gets a little bit much more. complicated attempting to bargain accessibility to the EHR, for instance,. firewall softwares that may be in place.Um, let ' s
take the third example.
right here. Currently you'' ve got the carrier in the center. Today'. the patient ' s in the house again, for different reasons, possibly they need. to care for somebody, maybe their auto broke down multiple factors.
why that may happen. Once again, that can be very tough, among.
things that has actually actually become really, really clear to me is.
the breadth. And also regrettably, deepness of the electronic divide in.
this country. I was certainly mindful of it.We ' ve been I'' ve. been doing this for nearly 12 years, I'' ve known it ' s out. there. But this has really been brought home during the pandemic. of the absence of connection in Indian nation. To make sure that obtains.
extremely tough. And after that the last one here, which is our most.
testing circumstance, however the one that we'' re dealing with.
quite a whole lot now, you obtained the service provider in the house, the person at.
home, and exactly how do you make that connection resolve every one of.
the open Web accessibility to the human resources, the links, the.
organizing, it obtains rather made complex. So simply be believing.
concerning this. If you'' re planning telehealth or requiring to pivot.
to a various one of these scenarios, there are great deals of.
different points that you need to be aware of for each and every of.
these.Next slide,

please. So, at the broadest degree, right here.
are several of your considerations. I just want you to think about.
if you'' re mosting likely to be deploying telehealth, really essentially,.
what'' s your platform and your devices, as I simply claimed, this,. this has actually sort of vanished in to a large degree right here lately with.
the the leisure of HIPAA, you get your iPhone, they choose.
up their apple iphone, and also you'' re good.
In theory, anyway,. presuming connection, which is our second one, but there.
doesn'' t need to be the investment that there made use of to be.
until a health regarding devices goes. Currently, we don'' t. understand if that ' s mosting likely to stay around.
So what I would certainly. encourage you'to do if you ' re using systems that aren ' t. HIPAA certified, which is you ' re well, within your right, it ' s at.

the very least for the following five or six weeks.Be thinking of what. you ' re going to do after that, due to the fact that I'' m actually worried.
that a whole lot of our programs are going to be left type of high.
and also completely dry with no HIPAA certified way to supply the very same sort of.
treatment. Yes, there are platforms around. They'' re HIPAA. certified. Yes, they normally set you back cash. As well as they'' re maybe.
not as customer friendly as you'' ve been utilized to. But be you should.
be thinking of those if you'' re if you ' re
planning on. maintaining telehealth, I might be incorrect which they forgo HIPAA.
or maintain the the loosened up regulations in position for this.
however it'' s something to be familiar with. The various other thing simply to.
consider too is that there was a time when I entered into.
this 12 years ago.It expenses a whole lot. Our basic Up until a health and wellness.
device costs regarding $15,000, I can get a person attached for the.
cost of an additional monitor and also a cam. So I'' ll know 150 bucks.
now. So in bench, the barrier to entry for devices goes.
actually come down considerably. So put on'' t allowed that stop you. Simply.
bear in mind it. And again, mostly the system and whether.
it'' s HIPAA certified. bandwidth. This is one of the questions you.
obtain at all times, how much data transfer do I require? However, it'' s not that basic. Extra is constantly better. So that'' s the good information. The concern is right here. As well as once more, I'' ll. get way extra into this in my conversation next week, is that.
it'' s not necessarily just how much data transfer you have, it'' s
exactly how. a lot clearance you have in that.So if you

' ve got a pipeline that'' s. half complete, and afterwards you want to do telehealth, that'' s terrific,.'since there ' s great deals of space between the water degree and a.
pipe and after that on top of that pipe, if I'' ve got an actually fat.
pipe, yet it is complete throughout the day, every day with people doing.
various other things. It doesn'' t matter just how fat the pipe is, it'' s. currently all being made use of. So telehealth would certainly be extremely.
challenging. If you have a yard pipe, yet no person'' s truly. using it. You can do telehealth via a really little connection. So bandwidth, the extra the far better. And also it'' s actually about. the use of the transmission capacity that you have as well as that clearance.
in there. We'' ll enter that even more, like I claim next week, yet.
it is something to think of. One of the things that I think.
people sometimes forget is just how am I mosting likely to record care? Exactly how'' s the supplier mosting likely to document treatment? Very vital,.
yet it'' s something that'' s actually simple to overlook.Most of us.

have digital health and wellness document, if that carrier is not in your.
facility, just how do they obtain accessibility to that digital health.
record? Do they need to make use of an online private network, a VPN,.
that that'' s what occurs within nightshift system? Can you provide.
them accessibility to it some various other means? So be believing regarding that.
that can be a showstopper. Additionally, if you'' re collaborating with the.
prescriber, things obtain quite a little bit more made complex because just how.
are they going to recommend in your system? Does your.
digital health and wellness document allow them to suggest.
digitally? If so, that'' s fantastic. What regarding regulated.
substances, this is where it gets really complicated for those.
of you who had to take care of this, and also the Medication Enforcement.
Management DEA. So essentially, it calls for a.
regulated compound which are can be pain medications, which can be.
medications for ADHD, which can be anti anxiousness medicines, they.
need what they call a wet trademark.That indicates there''
s no faxing, that means that there'' s no sort of just prescribing and also the normal means, but they need to, there'' s usually a minimum of 2 or 3 factors that need to be to verify your identity if you'' re doing it electronically.So regulated substance recommending can be really challenging. So once more, something to be familiar with if you ' re collaborating with the prescriber. Inform the'coordinator, I will certainly beat this drum loud and clear next week just stated it here. This is what your program, in my opinion, in my experience running a program for 12 years having 26 websites around the nation, our success, giving tele beaver health and wellness counts on the tele coordinator at that center, we can have the supplier online, we can have everything ready to go.
Yet if that planner where that person is isn ' t readily available, doesn ' t turn on the devices doesn ' t stroll the individual into the space doesn'' t. routine, the patient doesn ' t call the client in advance,. things sort of fall apart.So really be considering this.
This is not something that we

generally take a complete. time position for many programs. But it is someone who needs to.
be totally devoted when the telehealth facility is running.
They don ' t requirement to be doing any other activities. They require to. be entirely focused on that program.
As well as likewise, I would state. also past that program, they need time
to collaborate to telephone calls. patients and points like that. So they can have other
obligations. But throughout that clinic, they need to be really concentrated. As well as. this can be all type of individuals, we ' ve had individuals that are.
assistants do this. We ' ve had nurses do this, we
' ve had. therapists do this.
This role isn ' t defined by an occupation or. by a certificate, it is really a duty that requires to be feel. filled up. As well as it requires to be someone who corresponds,. somebody that is responsive and somebody who ' s reliable.So tele. planner is really among the tricks that we
spoke about a great deal. Following slide. I ' m going to cover things up below as well as fast. about it. You ' ll need a back-up strategy as well as two backup strategies. So. you need a medical backup strategy person
. The person claims I ' m. mosting likely to go injured myself today.
What are you going to do? You require to have a strategy for that we do not release to a website till. we have a backup strategy established up for the professional side. You additionally require.
to modern technology back-up plan. What happens if your web stops working? What happens if.
the sound goes dead but if the video goes dead, you'' ve need to. have an innovation

backup plan.Both of those For us need to be.
in location prior to we start services. And also after that finally, and.
you listened to a lot more regarding invoicing later on sustainability. This is.
great for the short-term, we'' ve seen tons of programs pivot to.
telehealth to satisfy person'' s needs, which is remarkable.
Yet is. it something you can maintain? I'can tell you from what I ' m. hearing, patients enjoy this mostly. And I ' m hearing Well,.
why can'' t we do this constantly from clients, I put on ' t want. to drive three hours for 20 minutes, med get in touch with my.
psychiatrists, I intend to say a residence and do that right here. It'' s a lot. a lot more comfy, I can get the same type of care.And now I.

wear'' t need to take my children out of college or miss out on work, or I.
can, you understand, still look after my mommy. So sustainability requires to.
be attended to, because I think our clients are mosting likely to desire.
to maintain this up, and perhaps a lot of our suppliers will certainly do. With that. I'' m going to finish up my

comments.And if there are.
any concerns, please place them in the conversation or in the q&& a pod. Thanks, everyone. Many thanks a lot Dr. for it. And.
let'' s go to the next slide. As well as we ' ll have Lucy and also Michael. Talk about payment and also technological aid. I never recognize if I need to wait.
for Lucy or I ought to begin Hey, this is Mike longenecker with.
Washington State Medicaid. Um, I'' m going to go type of quick.
due to the fact that Dr.Ford just claimed a great deal of the information that I'' m. preparing yourself to provide that was so trendy to pay attention to when.
mosting likely to the following slide. This is our call info. There.
we can see the very first email address Tribal Affairs at HCA. That'' s our ticket system. So if you ever want to get to out to.
any one of us on our team simply send out an inquiry over to Tribal.
Affairs at HCA and also I desire to go or else there'' s Jesse Dean or.
manager myself, insurance claims and also billing. lucilla Mendoza,.
behavioral health administrator, Lena country belongs to Medicaid.
change. Divine It is our management assistant and.
we'' ve got our 3 intermediaries there. We have one uninhabited.
liaison placement now. Following slide. This is simply back-up.
details for later. My only remorse on this slide is I.
dream I would have claimed telehealth as well as telemedicine.
since telehealth is the umbrella term. I should have put.
that word first. But these are the links to our payment guides.
that Healthcare Authority COVID internet site inform you when COVID-19.
initially begun, that COVID website had one record on.
possibly two.If we go check out it today, there'' s concerning 97. papers therein. So it ' s just responding to the pandemic with.
details and of training course our payment guides. A quick reference.
on telemedicine is a noticeably defined term in our whack, however.
we put on'' t have a wack interpretation of telehealth.
We ' ll most likely to the. next slide. Why is that important? It took
me a pair. of months collaborating with billing individuals to come up with this.
little bicycle analogy. If we return a year, you know, soon as a.
year back as well as COVID didn'' t even begin yet.We were allowed to.
trip bikes. telemedicine, telemedicine is a bicycle. So we.
were only permitted to compose bikes. Telephone call are out of.
scope. Yes, doctors could have done phone calls a year ago, yet.
we'' ll collection that out of range. So bicycles were the only tool that.
we'' re allowed to ride, the pandemic begun and as Dr. For.
claimed, the other forms of telehealth opened up and also we are.
allowed to use Skype which is that what I state the tricycle.
we'' re enabled to utilize phone telephone calls, which is the unicycle. The integral part concerning this slide and when it concerns.
invoicing is just that thing with 2 wheels can be called a.
bicycle.Why is that so

essential? We'' re gon na take a look at.
zoom actually quick. If we'' re making use of HIPAA certified zoom, it
. satisfies the definition of HIPAA conformity, after that it is.
telemedicine. If we'' re making use of the zoom version that is not HIPAA.
compliant, that is the tricycle we are permitted to write the.
tricycle throughout the pandemic. So just trying to get that point.
throughout, we can utilize all the devices we need to throughout the pandemic. However just a bicycle was a bicycle as well as just a phone telephone call was a.
phone telephone call. Why is that so crucial? We'' re going
to. briefly go to the next number of slides. This is billing down in.
the weeds. I owe billing people feel free to connect to me at.
whenever. I constantly sort things by category. This very first slide is.
for medical or excuse me telemedicine.We ' ve got clinical
,.'oral, mental wellness and also SGD how you construct the code in the.
modifiers and also the referrals will certainly take place to the following slide. And also this next slide is telehealth which is other kinds.
of telemedicine as well as you can see I do the very same thing clinical,.
dental, mental wellness and Su D the referral And also how you expense,.
when it comes to invoicing? I inform you, for many individuals, I am going.
to claim connect to me since I attempt and also make a slide that would.
address for Washington, all 29 people and have the slide.
actually work. It'' s truly hard. There'' s a great deal of one. on one interaction that I do on a daily basis'.
And I think that ' s the last.
slide. Thanks extremely a lot, Michael, I. value the details.
As I kept in mind in the chat, we ' re holding. all concerns up until the end when Katherine as well as Jen are going to. facilitate a conversation. So if you have any kind of inquiries, please.
do not hesitate to type them right into the q&& a section, and after that we'' ll.

address them.Or if you desire to ask a question aloud, you can.
increase your hand and we will certainly contact you throughout that discussion. Yet today we'' ll move on to Dr. Megan blue, if she could do.
her presentation. Hi, thanks. Hi, everybody. As well as I kind of agree with Michael, I think there'' s going. to be a whole lot of repeated motifs right here due to the fact that a few of the important things.
that Dr. Ford discussed absolutely correspond what.
we'' ve experienced here. So my name is Megan Balu, from.
Cherokee Country, however I'' m currently the Director of.
behavior health for lummi nation in Washington.So I ' m. mosting likely to
speak'a little regarding our experience at the beginning.
of COVID, what'' s functioned, what our continuing obstacles are. So.
next slide. So this is just an introduction of kind of, throughout the.
tribe, what the experience with COVID was. So our really initially.
situation here in this area, occurred on March 12, our first.
validated situation, as well as you can see that that following day, the.
school was shut. Several days later, gambling establishment shut a Shelter.
in position Order entered into area on the 22nd. Therefore I'' m type of. regular with that graph. You understand, our numbers kind of went.
up swiftly, we had a really proactive collaboration between.
management and also our public wellness team to actually try to, you understand,.
the squash the curve then, with a number of various other.
peaks, one occurring once again in April. And after that another little top.
taking place all not that lengthy ago, in July. And also when the slide was.
made, regarding a month earlier, there are 59 instances, we really have.
one brand-new favorable case today. However for the many component, these are.
truly proactive measures have actually really helped decrease the benefit.
or the impact in the community.Next slide.

So simply to type of overlay how.
that impacted our behavior health and wellness solutions throughout that exact same.
timeline. So March 11. And allow me leadership actually announced.
an early launch type of at the last min, and it was it was.
seen as a test to see how prepared we were for an.
emergency situation, preparing for that at some time in the future, COVID.
might influence the community. So team was asked, you have about.
two hours to get anything you require to function from residence. And also.
allow'' s just see how this works. The extremely list below day, we had.
our first positive case, and also lots of people never ever throughout throughout.
the people never went back to the workplace. So it simply took place.
that, you know, that sort of happened because order. That day.
that following day, Behavioral Health Management fulfilled, attempted to quickly.
brainstorm you recognize, just how, exactly how are we going to make these.
adjustments so swiftly, we bought 25 expert zoom. counts that.
day, luckily, due to the fact that I assume the final acquisitions, so we got.
right in there as well as time to obtain those process within a couple of.
hours.That weekend are
one of our personnel evaluated. favorable for covid, which truly highlighted the need for us to. move promptly to telebehavioral wellness due to the fact that all the clients. that individual had actually been available in call with that week as well as several. team had to be quarantine that phone following week. Fortunately,. everyone ' s wellness boosted as well as wasn ' t affected. But'it. definitely showed us that'we needed to do that swiftly. So. that that following week, the 21st all psychological wellness. therapists had their zoom accounts, they all individually. called the clients, they had their customers on their caseload,. spoken about what was taking place, kind of gave each individual each. client the time to ask inquiries to consider those alternatives and also. to use those services and I do think that was a crucial
as well as that ' s. preserving that that'preserving that personal. partnership to have each medical professional talk separately at. that point with their clients.Okay, currently, next slide. Simply a. really fast review

of what our behavior health and wellness staffing. looks like at this moment. So we have it administrative personnel we. have, it ' s type of ridiculous to damage it'up by doing this, due to the fact that. we ' re all one group.
However we do have many mental wellness. medical professionals, situation outreach clinicians, and afterwards some grant. staff, but everybody functions together. So actually a. combination of therapists that are doing individual as well as team. sessions and additionally some simply area education on tension,. as well as people that are truly out still in the.
area doing outreach as well as education.Okay, following slide.
I simply I ' m truly impressed by.

this, these numbers. As well as I', once again, I believe it truly talks. to that individual link, having the ability to remain to have our clinicians and to talk independently with. their clients that the very first two columns, it checks out our 2019. course matter on our 2020 session matter. And also, as I claimed previously,. you understand, as mid March when we made that switch, and also we have.
not seen a dip in our customer numbers, so we actually have a.
lower no show today, which I assume a whole lot of people It seems.
like perhaps are experiencing, and we have had a boost demand.
for services. I believe that'' s a mix of, again, that.
personal link, as well as additionally a great deal of really good social media,.
and also interaction concerning what we need to offer, as well as how to access.
our care. Okay, next slide. Therefore making certain that we.
always have those backups, there'' s lots of times when,. for whatever factor, on one end, or the festival and reaching a.
great deal of people. As well as it was actually an initial challenge, figuring.
out just how to do every one of our documents that had constantly been,.
you know, signatures, pins on paper, and also doing that remotely. And so buying an electronic trademark program to be able to.
obtain the ROI and also permissions as well as points like that signed as well as placed.
into the graph was a challenge.But I believe one that isn ' t. ideal, however we ' ve
functioned out a great deal of'those issues. Being. able to supply clients with the ideal technology, there. are many, lots of people, medical professionals, along with customers.
that did not have a gadget that was functioning in their location with.
the ability to join zoom. So in Washington, we were.
truly lucky that the Healthcare Authority had the ability to.
provide a great deal of complimentary iPhones, that were no charge to the client,.
no cost to the tribe, we distributed around 100 of those.
to clients that did not have smart devices, or smart gadgets. Which really, we were able to do that quite quickly. As well as that.
certainly was a massive component of us having the ability to continue to.
supply those services. As I discussed, we have a great deal of our.
personnel that truly tackled the strong social networks visibility. So.
putting out lots of details regarding dealing about wellness,.
they do daily psychological health and wellness videos that also consist of how to.
gain access to solution, however we'' ve had an actually positive response in the.
neighborhood concerning also individuals who not aren'' t necessarily accessing. our counseling services, which is having the ability to obtain that the.
health and wellness and wellness information bent on as many individuals as.
possible.One thing that

we have spoken with actually several.
customers is that the preconception that they felt needing to stroll in our.
front door was eliminated. Therefore that'' s component of the program rate,
. that ' s component of some people accessing psychological healthcare for. the first time that that for whatever factor, you understand,.
didn'' t feel comfy going through our doors, yet they really feel.
comfy accessing that care from there, the personal privacy of their.
houses. Therefore that'' s been an absolutely a favorable
. And after that. I believe I'just don ' t want to, you know, overlook the
. importance of caring for ourselves and also each other.So.

seeing to it that we maintain personnel check ins multiple times a.
week. So we have our zoom conferences several times a week.
with the complete staff, mental health personnel to issue address as.
swiftly as possible, any type of barriers that we might have. And also.
simply sign in on each various other, sustain each various other. Okay, following.
slide. So what barriers still exist, again, simply poor.
web, Wi Fi cellular link. So among the important things.
that we were able to carry out in addition to giving some smart.
gadgets we established outside of our medical facility, what we.
call an iPad visit. So if there'' s just no means for a client. to attach to their counselor or their medical provider, in the. area that they are currently, like their house or.
their office, clients can in fact pull their car right into a.
semi private room outside of our medical centers, somebody.
gets an iPad, and also they can perform those zoom employs that.
establishing that connections in actually two points to privacy.Barriers most definitely exist with. personal privacy. So I simply had somebody talking regarding this yesterday. So. a person that is able to access their clinician from their house,. but they have no personal privacy within their house. So part of what they. desire to chat concerning as obviously some extremely confidential private. info, however they have nowhere
within their residence to. talk about that without their whole family being able to hear. those things. So trying to find out just how to provide individuals. keeping that private space. And also that private area is still. an obstacle. And we ' re attempting
to consider methods to'function about. that. And also that really ties right into services with young people, I assume our. youth have an included layer one, they could not
also have actually a. tool. So they are having to act, let ' s claim for instance, a. teen, they ' re needing to ask their moms and dads to utilize their. smartphone to take part in the session.And then a few of what. they wish to speak about, for instance, may not be something.
their will certainly they ' re wanting to show their parents, and.
they'wear ' t have the capability to drive someplace else to have. that call. So we ' re truly looking
for means to continue to. outreach with young people and also offer them an exclusive room to have. those solutions. And after that I believe it ' s simply hard on everybody. right to feel that isolation, getting used to residence offices.So a. lot
of concentrate on therapist health, and we ' re making sure.

of ourselves so we can better look after others.
So we ' ve. done things like have our physical'specialist, join some of. our team conferences to speak about how to best established a house office. to ensure that telehealth doesn ' t necessarily have that negative. influence on our therapists. Okay, following slide.
Oh, that ' s it. Sorry. Great, thank you for touching on. that, Megan, regarding the, you recognize, dealing with yourselves.
as you'' re caring for various other people. I assume that has truly.
emerged as a problem throughout this period. So thank you for that. I.
believe prior to we most likely to the conversation, we have Melissa as well as.
Micah who didn'' t have slides, however we wanted to offer them the.
chance to chat a little about their program. So let'' s. ask Melissa First, if she'' d like to provide us an overview of what.
she'' s doing? Yes. Can everyone hear me alright? Yes, we can.Excellent.

That'' s, that ' s always. a good idea with tele tele anything nowadays. So I help.
Camus path. And also we offer drug abuse treatment.
services, mental health and wellness therapy services, gaming.
treatment services, and afterwards we likewise handle the crisis solutions.
for the people. So we we were in this similar situation, as I.
think everyone throughout the state, we made the transition to.
telehealth in 13 hrs. And we had no we didn'' t have any kind of equipment.And we still use desktops,.
due to the cost. laptops are dramatically a lot more costly.
than desktops. We didn'' t have web cams you couldn ' t get web cams.
from or any individual. Um, and also so we we just we had to type of.
hit the ground running and also identify exactly how to do it as well as we.
had the ability to come with each other as a team. We used our personal.
equipment in your home and also our IT staff appeared and also establish it up to.
raise the discretion as best as they can in the.
protections required. Um, we certainly have hit a great deal of.
obstacles. And also it'' s it ' s fantastic that.
Medicaid has actually has actually really helped in making this procedure smoother.
for reimbursement. It has we have actually not experienced the exact same.
procedure with private insurance firms. So we fulfill a great deal of.
challenges with repayment via the tele for the tele.
solutions with them at this time, which to make sure that'' s. something that we'' re regularly working on and also.
communicating with those represented agents from.
like Blue Cross to address that.It ' s definitely extra team.
intensive. Our our need for situation treatments boosted. We went from an overall of four people on situation plans to.
27 in the month of April. We do not have a hike COVID caseload the people has.
just had 4 individuals that checked positive for COVID. So.
we'' ve been really privileged for that. But the innovation.
restrictions on the appointments is extreme. The access to.
solutions, we had the ability to get iPhones From HCA also, but.
they put on'' t have signal. So, so they have a, they have a cell.
phone, however they can'' t use it.
And, you know,. transport to where Wi Fi solutions are readily available openly.
was is likewise an obstacle due to the fact that transportation is not easily.
readily available in the communities. And so it'' s just there has been. a great deal of obstacles for people accessing care.And,.

you understand, not every solution is helping every customer. As well as so.
we'' re simply constantly needing to interact to discover a new.
remedy for a brand-new issue, we certainly have actually seen a decrease.
of boost in compound abuse teams. People wear'' t really feel that
. exact same link to their group participants that they do in person. And also so we'' ve been we ' ve recently started some dialogue sessions.
with our clients on just how can that just how can we work to construct that.
link in the team setup? Through the tele design that they.
are usually they'' re made use of to having by being in person.That ' s every little thing for'me. Many thanks a lot, Melissa. Child, it.
seem like some common motifs are establishing here. And also allow'' s. transform it over to Micah. what he needs to state regarding what he'' s been.
doing.Introductions everyone, everybody,
can you hear me? Okay? We'' re in fact situated in Salem,
Oregon, we'' re one-of-a-kind website, whereas licensed institution based
health and wellness center in the state of Oregon, we serve thorough
institution based healthcare solutions, and also totally integrated
behavioral health and wellness services offering the chamalla Indian High
School, which offers young people coming from all over the nation
70 or even more tribes, in a normal year representative representing
20, or more different states.So there ' s
always been challenges. As Well As Dr. Ford has been a phenomenal source for us over
the years. And for trainees that allow'' s state leave at the end of the academic year, and also care transition planning, and also just how to best coordinate and also browse intricate care problems, such as we have a young people that we made reference for domestic treatment. And their therapy is done, allow'' s say in July when all the pupils have actually left and and you have treatment control, planning concerns, since there'' s no suitable step down treatment in their local community.So we ' ve
type of been browsing least the one decade I'' ve been right here, some of the intricacies around complex care. The last pair years, we'' ve additionally added integrated behavior health, and adding integrated LCS, W'' s and psychiatric registered nurse specialists within our clinical house design. And also so we'' ve been adding a lot more tele beaver wellness service and even more standard solutions simply generally. And we'' ve kind of used the care coordination kind solutions for many years in terms of summer season for students that allow'' s state we leave and also we understand they ' re preparation on returning has it relates to COVID. Because our pupils had to leave quickly in March, at the earliest signs that this might be turbulent, we truly accelerated our treatment shift procedure and source connections with tribal house communities.And we did some things that we typically would refrain from doing. At the end of the academic year, we consulted with all the pupils and also simply did some truly strong outreach, type of mental health promotion, and followed it up with an extensive demands assessment study, that we used our collaboration with the college to go out to the pupils, and after that additionally supplied a. extensive list of web based resources and sustains. And also that. type of got us considering and afterwards part of that brought about us,. for those that have been active in treatment, having that. disruption, producing a bridge continuity for telebehavioral. Wellness over the summer.But I think the larger thing for us is.
it really got us assuming regarding
we require to be more deliberate.
on how we make use of technology to boost the degree of top quality and.
gain access to as well as the services we supply. Therefore part of this,.
that ' s a part of a few of the partnerships within the Health. Board and we are native and also, and also other points available that.
really reassessing exactly how we use tele behavioral health and wellness solutions.
instead of just the conventional therapy lens, considering it.
via a thorough continuum of treatment lens.
As well as so. that ' s sort of improved our technique this'year because for. our institution based young people now there ' s no strategies for them to. return on site on school. So a few of things that we ' ve. done is we ' re creating strategies of exactly how we'can produce, like. promo videos obtaining more info resources out there. We ' ve designated a social area care organizer. that ' s beginning as college applications as the trainees are. doing distance understanding, mapping where all our children are coming. from and start mapping an extensive, what resources. are readily available in their neighborhood, collaborating with the. school based counselors, so we can actually step up our care. control game.So for instance, if we have a supplier.
that was the key counselor in 2014, but as a result of the demands.
of that pupil, it might not be suitable for that medical.
Caribbean gave using tele paper health, versus that.
company might be much better position to try to obtain them.
gotten in touch with a regional therapist or local resources, as well as support. it a lot more as a system of care, treatment coordination, continuity of
. care assistance. So we ' ve been really kind of tough kind.
of some of our standards, we got to out to all the.
behavior health and wellness consultants, as part of this effort of
the. Lino data source to start mapping, all the various from social.
solutions, food, sources, sanctuary, behavioral health and wellness,. begin like a resource community source database
, and attempt to. develop a wider joint so we can moving on be a great deal. a lot more receptive, in terms of just how we can optimize the system
of. treatment with innovation that we ' re privileged to we had an.
existing collaborative with the aim Center at the University of
. Washington as component of our integrated behavior health in.
a collective give we did with storage space box, which had.
certain things they were going to get for us for that.So we.
had the ability to obtain 8 iPads that were so you ' re capable.

As well as.
we run into difficulties with our network and placing them to make use of. but however it ' s it ' s absolutely been a challenge.
A few of our.'newer providers, more recent IHS concerns about supplying.
solutions throughout state lines. However in general, our team is kind of
. considering this, exactly how do we how do we turn this right into.
chance? So we can reassess our technique to
just how we can. maximize our system of treatment.
I ' ll relocation in this way, knowing that. I didn ' t simply
freeze'. No, that'' s fantastic. Thanks so. much. This has been fantastic to hear what everyone ' s functioning on. along with the, as a whole the parameters that everyone '
s. working with, and just how cutting-edge people have actually been relating to and also.
how fast just how quickly so people simply turn this thing right.
about as well as leapt in.And it'' s amazing to hear all of these.
pointers and also referrals and also kind of what individuals are doing.
to react to this. I wish to open this moment now for.
discussion. As well as I simply realized I forgot to introduce myself. I'' m sorry. Jeff bash, why miska Catherine akia. My name is.
Katherine akia. Combination member and also below today as a.
consultant for American Indian Wellness Payment to kind of
. launch this conversation part part. And also my colleague, Jen.
Olson will certainly additionally be helping out. Hey, Jen, great. It'' s your. videos. Yes.
And also I additionally am I would certainly like.'to open it up if there ' s any various other tribal programs that would. like to share their experience with telebehavioral. Health. Yes. As well as in order to make this.
component of the discussion, the most interactive feasible via.
webinar, we there'' s a pair of things I desire to advise people,. you ' re welcome to put inquiries
into the chat.I ' ve in fact
got. a Word paper going and I'' m just cut and also paste them all in.
there to try to ensure we struck all of the concerns today. And.
any various other concerns that are not attended to today that will certainly make.
sure that we struck them up next week. Also, you'' re welcome
to. increase your hand. We ' ll obtain you unmuted.
If you favor chatting. that that functions truly'well as well. We ' ll get that going as. well. So we ' ll do the chat function. You ' re always welcome. to the raise hand.
we ' ll unmute you. As well as then likewise the other. point might be to sorry to address a few survey inquiries.
So. we ' re going to obtain a number of surveys going just to'obtain your.
your fingers and also your mouse is going. And also we ' ll have everyone. respond to the very first survey concern showing up in just a moment.
As well as. on the other hand, I am reducing and also pasting a couple of the. questions from the conversation here. The first survey concern to. everyone, the length of time have you been
using telehealth. services? So I kind of would like to know
, was. anybody doing it beforehand along with how much time individuals jump.
in red as it took place? Or did some folks perhaps wait a little.
little bit while and afterwards begin the telehealth services? provide people a few more minutes.While I ' m going
allowing'the poll. inquiries go, I wished to allow you recognize the three inquiries. that I have seen thus far.
One I can respond to today, will you. have the ability to send a copy of the slides? Yes, regarding my. understanding is that the center will certainly have not only recording of. the webinar, yet we ' ll have products available as well.So. we'' ll ensure that everybody gets those.
The next question,. this question turned up throughout Dr. Ford ' s discussion. But I believe. really, it would certainly be terrific for all the panelists, however Dr. Ford,. I ' ll have you kick it off. Which is can you provide. suggested system websites? Right. Hi, everybody. This is. Chris once more. Um, so the
short solution is no. As a federal. employee, I can'' t give any referrals for certain
. items. Nevertheless, I can provide some basic guidelines, as well as you.
all should recognize. So 2 things to keep in mind. One is IHS, right when.
this hit, we really released our initial across the country telehealth.
system that can get to into people home and also was tool.
agnostic, the Cisco conference system, this is open to anyone.
who has a an IHS D one account. So if you have that within your.
program, you can utilize this system, the platform is excellent,.
it'' s not great.It ' s really established for video conferences. So within.
that context, we are now doing market research, we'' ve consulted with. at the very least half a lots vendors, we'' re meeting with 2 or three.
a week to try to see what'' s available for system that we
may. wish to make use of long term. So a number of things that we are.
looking for that I would certainly motivate you to try to find in.
systems on functionality. If it'' s hard to use, companies won'' t. usage it. Just that ' s the bottom line. Um, safety. For us, this.
is a huge deal. Um, so while HIPAA demands have actually been.
waived for us, we still drop under lots of, lots of other regs that.
have not been waived. So we'' ve been really mindful regarding utilizing. various other systems we can, however we'' ve been mindful regarding it. The third point I would certainly assume that you require to consider.
with your platform is just how does it operate in reduced data transfer, high.
latency environments. We'' ve listened to everybody claiming that.
connectivity is challenging in Indian Nation, you need a.
platform or software program that I will claim falls short beautifully, when the.
data transfer starts getting constrained.Does it simply reduced.

simultaneously? Or can you move to a voice just call? Those kinds. of things are points I'' ve recommend that you look at. And.
finally, again, now you can utilize almost anything. But.
looking ahead, is it something that is HIPAA certified, or.
could become HIPAA certified in the future? So I don'' t have a. specific suggestions. Yet those are the points that I.
suggest you look for in a video system. make excellent recommendations. Thanks, Dr. billu? Or Melissa, are you do you desire to
. talk a little about the platforms that are helping.
you? Where you may be headed? Sure. And I have our.
psychiatrist, Dr. Danny here with me too. We have been.
making use of the expert zoom permit given that starting and also.
that'' s behavior health and wellness and after that likewise at the clinical center, if you desire to.We ' ve also been utilizing Microsoft.
Groups though, which is what the rest of the type of lamination.
staff members are utilizing. And so especially when it comes to.
scientific seminars, often we make use of that enhancement to to zoom,.
yet yep, zoom was something that we'' re able to take on early. I also simply intend to put in a plug for Dr. Ford too. Dr. Ford was very gracious to satisfy with the type of lummi Country.
early in, I believe it was October last year.And so it practically really felt. like we had a running running start when it came to COVID because I. assume we went to least thinking of what several of these. obstacles might be and also he aided to sort of emphasis some of our. discussion along with accessibility some sources that are possible. for Indian country. So I think we are really thankful as well as I was. going with my mind as I heard him talking earlier.And for chemists path we are. utilizing zoom however it ' s really done

through our digital.
healthcare. document system, and also which is incredibly hassle-free,.
due to the fact that it sends the appointments instantly to.
the customers and then it documents like who it was in.
presence. So it does a whole lot of that self monitoring for us as. well. We were privileged that we transitioned to an electronic. record system concerning a year and also a half ago.
On Thanks, and also Micah, did you. wish to read it the system that you ' re using that works the. best? Sure.
We'' ve been making use of the IHS system Dr. For.
referred to, and we were lucky to obtain the mobile phone.
offered to us. Yet we'' ve type of mostly counted on telephonic,.
specifically for the student outreach, so for, for any videos.
things for integrated behavior health.But what we

' ve found is.
essentially, our trainee based things to go old made.
telephone has actually functioned the ideal and been one of the most trustworthy,.
particularly for the young people. On the various other end. Thank you so a lot for those.
suggestions actually useful. Simply to hopefully everybody saw.
the results, yet if not, it was 30%, you know, 6 months or 6.
months, as well as nearly the majority of the remainder in the last 6.
months. So everyone feels like everybody on this phone call until now. Oh, thanks. 50% has been doing time off for several.
months, a minimum of. Everyone'' s a little bit right into

this now.And go on and also introduce the following.
survey for us. Uh, Katherine, previously, as we'' re. doing that, I simply wished to state it for companies in.
Washington State. As Well As the Wellness Care Authority did purchase a.
bulk amount of zoom licenses, the HIPAA compliant variation,.
that are offered to any behavior wellness service provider in.
Washington State. And they are HIPAA compliant versions.So.

when sometimes we'' ve obtained inquiries like I can'' t document my. presentation. And that ' s since that functions and also not available.
but we supply the boom accredits to STD suppliers, medical.
carriers, even avoidance carriers or recovery supports,.
like your certified peer counselors, and also prevention team.
trained to fulfill with, you understand, us. So I'' m gon na put the web link to.
the application, we still have those zoom licenses readily available. I'' ll placed that in the chat box.And I ask forgiveness, I ought to have.
place that in our presentation. However, , that is one source.
that is readily available. And afterwards just sharing regarding the work of the.
providing phones, to people in Washington State, to people.
and clients. Which was a collaboration with the emergency.
administration group that'' s in Washington State.
As well as they. usually dealt with, like the significant phone companies to access.
some of those sources that we were able to venture out into the.
communities. I understand we'' re still trying to find out how to. proceed that or add mins to phones that were purchased.So.

simply something to think of for our state and also for various other.
states. Those that are getting involved on the phone call. So I will put that in the conversation.
box currently. Many thanks. Thanks getting some notes.
to ensure we placed in our q&& an afterwards. We'' ll capture that.
you still have a health care 30 licenses. Okay, so the following component.
I wanted to next question that was placed in the conversation a bit.
earlier was those thumbs the licenses? Some state licenses.
are not needed? I'' ve heard that many 3rd party payers.
needing them. So if somebody would certainly like to address that,.
either. Dr. Ford a mix or as well as after that right after that,.
possibly Michael much longer, you'' ve obtained anything detailed on that particular. Right. Hi, this is Chris once more. Um, we'' ve encounter this pre COVID as well. It is a.
difficulty. Allow me offer you an extremely quick example. three states.
in the US need or allow psycho therapists to prescribe.
medicines with extra training and also licensure.New.

Mexico being one of those. So, so if my program hires a.
prescribing psychologist they can recommend throughout the.
nation under the government umbrella. Nevertheless, that doesn'' t. imply they ' re going to obtain reimbursed for those services. We have a prescribing psychologist in Wisconsin,.
supplying care Within Wisconsin, Wisconsin states we'' ll compensate. you for your, your counseling, however we ' re not going
to compensate. you for your prescribing. So this is not anything new.
always. Although it appears like if you'' re within the extent. that is comparable. This is a strange one since psycho therapists wear'' t. usually prescribe, but if within a comparable extent, we appears.
like it would certainly be more most likely for them to recommend or to I'' m. sorry, to be able to repay what we have done, we made a.
habit of connecting to the state CMS get in touch with and also by proxy.
3rd party payers and also trying to function that out with them,.
informing them as to why as a government entity or tribal entity,.
points are various. So you may attempt that. However it can be a.
challenge. As well as then I wished to examine in with Michael.
longenecker, on the seminal fluid that he took into the chat.Really shamed on those. slides I created.
I was simply paying attention, I believed, Oh, I.
never ever spoke about the IHS encounter price, which'' s. possibly among the biggest concerns. Remember those 3.
sorts of bikes, you know, the bicycle, telemedicine that'' s. been qualified for the IHS experience price given that we had actually a.
state plan amendment in 2018. But the telephone calls and the.
Skype the other, you understand, the tricycle unicycle.Those.

formerly did not qualify for the IHS encounter price, yet a.
state strategy change entered into result. I tell you two weeks.
after the pandemic begun, as well as those do certify for the.
experience price during the pandemic. I believe I heard a.
inquiry about 3rd party payers as well as calling for in state.
licensing. I understand that for Washington carrier one and the.
handled care companies that we deal with, we respect the out.
of state licensure for you recognize, the docks that might be least.
certified out of state. I put on'' t learn about the third party. payers, however, if you have a problem with a third party payer. Let us recognize. I believe that'' s all of course, no, thanks.
Thanks so. much. It ' s really useful.
And also we ' ll take an appearance at our. most recent poll results.What are your long-term objectives? telehealth? So it resembles we ' ve obtained um, just continue. using it, but return in face to face simply a bit with.
that proceed. And I'' m hybrid. Okay. So virtually everybody'' s. looking at a crossbreed design going forward. That'' s truly terrific. Thanks. Thank you a lot. And also we, if. you intend to launch the next poll inquiries, go
to Beast following. poll inquiry. Now, were there any type of raised give out there? Did.
any person wish to unmute themselves and ask the question.
to among the panelists. The next four questions up on.
your screen.And ideally, if you have training needs around. telehealth, how would you prefer to receive these trainings? And also. this is truly valuable for every one of our panels on the phone, as. well as the people arranging this to actually know what ' s the. finest means to get details bent on everyone. I ' m calling via the conversations. I. think I ' ve obtained everyone the 3 inquiries'that were asked. previously. Oh, we have an inquiry that simply. can be found in. While we ' re awaiting
the poll results. We ' ll give the. survey a moment and also come
back to the just how to provide telehealth.
training.The question to the
panelists is the length of time will. telehealth be reimbursable
at the experience price in Washington. State 21st century many people maintain.
chatting while they ' re under the call.
They ' re still soft. I. wish I had the answer to that.
I indicate a computer system individual I would. like to provide you an actual date. But the state plan change. that allows the encounter price for telehealth permits the. experience price for telehealth throughout the guv declared. state of emergency situation. When is that mosting likely to finish No, we.
don ' t recognize. Yet simply a reminder that.
telemedicine you recognize, they have a certified variation that was. previously eligible for the IHS as well as counter rape
. Maybe you got the desliming. bicycle powered unicycle trying
to do a billing webinar. I ' m like, how do I obtain the distinction?'Because it ' s in my. dumb little brain.It ' s actually

So'I just developed. these bicycles.
I liked it. It was practical for.
me. Thanks. Um, here we have from Debbie.
Listen, simply in free information. So comas tribe is.
introducing a comprehensive primary as well as behavior homeless,.
homeless and also health and wellness program currently for 11 120 moneyed by.
hersa and also CDC COVID gives that would be Deb, do you mind if we.
unmute you? As well as you could allow us understand a little bit concerning that? unmuting so someone else? Oh, computer mic isn'' t on. Okay. Well, thank you a lot. No fears. Thanks so much. Thank you for sharing that with us. That would be great to hear.
more about. As well as I believe I was simply speaking with Jen Olson that.
someone else could be on today that was also can offer some.
updates on their program. As well as I had a nice conversation with.
calots. As well as also, I think, scope, squawks and also Island, if.
anybody wishes to share any type of info on lessons they'' ve. learned, rotating to telemedicine, as well as I would certainly also what I listen to.
Michael Longnecker, I hear you'' re stating that if we were to.
equipment our tribal clinics in the direction of tele medicine, that that may.
be a lot more reimbursable.Post the public.

wellness emergency.
So as lengthy as all of us have an understanding of.
what is required in position for telemedicine Is that proper? And I'' m certain we.
can share some records on that particular. That'' s proper. Yet what I'' ve. observed is plan adjustments. So that'' s that ' s generally what I.
need to claim and also telehealth may end up being experience qualified six.
months from now, regardless of the pandemic, however at this time,.
the phone conversation and Skype are qualified for that kind of.
price throughout the pandemic, that you'' re right, changing in the direction of a.
HIPAA certified telemedicine in the long run per the current.
guidelines would certainly keep an IHS encounter rate. Sir, I ought to chat about that. I care that you need to close.
the survey. Yeah, awesome. Yeah. Okay. If you'' ve got training.
needs, excellent. Okay. So short one hour educational concerns. Excellent to recognize. We'' re seeing a great deal of details around ideal.
since individuals sort of zoom out.There'' s zoom, zoned out
after about 70 mins, right. You can'' t go a lot past an hour zoning out on resumes. To make sure that'' s. really terrific to know.Thank you, everybody. Well, with. that in mind, and also due to the fact that we just got a pair minutes as well as we.
are coming up on that time. Any type of other questions for the.
panelists? If you feel on a scroll to the.
second to the last slide, well, people are generating.
questions and also more. And one more. So I simply desired to place this up.
below. This is a collection of sources that are readily available to any individual in.
Washington State.To call it

' s sort of a telehealth program in.
that carriers can call any one of these lines, to have case.
discussions with a psychoanalyst for you know, assistance and.
assisting to take care of a particularly challenging case or something.
like that. Therefore we have the psychiatry assessment line.
PCL, which is for suggesting suppliers with grown-up psychiatry.
or addictions inquiries. There'' s the collaboration access line,.
which is generally the same thing, yet for individuals who are.
youngsters or teenagers. And after that we have the the friend for.
mommy'' s line, which is for companies, not necessarily.
suggesting carriers. That'' s the one line that you don'' t have. to be a prescriber to

call.And, as well as you can talk with a.
psychiatrist about behavior wellness inquiries associated with.
maternity as well as postpartum people. And afterwards also, every.
Thursday, it really is simply going on today we have the.
psychiatry and also dependencies situation meeting series. And it''
s an. resemble program, if you'' re knowledgeable about that, where we have a.
didactic every week, adhered to by situation presentations and.
discussion. So you'' re every one of these are complimentary solutions to.
anybody in the state of Washington. And you'' re greater than. welcome to sign up with to any of those. Great, thank you. And also I just.
wanted to restate that what we'' ll do is we ' ll prepare I ' ve. been taking some notes, both from lemon capital presentations.
pertaining to the technologies and also the obstacles. So there are some.
obstacles, zillion i think that i put on'' t recognize if anybody ' s figured.
out an excellent solution, but great deals of folks have obtained some great.
workarounds.So we ' ll order those up as well as pull those with each other. So. that following week when we'' re talking about a little bit extra.
entering into, you know, what are a few of the services that.
individuals are finding that are functioning? We can maintain selecting.
that and also just actually value sharing today on what'' s been.
functioning. Right. Last slide, please.

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