Medical-Legal and Reimbursement

This page will help teams identify PMHCA team’s unique legal framework. It will guide the work between their institution, emergency department (ED) partners, and community partners.

Disclaimer: Please remember that the EIIC team is not a legal entity and cannot provide legal advice to your team. However, we can provide some general considerations based on our interactions with PMHCA teams and our understanding of the potential risks and liabilities that may impact PMHCA teams. We recommend seeking guidance from your institution's legal counsel on all matters related to your program's work.

Understanding Your Team’s Legal Framework

Every PMHCA team is unique in its composition and structure. Legal considerations may vary depending on the state, institution, and ED. To guide a PMCHA's ED expansion work, there are general considerations that the team can make. These may include but are not limited to:

  • Billing and reimbursement programs
  • Clinician licensing requirements
  • Contracts (formal and informal)
  • Hospital regulations
  • Liability concerns
  • Risk assumption and mitigation
  • Technology restrictions

Increasing Access to Mental and Behavioral Health Resources via Telehealth

Telehealth is making it possible to reach more people. It also provides critical mental and behavioral health resources to patients and their families. Navigating the telehealth landscape can be daunting, but it doesn’t have to be. Your team can utilize several resources as you explore telehealth’s role in your work.

Internal Assessment for Teams

Working with Emergency Departments (EDs) involves compliance with various medical and legal requirements to ensure the delivery of high-quality healthcare and adherence to regulations.

Here are some important questions to consider to determine your team's medical-legal and reimbursement needs:

Team Activity   Pro-Tips   The 4 S's of Medical-Legal and Reimbursement  

As you navigate the legal parameters of your ED work, use the following questions as a guide:

  • Who is your legal counsel?
    • Are they on your team?
  • What does the engagement with your legal counsel look like?
    • Do you meet with them regularly?
    • Do they attend standing meetings?
  • When do you plan on connecting your legal team with the ED’s legal department?
  • Where is your counsel located?
    • Are they in-house or at another institution?
  • Why have you chosen the legal counsel that you have?
    • Do they specialize in any kind of particular law?
    • Were they recommended based on your home institution?
  • How will you plan on connecting with the ED’s legal department?
  • How are you utilizing your legal counsel in your program’s work?

  • Risk and Liability Considerations
    • PMHCA teams are generally set up to support healthcare providers, not patients. However, some teams are exploring the possibility of offering direct support to patients. It's important to note that the level of risk increases as the team's work gets closer to the patient. Interacting with patients can pose a greater risk than providing education to healthcare providers. This places a higher burden of liability on your team. Even the language used when communicating with providers can affect the risk level. For example, offering suggestions instead of guidance. PMHCA teams have different approaches to handling these considerations. However, teams should seek legal advice to determine the appropriate risk level for their group.
  • Working with the ED’s Legal Department
    • Working with Emergency Departments (EDs) involves compliance with various medical and legal requirements. This ensures the delivery of high-quality healthcare and adherence to regulations. Even if your counsel has a certain opinion about your chosen path, it will still need to be reviewed and approved by the ED's legal counsel. To avoid any legal obstacles that may hinder your program's work and ensure that all parties involved understand the level of risk being taken, it is advisable to involve the ED's legal department from the beginning.
  • The Legal Landscape Around Telehealth – State-Level
    • Each ED has its telehealth policies and each state has unique legal frameworks guiding telehealth. The National Consortium of Telehealth Resource Centers (NCTRC) promotes telehealth services and best practices across the United States. You can find out more about telehealth services in your area by visiting their website.
  • Learn from Others – Connect with Other PMHCA Teams
    • During our collaboration with various PMHCA teams, we found that they connected with more advanced teams to learn about navigating legal issues while interacting with EDs. This ranged from the language used with providers to the information provided in patient education resources. We recommend connecting with your colleagues to learn about best practices or sharing yours!
  • Stuff: What are the legal tools and resources you have available to you?
  • Staff: What does your current legal infrastructure look like?
  • Space: What legal resources are you exploring both within and outside of your space?
  • Systems: How are you navigating the legal landscape when working with EDs?
For helpful links to resources, visit our PMHCA Resource Library!