SSA - POMS: DI 22510.013 - Telehealth Consultative Examination (THCE) - General

A. Definition of a telehealth consultative examination (THCE)

A THCE is a consultative examination (CE) that:

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Uses audio and video technology to allow remote interaction between a CE source and a claimant or beneficiary,
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Requires the claimant or beneficiary to participate using a personal device at their home or other private location, and
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Requires the claimant or beneficiary to participate using a platform selected by the CE source.

For information on:

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The definition of a video CE, see DI 22510.001A.1.b.
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The policies and procedures for video CEs, see DI 22510.012.

B. General THCE guidelines

Disability Determination Services (DDS) may schedule a THCE only if all the following requirements are met:

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The type of THCE is permitted (see DI 22510.013C in this section),
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The claimant (parent of a minor child or legal guardian) agrees to participate in a THCE (see DI 22510.014C),
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The claimant meets all the requirements in DI 22510.013D in this section, and
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The CE source meets the privacy and information security requirements in DI 22510.013E.1 in this section.

C. Types of THCEs permitted

DDS may schedule the following types of THCEs for claimants aged 5 and older:

1.

Psychiatric CEs
2.

Psychological CEs without standardized testing
3.
Speech and language CEs
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  When scheduling a speech and language THCE for a child whose primary language is Spanish, DDS must require the CE source to use standardized tests published in Spanish.
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  When scheduling a speech and language THCE for claimants whose primary language is not English, DDS must choose a CE source who is fluent in the claimant’s primary language.
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  DDS must not use interpreters for speech and language THCEs.

D. Claimant requirements

1. Determining when a THCE is appropriate

Before offering a claimant the opportunity to participate in a THCE, DDS must consider whether a THCE is appropriate. DDS should review the available evidence, supplemented by any interactions with the claimant, to identify any significant limitations in the claimant's ability to:

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Hear others in face-to-face conversations (including with the use of a hearing aid(s)),
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Follow simple instructions, and
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Concentrate.

If the claimant has or alleges significant limitation in any of these capacities, DDS will schedule an in-person CE. DDS may ask for medical or psychological consultant, or medical advisor, advice to help decide whether a THCE is appropriate for the claimant.

2. Technology and environment for THCEs

The claimant must:

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Participate from a private, quiet environment conducive to the examination,
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Have a reliable internet connection, and
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Use a device with a camera and microphone (audio and video are required), such as a smartphone, tablet, laptop, or desktop computer.

IMPORTANT: For speech and language THCEs, the claimant cannot use a smartphone because the screen is too small for standardized testing. Instead, the claimant must use a tablet with a diagonal screen display of at least 9.7 inches, a laptop, or a desktop computer.

If the claimant cannot meet all the above requirements, DDS will schedule an in-person CE.

NOTE: The CE source must confirm that the internet connection allows both the CE source and claimant to adequately see, hear, and participate in the THCE. In addition, the CE source must also ask the claimant to confirm participation from a private location. If these conditions are not met, the CE source will terminate the THCE, and DDS will schedule an in-person CE.

3. Proper identification for THCEs

If the claimant is an adult or a child with a valid, unexpired government-issued photo identification (ID) (e.g., United States (U.S.) State-issued driver’s license, U.S. State-issued ID card, U.S. passport, U.S. military ID, or U.S. tribal ID), the claimant must show their ID over the video connection as evidence of identity. If the claimant is an adult who does not have the required ID, DDS will schedule an in-person CE.

If the claimant is a child without a government-issued photo ID:

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The claimant must show, over the video connection, an original ID document as evidence of age and identity, such as a government-issued non-photo ID (e.g., birth certificate) or a nongovernment-issued photo ID (e.g., student ID), or
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The CE source must include a physical description of the claimant in the CE report unless the CE source is the claimant's own medical source and has a treating relationship with the claimant.

IMPORTANT: DDS must confirm that an adult claimant has a current and valid, unexpired government-issued photo ID before scheduling a THCE.

NOTE: The CE source must verify the claimant's identity and document verification in the CE report (see DI 22510.015A.3 and DI 22510.035A). If the CE source is unable to verify the identity of the claimant, the CE source will terminate the THCE, and DDS will schedule an in-person CE.

E. CE source requirements

1. Privacy and information security

Only qualified CE sources who are “covered entities” under the Health Insurance Portability and Accountability Act (HIPAA) as defined in 45 CFR 160.103, and follow HIPAA rules and requirements, may conduct THCEs. HIPAA and associated HIPAA Rules sufficiently protect participant privacy and agency interests. The CE source is responsible for ensuring compliance with HIPAA’s requirements relating to telehealth platforms or applications.

For more information on selecting a qualified CE source, see DI 22510.010.

2. Licensure

Generally, a CE source may only conduct CEs across State borders if they are licensed in multiple states or hold a license that permits them to do so. Many State licensing laws and regulations disallow healthcare providers to practice across state borders without appropriate licensing in the other state(s). However, some States permit healthcare providers to practice across State borders during exigent circumstances, such as National or State emergencies, to meet healthcare needs. DDS must confirm state licensing requirements before scheduling a THCE with a CE source who is located in a different State than the claimant.

For more information on DDS responsibilities when purchasing a CE across state lines, see DI 39545.225.

F. DDS processing of assistance requests (AR) for THCEs

DDS will process ARs submitted by the Office of Hearing Operations (OHO) (or other adjudicating components) for THCEs that meet all the following requirements:

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The type of THCE is permitted (see DI 22510.013C in this section), and
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The requesting office has contacted the claimant (parent of a minor child or legal guardian) and has obtained agreement to participate in a THCE (see DI 22510.014C), and
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The requesting office has documented the claimant’s (parent of minor a child or legal guardian) agreement in the folder (see DI 22510.014C).

NOTE: If the AR does not meet these requirements, DDS may reject the AR. For more information on ARs for CEs, see DI 29501.010 and DI 29505.001. For OHO procedures for obtaining and documenting agreement to participate in a THCE, see HALLEX I-2-5-20.

Social Security

Program Operations Manual System (POMS)

DI 22510.013 Telehealth Consultative Examination (THCE) - General