SAP Tips on Remote DOT SAP Evaluations

By: Laura Dashner, ASAP

As you know, Office of Drug and Alcohol Policy & Compliance (ODAPC) issued a much welcome Statement of Enforcement Discretion regarding the requirement for face-to-face assessments and evaluations in 49 CFR §40.291, §40.293, §40.307 and re-qualification timelines outlined in 49 CFR §40.281(d). The ODAPC notice acknowledges that remote assessments may not provide as much information as a face-to-face assessment does, but states that during the COVID-19 pandemic, a remote assessment is better than no assessment at all. This temporary guidance states that ODAPC will not take enforcement actions against Department of Transportation (DOT) Substance Abuse Professionals (SAPs) who provide remote assessments for the remainder of this public health crisis or until June 30, 2020 whichever comes first. As SAPs in the industry, we welcome this guidance, allowing us to continue supporting the transportation industry during this crisis.

ASAP is committed to the highest level of security on behalf of our employers, SAPs and employees. For ASAP referrals, we are asking that our SAP providers use a HIPAA compliant platform to conduct remote assessments and evaluations. We are aware that Health and Humans Services (HHS) is not enforcing HIPAA compliance regarding telehealth during this crisis. However, our concern is potential liability for all parties. There are a number of affordable HIPAA compliant options listed in the HHS Notification of Enforcement Discretion. Please reach out to us if you need guidance on HIPAA compliant telehealth software that is easy to use and affordable.

Before the Evaluation

1. Choose your platform. The platform MUST provide real time audio and visual communication.
2. Evaluate the quality of the platform chosen as well as your own equipment. Note the ODAPC Statement of Enforcement Discretion states that SAPs must “ determine if the quality of the technology (e.g., speed of the internet connection, clarity of the display, application being used, etc.) is sufficient for you to gather all the visual (e.g., non-verbal physical cues) and audible information you would normally observe in an in-person face-to-face interaction.”
3. Note that, HIPAA compliant tele-health platforms should offer easy access to a Business Associate Agreement (BAA). Please save the BAA for your records.
4. Be aware of state laws or licensure limitations before conducting remote evaluations. Many states have very specific guidelines that are still enforceable. Additionally, you may not be licensed to practice across state lines.
5. Test-run whatever tele-health platform you choose. Have a “meeting” with someone to learn how to walk a new user through getting started. Be sure that your audio and video work.
6. Discuss the platform with your client. Will they be using a computer, phone or tablet? Android or Apple? You may want to email specific instructions to the client.
7. Find a private space to perform the evaluation. This could be a home office or study. Make sure the space is distraction free and has no PHI/PII visible to the individual on the other side of the camera.
8. Decide how you will handle payment and paperwork that may need to be signed. As always, for ASAP cases, we will handle payment details. We also have a HIPAA compliant e-signing platform. We will send any paperwork required to the individual before the evaluation and then securely email those documents to the SAP.
9. Be sure the driver is registered with the FMCSA Clearinghouse and has designated you as the SAP.  Clearinghouse requirements have not changed.

During the Evaluation

1. Follow the same clinical process that you would for a face-to-face assessment, including assessment tools and psychosocial history. Choose an assessment tool that can be conducted via interview. The primary responsibility of the SAP has not changed.
2. Check the Employee’s ID.
3. Remember to look carefully for verbal and nonverbal cues during the remote evaluation.  The SAP Guidelines describe non-verbal cues, “Body language and appearance offer important physical cues vital to the evaluation process. Tremors, needle marks, dilated pupils, exaggerated movements, yellow eyes, glazed or bloodshot eyes, lack of eye contact, a physical slowdown or hyperactivity, appearance, posture, carriage, and ability to communicate…”

After the Evaluation

• In your report, document if the evaluation was performed remotely. Example might be “John Doe was assessed on April 25.
• As a result of the COVID-19 pandemic, the assessment was conducted remotely using [enter platform, such as VSEE, GoToMeeting, Zoom for Healthcare].”

Please contact us at 410.366.3899 x.604 if you have any questions. We are in this together and are happy to work with you.

Be safe and stay healthy. Thank you.

Laura Dashner, CEO

• DOT COVID-19 Drug & Alcohol Testing Statement of Enforcement Discretion for Substance Abuse Professionals and Service Agents
• Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency
• The Substance Abuse Professional Guidelines