American Speech-Language-Hearing Association

State Telepractice Requirements

Alabama, Arkansas, California, Delaware, District of Columbia, Georgia, Iowa, Kentucky, Louisiana, Maryland, Montana, North Carolina, Ohio, OklahomaSouth Dakota, TennesseeTexas, West Virginia and Wyoming have laws and regulations, definitions or policies related to the use of telepractice for audiologists and speech-language pathologists, which are summarized below. The information is reviewed on an annual basis. Please be advised that laws, regulations and policies may change at any time, so always check with your state for the most up-to-date information.

If you are interested in advocating for the regulation of telepractice in your state, view our model legislation for interstate telepractice [PDF] and model regulation for telepractice [PDF] for suggested language.

States with Laws and Regulations Regarding Telepractice

Alabama

870-X-2-01   Exemptions (j)

Any practitioner who does not qualify for an exemption must hold an Alabama license.  This shall be required for all individuals providing services for consumers in Alabama via in-office practice as well as telepractice or any other electronic means.

Alabama Rules and Regulations [PDF]

Delaware

§9.2.1.4   Code of Ethics

Licensees shall not evaluate or treat a client with speech, language, or hearing disorders solely by correspondence. Correspondence includes telecommunication.

Delaware Rules and Regulations

Georgia

§609-13-.01 Telecommunications

Any person in this state or physically located in another state or foreign country who,using telecommunications and information technologies through which speech-language pathology information and auditory-vestibular system information or data is transmitted, performs an act that is part of a patient care service located in this state, including but not limited to any measures of speech-language pathology or auditory-vestibular system function or hearing instrument selection, fitting, or dispensing that would effect the diagnosis or treatment of the patient is engaged in the practice of speech-language pathology or audio logy in this state.

§609-13-.02 License Requirement

Any person who performs such acts through such means as described in Rule 609-13-.01 shall be required to have a license to practice speech-language pathology or audiology in
this state and shall be subject to regulation by the Board.

§609-13-.03 Restrictions

No out-of-state or foreign practitioner shall have ultimate authority over the speech language or auditory-vestibular system health care of a patient who is located in this state. Any such practitioner in this state, another state, or a foreign country shall abide by the rules of the Board.

§609-13-.04 Exemptions.

(1) This shall not apply to:

(a) the acts of a speech-language pathologist or an audiologist located in another state or foreign country who provides consultation services at the request of a speech-language
pathologist or an audiologist licensed in this state; (b) the acts of a speech-language pathologist or an audiologist licensed in another state or foreign country who:

  1. provides consultation services without compensation, remuneration, or other expectation thereof and without altering, adjusting, or manipulating hearing aid device controls; or
  2. provides consultation service to a graduate school located in this state and approved by the Board; or
  3. The acts of a speech-language pathologist or an audiologist located in another state or foreign country when invited as a guest of any graduate school or institution of higher
    learning approved by the Board, state, or national accrediting body or component thereof, for the sole purpose of engaging in professional education through lectures, clinics, or demonstrations.
    • This shall not be construed to alter the scope of practice of any health care provider or
      authorize the delivery of health care services in a setting or in a manner not otherwise
      authorized by the laws of this state.

§609-13-.05 Patient Records for Telecommunications

All persons subject to the provision of the Code section 43-44-7 shall be required to comply with all applicable requirements of the laws of this state relating to the maintenance of patient records and the confidentiality of patient information, regardless of where such speech-language pathologist or audiologist may be located and regardless of where or how the records of any patient located in this state are maintained.

Georgia Rules and Regulations

Iowa

§645.300

The provision of speech pathology or audiology services in Iowa through telephonic, electronic, or other means, regardless of the location of the speech/language pathologist or audiologist, shall constitute the practice of speech pathology or audiology and shall require Iowa licensure.

Iowa Rules and Regulations [PDF]

Kentucky

201 KY.Admin.Regs 17:110 Telehealth and telepractice

NECESSITY, FUNCTION, AND CONFORMITY: KRS 334A.200 requires the Board of Speech Language Pathology and Audiology to promulgate administrative regulations to implement the use of telehealth services by speech-language pathologists and audiologists. This administrative regulation establishes requirements for the use of telehealth services.

Section 1. Definitions

(1) "Client" means the person receiving the services of the speech-language pathologist or audiologist and the representative thereof if required by law.
(2) "Telehealth" is defined by KRS 334A.200(3).
(3) "Telepractice" means the practice of speech language pathology or audiology as defined by KRS 334A.020
(4) and KRS 334.020(6) respectively provided by using communication technology that is two (2) way, interactive, and simultaneously audio and video.

Section 2. Client Requirements

A practitioner-patient relationship shall not commence via telehealth. An initial, in-person meeting for the practitioner and patient who prospectively utilize telehealth shall occur. A licensed health care practitioner may represent the licensee at the initial, in-person meeting. A licensee who uses telehealth to deliver speech language pathology or audiology services or who telepractices or the licensed healthcare practitioner representing the licensee shall, at the initial, in-person meeting with the client:

(1) Make reasonable attempts to verify the identity of the client;
(2) Obtain alternative means of contacting the client other than electronically;
(3) Provide to the client alternative means of contacting the licensee other than electronically;
(4) Document if the client has the necessary knowledge and skills to benefit from the type of telepractice provided by the licensee; and
(5) Inform the client in writing about:
(a) The limitations of using technology in the provision of telepractice;
(b) Potential risks to confidentiality of information due to technology in the provision of telepractice;
(c) Potential risks of disruption in the use of telepractice;
(d) When and how the licensee will respond to routine electronic messages;
(e) In what circumstances the licensee will use alternative communications for emergency purposes;
(f) Who else may have access to client communications with the licensee;
(g) How communications can be directed to a specific licensee;
(h) How the licensee stores electronic communications from the client; and
(i) That the licensee may elect to discontinue the provision of services through telehealth.

Kentucky Rules and Regulations [PDF]

Louisiana

§130 Telepractice

A. Licensed audiologists and speech-language pathologists can provide telehealth services through telephonic, electronic, or other means including diagnosis, consultation, treatment, transfer of healthcare information and continuing education. Telepractice regardless of where the service is rendered or delivered constitutes the practice of speech-language pathology or audiology and shall require Louisiana licensure.

Louisiana Rules and Regulations [PDF]

Louisiana Act 442-Effective August 2, 2014

New law provides that a patient receiving telemedicine services maybe in any location at the time that the telemedicine services are rendered and a telemedicine provider may be in any location when providing telemedicine services to a patient.

New law requires a telemedicine provider to document the telemedicine services rendered in the patient's medical records according to the same standard as that required for nontelemedicine services. Medical records, including video, audio, electronic, or other records generated as a result of providing telemedicine services shall be considered as confidential and shall be subject to all applicable state and federal laws and regulations relative to the privacy of health informationNew law defines "telehealth" as a mode of delivering healthcare services that utilizes information and communication technologies to enable the diagnosis, consultation, treatment, education, care management, and self-management of patients at a distance from healthcare providers and which allows services to be accessed when providers are in a distant site and patients are in the originating site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.

New law authorizes each state agency or professional or occupational licensing board or commission that regulates the practice of a healthcare provider to promulgate any rules necessary to provide for, promote, and regulate the use of telehealth in the delivery of healthcare services within the scope of practice regulated by the licensing entity.

New law requires that the rules shall, at a minimum, provide for all of the following: (1) Application of all laws regarding the confidentiality of healthcare information and the patient's rights to the patient's medical information to telehealth interactions.

(2) Application of the same standard of care by a healthcare provider as if the healthcare services were provided in person.

(3) (a) Licensing or registration of out-of-state healthcare providers who seek to furnish healthcare services via telehealth to persons at originating sites in La. The rules shall ensure that any such healthcare provider possesses, at a minimum, an unrestricted and unencumbered license in good standing to perform the healthcare service in the
state in which the healthcare provider is located, and that the license is comparable to its corresponding license in La. as determined by the respective La. Licensing agency, board, or commission.
 (b) Each state agency and professional or occupational licensing board or commission is authorized to provide by rule for a reasonable fee for the license or registration.

(4) Exemption from the telehealth license or registration requirement for the consultation of a healthcare professional licensed by this state with an out-of-state peer professional.

Nothing in new law shall be construed to authorize a state agency or licensing board or commission to expand, diminish, or alter the scope of practice of any healthcare provider.

Louisiana Practice Act

Montana

§37-15-314

(1) An audiologist or speech-language pathologist who is licensed under and meets the requirements of this chapter may engage in telepractice in Montana without obtaining a separate or additional license from the board. 

(2) Except as provided in 37-15-103, an audiologist or speech-language pathologist who is not a resident of Montana and who is not licensed under this chapter may not provide services to patients in Montana through telepractice without first obtaining a license from the board in accordance with this part. 

(3) An audiology aide or assistant or a speech-language pathology aide or assistant may not engage in telepractice. This section does not prohibit an audiology aide or assistant or a speech-language pathology aide or assistant from serving as a facilitator.

Montana Practice Act

§37-15-102

(5) "Facilitator" means a trained individual who is physically present with the patient and facilitates telepractice at the direction of an audiologist or speech-language pathologist. A facilitator may be but is not limited to an audiology or speech-language pathology aide or assistant.

(6) "Patient" means a consumer of services from an audiologist or speech-language pathologist, including a consumer of those services provided through telepractice.

(11) "Telepractice" means the practice of audiology or speech-language pathology by an audiologist or speech-language pathologist at a distance through any means, method, device, or instrumentality for the purposes of assessment, intervention, and consultation.

Montana Practice Act

Rule I definitions

(1) "Asynchronous" means a method of exchanging information that does not require the patient and the provider to be available at the same time. Examples of such communication, also known as "store-and-forward" transmission, include e-mails, faxes, recorded video clips, audio files and virtual technologies and e-learning programs.

(2) "Synchronous" means interactive transmission of data occurring bi-directionally in real time and requiring the patient and the provider be available at the same time.

Rule II provision of telepractice serives

(1) The provision of speech-language pathology or audiology services in this state through telepractice, regardless of the physical location of the speech-language pathologist or audiologist, constitutes the practice of speech-language pathology or audiology and is subject to state licensure requirements and regulation by the board.

Rule III limits on telepractice

(1) No person licensed as a speech-language pathologist or audiologist in another state may engage in the practice of speech-language pathology or audiology in Montana, including telepractice services, unless a license to practice has been issued in Montana.

(2) A person located outside this state who provides speech-language pathology or audiology telepractice services to any patient in Montana shall be appropriately licensed in the jurisdiction in which the person providing telepractice services is located.

(3) All telepractitioners must abide by any statute or rule of this state governing the maintenance of patient records and patient confidentiality, regardless of the state where the records are maintained.

Rule IV delivery of telepractice serices

(1) Telepractice services may be delivered in a variety of ways, including:
      (a) Asynchronous transmission:
          (i) store-and-forward model/electronic transmission of stored clinical data from one location to another usually by the Internet via e-mail or fax; and
          (ii) video and audio transmission through regular mail service delivery and express delivery services; and
      (b) Synchronous transmission:
          (i) clinician interactive model is a real time interaction between provider and patient that may occur via audio or audio/video transmission over telecommunication links such as telephone, Internet, or other methods for distance communication, including:
      (A) videoconferencing;
      (B) remote control software applications;
      (C) computer applications;
      (D) e-mail correspondence, including attachments; or
      (E) self-monitoring/testing model, which refers to the patient who receives the services and provides data to the provider without a facilitator present at the site of the patient.
(2) Live versus stored data refers to the actual data transmitted during the telepractice. Live, real time, and stored clinical data may be included during the telepractice.

Rule V quality of telepractice services

(1) Elements of quality assurance include the competency of licensees, selection of patients, appropriateness of technology to the service being delivered, identification of appropriate outcome measures, collection of data, and satisfaction of the patient, caregiver, and provider.
(2) Telepractice services must conform to professional standards, including all appropriate and applicable codes of ethics.
(3) Licensees shall not engage in false, misleading, or deceptive advertising of telepractice services.
(4) Telepractice services may not be provided solely by correspondence, e.g., mail, e-mail, and faxes, although such may be adjuncts to telepractice.
(5) Licensees shall engage in only those aspects of the professions that are within the scope of their competence, considering their level of education, training, and experience.
(6) Telepractice services must be in compliance with safety and infection control policies and procedures.

Rule VI establishing the practitioner-patient relationship

(1)  A practitioner-patient relationship may commence via telepractice following a practitioner's in-person evaluation of the prospective patient to assess the patient's:
      (a)  need for services; and
      (b)  candidacy for telepractice, including behavioral, physical, and cognitive abilities to participate in telepractice services. Telepractice services may be provided by the     patient's evaluator or another qualified speech-language pathologist or audiologist by the board.

(2)  Prior to initiating services, a speech-language pathologist or audiologist shall:
      (a) make reasonable attempts to verify the identity of the patient;
      (b) obtain alternative means of contacting the patient other than electronically;
      (c) provide to the patient alternative means of contacting the licensee other than electronically;
      (d) document whether the patient has the necessary knowledge and skills to benefit from the type of telepractice provided by the licensee;
      (e) determine the availability of a facilitator, if needed, with the necessary level of training to assist at the patient's location;
      (f) provide orientation and training to the patient in the use of telepractice equipment and the telepractice protocol at an appropriate level for the patient; and
      (g) inform the patient in writing of the following:
      (i) the limitations of using technology in the provision of telepractice;
      (ii) the potential risks to the confidentiality of information due to technology used in telepractice;
      (iii) the potential risks of disruption in the use of telepractice;
      (iv) when and how the licensee will respond to routine electronic messages;
      (v)  in what circumstances the licensee will use alternative communications for emergency purposes;
      (vi) who else may have access to patient communications with the licensee;
      (vii)  how communications can be directed to a specific licensee;
      (viii)  how the licensee stores electronic communications from the patient; and
      (ix)  that the licensee may elect to discontinue the provision of telepractice services.

(3) The written document required by (2)(g) shall be signed by both the licensee and the patient and maintained in the clinical record. If the patient is a minor, the document shall be signed by the patient's parent or guardian.

Rule VII competence-practice limits-maintenance and retention of records

(1)  A licensee using telepractice to deliver services shall:
      (a) complete four hours of board-approved telepractice training prior to engaging in telepractice in Montana;
      (b) limit telepractice services to the licensee's scope of practice;
      (c) maintain continuing competency or associate with a group who has experience in telepractice delivery of care;
      (d) use methods for protecting health information that include authentication and encryption technology;
      (e) limit access to protected health information to only those necessary for the provision of services or those required by law; and
      (f) ensure that confidential communications obtained and stored electronically cannot be recovered and accessed by unauthorized persons when the licensee disposes of electronic equipment and data.

(2)  A speech-language pathology or audiology aide or assistant may function as a facilitator, but may not provide telepractice services.

Montana Rules and Regulations

North Carolina

21 NCAC 64 .0219   TELEPRACTICE

(a) For purposes of this Rule, the following words shall have the following meanings:    
     (1) "Patient site" means the patient"s physical location at the time of the receipt of the telepractice services.
     (2) "Provider" means a licensed speech and language pathologist or audiologist who provides telepractice services.
     (3) "Provider site" means the license"s physical location at the time of the provision of the telepractice services.    
     (4) "Telepractice" means the use of telecommunications and information technologies for the exchange of encrypted patient data, obtained through real-time interaction, from patient site to provider site for the provision of speech and language pathology and audiology services to patients through hardwire or internet connection. Telepractice also
includes the interpretation of patient information provided to the licensee via store and forward techniques.
(b) Telepractice shall be obtained in real time and in a manner sufficient to ensure patient confidentiality.
(c) Telepractice is subject to the same standard of practice stated in 21 NCAC 64 .0205 and 21 NCAC 64 .0216 as if the person being treated were physically present with the licensee. Telepractice is the responsibility of the licensee and shall not be delegated.
(d) Providers must hold a license in the state of the provider site and shall be in compliance with the statutory and regulatory requirements of the patient site.
(e) Licensees and staff involved in telepractice must be trained in the use of telepractice equipment.
(f) Notification of telepractice services shall be provided to the patient and guardian if the patient is a minor. The notification shall include the right to refuse telepractice services and options for alternate services delivery.
(g) Telepractice constitutes the practice of speech and language Pathology and Audiology in both the patient site and provider site.

North Carolina Rules and Regulations [PDF]

Ohio

§4753-2-01 Telehealth Communication

(A) Definitions

(1) "Asynchronous" means recorded therapy sessions submitted for later review.
(2) "Board" means the Ohio board of speech-language pathology and audiology.
(3) "Facilitator" means the individual at the client site who facilitates the telehealth service delivery at the direction of the audiologist or speech language pathologist. For purposes of fulfilling their role, as defined under this chapter, an individual may serve as a facilitator, at the direction of the audiologist or speech language pathologist, without becoming licensed as an aide under section 4753.072 of the Ohio Revised Code.
(4) "Patient" means a consumer of telehealth services.
(5) "Provider" means an audiologist or speech-language pathologist who provides telehealth services.
(6) "Service delivery model" means the method of providing telehealth services.
(7) "Site" means the client/patient location for receiving telehealth services.
(8) "Stored clinical data" means video clips, sound/audio files, photo images, electronic records, and written records that may be available for transmission via telehealth communications.
(9) "Synchronous" means therapy sessions occurring via telepractice applications using real time, encrypted videoconferencing.
(10) "Telehealth" means the use of telecommunications and information technologies for the exchange of information from one site to another for the provision of audiology or speech-language pathology services to an individual from a provider through hardwire or internet connection.
(11) "Telepractice" means the practice of telehealth.

(B) Service delivery models

(1) Telehealth may be delivered in a variety of ways, including but not limited to, those models listed in this paragraph.
(2) Store-and-forward model/electronic transmission is an asynchronous electronic transmission of stored clinical data from one location to another usually by the internet via email and fax.
(3) Synchronous clinician interactive model is a real time interaction between the provider and patient that may occur via encrypted audio and video transmission over telecommunication links including, but not limited to, videoconferencing.
(4) Live versus stored data refers to the actual data transmitted during the telepractice. Both live, real-time and stored clinical data may be included during the telepractice.

C) Guidelines for the use of telehealth

(1) A provider shall be accountable for any ethical and scope of practice requirements when providing telehealth services.
(2) The scope, nature, and quality of services provided via telepractice are the same as that provided during in-person sessions by the provider.
(3) The quality of electronic transmissions shall be appropriate for the provision of telehealth services as if those services were provided in person.
(4) A provider shall only utilize technology with which they are competent to use as part of their telepractice services.
(5) Equipment used for telehealth services shall be maintained in appropriate operational status to provide appropriate quality of services.
(6) Equipment used at the site at which the patient is present shall be in appropriate working condition and deemed appropriate by the provider.
(7) The provider shall be responsible for assessing the client's candidacy for telehealth, including behavioral, physical, and cognitive abilities to participate in services provided via telecommunications.
(8) A provider shall be aware of the patient's level of comfort with the technology being used as part of the telehealth services and only accept for treatment via telecommunications patients who can reasonably be expected to benefit from a service delivery model under section in paragraph B of this rule and continue with such treatment when there is reasonable expectation of further benefit.
(9) As pertaining to liability and malpractice issues, a provider shall be held to the same standards of practice as if the telepractice services were provided in person.
(10) A provider shall be sensitive to cultural and linguistic variables that affect the identification, assessment, treatment, and management of the clients.
(11) Telehealth providers shall comply with all laws, rules, and regulations governing the maintenance of client records, including client confidentiality requirements, regardless of the state where the records of any client within this state are maintained.
(12) Notification of telehealth services should be provided to the client, the guardian, the caregiver, and the multi-disciplinary team, if appropriate. The notification shall include, but not be limited to: the right to refuse telehealth services, options for service delivery, and instructions on filing and resolving complaints.

(D) Limitations of telehealth services

A provider of telehealth services shall inform the patient as to the limitations of providing these services, including, but not limited to, the following:
(1) The inability to have direct, physical contact with the patient is a primary difference between telehealth and direct in-person service delivery; and
(2) The quality of transmitted data may affect the quality of services provided by the provider.

(E) Requirements of personnel providing telehealth services

(1) A provider of telehealth services who practices in the state shall be licensed by the board.
(2) A provider of telehealth services shall be competent in both the type of services provided and the methodology and equipment used to provide the service.
(3) A provider of telehealth services who resides out of state and who provides services to Ohio residents shall be licensed by the board.

Ohio Rules and Regulations

Oklahoma

§690:10-3-9 Use of Telepractice

  1. Licensees may evaluate and treat patients/clients receiving clinical services in Oklahoma by utilizing telepractice. Telepractice is defined as the application of telecommunications technology to deliver professional services at a distance by linking clinician to patient/client or clinician to clinician for assessment, intervention and/or consultation. 
  2. Telepractice shall be obtained in real time and in a manner sufficient to ensure patient confidentiality. 
  3. Telepractice is subject to the same standard of practice as if the person being treated were physically present with the licensee. Telepractice is the responsibility of the licensee and shall not be delegated.
  4. Licensees and staff involved in telepractice must be trained in the use of telepractice equipment (Rules 690:15-1-4) ethical proscriptions: Licensees must not provide clinical services except in a professional relationship. They must not evaluate or treat solely by correspondence or telepractice. This does not preclude follow-up correspondence with persons previously seen, or providing them with general information of an educational nature. 

§690:15-1-4 Ethics Proscriptions

D) Licensees must not provide clinical services except in a professional relationship.  They must not evaluate or treat solely by correspondence or telepractice.  This does not preclude follow-up correspondence with persons previously seen, or providing them with general information of an educational nature.

Oklahoma Rules and Regulations [PDF]

South Dakota

36-37-1

"Telepractice," "telespeech," "telespeech-language pathology," or "telehealth," whether used separately or together. Telepractice service means the application of telecommunication technology to deliver speech-language pathology at a distance for assessment, intervention, or consultation.

36-37-7 Telepractice

Any person who is licensed as a speech-language pathologist in South Dakota may provide speech-language pathology services via telepractice. Services delivered via telepractice shall be equivalent to the quality of services delivered face-to-face.

South Dakota Practice Act

Tennessee

1370-01-.21 USE OF TELECOMMUNICATION TECHNOLOGY.

(1) Policy Statement. Audiologists and Speech Language Pathologists often use telecommunication technology to deliver services to clients in Tennessee who are physically present at a different location in the state at the time they receive the services. Such use of telecommunication technology by Audiologists and Speech Language Pathologists is in the public interest provided the practitioners comply with the requirements of this rule.

(2) Audiologists and Speech Language Pathologists licensed in Tennessee may deliver services to clients in Tennessee through the use of telecommunication technology, including but not limited to dedicated video systems, computers, and other similar devices linked via hardwired or internet connections.

(3) The services delivered through the use of telecommunication technology shall be equivalent in quality to services delivered face-to-face.

(4) Audiologists and Speech Language Pathologists using telecommunication technology to deliver services must have the necessary knowledge and skills, obtained through education, training, and experience, to utilize such technology in a competent manner.

(5) The use of telecommunication technology, including but not limited to the equipment, connectivity, software, hardware, and network compatibility, must be appropriate for the particular service being delivered and must be able to address the unique needs of the client. A licensed audiologist or speech language pathologist must always be physically present at the hub site while interactive telecommunication technology is being utilized to deliver services to a client who is physically present at the distant (remote) site. No asynchronous use of telecommunication technology is permitted by this rule.

(6) An Audiologist or Speech Language Pathologist utilizing telecommunication technology to deliver services to a client is responsible for:

    (a) Assessment of the ability of the client to participate meaningfully in the services delivered in this manner, including but not limited to the client’s physical, cognitive, and behavioral abilities; and 
    (b) Proper calibration of the clinical instruments utilized to deliver services in accordance with standard operating procedures and manufacturer’s specifications.

(7) The client and/or the client’s family members or caregivers shall be informed of the available service delivery options and shall give consent to the use of telecommunication technology for the delivery of services before that method of service delivery is utilized.

(8) When delivering services through the use of telecommunication technology, the Audiologist or Speech Language Pathologist shall:

    (a) Comply with all laws and rules governing the maintenance of client records, including but not limited to client confidentiality requirements; and 
    (b) Comply with all professional standards governing the delivery of services by Audiologists and Speech Language Pathologists, including but not limited to the applicable Code of Ethics and other relevant professional policy documents.

RULES FOR SPEECH PATHOLOGY AND AUDIOLOGY CHAPTER 1370-01 (Rule 1370-01-.21, continued)

(9) An Audiologist or Speech Language Pathologist shall not deliver services to a client solely through the use of regular mail, facsimile, or electronic mail, although these methods of communication may be used to supplement the delivery of services face-to-face or through the use of telecommunication technology.

(10) This rule applies only to the delivery of services through the use of telecommunication technology within the state of Tennessee. It does not apply to the delivery of services when either the client or the Audiologist or Speech Language Pathologist is physically located outside the state of Tennessee.

Tennessee Rules and Regulations [PDF]

Texas

§741.214 Limitation of Telehealth Services

§741.211 Definitions

The following words and terms when used in this chapter shall have the indicated meanings unless the context clearly indicates otherwise.
  (1) Board—The Texas State Board of Examiners for Speech-Language Pathology and Audiology.
  (2) Client—A consumer of telehealth services.
  (3) Client/Patient Site—Location of the patient or client at the time the service is being furnished via telecommunications.
  (4) Consultant—Any professional who collaborates with a provider of telehealth services to provide services to clients.
  (5) Facilitator—Individual at the client site who facilitates the telehealth service delivery at the direction of the audiologist or speech language pathologist.
  (6) Provider—A speech-language pathologist or audiologist fully licensed by the board who provides telehealth services.
  (7) Provider Site—Site at which the speech-language pathologist or audiologist delivering the service is located at the time the service is provided via telecommunications.
  (8) Telehealth—The use of telecommunications and information technologies for the exchange of information from one site to another for the provision of speech-language pathology or audiology services to a client from a provider.
  (9) Telehealth Service—The application of telecommunication technology to deliver speech-language pathology and/or audiology services at a distance for assessment, intervention, and/or consultation.
  (10) Telepractice—The practice of telehealth.

§741.212   Service Delivery Models

(a) Telehealth may be delivered in a variety of ways, including, but not limited to those set out in this section.
  (1) Store-and-forward model/electronic transmission is an asynchronous electronic transmission of stored clinical data from one location to another.
  (2) Clinician interactive model is a synchronous, real time interaction between the provider and client or consultant that may occur via telecommunication links.
(b) Self-monitoring/testing model refers to when the client or consultant receiving the services provides data to the provider without a facilitator present at the site of the client or consultant.
(c) Live versus stored data refers to the actual data transmitted during the telepractice. Both live, real-time and stored clinical data may be included during the telepractice.

§741.213 Guidelines for the Use of Telehealth

(a) A provider shall comply with the board's Code of Ethics and Scope of Practice requirements when providing telehealth services.
(b) The scope, nature, and quality of services provided via telehealth are the same as that provided during in-person sessions by the provider.
(c) The quality of electronic transmissions shall be equally appropriate for the provision of telehealth services as if those services were provided in person.
(d) A provider shall only utilize technology which they are competent to use as part of their telehealth services.
(e) Equipment used for telehealth services at the clinician site shall be maintained in appropriate operational status to provide appropriate quality of services.
(f) Equipment used at the client/patient site at which the client or consultant is present shall be in appropriate working condition and deemed appropriate by the provider.
(g) The initial contact between the provider and client shall be at the same physical location to assess the client's candidacy for telehealth, including behavioral, physical, and cognitive abilities to participate in services provided via telecommunications.
(h) A provider shall be aware of the client or consultant level of comfort with the technology being used as part of the telehealth services and adjust their practice to maximize the client or consultant level of comfort.
(i) When a provider collaborates with a consultant from another state in which the telepractice services are delivered, the consultant in the state in which the client receives services shall be the primary care provider for the client.
(j) As pertaining to liability and malpractice issues, a provider shall be held to the same standards of practice as if the telehealth services were provided in person.
(k) A provider shall be sensitive to cultural and linguistic variables that affect the identification, assessment, treatment, and management of the clients.
(l) Upon request, a provider shall submit to the board data which evaluates effectiveness of services provided via telehealth including, but not limited to, outcome measures.
(m) Telehealth providers shall comply with all laws, rules, and regulations governing the maintenance of client records, including client confidentiality requirements, regardless of the state where the records of any client within this state are maintained.
(n) Notification of telehealth services should be provided to the client, the guardian, the caregiver, and the multi-disciplinary team, if appropriate. The notification shall include, but not be limited to: the right to refuse telehealth services, options for service delivery, and instructions on filing and resolving complaints.

§741.214 Limitations of Telehealth Services

Telehealth services may not be provided by correspondence only, e.g., mail, email, faxes, although they may be adjuncts to telepractice.

§741.215 Requirements for Personnel Providing Teleheath Services

(a) A provider of telehealth services who practices in the State shall be licensed by the board.
(b) A provider of telehealth services shall be competent in both the type of services provided and the methodology and equipment used to provide the service.

Texas Rules and Regulations

West Virginia

§29-1-15 Telepractice

15.1        Definitions.
15.1.a.    "Asynchronous" is defined as images or data that are captured and transmitted for later review by a provider.
15.1.b.    "Client/Patient" is defined as a consumer of telepractice services.
15.1.c.    "Facilitator" is defined as the individual at the client site who facilitates the telepractice service delivery at the direction of the speech-language pathologist or audiologist. 
For purposes of fulfilling the facilitator role at the direction of the speech-language pathologist or audiologist, an individual does not have to become licensed as an aide.
15.1.d.   "Provider" is defined as a speech-language pathologist or audiologist, fully licensed by the board, who provides telepractice services.
15.1.e.   "Service Delivery Model" is defined as the method of providing telepractice services.
15.1.f.    "Site" is defined as the client/patient location for receiving telepractice services.
15.1.g.    "Stored Clinical Data" is defined as video clips, sound/audio files, photo images, electronic records, and written records that may be available for transmission via telepractice communications.
15.1.h.   "Synchronous" is defined as interactive audio and video telepractice service occurring in real time.
15.1.i.    "Telepractice Service" is defined as the application of telecommunication technology to deliver speech-language pathology and/or audiology services at a distance for assessment, intervention and/or consultation.
15.2.      Service Delivery Models
15.2.a.   Telepractice Services may be delivered in a variety of ways, including, but not limited to those set out in this section.
15.2.a.1. Store-and-forward model/is the asynchronous capture and transmission of clinical data from one location to a provider.
15.2.a.2. Synchronous clinician interactive model is a real time interaction between the provider and client/patient that may occur via encrypted audio and video transmission over telecommunication links including, but not  limited to, videoconferencing.
15.3.       Guidelines for Use of Facilitators
15.3.a     Facilitators may be used to assist clients on site when telepractice services are provided.  The Speech-Language Pathologist or Audiologist is responsible for conducting the session and directing the activities of the facilitator.  The facilitator may be a teacher's aide, a nursing assistant, a speech-language pathology or audiology assistant or other type of support personnel.
15.3.b.     The Speech-Language Pathologist or Audiologist is responsible for ensuring the facilitator is appropriately trained to provide the type of assistance needed.  Activities may include:
15.3.b.1.   Escorting client/patient or student to and from sessions;
15.3.b.2.   Establishing and troubleshooting the telepractice connection;
15.3.b.3.   Setting up therapy materials;
15.3.b.4.   Positioning the client/patient at the direction of the Speech-Language Pathologist or Audiologist;
15.3.b.5.   Remaining with the client/patient or student during sessions;
15.3.b.6.   Assisting with behavior management, as needed;
15.3.b.7.   Communicating with on-site staff or teachers about scheduling, and
15.3.b.8.   In some instances serving as the interpreter.
15.4.        Guidelines for Use of Telepractice.
15.4.a.     The provider shall comply with the West Virginia Board of Examiners for Speech-Language Pathology and Audiology Code of Ethics as set forth in 29CSR5 and Scope Practice requirements set forth in West Virginia Code §30-32-13 & §30-32-14, when providing telepractice services.  Failure to comply will be grounds for disciplinary action as described in West Virginia Code §30-32-19.
15.4.b.     Telepractice services delivered via telecommunication technology must be equivalent to the quality, scope and nature of services delivered face-to-face, i.e., in person.
15.4.c.     The quality of electronic transmissions shall be appropriate for the delivery of telepractice services as if those services were provided in person.
15.4.d.     Providers must have the knowledge and skills to competently deliver services via telecommunication technology by virtue of education, training and experience.
15.4.e.     Providers are responsible for assessing the client's candidacy for telepractice including behavioral, physical and cognitive abilities to participate in services provided via telecommunications.
15.4.f.     A provider shall be sensitive to cultural and linguistic variables that affect the identification, assessment, treatment and management of the clients/patients.
15.4.g.    Equipment used for the delivery of telepractice services at the provider site shall be maintained in appropriate operational status to provide appropriate quality of services.
15.4.h.    Equipment used at the client/patient site shall be in appropriate working condition and deemed appropriate by the provider.
15.4.i.     As pertaining to liability and malpractice issues, a provider shall be held to the same standards of practice as if the telepractice services were provided in person.
15.4.j.    Telepractice providers shall comply with all laws, rules and regulations governing the maintenance of patient/client records, including patient/client confidentiality requirements, regardless of the state where the records of any patient/client within this state are maintained.
15.4.k.    Notification of telepractice services should be provided to the patient/client, the guardian, the caregiver, and the multi-disciplinary team, if appropriate.  The notification shall include, but not be limited to:  the right to refuse telepractice services and options for service delivery.
15.5.       Limitations of Telepractice Services
15.5.1.    Telepractice services shall not be provided by correspondence only, e.g., mail, e-mail, fax, although they may adjuncts to telepractice.
15.5.2.    Telepractice services shall not be provided by:
15.5.2.a. Speech Pathologists with a provisional license while completing a postgraduate professional experience/clinical fellowship year. 
15.5.2.b. Speech Pathology or Audiology Assistants
15.6.       Licensure Requirements for Providing Telepractice Services.
15.6.1.    A provider of telepractice services who practices in this State shall be licensed by the Board, per license requirements set forth in WV Code, §30-32-9., §30-32-10. & WV Code Rules §29-1.
15.6.2.    A provider of telepractice services who resides out of this State and who provides telepractice services to clients/patients in West Virginia shall be licensed by the Board, per license requirements set forth in WV Code, §30-32-9. & §30-32-10. & WV Code Rules §29-1.
15.6.3.    A provider of telepractice services shall be competent in both the type of services provided and the methodology and equipment used to provide the services.

West Virginia Rules and Regulations

Wyoming

§33-33-103 Persons and practices affected

(a) License shall be granted either in speech pathology or audiology independently, or both.

(b) No person shall practice or represent himself as a speech pathologist or audiologist unless licensed pursuant to this act.

(c) The provision of speech pathology or audiology services in this state, through telephonic, electronic or other means, regardless of the location of the speech pathologist or audiologist, shall constitute the practice of speech pathology or audiology and shall require licensure as provided in this chapter, and a person located outside of this state providing speech pathology or audiology consultation services to any person in this state shall be appropriately licensed in the jurisdiction in which he is located.

Wyoming Practice Act

States with Policy Statements Regarding Telepractice

California

California and District of Columbia have policies related to the use of telepractice for audiologists and speech-language pathologists.

Telehealth is viewed as mode of delivery of health care services, not a separate form of practice. There are no legal prohibitions to using technology in the practice of speech-language pathology, audiology, or hearing aid dispensing, as long as the practice is done by a California licensed practitioner. Telehealth is not a telephone conversation, e-mail/instant messaging conversation, or fax; it typically involves the application of videoconferencing or store and forward technology to provide or support health care delivery.

The standard of care is the same whether the patient is seen in-person, through telehealth or other methods of electronically enabled health care. Practitioners need not reside in California, as long as they have a valid, current California license.

The laws govern the practice of speech-language pathology, audiology, and hearing aid dispensing, and no matter how communication is performed, the standards of care is no more or less. Practitioners using Telehealth technologies to provide care to patients located in California must be licensed in California and must provide appropriate services and/or treatment to the patient.

California licensed speech-language pathologists, audiologists, and hearing aid dispensers practicing medicine in other states:

Licensees intending to practice via telemedicine technology to treat patients outside of California should check with other state licensing boards. Most states require practitioners to be licensed, and some have enacted limitations to telemedicine practice or require or offer a special registration for interstate practice.

California Policy Statement

District of Columbia

Policy:
The Board of Audiology and Speech-Language Pathology will deem it a violation of its regulations if an audiologist or speech-language pathologist provides services in the District of Columbia without a District of Columbia license, regardless of whether the professional providing services is physically located in the District of Columbia or another jurisdiction.

Analysis:
District of Columbia law at Title 3, Chapter 12, section 1205.01, requires the licensure of providers of health care services in the District of Columbia. With regard to audiologists and speech-language pathologists, the law provides as follows:

License, registration, or certification required. (a) A license issued pursuant to this chapter is required to practice, audiology, speech-language pathology…in the District, except as otherwise provided in this chapter.

The Board of Audiology and Speech-Language Pathology wanted to clarify that any person providing audiology or speech-language pathology services in the District of Columbia must be licensed, and the licensure requirement is applicable regardless of the physical location of the person(s) providing the services.

District of Columbia Policy Statement

State that Define Telepractice

Arkansas and Maryland, have definitions related to the use of telepractice for audiologists and speech-language pathologists.

Arkansas

§17-100-103 Definitions

Telepractice: means telespeech, teleaudiology, teleSLP, telehealth, or telerehabilitation when used separately or together; and "Telepractice service" means the application of telecommunication technology equivalent in quality to services delivered face-to-face to deliver speech-language pathology or audiology services, or both, at a distance for assessment, intervention or consultation, or both.

Arkansas does not currently regulate telepractice but does define it in the scope of practice.

Arkansas Practice Act [PDF] 

Maryland

§2–101 Definitions

Definition: Telehealth means the use of telecommunications and information technologies for the exchanges of information from one site to another for the provision of health care to an individual from a provider through hardwire or Internet connection.

Maryland Practice Act [PDF]

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