American Speech-Language-Hearing Association

State Telepractice Requirements

Alabama, Arkansas, California, Delaware, District of Columbia, Georgia, Iowa, Kentucky, Louisiana, Maine, Maryland, Montana, North Carolina, Ohio, Oklahoma, Oregon, South Dakota, Texas, West Virginia and Wyoming have laws, regulations, 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.

Alabama

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.

Arkansas

"Telepractice" means telespeech, teleaudiology, teleSLP, telehealth, or telerehabilitation when used separately or together.

"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.

California

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.

Delaware

State Code of Ethics provision states that licensees shall not evaluate or treat a client with speech, language, or hearing disorders solely by correspondence. Correspondence includes telecommunication.

District of Columbia

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.

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. The exemptions from licensure found at Title 3, Chapter 12, section 1205.2 are applicable to telepractice.

This policy statement does not address persons who are located in the District of Columbia but who are providing services outside of the District.

Georgia

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 affect the diagnosis or treatment of the patient is engaged in the practice of speech-language pathology or audiology in this state and as such must be required to have a state license and shall be subject to regulation by the Board. 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. This section does not apply to the following:

  1. The acts of a speech-language pathologist or an audiologist located in another state or foreign country who provides consultation at the request of a state licensee
  2. The acts of a speech-language pathologist or audiologist licensed in another state/country who provides consultation services without compensation, remuneration and without altering, adjusting or manipulating hearing aid device controls or provides consultation services to a graduate school located in this state and approved by the Board or when invited as the guest of a graduate school or institution of higher learning for the sole purpose of engaging in professional education through lectures, clinics, or demonstrations
  3. This section 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 authorized by the laws of this state.
  4. All persons subject to the provisions of this Code section shall be required to comply with all applicable requirements of the laws of this state relation 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.

Iowa

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.

Kentucky

  1. A treating speech-language pathologist or audiologist who provides or facilitates the use of telehealth shall ensure:
    1. That the informed consent of the patient or other appropriate person with authority to make the health care treatment decision for the patient is obtained before services are provided; and
    2. That the confidentiality of the patient's medical information is maintained as required by applicable law. At minimum, confidentiality shall be maintained through appropriate processes, practices and technology as designated by the Board of Speech-Language Pathology and Audiology and that conform to applicable federal law.
  2. The board shall promulgate regulations to implement this section and to:
    1. Prevent abuse and fraud through the use of telehealth services;
    2. Prevent fee-splitting through the use of telehealth services; and
    3. Utilize telehealth in the provision of speech language pathology or audiology services and in the provision of continuing education.
  3. Telehealth means the use of interactive audio, video, or other electronic media to deliver health care. It includes the use of electronic media for diagnosis, consultation, treatment, transfer of health or medical data, and continuing education.

Louisiana

State Code of Ethics provision: Individuals may practice by telecommunication (i.e., telepractice, telehealth, e-health) provided they hold the appropriate licensure for the jurisdiction in which the service is rendered and delivered.

Maine

"Indirect Supervision" is defined to include demonstration, record review, review, and evaluation of audio or videotaped session, interactive television, and supervisory conferences that may be conducted by phone. Continuing education may include courses to enhance the efficacy of telepractice.

Maryland

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.

Montana

An audiologist or speech-language pathologist who is licensed in Montana may engage in telepractice in Montana without obtaining a separate or additional license from the board. An audiologist or speech-language pathologist who is not a resident of and who is not licensed in Montana may not provide services to patients in Montana through telepractice without first obtaining a license from the board. An audiology aide or assistant or a speech-language pathology aide or assistant may not engage in telepractice. This does not prohibit an audiology aide or assistant or a speech-language pathology aide or assistant from serving as a facilitator.

Scope of Telepractice Requirements

  1. The quality of services provided through telepractice must be equivalent to the quality of audiology or speech-language pathology services that are provided in person and must conform to all existing state, federal, and institutional professional standards, policies, and requirements for audiologists and speech-language pathologists.
  2. Technology used to provide telepractice, including but not limited to equipment, connectivity, software, hardware, and network compatibility, must be appropriate for the service being delivered and must address the unique needs of each patient. Audio and video quality utilized in telepractice must be sufficient to deliver services that are equivalent to services that are provided in person. A person providing telepractice services is responsible for calibrating clinical instruments in accordance with standard operating procedures and the manufacturer's specifications.
  3. A person providing telepractice services shall comply with all state and federal laws, rules, and regulations governing the maintenance of patient records, including maintaining patient confidentiality and protecting sensitive patient data.
  4. A person providing telepractice services shall conduct an initial assessment of each patient's candidacy for telepractice, including the patient's behavioral, physical, and cognitive abilities to participate in services provided through telepractice. Telepractice may not be provided only through written correspondence.
  5. At a minimum, a person providing telepractice services shall provide a notice of telepractice services to each patient and, if applicable, the patient's guardian, caregiver, or multidisciplinary team. The notification must provide that a patient has the right to refuse telepractice services and has options for service delivery and must include instructions on filing and resolving complaints.

North Carolina

  1. Licensees may utilize telepractice to treat patients receiving clinical services in North Carolina. Telepractice means the use of telecommunications and information technologies for the exchange of encrypted patient data, obtained through real time interaction, from one site to another for the provision of speech and language pathology and audiology services to patients through hardwire or Internet connection.
  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.

Ohio

State Code of Ethics provision

  1. Licensees may practice via telecommunications within the state where not prohibited by law.
    1. Support personnel in off-site locations assisting in clinical care, shall be licensed aides under Chapter 4753 of the Revised Code.
    2. Evaluation and/or treatment shall not be solely by correspondence.

Clinical Fellowship Supervision Rule (4753-3-07)

  1. Professional experience shall entail the direct involvement of the supervisor in any and all ways, which may include telepratice that will permit the supervisor to monitor, improve, provide feedback, and evaluate the applicant's performance in professional employment.
  2. When onsite supervision occurs via telepractice applications, supervision shall occur using real time, synchronous, encrypted videoconferencing and shall meet the supervision requirements as specified in this rule.
  3. Asynchronous, recorded therapy sessions submitted for later review shall not meet the requirements for onsite supervision but may suffice as "Other Supervisory Activity" as outlined in the supervision log.

Oklahoma

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

Administrative Regulations (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 680:15-1-4) 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

Oregon

In remote geographic areas of the state or in other situations with severe shortages of licensed personnel, where direct supervision requirements cannot be met by an on-site speech-language pathologist, educational facilities may apply for a one-year exemption from certain requirements for supervision of certified speech-language pathology assistants.

  1. This exemption allows educational facilities to use the review and evaluation of audio- or video-taped records or live audio- or video-conferencing of clinical interactions, or a combination thereof, to provide a portion of the required direct supervision hours, up to a maximum of 75% of the required direct supervision hours.
  2. During the exemption period, a licensed speech-language pathologist may supervise up to four full-time equivalent certified speech-language pathology assistants.
  3. This exemption will expire on July 31 of the year in which it is granted. An exemption shall only be granted for a maximum of two years out of each consecutive five year period.

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: 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.

Texas

  1. Telehealth: the use of telecommunications and information technologies for the exchange of information form one site to another for the provision of speech-language pathology or audiology services to a client from a provider.
  2. Telehealth Service: the application of telecommunication technology to deliver speech-language pathology or audiology services at a distance for assessment, intervention and/or consultation.
  3. Service Delivery Models: includes store and forward (asynchronous), real-time interaction (synchronous) which includes self-monitoring and live, real-time and stored data transmissions.
  4. Guidelines for Use: must comply with State Board of Examiners's Code of Ethics and Scope of Practice; scope, nature and quality of services must be the same as that provided during in-persons sessions; the initial contact between the provider and clients shall be at the same physical location to assess the client's candidacy for telehealth; for consultation purposes, the consultant in the state in which the client receives services shall be the primary care provider; providers must comply with all client records and confidentiality requirements; notification of provision of telehealth services should be provided to the client, guardian, caregiver and multi-disciplinary team; upon request, a provider shall submit to the board data which evaluates effectiveness of services provided via telehealth including outcome measures.
  5. Telehealth services may not be provided by correspondence only (e-mail, mail, faxes) although they may be adjuncts to telepractice.
  6. Personnel Requirements: must be licensed by the State Board of Examiners; must be competent in equipment, methodology and type of services provided.

West Virginia

(22) "Telepractice" means the application of telecommunication technology to deliver speech-language pathology or audiology services through real time interaction from one site to another for assessment, intervention or consultation in a manner sufficient to ensure patient confidentiality.

§30-32-16. Telepractice services.

  1. Licensed speech-language pathologists and audiologists may provide services in this state by telepractice.
  2. Speech-language pathologists and audiologists providing services by telepractice shall deliver services consistent with the quality of services delivered in person, and shall:
    1. Acquire written informed consent from the student, patient or client before the services are provided;
    2. Maintain the confidentiality of the student, patient or client as required by law;
    3. Provide documentation of the delivery of services;
    4. Train assistants before allowing them to assist in the delivery of service by telepractice, and document the training and delivery of service by the assistants; and
    5. Meet any other requirements set by the board.

Wyoming

The provision of speech pathology or audiology services in this state, through telephonic, electronic or other means, regardless of the location of the speech pathologists or audiologists, shall constitute the practice of speech pathology or audiology and shall require licensure as provided in this chapter.

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