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State Provisions Update for Telepractice

Updated April 2012

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.
(870-X-2.01(j))

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.

Practicing 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.

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. 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.

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.

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 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. CE 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 (see also regulations at 10.41.06).

North Carolina

  1. Licensees may utilize telepractice to treat patients receiving clinical services in North Carolina by utilizing telepractice. 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.

(regulation 21 NCAC 64.0219); authority G.S. 90-304-(a)(3) Eff. Sept. 1, 2010

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.

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.

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.Telepractice shall be obtained in real time and in a manner sufficient to ensure patient confidentiality.
  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. [OAR Docket #11-805A; filed 5-31-11]Effective 7-11-11

Also within (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 31st 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

"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.

Texas

§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

  1. 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.
  2. 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.
  3. 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

  1. A provider shall comply with the board's Code of Ethics and Scope of Practice requirements when providing telehealth services.
  2. The scope, nature, and quality of services provided via telehealth are the same as that provided during in-person sessions by the provider.
  3. The quality of electronic transmissions shall be equally appropriate for the provision of telehealth services as if those services were provided in person.
  4. A provider shall only utilize technology which they are competent to use as part of their telehealth services.
  5. Equipment used for telehealth services at the clinician site shall be maintained in appropriate operational status to provide appropriate quality of services.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. A provider shall be sensitive to cultural and linguistic variables that affect the identification, assessment, treatment, and management of the clients.
  12. 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.
  13. 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.
  14. 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 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.

Source Note: The provisions of this §741.214 adopted to be effective January 16, 2011, 36 TexReg 43.

Wyoming

  1. 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 audiologists, shall constitute the practice of speech pathology or audiology and shall require licensure as provided in this chapter.

Questions?

Contact:

Janice A. Brannon
Director, State Special Initiatives
Government Relations & Public Policy
American Speech-Language-Hearing Association
2200 Research Boulevard #220
Rockville, MD 20850-3289
Phone: 301-296-5666