FAQs on Telepractice Reimbursement and Licensure

Do private insurance companies pay for services provided via telepractice?

In some states. Currently 15 states have passed legislation mandating coverage of telemedicine. They are: California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, Maryland, Michigan, New Hampshire, Oklahoma, Oregon, Texas, Vermont and Virginia. Generally, the mandates require health insurers, subscription plans and health maintenance organizations to cover the cost of health care services provided through telemedicine on the same basis as those provided through in-person visits.

Some health insurers outside of these states may be reimbursing, as well. For example, in March of 2008, Aetna and Cigna health plans announced their intent to cover accepted services delivered via telemedicine. In the end, with all the variability that exists, it is important to check first with the payer.

Does Medicaid pay for telepractice?

Again, it varies by state. Missouri specifically names speech therapists as recognized providers for telehealth under Missouri HealthNet (Medicaid), Colorado and Maine reimburse SLPs under broad provider provisions, California reimburses and Virginia and Ohio will pay for services provided to Medicaid-eligible children in schools. All states have the option of adding such coverage resulting in scattered reports of reimbursement from various states. ASHA is working with several states associations and their Medicaid offices to gain consideration of telepractice.

Information on telemedicine and Medicaid is available from CMS.

Does Medicare pay for telepractice?

Medicare will reimburse for some forms of telepractice (they call it telehealth or telemedicine) but, as of now, speech-language pathology and audiology services are not included in these provisions. Each year legislation is introduced that would expand telehealth coverage for Medicare beneficiaries.

A description of the current state of telehealth and Medicare [PDF] is available from CMS.

What are the licensure requirements for telepractice?

Of the states that include telepractice in audiology and speech-language pathology licensure laws, many specify that the professional must be licensed both at home and in the state in which the patient is located. Recognizing that this can be a burden to practitioners, ASHA is encouraging state licensure boards to consider alternative models of licensure to ease the barriers [PDF] to use of this service modality.

Additionally, at least 14 states and the District of Columbia already have telepractice provisions promulgated by their state licensure boards that you should be aware of before initiating any actions in those states. ASHA is working with a coalition of other provider organizations to address the issue of interstate licensure portability for the use of telepractice.

Read more about licensure trends in telepractice. View the State Licensure Telepractice Provisions.

If the clinician crosses state lines while traveling or on vacation, can telepractice services still be delivered to the client/patient?

Some states may have policies that would allow a non-resident clinician to practice in that state for a specified amount of time. For example, some state practice acts have exemption clauses that allow a licensed individual who is visiting from a different state (with equivalent licensure requirements) to provide services without another state license for up to 30 days per calendar year. In addition, these services must be provided in cooperation with a locally licensed practitioner. These exemptions, where they exist, remain untested for use with a telepractice service delivery model (Cason & Brannon, 2011). It is always recommended that clinicians check with individual state licensure boards before delivering telepractice services in any circumstance. See State Provisions Update for Telepractice (ASHA, 2012).

How do you evaluate a potential employer if they want to hire you to conduct telepractice?

ASHA's standards and requirements apply only to ASHA-certified members and do not regulate organizations or non-certified members. However, ASHA-certified clinicians who want to determine if a prospective telepractice employer has quality standards in place and provides clinician training and support might ask some of the following questions.

• How do the employer's policies and technology protect client/patient privacy and security?
• How does the employer support and facilitate communication with other stakeholders outside the therapy session (e.g., teachers, family members, rehab team, IEP meetings)?
• What features does the employer's system offer (e.g., camera zoom, picture-in-picture, bandwidth)?
• Does the employer have business associate agreements, particularly if it shares Protected Health Information (PHI) with 3rd party payers?
• What training is provided to the clinician, and does the clinician have to demonstrate competencies in the use and knowledge of telepractice that aligns with ASHA's guidance?
• What kind of ongoing technical and clinical support is provided by the employer to the clinician?
• Who is responsible for the facilitator?
• Does the employer have a process for evaluating telepractice sessions to ensure that the quality of service is the same as that provided by in-person service?
• Does the employer provide malpractice insurance?
• Does the employer assist with securing additional state licenses if the practice is to be multi-state?
• Does the employer benchmark telepractice outcomes with on-site (traditional) outcomes to ensure equivalent levels of service?