The use of telepractice in health care and related fields is growing as a means of increasing access to services in sparsely populated and underserved areas. Despite its increased use and advocacy to improve insurance coverage for telepractice services, Medicare and Medicaid either do not allow telepractice or greatly restrict reimbursement for audiology and speech-language services provided through telepractice.
Q: What exactly is telepractice?
In its position statement on telepractice, ASHA defines telepractice as "the application of telecommunications technology to deliver professional services at a distance by linking clinician to client, or clinician to clinician, for assessment, intervention, and/or consultation." The document also states that the "use of telepractice does not remove any existing responsibilities in delivering services, including adherence to the Code of Ethics, Scope of Practice, state and federal laws (e.g., licensure, HIPAA [Health Insurance Portability and Accountability Act], etc.) and ASHA policy documents on professional practices." The quality of services provided must be consistent with the quality of services delivered face-to-face.
Telepractice also may be called "telehealth" or "telemedicine" in government and insurance regulations.
Q: Does Medicare cover telepractice for speech-language pathology or audiology services?
No. Medicare is a federal health care program administered by the Centers for Medicare and Medicaid Services (CMS). Under CMS guidelines, only physicians, physician assistants, nurse practitioners, clinical nurse specialists, nurse-midwives, clinical psychologists, clinical social workers, and registered dietitians or nutrition professionals are reimbursed for services provided remotely to Medicare beneficiaries.
The only eligible facilities (i.e., the "originating site" where the Medicare beneficiary is located at the time of services) are a physician or practitioner's office, critical access hospital, rural health clinic, federally qualified health center, hospital, hospital-based or crucial-access hospital-based renal dialysis center, skilled nursing facility, and community mental health center. Further, only certain services are covered.
Q: Will Medicare law change?
Speech-language and audiology services delivered by telepractice may be covered by Medicare in the future. Two bills that could affect coverage are pending in Congress. The Rural Telemedicine Enhancing Community Health (TECH) Act (S. 2741) would establish a pilot Medicare project to demonstrate the effectiveness of telepractice services, including speech-language pathology services, for treating individuals who have had a stroke. The Medicare Telehealth Enhancement Act of 2009 (H.R. 2068) would include audiologists and speech-language pathologists among the professionals eligible to provide Medicare telepractice services and would expand Medicare reimbursement for services delivered remotely.
In addition, the Patient Protection and Affordable Care Act (PPACA, the health care reform bill) created the Center for Medicare and Medicaid Innovation (CMI), which will be part of CMS. CMI, set to be in operation on Jan. 1, 2011, was created to test innovative payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care to individuals. One model under consideration for testing is the provision of telepractice services for behavioral issues and stroke in rural areas; SLPs may have the opportunity to participate in this model.
Q: Does Medicaid cover telepractice for audiology and speech-language pathology?
The answer is not a simple yes or no. Medicaid is a federal/state entitlement program for low-income families and individuals. Medicaid gives states a great deal of flexibility with only a few broad mandates that must be met to receive matching federal funds. Each state administers its own program; establishes its own eligibility standards; chooses the type, amount, duration, and scope of services; and sets the rate of payment for those services.
Although both Medicare and Medicaid programs are administered at the federal level by CMS, the states' flexibility in providing optional services and determining reimbursement rates has allowed telepractice to gain a foothold in Medicaid. For Medicaid purposes, telehealth is defined as "the use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision, and information across distance" and may be covered as a reimbursable service under section 1905(a) of the Social Security Act.
Each state Medicaid program, therefore, may or may not allow reimbursement for telepractice. ASHA is aware of three state Medicaid programs that reimburse for telepractice:
- Oklahoma's "SoonerCare" program recognizes telemedicine networks as an acceptable medium for the delivery of services when a school is the originating site for the delivery of services to an eligible student. This provision greatly enhances the delivery of services in a state that includes substantial rural and underserved areas.
- Missouri amended its state Medicaid plan in 2009 to include licensed SLPs as eligible providers of telepractice services.
- Kentucky, in the midst of a regulatory re-write, is adding SLPs to its list of accepted providers for telepractice reimbursement.
ASHA encourages state associations to meet with key personnel in their local Medicaid offices about including telepractice as a recognized, reimbursable service under the state Medicaid program.