Texas Telepractice Requirements for Audiologists and Speech-Language Pathologists

The information below is collected from state licensure boards or regulatory agencies responsible for regulating the professions of audiology and/or speech-language pathology. 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.

Telepractice State Licensure Board Requirements

§ 111.210 Definitions

Unless the context clearly indicates otherwise, the following words and terms, when used in this subchapter, shall have the following meanings.

(1) Client—A consumer or proposed consumer of speech-language pathology or audiology services.

(2) Client siteThe physical location of the client at the time the services are being furnished via telecommunications.

(3) ConsultantAny professional who collaborates with a provider of telehealth services to provide services to clients.

(4) FacilitatorThe individual at the client site who assists with the delivery of the telehealth services at the direction of the audiologist or speech-language pathologist.

(5) ProviderAn individual who holds a current, renewable, unrestricted speech-language pathology or audiology license under Texas Occupations Code §401.302 and §401.304; or an individual who holds an audiology intern license under Texas Occupations Code §401.311.

(6) Provider siteThe physical location at which the speech-language pathologist or audiologist delivering the services is located at the time the services are provided via telecommunications which is distant or remote from the client site.

(7) TelecommunicationsInteractive communication at a distance by concurrent two-way transmission, using telecommunications technology, of information, including, without limitation, sound, visual images, and/or computer data, between the client site and the provider site, and required to occur without a change in the form or content of the information, as sent and received, other than through encoding or encryption of the transmission itself for purposes of and to protect the transmission.

(8) Telecommunications technologyComputers and equipment, other than telephone, email or facsimile technology and equipment, used or capable of use for purposes of telecommunications. For purposes of this subchapter, the term includes, without limitation:

    (A) compressed digital interactive video, audio, or data transmission;

    (B) clinical data transmission using computer imaging by way of still-image capture and storage and forward; and

    (C) other technology that facilitates the delivery of telepractice services.

  (9) TelehealthThe 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.

  (10) Telehealth servicesThe application of telecommunication technology to deliver speech-language pathology and/or audiology services at a distance for assessment, intervention, and/or consultation.

  (11) TelepracticeThe use of telecommunications technology by a license holder for an assessment, intervention, or consultation regarding a speech-language pathology or audiology client.

  (12) Telepractice servicesThe rendering of audiology and/or speech-language pathology services through telepractice to a client who is physically located at a site other than the site where the provider is located.

§ 111.211  Service Delivery Models of Speech-Language Pathologists

(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.

§ 111.211 Requirements for the Use of Telehealth by Speech-Language Pathologists

(a) The requirements of this section apply to the use of telehealth by speech-language pathologists.

(b) A provider shall comply with the commission's Code of Ethics and Scope of Practice requirements when providing telehealth services.

(c) The scope, nature, and quality of services provided via telehealth are the same as that provided during in-person sessions by the provider.

(d) The quality of electronic transmissions shall be equally appropriate for the provision of telehealth services as if those services were provided in person.

(e) A provider shall only utilize technology which they are competent to use as part of their telehealth services.

(f) Equipment used for telehealth services at the clinician site shall be maintained in appropriate operational status to provide appropriate quality of services.

(g) 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.

(h) The initial contact between a licensed speech-language pathologist and client may be at the same physical location or through telehealth/telepractice, as determined appropriate by the licensed speech-language pathologist.

(i) A provider shall consider relevant factors including the client's behavioral, physical, and cognitive abilities in determining the appropriateness of providing services via telehealth/telepractice.

(j) 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.

(k) 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.

(l) 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.

(m) A provider shall be sensitive to cultural and linguistic variables that affect the identification, assessment, treatment, and management of the clients.

(n) Upon request, a provider shall submit to the department data which evaluates effectiveness of services provided via telehealth including, but not limited to, outcome measures.

(o) 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.

(p) Notification of telehealth services shall 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.

§ 111.213 Limitations on the Use of Telecommunications Technology by Speech-Language Pathologists

(a) The limitations of this section apply to the use of telecommunications technology by speech-language pathologists.

(b) Supervision of a licensed assistant in speech-language pathology may be undertaken through the use of telecommunications technology as described under §111.51 and as follows:

  (1) no more than two (2) hours of direct supervision per month shall be undertaken through the use of telecommunications technology; and

  (2) no more than six (6) total hours of supervision per month shall be undertaken through the use of telecommunications technology.

(c) Direct supervision of a licensed intern in speech-language pathology shall not be undertaken through the use of telecommunications technology.

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

§ 111.214 Requirements for Providing Telehealth Services in Speech-Language Pathology

(a) A provider of telehealth services who practices in the State of Texas shall be licensed by the department.

(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.

§ 111.214 Requirements for Providing Telepractice Services in Audiology

(a) Unless otherwise legally authorized to do so, an individual shall not render telepractice services in audiology from the State of Texas or to a client in the State of Texas, unless the individual qualifies as a provider as that term is defined in this subchapter and renders only those telepractice services that are within the course and scope of the provider's licensure and competence, and delivered in accordance with the requirements of that licensure and pursuant to the terms and conditions set forth in this section.

(b) The provider shall use only telecommunications technology that meets the definition of that term, as defined in this subchapter, to render telepractice services. Modes of communication that do not utilize such telecommunications technology, including facsimile and email, may be used only as adjuncts.

(c) Subject to the requirements and limitations of this section, a provider may utilize a facilitator at the client site to assist the provider in rendering telepractice services.

(d) The provider shall be present at the provider site and shall be visible and audible to, and able to see and hear the client and the facilitator via telecommunications technology in synchronous, real-time interactions, even when receiving or sending data and other telecommunication transmissions in carrying out the telepractice services. The provider is responsible for the actions of the facilitator and shall monitor the client and oversee and direct the facilitator at all times during the telepractice session.

(e) The provider of telepractice services, prior to allowing a facilitator to assist the provider in rendering telepractice services, shall verify and document the facilitator's qualifications, training, and competence in each task the provider directs the facilitator to perform at the client site, and in the methodology and equipment the facilitator is to use at the client site.

(f) The facilitator may perform at the client site only the following tasks:

  (1) those physical, administrative, and other tasks for which the provider has trained the facilitator in connection with the rendering of audiology services for which no form of license, permit, authorization or exemption under the Texas Occupations Code is required; and

  (2) a task for which the facilitator holds and acts in accordance with any license, permit, authorization or exemption required under the Texas Occupations Code to perform the task.

(g) A provider shall not render telepractice services to a client in those situations in which the presence of a facilitator is required for safe and effective service to the client and no qualified facilitator is available to the client during the telepractice session.

(h) The scope, nature, and quality of the telepractice services provided, including the assistance provided by the facilitator, shall be commensurate with the services the provider renders in person at the same physical location as the client.

(i) The provider shall not render telepractice services unless the telecommunications technology and equipment located at the client site and at the provider site are appropriate to the telepractice services to be rendered; are properly calibrated and in good working order; and are of sufficient quality to allow the provider to deliver equivalent audiology service and quality to the client as if those services were provided in person at the same physical location. The provider shall only utilize telecommunications technology and other equipment for the provider's telepractice which the provider is competent to use.

(j) Providers and facilitators involved in the provider's delivery of telepractice services shall comply with all laws, rules, and regulations governing the maintenance of client records, including client confidentiality requirements. Documentation of telepractice services shall include documentation of the date and nature of services performed by the provider by telepractice and of the assistive tasks of the facilitator.

(k) Except to the extent it imposes additional or more stringent requirements, this section does not affect the applicability of any other requirement or provision of law to which an individual is otherwise subject under this chapter or other law.

§ 111.216 Limitations on the Use of Telecommunications Technology by Audiologists

(a) The limitations of this section apply to the use of telecommunications technology by audiologists.

(b) Supervision of a licensed assistant in audiology may be undertaken through the use of telecommunications technology as described under §111.91, except for duties described under §111.92(c)(1) - (4) where the supervisor must provide in-person, direct supervision.

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

Citation: 16 Tex. Admin. Code § 111.21 

Telesupervision State Licensure Board Laws and Regulations

Telesupervision is permitted for support personnel under indirect or direct supervision. Telesupervision is permitted for student interns under indirect supervision, not under direct supervision. There are no rules or regulations for clinical fellows, contact the licensure board. 

Support Personnel

Permitted.

Definitions

(14) Direct Supervision related to Assistants (Speech-Language Pathology and Audiology)—Real-time observation and guidance by the supervisor while a client contact or clinical activity or service is performed by the assistant. Direct supervision shall be performed in person or via telepractice/telehealth as authorized and prescribed by this chapter.

(24) Indirect supervision related to Assistants (Speech-Language Pathology and Audiology)—The supervisor performs monitoring activities or provides guidance to the assistant, either of which does not occur during actual client contact by the assistant or while the assistant is providing a clinical activity or service. Telepractice/telehealth may be used for indirect supervision as authorized and prescribed under this chapter.

Citation:  16 Tex. Admin. Code § 111.2  

Clinical Fellow

Unclear.  

Student Intern

Permitted with indirect supervision, not with direct supervision.

Definitions

(15) Direct supervision related to Interns (Speech-Language Pathology)—Real-time observation and guidance by the supervisor while a client contact or clinical activity or service is performed by the intern. Telepractice/telehealth may not be used for direct supervision of Speech-Language Pathology Interns.

(25) Indirect supervision related to Interns (Speech-Language Pathology)—The supervisor performs monitoring activities or provides guidance to the intern, either of which does not occur during actual client contact by the intern or while the intern is providing a clinical activity or service. Telepractice/telehealth may be used for indirect supervision as authorized and prescribed under this chapter.

Citation: 16 Tex. Admin. Code § 111.2  

Telepractice Reimbursement Laws and Regulations

Telepractice Private Insurance 

No laws or regulations identified that include audiology or speech-language pathology. 

Telepractice Medicaid

The law includes speech-language pathology in school-based setting.  

REIMBURSEMENT FOR CERTAIN TELEHEALTH SERVICES 

(a)  In this section, "health professional" means an individual who is:

(1)  licensed, registered, certified, or otherwise authorized by this state to practice as a social worker, occupational therapist, or speech-language pathologist;

(2)  a licensed professional counselor;

(3)  a licensed marriage and family therapist; or

(4)  a licensed specialist in school psychology.

(b)  The commission shall ensure that Medicaid reimbursement is provided to a school district or open-enrollment charter school for telehealth services provided through the school district or charter school by a health professional, even if the health professional is not the patient's primary care provider, if:

(1)  the school district or charter school is an authorized health care provider under Medicaid; and

(2)  the parent or legal guardian of the patient provides consent before the service is provided.  

Citation: Tex. Govt. Code § 531.02171 

ASHA Guidance

Telepractice State Licensure

  • Obtain a license from the state in which you reside and from the state in which the patient/client resides.
  • If a state has not established regulations on telepractice, then contact the licensure board for further guidance and ask for written verification.
  • It is the responsibility of the clinician to review the regulations on the state licensure board website in their entirety and regularly for updates or changes.

Telesupervision

If a state has not established regulations on telesupervision, then contact the licensure board for further guidance and ask for written verification.

Reimbursement for Telepractice Services

Audiologists and speech-language pathologists should keep in mind that while a state may have passed telepractice reimbursement laws and/or regulations, this does not guarantee that payers will reimburse for these services. Learn more about considerations for audiologists and speech-language pathologists.

Resources

For further information on telepractice requirements for audiologists and speech-language pathologists, please visit these websites:

Questions regarding state advocacy issues? Call ASHA at 800-498-2071 and ask for the State Advocacy Team.      

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