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Stretch Your Knowledge of Telepractice

Learn about telepractice definitions, benefits, ethical considerations, Medicaid reimbursement, and FERPA/HIPAA compliance. Explore available resources and overcome licensure barriers. Enhance knowledge for successful telepractice implementation.

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Stretch Your Knowledge of Telepractice

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  1. Stretch Your Knowledge of Telepractice

  2. Shannon Morey, JD Director, State Health Care and Educations Affairs Disclosure Information Financial:  I am a paid employee of ASHA. Non-Financial: none

  3. Learning Outcomes • Demonstrate an understanding of Medicaid reimbursement currently with telepractice in at least two states. • Identify two licensure requirements and two barriers to practice. • List two resources available to assist with telepractice implementation, licensure and regulation.

  4. Overview • Definitions • Terms • Benefits • Practice Considerations • FERPA/HIPAA • Barriers • Licensure/Regulationsons • Telesupervision • Reimbursement • Resources

  5. What is Telepractice? “Telepractice is the application of telecommunications technology to the delivery of speech-language pathology and audiology professional services at a distance by linking clinicians to client/patient or clinician to clinician for assessment, intervention, and/or consultation.”

  6. Benefits of Telepractice • Provides access to services in rural areas • Decreases the requirement for audiologist or SLP to cover large territories • Saves the school system on travel costs and loss of time • Allows more flexibility in schedule • Assists with collaboration among staff Schools

  7. Benefits of Telepractice • Provides access to services in rural areas • Decreases the requirement for patients with decreased mobility to travel to a provider • Saves the patient money on travel and loss of work • Saves provider money if transportation costs are covered in policy Healthcare

  8. Types of Telepractice Live Interactive • Participants interact in real time • Synchronous Store and Forward • Electronic storage and privacy • Asynchronous Collect Store Transmit Interpret

  9. Practice Considerations

  10. Client/Student Selection • Physical and sensory • Cognitive, behavioral and motivational • Communication • Support Resources

  11. Facilitators • Verify institution or state regulations • Role of a facilitator

  12. Environmental Considerations • Privacy • Noise • Cluttered • Too light • Too dark

  13. Ethics, Scope & Regulations • ASHA Code of Ethics • State Scope of Practice • Federal and State Regulations

  14. Applications Videoconferencing Platforms/Hardware/Software • Business Class • Software-Based • Public Domain

  15. Technology • Computer • Camera • Headset • Microphone

  16. Connectivity Connectivity • Network Speed – minimum bandwidth 384 Kbps • Quality of video and Audio clarity • Available bandwidth • Multiple users • Alternate communication options • Phone • Technology compatibility • Secure transmission

  17. Federal Laws & Telepractice

  18. FERPA & HIPAA Family Educational Rights and Privacy Act • Federal law that protects the privacy of students’ “education records” Health Insurance Portability and Accountability Act • Federal law that protects the privacy and security of health information • Established national standards and requirements for electronic health care transactions • Sets limits and conditions on the uses and disclosures without patient authorization • Gives patient rights to examine and obtain a copy of their health records and request corrections

  19. FERPA & Telepractice How does FERPA Regulations impact telepractice? • Requires student or parent consent prior to the disclosure of education records including billing Medicaid It is recommended that you involve the student and parent in deciding if they are comfortable with telepractice

  20. HIPAA & Telepractice How does HIPAA Regulations impact telepractice? • Requires that health records be kept secure • Requires telepractice sessions be protected from unauthorized access • Transmission security – data must be encrypted Managing Risk • Obtain documentation of informed consent from client/patient/student/parent.

  21. FERPA & HIPAA • The HIPAA Privacy Rule specifically excludes from its coverage those records that are protected by FERPA • Most cases HIPAA does not apply to an elementary or secondary school

  22. FERPA, HIPAA & Medicaid Electronically transmitting health care claims to a health plan for payment such as billing Medicaid in the education setting • The school is a HIPAA covered entity and must comply with the HIPAA transactions and code sets and identifier rules with respect to such transactions

  23. FERPA, HIPAA & Telepractice Scenario 1: A child with an IEP is provided telepractice services by a SLP who is an employee of the public schools and is on school property. All records remain at the school. Do you follow FERPA or HIPAA?

  24. FERPA, HIPAA & Telepractice Scenario 2: A child with an IEP is provided telepractice services by a SLP who is an employee of a private practice and is contracted to the public schools. The SLP bills for her services to the school district. Do the records fall under FERPA or HIPAA?

  25. FERPA, HIPAA & Telepractice Scenario 3: A SLP provides services via telepractice and bills Medicaid. Does this fall under HIPAA or FERPA?

  26. Barriers to Telepractice

  27. Licensure & Regulations

  28. Telepractice Licensure & Regulations

  29. Oops! How did I miss that?

  30. Telepractice Regs: State Examples Kansas • Unlawful to engage in the practice unless you hold a license or are not specifically exempted • Cannot hold yourself out as an audiologist or speech-language pathologist unless licensed • No guidance on telepractice • Misdemeanor if you violate any of this act.

  31. Telepractice Regs: State Examples Kentucky • A practitioner–patient relationship shall not commence via telehealth. An initial, in-person meeting for the practitioner and patient who prospectively utilize telehealth shall occur. A licensed health care practitioner may represent the licensee at the initial, in-person meeting. A licensee who uses telehealth to deliver speech language pathology or audiology services or who telepractices or the licensed healthcare practitioner representing the licensee shall, at the initial, in-person meeting with the client

  32. Telepractice Regs: State Examples 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.

  33. Telepractice Regs: State Examples Louisiana • Louisiana Act 442, enacted August 1, 2014 requires an out-of-state audiologist or SLP to maintain a license in the state in which they reside and register in Louisiana in order to deliver telehealth services. • The licensure board has not implemented a registration process or developed the application form for out-of-state providers. A full license is required until implemented.

  34. Telepractice Regs: State Examples Wisconsin • No telepractice guidance • Requires practitioner to interpret the law • HAS 6.08 Limited Permit • A nonresident applicant • Valid for 45 days in a calendar year

  35. Telepractice Regs: State Examples Licensure exception for U.S. Military/Veterans Administration/Public Health Service Officers practicing in Federal settings

  36. Telepractice Regs: South Carolina Current policy allows for telepractice in South Carolina • South Carolina Board of Examiners in Speech-Language Pathology and Audiology • Telepractice FAQs • Policy Regarding Telepractice

  37. Licensure – Alternate Models

  38. Licensure – Alternate Models • Multi-state Compact • One license in the state the individual resides • No additional licenses to practice across state lines • State boards work together • Licensure Endorsement • A streamlined application process • Available to individuals who are licensed in another state that has comparable requirements in the state they are applying

  39. Licensure – Alternate Models • Mutual Recognition • States recognize a license in another mutual recognized state and the individual can qualify for an equivalent type license • Reciprocity • The state may grant a license when an individual has a license in another state. The individual must satisfy all licensing requirements mandated by state law, however, it makes it easier to apply for a license without having to complete more educational training/college coursework at the time of the application. Some states may have additional requirements but these can be met after the individual begins his/her job

  40. Licensure – Alternate Models • Limited License • Allows an individual to practice under limited provisions • For example – Allowing an individual with a license from another state to obtain a limited license to practice via telepractice only • Registration • Requires an individual with a state license in another state to register in the state the patient is located. Allows state boards to monitor and keep track of individuals without the individual incurring as much cost as a regular license

  41. Interstate Compact Update Winter 2019

  42. Speech-Language-Hearing Interstate Compact (SLHIC)

  43. SLHIC Timeline

  44. SLHIC Current Status • Stakeholder review competed • Drafting Team meeting in February 2019 to review comments and incorporate into draft, if needed. • Advisory Committee meeting in March 2019 to finalize document. • Legislative briefing to be held in August 2019 to introduce concept to key legislators. • Compact will begin to be introduced in January 2020 in state legislators for adoption. • Compact will go into effect when 10 states have adopted the language.

  45. State Participation in Health Compacts Washington Maine Montana North Dakota Minnesota Vermont Oregon New Hampshire New York Wisconsin Idaho Massachusetts South Dakota Rhode Island Michigan Wyoming Connecticut Pennsylvania Iowa New Jersey Nebraska Nevada Ohio DC Delaware Indiana Illinois Utah West Virginia Maryland Colorado California One Compact Two Compacts Three Compacts Four Compacts Five Compacts Virginia Kansas Missouri Kentucky North Carolina Tennessee Oklahoma Arizona South Carolina New Mexico Arkansas Georgia Alabama Mississippi Texas Louisiana Florida Alaska Hawaii Health Compacts include: Advanced Practice Registered Nurse; Emergency Medical Services; Medicine; Nursing; Physical Therapy; Psychology

  46. SLHIC Resources • Audiology and Speech-Language Pathology Interstate Compact Webpage: http://www.asha.org/Advocacy/state/Audiology-and-Speech-Language-Pathology-Interstate-Compact/ • Questions? Comments? Concerns? • interstatecompact@asha.org • Dan Logsdon – CSG Contact - dlogsdon@csg.org • Susan Adams – ASHA Contact - sadams@asha.org

  47. Licensure Scenario Scenario 1: The school district hires a contract SLP or company to provide speech therapy services via telepractice. The SLP is not in the state that the school currently resides in. Where does the SLP have to have a license?

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