9/19/2014. Disclosure. Telepractice 101: Practice, Regulation and Reimbursement Janet Deppe, MS CCC-SLP Director, State Advocacy

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1 Disclosure Telepractice 101: Practice, Regulation and Reimbursement Janet Deppe, MS CCC-SLP Director, State Advocacy Janet Deppe, Director State Advocacy Financial: I am a paid employee of ASHA Non-Financial: I am an ASHA member, I support ASHA s Public Policy Agenda which includes the advocacy initiatives that the association supports; I am the ex-officio of ASHA s School Finance Committee which advocates for increased financial support and other non-financial initiatives for school-based ASHA members. What we will cover today What we will cover today Definitions and Terms History Applications in Audiology and Speech- Language Pathology Benefits Practice considerations Barriers Reimbursement Alternative Models ASHA approved licensure model Federal legislative resources Reimbursement Telepractice resources What Is Telepractice? Terms Telepractice is the application of telecommunications technology at a distance by linking clinician to client, or clinician to clinician for assessment, intervention, and/or consultation. -ASHA 2004 position statement 1

2 History oftelemedicine/telehealth As early as 1910 Medical/hospital usage Radiology, dermatology Types of telemedicine Store and forward (asynchronous) Interactive (synchronous) Self-monitoring/testing Hardware (courtesy of National Rehabilitation Hospital) Internet Videoconferencing courtesy of National Rehabilitation Hospital Data Sharing Camera (to send video) Videoconference Software Microphone (to send audio) Speakers (to receive audio) Technology Requirements Use of Telepractice Sufficient bandwidth for quality signal POTS, DSL, ISDN (T1-T4 lines), cable, satellite Protection of privacy Encryption, virtual private networks, secure certificates 2

3 Use of Telepractice Benefits Schools 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 Where Is It Being Used? Practice Considerations Schools Home health Hospitals Clinics Client Selection Connectivity Regulation s Telepractice Technologie s Environme nt Application s Ethics Scope Facilitators Practice Considerations Practice Considerations State and federal regulations pertaining to electronic storage and privacy Store and Forward Collect Store Transmit Interpret Types of technologies Privacy protection Hardware and software applications Encryption VPN Firewall applications Connectivity Network Speed minimum bandwidth 384 Kbps Available bandwidth if multiple users Alternate communication options Technology compatibility Secure transmission Facilitators Verify institution or state regulations Environmental Considerations and Practice Areas 3

4 Practice Considerations Barriers Client/Student Selection Physical and sensory Cognitive, behavioral and motivational Communication Support Resources Code of Ethics Scope of Practice Regulations Delaware Not permitted Licensees shall not evaluate or treat a client with speech, language, or hearing disorders solely by correspondence. Correspondence includes telecommunication. 4/3700.shtml Arkansas Definition Only Telepractice: means telespeech, teleaudiology, teleslp, telehealth, or telerehabilitation when used separately or together; and Telepractice service means the application of telecommunication technology equivalent in quality to services delivered face-to-face to deliver speech-language pathology or audiology services, or both, at a distance for assessment, intervention or consultation, or both. 4

5 -Alternate Models Iowa Required 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. Multi-state Compact Endorsement Mutual Recognition 0.pdf Reciprocity Limited License Registration -Alternate Models -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 Endorsement A streamlined application process Available to individuals who are licensed in another state that has comparable requirements in the state they are applying 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. -Alternate Models -Alternate Model 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. Florida Senate Bill 1646 Registration Louisiana House Bill 1280 Registration 5

6 Scenarios Scenarios 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? Scenario 2: The SLP is an employee of the school district but must travel over a mountain pass to see her second school so telepractice is provided. What license does this SLP need to have to practice? ASHA Approved Model licensure Medicaid First CMS Definition of Telehealth - The use of telecommunications and information technology to provide access to health assessment, diagnosis, intervention, consultation, supervision and information across distance Type, amount, duration, scope of services, payment rate not defined Feds require efficiency, economy and quality of care Federal Telepractice Legislation HR 3077: Telemedicine Bill Amends the Social Security Act Permits medicare providers licensed in one state to provide telemedicine services to beneficiaries in another state Once adopted, states would need to develop definition of telemedicine services Sponsored by ATA Thompson Bill: Introduced this year by Mike Thompson and Glenn Thomson that seeks to phase in expansion of telehealth coverage under Medicare The current version includes SLPs and Audiology services Reimbursement 6

7 Medicaid Medicaid Medicaid Medicaid Minnesota Reimburses for Medicaid eligible children if all IEP service requirements are met New Mexico Reimburses for school-based health services including speech Ohio and Virginia Cover Medicaid eligible children in the schools California Reimburses all licensed providers Missouri Lists SLPs as participating providers. However, they have another network that must approve the technology first. Colorado and Maine Reimburses under broad provisions Medicaid Medicare Kentucky Covers telepractice services provided by SLPs employed by a physician, hospital, outpatient department, home health agency and nursing facility. Providers must be an approved member of the Kentucky Telehealth lth Network and comply with standards d and protocols established by the Kentucky Telehealth Board. There are no stipulations on the site location per the Telehealth Network and Board There is potential for hospital based SLPs who receive a contract with the schools to provide services for Medicaid eligible children and bill Medicaid. 7

8 Medicare Private Insurance Private Insurance Private Insurance Private Insurance Mandates State level New bills proposed mandating coverage Reimbursement Varies Source: American Telemedicine Association State Liaisons 8

9 State Liaisons Northeastern Region Susan Adams, Director, State Central Region Legislative & Regulatory Janet Deppe, Director, State Advocacy Advocacy Southern Region Western Region Cheris Frailey, Director, State Eileen Crowe, Director, State Education and Legislative Association Relations Advocacy State-by-State pages - licensure requirements and contacts States - Telepractice regulations Telepractice-Requirements/ Telepractice Portal Asha s code of Ethics Barriers Scope of Practice Trends State Telepractice Requirements International Considerations FAQs on Reimbursement and Client/Patient Selection Practice Areas Videoconferencing Equipment Connectivity Suggestions SLP Practice Issues: Janet Brown, jbrown@asha.org Medicaid Reimbursement: Laurie Alban-Havens, lalbanhavens@asha.org Questions About Private Pay Reimbursement: Janet McCarty, jmmcarty@asha.org Federal Telemedicine Bills/Laws: Sam Hewitt, shewitt@asha.org Sig 18 ASHA Community State Associations ATA American Telemedicine Association C-TEL Center for Telehealth and e-health Law Regional Telehealth Resource Center Center for Connected Health Policy- Federally Designated National Telehealth Policy Resource Center The National Telehealth Technology Assessment Resource Center 9

10 Questions Janet Deppe MS, CCC-SLP Director, State Advocacy