Multi-State Telepractice What s the Catch? Janet Brown, MA CCC-SLP Director, Health Care Services Mississippi Speech & Hearing Convention Disclosure Financial ASHA employee Non-financial Ex officio to SIG 18 (Telepractice) Staff liaison to ASHA committees writing documents on telepractice Remember This? 1
And This? How Telepractice Has Grown! 1990s first internal discussions 2003 first committee to write ASHA documents 2010 Special Interest Group 18 (Telepractice) formed 2013 SIG has over 1000 members ASHA s Definition 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, 2005 Speech-Language Pathologists Providing Clinical Services via Telepractice: Position Statement 2
Quality Proviso The use of telepractice does not remove any existing responsibilities in delivering services Therefore, the quality of services delivered via telepractice must be consistent with the quality of services delivered faceto-face. ASHA, 2005 Speech-Language Pathologists Providing Clinical Services via Telepractice: Position Statement Terminology Makes a Difference Using telepractice as a means of direct service delivery Telespeech, telehealth, telemedicine, telerehab, teletherapy Typically via teleconferencing ( face-to-face, but not in person NOT distance education NOT distance supervision Why This Can Be Confusing Telepractice: students delivering services via teleconferencing with supervisor sitting with them Telesupervision: Clinical Fellow delivering services face-to-face with supervisor observing via teleconferencing 3
And In Education Distance learning may incorporate interactive videoconferencing, virtual classrooms May be used to teach SLPs Not used to describe SLP services Bottom Line CLEARLY DOCUMENT WHAT YOU DO!! Service was provided via telepractice Type of equipment used Transmission medium Modifications that were made to standardized assessment or treatment procedures Types of Telehealth Synchronous (real time) Asynchronous (store and forward) Images, data Self-monitoring (not typically used in SLP) 4
Telepractice Examples Schools Direct service Health Care Home health Research Private practice Private health plans Photo: Courtesy of National Rehabilitation Hospital Technology Components Equipment Hardware Dedicated system, computer Camera, monitor, microphone, multisite capability Software Peripheral devices Document camera, videoendoscope Types of Technology 5
Internet Videoconferencing Software Data Collaboration Tools Courtesy of: David Brennan, National Rehabilitation Hospital Licensure What is licensure for? Current status full licensure in state where client resides ASHA model regulations: general and interstate practice 6
Problems with State Licensure for Telehealth Non-uniformity of state laws and regulations Lack of agreement on terms, jurisdiction Non-portability Time and expense to providers Administrative redundancy Restrictive language Fears Portability Models Nurse Licensure Compact (24 states, including MS) Limited/Special License (Federation of State Medical Boards) Expedited Licensure by Endorsement (FSMB)-uniform requirements, applications, credentials Federal Exemption VA, DoD employees ASHA s Model Language Services must be equivalent to face-to-face Competency of clinician Appropriateness of client, equipment Notification of telepractice to client, guardian, caregiver, team Telepractice may not be provided by correspondence only (mail, e-mail, fax) 7
ASHA s Proposed Limited License for Interstate Practice Does not have an office in the state Consultant: provides consultations to primary service provider in state Exceptions for: episodic or infrequent services or consultation teaching or research emergency or disaster Reimbursement--Medicare Physicians, nurses, CSWs, psychologists, dietitians for selected CPT codes Designated originating sites Rural health professional shortage area Outside Metropolitan Statistical Area ASHA and ATA advocacy http://www.cms.hhs.gov Search Telehealth Services Fact Sheet Reimbursement--Medicaid Varies from state to state Need approved CPT codes to receive payment for using modifier Oklahoma has established Medicaid payments with schools receiving origination fee Missouri, but not for schools Kentucky, Virginia, Colorado at various stages 8
Reimbursement--Private Insurance Trend for state legislation to mandate payment for approved services California Colorado Georgia Hawaii Kentucky Louisiana Maine Maryland Michigan New Hampshire Oklahoma Oregon Texas Virginia Vermont Reimbursement--Schools Largest area for reimbursed telepractice Within-district or contractor services Virtual schools some providing special ed and related services e.g., North Carolina, Idaho, Colorado, PA Success with Private Insurers ASHA Leader Oct. 9, 2012 CareFirst Blue Cross/Blue Shield Keys to success: Training Competency Opt-out Consumer information 9
It s Not the Technology Planning, stakeholder support, training Business plan Who are the stakeholders Licensure, school boards Administrators at all levels Teachers, facilitators Parents, clients Training and information Managing expectations Ensuring Quality Competency of providers Selection of clients Appropriateness of technology Identification of outcomes/data collection Monitoring client, caregiver, provider satisfaction Provider Competency Knowledge and Skills Needed by Speech-Language Pathologists Providing Clinical Services via Telepractice ASHA, 2005 Establishing connection, troubleshooting Calibration of equipment Basic principles of teleconferencing Selection of clients, materials 10
Use of Facilitators Not the same as an assistant, because SLP is providing the treatment May be a teacher s aide, interpreter, family member, depending on setting Activities: Setting up connection, materials Behavior management Scheduling Other Telehealth Groups American Telemedicine Association Center for Telemedicine and e-health Association of Telehealth Service Providers Telemedicine Information Exchange Office for Advancement of Telehealth (HRSA) jbrown@asha.org 301-296-5679 http://www.asha.org/practice/ telepractice/ 11