The advent of telepractice poses unique problems with regards to state licensing, and many states are struggling to build the legal groundwork to allow access to treatment while still maintaining a standard of protection for residents. The problem lies in distance. A telepractitioner is not restricted to in-state practice, and can serve anyone in any location. While the efficacy of the treatment has been proven time and again, the traditional medical model calls for individual state licensing.
Some advocates argue that telepractice is nothing new. Doctors have been contacting each other for advice and consults since Alexander Graham Bell made the first call to Mr. Watson. Proponent Howard Belzberg points out that, “We are not moving from one type of medicine to another but just to a different form of transportation.” The question of whether separate state licensing has any value or validity has also been called to task over this issue. In what way does separate licensing protect state residents? Does this imply that medical professionals need a different set of qualifications to work in Oklahoma than they do in New Hampshire? If doctors have to be equally qualified to provide services to every American, then perhaps individual state licensing requirements are obsolete.
Determining Locus of Practice
Before any ruling on licensure requirements for telepractice can be considered, a consensus must be reached about where telepractice services actually take place. Is the service located with the practitioner, or the patient? If the powers that be decide that the service is located with the practitioner, the problem becomes much simpler. No multistate licensing is necessary, and the practitioner is bound by the laws in his/her home state.
Currently, speech-language pathologists may only engage in telepractice in states in which they hold a professional license. This is akin to needing a different driver’s license to drive in every US state and territory! Clinicians report duplicative paperwork, expense, and wait times; for some professions, there can be lack of uniformity for state credentialing requirements and fees.
States with Telepractice Regulations
Of the states that include telepractice in audiology and speech-language pathology licensure laws, many specify that the professional must be licensed both at home and in the state in which the patient is located. Additionally, at least 12 states and the District of Columbia already have telepractice provisions promulgated by their state licensure boards that you should be aware of before initiating any actions in those states.
Delaware – State Code of Ethics provision states that: licensees shall not evaluate or treat a client with speech, language, or hearing disorders solely by correspondence. Correspondence includes telecommunication.
District of Columbia – It is a violation of the regulations if an audiologist or speech-language pathologist provides services in DC without a DC license, regardless of whether the professional providing services is physically located in the District of Columbia or another jurisdiction. The policy does not address persons who are located in DC but who are providing services outside of the District.
Georgia – Any person in the state or physically located in another state or country who, using telecommunications and information technologies through which speech-language pathology information and auditory-vestibular system information is transmitted, is considered to be engaged in the practice of speech-language pathology or audiology in the state and as such must have a full state license and shall be subject to the regulation of the board.
Iowa – Provision of speech-language pathology and audiology services through telephonic, electronic or other means, regardless of the location of the SLP or audiologist, shall constitute the practice of speech-language pathology or audiology and shall require Iowa licensure.
Kentucky – 2007 Revised Statute establishes provisions for telehealth (including informed consent, confidentiality and other aspects of consumer protection) and defines it as “use of interactive audio, video, or other electronic media to deliver health care. It includes the use of electronic media for diagnosis, consultation, treatment, transfer of health or medical data, and continuing education.”
Louisiana – Ethical prescription which allows telepractice provided appropriate licensure is held for the jurisdiction in which the service is rendered and delivered.
Maine – Indirect supervision is defined to include demonstration, record review, review and evaluation of audio or videotaped session, interactive television and supervisory conferences that may be conducted by phone. CE may include courses to enhance the efficacy of telepractice.
Maryland – Telehealth means the use of telecommunications and information technologies for the exchange of information from one site to another for the provision of health care to an individual from a provider through hardwire or Internet connection.
Ohio – Licensees may practice via telecommunication within the state where not prohibited by law.
Oklahoma – Statute requires licensure for audiology and speech-language pathology services delivered in the state through telephonic, electronic, or other means, regardless of the location of the practitioner. Also within (Rules 680:15-1-4) ethical proscriptions: Licensees must not provide clinical services except in a professional relationship. They must not evaluate or treat solely by correspondence or telepractice. This does not preclude follow-up correspondence with persons previously seen, or providing them with general information of an educational nature.
Washington – Prohibits sale of hearing aids by telephone or mail.
Wyoming – The provision of speech pathology or audiology services in this state, through telephonic, electronic or other means, regardless of the location of the speech pathologist or audiologist, shall constitute the practice of speech pathology or audiology and shall require licensure provided in this chapter.
The current state-based licensure and regulation of rehabilitation professionals does not facilitate the practice of telespeech across state lines. Given today’s equipment capabilities and consumer adoption of the electronic delivery of many kinds of services, health care providers, including rehabilitation professionals, should be able to serve clients wherever they are needed.
What side do you come down on? Would you favor federal licensing and open practice across state lines? Or would you be more cautious and stay with individual state licensing?