Telepractice Laws and Billing in Your State Telepractice can expand your client base. But each state has different rules and some payers won’t cover it. Here’s what you need to know Policy Analysis
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Policy Analysis  |   December 01, 2016
Telepractice Laws and Billing in Your State
Author Notes
  • Cheris Frailey, MA, CCC-SLP, is ASHA director of state education and legislative advocacy. cfrailey@asha.org
    Cheris Frailey, MA, CCC-SLP, is ASHA director of state education and legislative advocacy. cfrailey@asha.org×
Article Information
Regulatory, Legislative & Advocacy / Policy Analysis
Policy Analysis   |   December 01, 2016
Telepractice Laws and Billing in Your State
The ASHA Leader, December 2016, Vol. 21, 24-25. doi:10.1044/leader.PA.21122016.24
The ASHA Leader, December 2016, Vol. 21, 24-25. doi:10.1044/leader.PA.21122016.24
If I have a telepractice client who lives in another state, do I need a license in that state?
Does Medicaid cover telepractice speech-language and audiology services?
Is holding a state license enough to bill insurance companies for telepractice services?
If you provide service remotely—or are thinking about starting telepractice services—you have asked these questions. The answers, however, are complicated and differ from state to state.
A look at state requirements may help provide the information you need to work with clients remotely.
Trends
Over the past few years, all but eight states have worked to regulate or reimburse for telepractice services, representing a significant effort to address requirements for audiologists and speech-language pathologists (see the accompanying map).
Licensure. As of October 2016, 21 state licensure boards have telepractice requirements for audiologists and SLPs, and more are considering laws and regulations to govern the practice in their states.
Insurance. Insurance reimbursement laws, sometimes referred to as telehealth/telemedicine parity laws, require private payers to cover services delivered remotely if those same services are covered in person. Some of these clearly define which health care providers are permitted to deliver the services, the types of conditions covered, and the setting in which the services are provided. Other laws are broad and unclear, leaving specifics open to interpretation. Some laws include Medicaid, state employee health plans, self-funded employee health plans and managed care. Of the 32 laws in place, however, only four specifically include audiology and speech-language services.
Medicaid. Medicaid reimbursement laws vary and may have limitations on location, providers, number of visits and settings. Verify in writing the requirements for accessing Medicaid reimbursement.
Of the 21 states that reimburse telepractice under Medicaid, seven cover audiology and speech-language pathology in the schools, six provide coverage in health care settings, seven provide reimbursement in both settings, and four are broad or not clearly defined.
Medicare. Under Medicare, audiologists and speech-language pathologists are not eligible providers of services delivered via telepractice.
Telesupervision. With a shortage of supervising clinicians across the country, telesupervision is a growing topic of interest. Some state licensure boards provide rules and regulations for support personnel, clinical fellows and student interns. However, no state specifically defines or clarifies guidance using the term telesupervision. Some language may indicate that supervision is appropriate with two-way video, interactive television or electronic means. Providers must contact the state licensure board to verify what is permitted.
The future
Telepractice continues to expand and become a more viable option for providing services. ASHA has been working at the federal level with other national associations and at the state level with state speech-language-hearing associations to promote telepractice and ease service-provision restrictions. Clinicians can help further this effort through their state speech-language-hearing association.
What Do I Need to Do?

It’s important to remember that laws may permit telepractice, but they do not guarantee reimbursement. So even if your state (or states, if you live in one jurisdiction but provide services to clients in another) has telepractice laws on the books, your clients’ health plans may not cover this type of service delivery.

Before starting telepractice, check out the relevant licensure regulations, state and federal laws, and reimbursement policies.

Licensure
  • Obtain a license in the state or states where you and your clients live.

  • If a state has not enacted telepractice rules or regulations, contact the state’s licensure board for further guidance. Ask for written answers to your questions.

State laws/regulations
Reimbursement
  • Many states have laws that regulate telepractice reimbursement, but those laws do not guarantee that you will be reimbursed or that payers have implemented the law into their plans.

  • Some state Medicaid manuals include guidance on billing for telepractice services. Verify that the information is in state statutes or regulations as well.

  • Verify with the insurance company or Medicaid that telepractice services are covered and request a written response that includes the requirements on how to bill, which codes and modifiers to use, and documentation requirements. Keep this written, dated documentation in case an issue or question of reimbursement comes up in the future.

Federal laws
  • Become familiar with the security compliance standards established in the Health Insurance Portability and Accountability Act (HIPAA) and Family Educational Rights and Privacy Act (FERPA).

  • Clinicians must ensure client/patient confidentiality: Protect devices with passwords; require a separate log in for each user; incorporate staff training on HIPAA and FERPA; use only secure portals to send messages to patients.

  • Enter a Business Associate Agreement with all business associates involved in your telepractice (such as billing companies, internet security vendors and web-based platforms) and verify their data encryption, emergency protocols and security measures.

ASHA resources
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FROM THIS ISSUE
December 2016
Volume 21, Issue 12