Telepractice

Medicaid Toolkit

ASHA defines telepractice as "the application of telecommunications technology to delivery of professional services at a distance by linking clinician to client, or clinician to clinician, for assessment, intervention, and/or consultation." ASHA adopted the term telepractice rather than the terms telemecine or telehealth to avoid the misconception or misperception that these services are used only in health care settings. Telepractice may be used to alleviate access-to-service issues caused by factors such as distance, lack of provider availability, or diminished mobility. ASHA considers telepractice to be an effective service delivery model as long as the quality of services is consistent with that of services delivered in person and the service provider follows professional guidelines and state and federal laws and regulations. ASHA's Practice Portal on Telepractice outlines key issues for audiologists and speech-language pathologists to consider when providing telepractice services.

Considerations

There is confusing variability in Medicaid telepractice services at the federal level. CMS views telepractice as a cost-effective means to deliver medical services and encourages states to develop telepractice approaches and expand coverage. However, coverage and standards for telepractice vary widely from state to state.

Some states limit the provision of services via telepractice to speech-language pathology only, some impose limits by setting, and some allow broader provision of telepractice across health care providers.
Almost all states have some form of coverage and reimbursement for services delivered via telepractice; however, not all cover audiology and/or speech-language pathology.
State Medicaid telepractice regulations must be read carefully. For example, in the Maine guidelines, covered services include physicians' and other services, including audiology and speech-language pathology services. However, other states may limit coverage to services provided by physicians only.
Some states may require specific documentation for telepractice, including but not limited to the addition of a modifier for billing.
Some states may require additional information prior to approving telepractice as a reimbursable service, such as:

reasons telepractice is required versus on-site services (geographic, physical, social barriers);
specific information about the telepractice service the patient is receiving;
any modifications made to assessment/treatment approach;
security and privacy measures
type, rate, and quality of video/audio transmission.

Advocacy

Advocacy activities regarding telepractice may target specific issues unique to a particular state.

Some states may require special Medicaid approval for the practitioner to be a telepractice provider.
Some states may limit telepractice coverage to specified rural areas.
More states are expanding telepractice coverage through legislation that mandates insurance reimbursement for telepractice services.
Some state Medicaid regulations have leveraged legislation in order to broaden coverage by private insurers.
Legislative language typically specifies that, if a service is reimbursed by insurance, that same service should be covered when provided via telepractice.