“If I could give one gift to the next generation, I would make it my purpose to give all children the chance to hear, laugh, and sing their song. All I need is a way to reach them.”
~Marnee’s Professional Wish, 2005
I am on my way to a wish-come-true. Telepractice is a medium through which a service reaches a need. It brings people together for growth and support. Equal access to therapy services is possible via telepractice. All children can have the chance to hear, laugh and sing their song. Telepractice gives us a way to reach them.
One by one, barriers to serving children via telepractice are diminishing. More associations are developing position statements and Codes of Ethics that positively involve telepractice. I still advocate for more regional support for providing practicum and CFY supervision via telepractice. On another positive note, evolving knowledge, technology, and bandwidth has advanced the quality of telepractice services. A challenge that remains is reimbursement and the disconnect between regions.
Fact: A region has struggled to find a same location Speech-Language Pathologist (SLP) and decided to research the possibility of using telepractice to bring services to the students. These students are covered under Medicaid; however, if they receive therapy services via telepractice, the cost is not reimbursable in this region (as per our contact person).
Why? Is the SLP’s service less worthy of reimbursement if telepractice is involved? Are the children’s services less worthy of being reimbursed if telepractice is involved? Maybe the reimbursement denial is because ‘nothing is written about telepractice in the rule book’ or that ‘no one else seems to be doing it.’ The point is that children are waiting on pieces of paper to be signed and for people to abandon the status quo so that they can access help before another school year escapes them.
Moving forward, I sought out more information about reimbursement. The Texas Speech-Language-Hearing Association (TSHA) website provides a useful document called: Recommended Telepractice Guidelines for Texas Speech-Language Pathologists, Audiologists, and Licensed Assistants in Speech/Language Pathology DRAFT ONE. Following is an excerpt that supports reimbursement for services delivered via telepractice:
A health benefit plan shall not exclude a service from coverage solely because the service is provided through telehealth and not provided through a face-to-face consultation.
A health benefit plan may provide coverage for a consultation at a site not within the telehealth network at the discretion of the insurer." (adapted from: Kentucky legislation KRS.304 Subtitle 17A)
Benefits for a service provided through telehealth required by this section may be made subject to a deductible, copayment, or coinsurance requirement...(although the requirements) may not exceed the deductible, copayment, or coinsurance required by the health benefit plan for the same service provided through a face-o-face consultation." (adapted from: Kentucky legislation KRS.304 Subtitle 17A)
Sections 68-1018 to 68-1025 and Title XXI of the federal Social Security Act, as amended, forhealth care services delivered through telehealth that are otherwise eligible for reimbursement under such program and federal act.
- Health care services delivered through telehealth are eligible to be covered by and reimbursed under the medicaid fee-for-service program
- Managed care contracts with managed care plans are amended to add coverage of health care services delivered through telehealth and any appropriate capitation rate adjustments are incorporated.
- The reimbursement rate for a telehealth consultation shall, as a minimum, be set at the same rate as for a comparable in-person consultation.
Telehealth Reimbursement Provisions of the Balanced Budget Act of 1997
- Removes a barrier to telehealth: the lack of reimbursement by Medicare to telemedicine providers
- Medicare to reimburse telemedical consultations in rural Health Personnel Shortage Areas (HPSAs), as defined by the U.S. Department of Health and Human Services, at normal co-pay rates
- No reimbursement for facility or transmission costs
For the entire document, follow this link: http://www.txsha.org/Practice_Guidelines/telepractice.asp.
More good news – ASHA has a plan. Speech-Language Pathologist Janet Brown, presented on telepractice at the Texas Speech-Language-Hearing Association (TSHA) in April, 2009. Her presentation, entitled “Telepractice: The Next Generation”, spoke to the developments and initiatives with telepractice. I was pleased to view the slides that are available on-line at: http://www.txsha.org/_pdf/Convention/09Convention/New%20Folder/Brown,%20Janet-Telepractice_The%20Next%20Generation.pdf
A slide on page six lists the Current ASHA Initiates in regards to telepractice:
- Developing model language for state licensure
- Committee is developing guidance on professional issues surrounding telepractice
- Supporting federal legislation for including SLPs and Audiologists as Medicare providers
- Tracking states where Medicaid pays for SLP services via telepractice
The above initiatives can help to streamline the language, guidelines, and knowledge surrounding telepractice so that we can take one big collective step forward in our profession of serving. I am excited about learning details as they become available.
In the spirit of learning, let’s have a conversation about reimbursement and telepractice. As a profession, let’s build a common knowledge base about the progress of reimbursement. What do you know? It would also be wonderful to hear from someone in the reimbursement field. Let’s partner to make a difference.
Marnee Brick, MSc
Speech-Language Pathologist and Director of Speech Therapy
TinyEYE Therapy Services (Speech Therapy Telepractice)
Growing smiles, mending spirits, engaging children in their lives