Montana Telepractice Turns 5: Webinar March 13, 2018
MSHA is committed to bringing educational opportunities! Keep your calendar available for a webinar on Tuesday March 13, 2018 to participate in Montana Telepractice Turns 5 by Rachel Stansberry and Diane Simpson. Attend and find out about what’s changed and where we’re going in Telepractice. Resources and recommendations will be provided! More details to come!
SLPs Providing Telepractice in Montana
MSHA has had several requests for a list of speech-language pathologist and audiologists providing telepractice in Montana. We are including names of therapists who have asked to be included on this list. If you would like your name added, please contact MSHA.
DeWit RiteCare Speech, Language & Hearing Clinic
Department of Communicative Sciences and Disorders
University of Montana
32 Campus Drive
Missoula, MT 59812-6695
Catherine “Kitty” Griffin M.C.S.D CCC- SLP
State of the Heart Therapy, Inc
209 Taylor Drive
Dillon, Mt 59725
Jane Reynolds, M.S., CCC-SLP
Kalispell Regional Healthcare
Kathleen DeLapp Cohn, M.S.,CCC-SLP, Director of Clinical Services
Rock Creek Teletherapy, LLC
1302 24th Street West, #132
Billings, MT 59102
Michelle Wisherd, M.S., CCC-SLP
Independent Contractor with PresenceLearning
The world of Telepractice changes quickly! Currently the licensure board is working on rule review package. At their meeting in June of 2016 they voted to remove the rules for an in person initial evaluation and for the four hours of training before beginning telepractice. These changes will appear in the upcoming rule package and the public will have opportunity to comment. Watch for information from the licensure board in May for the timeline on these changes.
Telepractice Law and Rules
MSHA is committed to supporting telepractice by providing training and information to practitioners and consumers. Practitioners should be familiar with both the law and the rules prior to initiating services via telepractice.
The complete law can be found by searching the Montana Code Annotated
37-15-102 (relevent portions)
(5) “Facilitator” means a trained individual who is physically present with the patient and facilitates telepractice at the direction of an audiologist or speech-language pathologist. A facilitator may be but is not limited to an audiology or speech-language pathology aide or assistant.
(6) “Patient” means a consumer of services from an audiologist or speech-language pathologist, including a consumer of those services provided through telepractice.
(11) “Telepractice” means the practice of audiology or speech-language pathology by an audiologist or speech-language pathologist at a distance through any means, method, device, or instrumentality for the purposes of assessment, intervention, and consultation.
37-15-314. Telepractice — authorization — licensure. (1) An audiologist or speech-language pathologist who is licensed under and meets the requirements of this chapter may engage in telepractice in Montana without obtaining a separate or additional license from the board.
(2) Except as provided in 37-15-103, an audiologist or speech-language pathologist who is not a resident of Montana and who is not licensed under this chapter may not provide services to patients in Montana through telepractice without first obtaining a license from the board in accordance with this part.
(3) An audiology aide or assistant or a speech-language pathology aide or assistant may not engage in telepractice. This section does not prohibit an audiology aide or assistant or a speech-language pathology aide or assistant from serving as a facilitator.
37-15-315. Scope of telepractice — requirements. (1) The quality of services provided through telepractice must be equivalent to the quality of audiology or speech-language pathology services that are provided in person and must conform to all existing state, federal, and institutional professional standards, policies, and requirements for audiologists and speech-language pathologists.
(2) Technology used to provide telepractice, including but not limited to equipment, connectivity, software, hardware, and network compatibility, must be appropriate for the service being delivered and must address the unique needs of each patient. Audio and video quality utilized in telepractice must be sufficient to deliver services that are equivalent to services that are provided in person. A person providing telepractice services is responsible for calibrating clinical instruments in accordance with standard operating procedures and the manufacturer’s specifications.
(3) A person providing telepractice services shall comply with all state and federal laws, rules, and regulations governing the maintenance of patient records, including maintaining patient confidentiality and protecting sensitive patient data.
(4) A person providing telepractice services shall conduct an initial assessment of each patient’s candidacy for telepractice, including the patient’s behavioral, physical, and cognitive abilities to participate in services provided through telepractice. Telepractice may not be provided only through written correspondence.
(5) At a minimum, a person providing telepractice services shall provide a notice of telepractice services to each patient and, if applicable, the patient’s guardian, caregiver, or multidisciplinary team. The notification must provide that a patient has the right to refuse telepractice services and has options for service delivery and must include instructions on filing and resolving complaints.
The Rules can be found by searching the rules
Rule I definitions
(1) “Asynchronous” means a method of exchanging information that does not require the patient and the provider to be available at the same time. Examples of such communication, also known as “store-and-forward” transmission, include e-mails, faxes, recorded video clips, audio files and virtual technologies and e-learning programs.
(2) “Synchronous” means interactive transmission of data occurring bi-directionally in real time and requiring the patient and the provider be available at the same time.
Rule II provision of telepractice serives
(1) The provision of speech-language pathology or audiology services in this state through telepractice, regardless of the physical location of the speech-language pathologist or audiologist, constitutes the practice of speech-language pathology or audiology and is subject to state licensure requirements and regulation by the board.
Rule III limits on telepractice
(1) No person licensed as a speech-language pathologist or audiologist in another state may engage in the practice of speech-language pathology or audiology in Montana, including telepractice services, unless a license to practice has been issued in Montana.
(2) A person located outside this state who provides speech-language pathology or audiology telepractice services to any patient in Montana shall be appropriately licensed in the jurisdiction in which the person providing telepractice services is located.
(3) All telepractitioners must abide by any statute or rule of this state governing the maintenance of patient records and patient confidentiality, regardless of the state where the records are maintained.
Rule IV delivery of telepractice serices
(1) Telepractice services may be delivered in a variety of ways, including:
(a) Asynchronous transmission:
(i) store-and-forward model/electronic transmission of stored clinical data from one location to another usually by the Internet via e-mail or fax; and
(ii) video and audio transmission through regular mail service delivery and express delivery services; and
(b) Synchronous transmission:
(i) clinician interactive model is a real time interaction between provider and patient that may occur via audio or audio/video transmission over telecommunication links such as telephone, Internet, or other methods for distance communication, including:
(B) remote control software applications;
(C) computer applications;
(D) e-mail correspondence, including attachments; or
(E) self-monitoring/testing model, which refers to the patient who receives the services and provides data to the provider without a facilitator present at the site of the patient.
(2) Live versus stored data refers to the actual data transmitted during the telepractice. Live, real time, and stored clinical data may be included during the telepractice.
Rule V quality of telepractice services
(1) Elements of quality assurance include the competency of licensees, selection of patients, appropriateness of technology to the service being delivered, identification of appropriate outcome measures, collection of data, and satisfaction of the patient, caregiver, and provider.
(2) Telepractice services must conform to professional standards, including all appropriate and applicable codes of ethics.
(3) Licensees shall not engage in false, misleading, or deceptive advertising of telepractice services.
(4) Telepractice services may not be provided solely by correspondence, e.g., mail, e-mail, and faxes, although such may be adjuncts to telepractice.
(5) Licensees shall engage in only those aspects of the professions that are within the scope of their competence, considering their level of education, training, and experience.
(6) Telepractice services must be in compliance with safety and infection control policies and procedures.
Rule VI establishing the practitioner-patient relationship
(1) A practitioner-patient relationship may commence via telepractice following a practitioner’s in-person evaluation of the prospective patient to assess the patient’s:
(a) need for services; and
(b) candidacy for telepractice, including behavioral, physical, and cognitive abilities to participate in telepractice services. Telepractice services may be provided by the patient’s evaluator or another qualified speech-language pathologist or audiologist by the board.
(2) Prior to initiating services, a speech-language pathologist or audiologist shall:
(a) make reasonable attempts to verify the identity of the patient;
(b) obtain alternative means of contacting the patient other than electronically;
(c) provide to the patient alternative means of contacting the licensee other than electronically;
(d) document whether the patient has the necessary knowledge and skills to benefit from the type of telepractice provided by the licensee;
(e) determine the availability of a facilitator, if needed, with the necessary level of training to assist at the patient’s location;
(f) provide orientation and training to the patient in the use of telepractice equipment and the telepractice protocol at an appropriate level for the patient; and
(g) inform the patient in writing of the following:
(i) the limitations of using technology in the provision of telepractice;
(ii) the potential risks to the confidentiality of information due to technology used in telepractice;
(iii) the potential risks of disruption in the use of telepractice;
(iv) when and how the licensee will respond to routine electronic messages;
(v) in what circumstances the licensee will use alternative communications for emergency purposes;
(vi) who else may have access to patient communications with the licensee;
(vii) how communications can be directed to a specific licensee;
(viii) how the licensee stores electronic communications from the patient; and
(ix) that the licensee may elect to discontinue the provision of telepractice services.
(3) The written document required by (2)(g) shall be signed by both the licensee and the patient and maintained in the clinical record. If the patient is a minor, the document shall be signed by the patient’s parent or guardian.
Rule VII competence-practice limits-maintenance and retention of records
(1) A licensee using telepractice to deliver services shall:
(a) complete four hours of board-approved telepractice training prior to engaging in telepractice in Montana;
(b) limit telepractice services to the licensee’s scope of practice;
(c) maintain continuing competency or associate with a group who has experience in telepractice delivery of care;
(d) use methods for protecting health information that include authentication and encryption technology;
(e) limit access to protected health information to only those necessary for the provision of services or those required by law; and
(f) ensure that confidential communications obtained and stored electronically cannot be recovered and accessed by unauthorized persons when the licensee disposes of electronic equipment and data.
(2) A speech-language pathology or audiology aide or assistant may function as a facilitator, but may not provide telepractice services.