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.
Finding rules and Regulations for license, supervision of aides and telepractice
At our January web meeting, we offered information on how to navigate the Montana Rules and Regulations.
Are you looking for Information on how to apply for a license? This address should take you to the page you need to get started. Click on the License Information tab and select what type you need.
One of the unique requirements in Montana is
“Passage of the Board of Speech-Language and Audiology Montana Jurisprudence exam with a score of 95% or higher”
This should take you to the license application and the exam is at the end.
The answers for this exam can be found by going to this page
and then searching for the rule.
Once you are licensed, it is helpful to have these links.
RULES FOR AIDES
Good luck and contact MSHA if you need help with this process!
MSHA End of the Year Summary
As we come to the end of 2015, I thought I’d share the highlights of our year by sharing our goals and progress. At our first meeting January, we established the following goals. Following each, I’ve summarized our progress.
- Maintain the high quality of Fall Convention and MSHA sponsored activities. Our fall convention was a success and we were also cosponsors of many CEU activities including the Ritecare Spring Conference with Sarah Ward.
- Maintain Membership at 200 and increase active members. We actually hit 300! We have 96 students, 164 SLPs, 24 Audiologists, 7 dual and 9 speech aides. Don’t forget to renew for 2016 if you haven’t already! We have members active on several issues including telepractice, convention planning, scholarship and licensure issues.
- Maintain Involvement at the National Level We received two grants from ASHA, our president-elect attended CSAP, our SEAL attended the schools conference. We nominated two members for national awards.
- Be active and involved in the legislature with issues that effect members. We successfully passed a bill to allow billing for E and M codes and we were actively involved in several other bills including one that allows for speech therapy coverage for individuals with Down’s Syndrome. We recently appeared at the Economic Affairs Interim Committee meeting to express our concern about license fees.
- Be active and involved with all our members including our students. We awarded two MSHA scholarships, we answered questions from members, provided monthly training on telepractice and addressed concerns about licensure fees. We launched our new website. We published out newsletter, the Communicator. We sent monthly emails and kept our facebook page active with monthly themes. We added a pinterest account. We had excellent student participation at convention for the poster session.
- Improve communication and involvement with the licensure board. We spent the year working to get a complete licensure board and we are now respectively requesting this new board to address our concerns about license fees.
We are proud of our members and our accomplishments. For 2016, we plan to survey members and continue to build groups to address our interests and concerns. We plan to offer monthly web meetings to address these concerns and we are encouraging and supporting groups to gather. We are working to provide fall convention offerings that will attract school based and medical based SLPs, audiologists and students. We welcome your input!
Happy New Year!
Rachel Stansberry, 2015 MSHA President.
Convention Highlights-Social Communication Development
- The importance of fully describing and discussing the setting in a story to help children recognize and truly understand all that is expected and unexpected within a given context. The kick off in story is what then separates the expected from the unexpected.
- The importance of narrating the same story from the view point of more than one character. This is a great way to work on perspective taking and help students understand that two different characters can have a different emotional reaction and plan in response to the same situation.
- The importance of teaching the thinking verbs as well as the verbs that tell how something is expressed (she called these the linguistic verbs).
- It’s often the illustrations that provide much of this information and we can use these as a teaching tool.
MSHA Fall Convention Summary
Many thanks to all of you who attended, participated, volunteered, contributed, voted, laughed, cried, listened, waited, and shared our fall convention with us in Billings. We were pleased with our turn out and our excellent program! Our illustrious treasurer, Shar, is finalizing our numbers and we’ll share those soon. In the meantime, we’d like to thank Molly Beck, our SLP at large and Jenn Closson, our past president for their service to our organization. They will be leaving our board at the end of the year. We will welcome Catherine Drescher. She is changing her role from secretary to president. We also welcome Brigette Watters as our new secretary and Kathleen Delapp-Cohn as our new SLP member at large. Stay tuned for more info on annual meeting, our convention highlights and reporting on the SLP and Audiology presentations.
What do you mean, you're not a morning person?
MSHA ANNUAL MEETING is October 16, 2015 at 7 am at the Crowne Plaza in Billings. Yes, you read that right, 7 am! For the past few years, we’ve had fewer people attend our luncheon, so we are trying something new. We’ll have coffee from City Brew and some breakfast. Our annual meeting is the time we look over all we’ve accomplished in the past year and make plans for the coming year. We elect new officers and recognize the current board members for their service to our organization.
Why just a year ago, Jenn Closson announced her vision for our new website. She and Diane Simpson wanted a user friendly site with visual appeal. One that included a blog from the president as well as guests. If you’ve found this page, you know that MSHA has the vision and the commitment to bring our ideas to life.
If you are a blogger and would like to be linked or guest blog on our site, let us know.
See you soon!- your MSHA president, Rachel
Board Meeting on September 9, 2015
On our Agenda…
Review of June Meeting Minutes and Committee Reports
New Business including Convention Plans, License Fee Action Update, Member Concerns, Nominations and Awards
Our Annual Meeting will be held at the Crowne Plaza in Billings at 7 am on October 16, 2015. We will review our year, our budget and elect new officers to the board. Hope to see you there!
The Latest on License Fees
We’ve been waiting patiently for the Governor to appoint the two new members to the licensure board. They will then be trained and MSHA has asked them to immediately attend to the license fee issue. We are also increasing our visibility and involvement with the interim committee in the legislature that is addressing fees for all licensure boards.