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From: Judy Kuster
Date: 10/15/02
Time: 3:13:31 PM
Remote Name: 134.29.30.25
The issue of "licensure" hasn't been resolved. In fact, there are many issues about telehealth that haven't been resolved - by our field, as well as other fields. I am presenting at the National Council of State Boards of Examiners for Speech-Language Pathology and Audiology conference on "Technology in the New Millennium: Telepractice and the Healthcare Practitioner Data Base" in St. Louis at the end of the week. My task is to explore what I see as some of the "ethics and issues in telehealth" in our discipline. You know, I wonder if we hadn't all pushed for "state licensure" this wouldn't be an issue. Our ASHA certification would have been sufficient. But who anticipated the impact of the internet when all of that debate was going on about licensure?
Your bottom line question - what about licensure between states. The first question raised is you need to be careful that what you are doing is not prohibited by law connected with licensure in that state. Licensure statues are not uniform, so that answer to that question probably varies. And then there is the question of whether or not that person actually is from where they say they are when you agree to serve them! There would be ways to people to tell Barry they are from his state, even if they weren't, in order for them to have access to the wonderful service that he can provide.
How will all of this be resolved? There are possibilities that are currently being explored in other fields, and undoubtedly thought about in ours as well.
A new type of licensure that recognizes telecommunications might be devised. Delivering services by telehealth is not just another means of doing therapy. It has special considerations that people need to be aware of, and perhaps have training in. A specialty licensure of some sort might be in order.
There might be agreements between states that ASHA certification will be sufficient, just like a driver's license allows us to drive in other states, as long as we abide by the driving laws in that state.
Or, it might be that if you are contacted by or want to serve a client that resides in another state where licensure is required, you'd have to apply for, qualify for, and PAY for licensure there, like insurance providers must do to sell insurance in other states. (Their licenses are only $15-$20 I believe, in most states, however;)
Maybe there is another solution, but those are the ones I've seen talked about.
It isn't just licensure, BTW, it is also reimbursement issues, whether or not your liability insurance covers telepractice, etc.
There is a huge list of "selected state bills" relating to legal and policy issues in telemedicine that you might find interesting. The URL is http://tie2.telemed.org/legal/state
Interesting question!
Judy Kuster