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South Carolina Board of Occupational Therapy

Frequently Asked Questions: Telehealth

 

What is telehealth?

Telehealth, also know as telemedicine, is the provision of health care, health information, and health education across a distance, using telecommunications technology and specially adapted equipment. Telehealth physicians, nurses and health care specialist assess, diagnose, and treat patients without requiring both individuals to be physically located in the same place, regardless of whether that distance is across the street, across a city, across a state or across continents.

What is the purpose of telehealth?

The purpose of telehealth is to increase cost efficiency, to reduce transportation expenses, to improve patient access to specialists and mental health providers, and to improve quality of care and communication among providers.

In what settings is telehealth practiced?

Telehealth is practiced in many settings such as rural hospitals, school districts, home health settings, nursing homes, cruise ships, battlefields, and even NASA space missions. Telehealth is well established in radiology and dermatology; and it is being expanded into home telehealth, mental telehealth, ocular telehealth, telepathology, and telerehabilitation.

How is telehealth delivered?

The delivery of telehealth can involve the use of videoconferencing, the Internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications to enable patients and health care providers at distant sites to interact. These interactions can occur face-to-face or through store-and-forward modes. Face-to-face interactions typically involve a two-way interactive television that allows for real time interaction between patients and health care providers. Face-to-face allows for real-time consultations by health care providers to patients at distant sites with dialogue and visual interaction. Store-and-forward interactions involve the capturing and transferring of digital images or information by storing them and forwarding them for use by a patient or health care providers in non-real-time. Store-and-forward allows secure clinical information to be sent like email to a provider or patient at a distant site with no real time dialogue or visual interaction.

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What are practitioner qualifications?

In addition to adhering to standard South Carolina licensing qualifications, occupational therapy practitioners using telehealth as a method of service delivery should display best practice and competences related to service delivery, operating hardware and software systems, and access to technical support. As with all licensed occupational therapy practice, it is the responsibility of the occupational therapy provider to obtain and maintain appropriate education and training related to patient populations being served and to practice settings.

What are the ethical issues concerning telehealth?

Client confidentiality is one of the major issues concerning telehealth (telemedicine). Occupational therapy practitioners will require the expertise of network professionals to ensure secure network connections with active firewalls and encryption modes. HIPAA compliance should be obtained and consumers should provide informed consent for the telehealth service and have the opportunity to refuse the service if they feel their safety or privacy will be compromised. Occupational therapy personnel should adhere to sections 40-36-30 and 40-36-10 of the SC Occupational Therapy Practice Act, and the SC Code of Regulation in Article 6, Chapter 94-10 Code of Ethics for Occupational Therapy personnel. These laws and regulations are available at www.llr.state.sc.us/pol/occupationaltherapy. In addition, it is recommended that the AOTA Code of Ethics (2005) and NBCOT Code of Conduct (2006) be reviewed for practice ethical considerations

What guidance is there for telehealth and the supervision of students and other personnel?

The Occupational Therapy Practice Act Sections40-36-20 (12) and 40-36-290 provide guidance regarding the supervision of occupational therapy students and personnel. These guidelines should be followed regardless of method of service delivery or practice setting for occupational therapy.

Does the Board control billing and reimbursement for occupational therapy services?

SC Board of Occupational Therapy does not control billing issues, insurance issues, or employment contracts. However, in the state of S.C., patients have "direct access” to occupational therapy, which means that a physician referral is not required (by law) to initiate or to continue services. This additionally means if a referral is provided, the state does not dictate if it comes from a physician, physician's assistant, nurse practitioner, chiropractor or various other source options (medical or non-medical). The state does not regulate the policies of third party reimbursement sources, nor does the state impose this referral freedom on employers who may prefer physician referrals. Each licensed occupational therapy practitioner needs to individually investigate the policies which relate to their practice/learning environments from multiple perspectives such as reimbursement sources, employers, accreditation agencies and malpractice insurance providers to identify any additional requirements or concerns, which may be germane to their practice. It is the responsibility of the occupational therapy practitioner to contact third-party payers (any company, organization, insurer, or government agency which makes payment for health care services received by a patient, such as the Centers for Medicare and Medicaid Services (CMS) for more information concerning telehealth and reimbursement.

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What about laws to practice of telehealth across state lines?

Occupational therapy practitioners using telehealth technology must adhere to licensure laws and other state legislation regulating the practice of occupational therapy in the state or states in which those services are received. Therefore, when telehealth technology is used to provide individual clients services (evaluation and intervention), the occupational therapy practitioner must be licensed in the state in which the client receives those services . The provision of consultation to another practitioner or continuing education content may or may not be addressed by individual state regulations. It is highly recommended that occupational therapy practitioners investigate those regulations per individual state to ensure compliance.

References:

American Occupational Therapy Association. (2005) Telerehabilitation Position Paper. Retrieved November 4, 2008 from http://www.aota.org

American Occupational Therapy Association. (2005). Occupational Therapy Code of Ethics. Retrieved from ethics page January 15, 2009 from http://www.aota.org

Center for Telehealth and E- Law. Retrieved March 26, 2009 from http://www.telehealthlawcenter.org/content/?page=18

Health Resources and Service Administration. Retrieved March 26, 2009 from http://www.hrsa.gov/telehealth

American Telemedicine Association. Retrieved March 26, 2009 from http://www.americantelemed.org

South Carolina Department of Labor, Licensing, and Regulation. Retrieved March 26, 2009 from http://www.llr.sc.gov/pol/occupationaltherapy/

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