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Survey Finds No Rhyme or Reason in Telehealth Rules for PTs, OTs

A state-by-state analysis of telehealth and telemedicine laws and guidelines for physical and occupational therapists finds that few states are setting the same rules - or even using the same terminology.

Source: ThinkStock

By Eric Wicklund

- A new analysis of state telemedicine and telehealth guidelines for physical and occupational therapists finds no discernible pattern of rules or regulations across the country – not even an agreement on what to call their policies.

The study, conducted by the Center for Connected Health Policy and included in the fall 2018 edition of the International Journal of Telerehabilitation, paints a confusing picture as to how state lawmakers and medical boards are addressing connected care technology used by PTs and OTs. Overall, it reports that 28 states have some sort of guidelines in place for patient-to-provider or provider-to-provider PT services, while 27 states have something in place for OT services.

“The findings here show that many states’ professional boards are creating their own telehealth policies, particularly OT and PT boards,” the report states. “Similar to what is observed in telehealth policies for other health professions, a uniform approach to establishing policies for OT and PT was not followed across states or professional boards. While many OT and PT professional boards enacted policy for telehealth, nearly as many states have instead adopted laws.”

“Additionally, while there appeared to be some trends regarding terminology and restrictions to specific telehealth modalities, the overall requirements and limitations on OT and PT varied across states,” the report adds. “This may be due to a tendency for states to follow pre-existing policy within other specialties in their state or political and economic variances between states which impacts telehealth policies overall.”

According to the study:

  • 20 states offer telehealth regulations for occupational therapy, while 17 have laws in place.
  • 24 states have telehealth regulations for physical therapy, while 34 have laws.
  • 14 states permit occupational therapists to use live video.
  • 25 states allow physical therapists to use live video.
  • 12 states permit the use of store-and-forward or asynchronous telehealth for occupational and/or physical therapy.
  • Four states permit the use of remote patient monitoring for occupational and/or physical therapy.
  • No states place geographical restrictions on the use of telehealth for occupational or physical therapy.

READ MORE: UAB Using $4.6M Grant to Apply Telehealth to Physical Therapy Program

The study notes that more states are adopting laws for telehealth and telemedicine use by PTs because of the Physical Therapy License Compact (PTLC), developed by the Federation of State Boards of Physical Therapy (FSBPT), which gives PTs and expedited pathway to practicing in other states that belong to the compact.

Nine states – Oregon, North Dakota, Utah, Missouri, Tennessee, Mississippi, Texas, Iowa and New Hampshire  – are now active, while another 12 states – Washington, Montana, Arizona, Colorado, Nebraska, Oklahoma, Louisiana, Kentucky, West Virginia, South Carolina, North Carolina and New Jersey – have enacted legislation but aren’t yet processing licenses. Three states - Virginia, Michigan and Georgia – have introduced legislation to join the compact.

The challenges extend all the way down to how each state defines the type of care provided.

Of the 47 states offering guidelines for either OT or PT, the CCHP reports, only 25 use either “telehealth” or “telemedicine;” the other 22 use terms such as “telecommunications” or “electronic.” And only nine states use “telehealth,” “telemedicine” or “telerehabilitation” to describe connected care services.

The study’s authors - Randal Trey Bierman, Mei Wa Kwong and Christine Calouro – note the hazy terminology mirrors the Centers for Medicare & Medicare Services’ recent efforts to separate remote patient monitoring from its telehealth guidelines.

READ MORE: Duke Affirms Cost Savings from Physical Therapy Via Telehealth

“This is similar to changes made to the 2019 Medicare Physician Fee Schedule, where the terms ‘telehealth’ and ‘telemedicine’ were not used when referring to some technology-enabled services, thereby allowing those services to not be affected by federal statutory limitations on the use of telehealth in Medicare,” they wrote. “While a direct correlation cannot be drawn between the two in this research, this may hold implications for the future of telehealth, which may forego use of typical terminology in favor of broader references to technology-enabled care for policies that reflect technologies’ role as just another tool to deliver healthcare.”

States are also far apart in defining what meets the definition for the patient-provider relationship. While Arkansas and Idaho allow telehealth to be used to define that relationship, Virginia indicates it’s necessary for PT. And only New Jersey and Rhode Island require providers to establish that relationship before using telehealth or telemedicine.

The study offers the conclusion that OTs and PTs will be using telehealth and telemedicine in larger numbers – and more states – as time progresses.

“The requirements and restrictions on the use of telehealth for both professions varies across all states, however few place additional burdens on providers beyond what is otherwise expected for the delivery of services,” the report notes. “This means that OT and PT providers in states which allow them to utilize telehealth to deliver services often may do so to their best clinical judgement and are not restricted to geographic or administrative requirements that exclude some populations from eligibility for telehealth. Just over half of all states provide policy for either OT or PT, though this number may increase as the policy landscape changes at both federal and state levels.”

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