Telepractice Current Policies related to COVID-19

April 29, 2020 COVID-19 Town Hall 

You can download a PDF of the slides, HERE

Telepractice Current Policies related to COVID-19

Last Updated: February 8, 2021

General Telepractice Information
  • Current Status: In the state of Illinois, telepractice is approved for licensed SLPs and audiologist. 
    • ORIGINAL EXECUTIVE ORDER RELATING TO TELEHEALTH SERVICES

      NEW STATE OF ILLINOIS EXECUTIVE ORDER to expand telehealth services and protect health care providers in response to COVID-19.
    • It is ISHA's understanding that the Executive Order expires when there is no longer a state of emergency.  A specific date regarding that has not yet been received. 
  • Policies below:
    • Executive Orders related to COVID-19 have been extended until March 6, 2021.
    • On May 5th, Governor Pritzker released Restore Illinois, a five-phased plan that will reopen the state, guided by health metrics and with marked by distinct business, education, and recreation activities characterizing each phase.  Common guidelines for all Phase 3 businesses and operations can be found in the Phase 3 Business Toolkit.
    • On Friday, April 23, 2020, the Governor’s Office has released a DRAFT version of the next stay at home Order, which he intends to file on April 30th.  Changes from the Order currently in effect are indicated by underscored and stricken language.
    • On March 19, 2020, Governor JB Pritzker issued an Executive Order to temporarily expand the availability of telehealth services to protect health care providers in Illinois during the COVID-19 pandemic.  In response to that Executive Order, the Illinois Department of Insurance has issued a memo detailing the requirements for insurance coverage of telehealth services.
  • Resources:
Audiology
  • Current Status: In the state of Illinois, telepractice is approved for licensed audiologists.
  • Resources:
    • ASHA has compiled a list of resources specifically for audiologists during the COVID-19 pandemic.
Early Intervention
Medical
  • Current Status: In the state of Illinois, telepractice is approved for licensed SLPs and audiologists. It is recommended that providers check with payors prior to services as there is inconsistency in payor coverage for telehealth services.
  • Policies below:
    • On April 30, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that audiologists and speech-language pathologists are now allowed to provide telehealth services to Medicare Part B (outpatient) beneficiaries.  Read more here.
Schools
  • Current Status: In the state of Illinois, telepractice is approved for licensed SLPs and audiologists.  It is recommended that providers check with payors prior to services as there is inconsistency in payor coverage for telehealth services.  "Medicaid pays for costs of direct, medically necessary services provided to eligible children who have disabilities in accordance with the Individuals with Disabilities Education Act (IDEA).  Illinois has actively supported this relationship since 1992, through the School-based Health Services program (SBHS)." (Illinois Department of Healthcare and Family Services School Based Health Services)
  • Resources:
    • The Office of Special Education Programs (OSEP), which is within the U.S. Department of Education's Office of Special Education and Rehabilitative Services, issued a question and answer document on September 28, 2020.  This document addresses inquiries concerning the implementation of the Individuals with Disabilities Education Act (IDEA) Part B provision of services in the current COVID-19 environment.
    • The Illinois State Board of Education (ISBE) has released Part 3 Transition Joint Guidance for starting the 2020-2021 School Year.
    • ISHA's School Affairs Committee has developed a document entitled "Resources for School-based SLPs and SLPAs: Telepractice, SLPAs and Medicaid."
    • The Illinois State Board of Education (ISBE) has released Part 3 Transition Guidance: Starting the 2020-21 School Year Frequently Asked Questions document dated July 9, 2020.  This document contains information regarding face coverings, social distancing, capacity limits, symptom screenings/temperature checks, self-quarantine, and remote learning.
    • The Illinois State Board of Education (ISBE) Weekly Message from June 29, 2020, has listed numerous resources and information that was posted to the COVID-19 webpage recently.
    • On April 27th, Dr. Carmen I. Ayala, State Superintendent of Education, released a letter that provides information and links to additional information due to the mandatory suspension of in-person learning.
    • ASHA has released a checklist for school-based professionals to assist in providing service delivery via telepractice.  You can access this checklist here.
    • ASHA's COVID-19: Tracking of State Laws and Regulations for School-based Telepractice were updated on April 7, 2020.  This document provides information on each state's requirement to practice in the school setting.
    • On March 27, 2020, the Illinois State Board of Education released guidance for Illinois Schools and School Districts regarding the mandatory suspension of in-person instruction.  The entire document can be found here.  This document also references a separate document released on March 18, 2020, that provides guidance for special education.  The March 18, 2020, document can be found here.

    • The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) gave Secretary of Education DeVos the power to appeal to Congress if she believes waivers should be made to provide flexibility concerning IDEA. 

      This is her recommendation to Congress where she requests a waiver solely to address transition timelines for students turning 3 and receiving services in Early Intervention. Her request is to extend the transition evaluation timelines to accommodate for delays while FTF evaluations cannot be conducted. This specifically allows for evaluations to be delayed until FTF meetings and assessments are permitted. Her request also provides for toddlers to continue receiving EI services after their 3 birthday until evaluations can be completed and eligibility determinations made on the part of the receiving school district.  This waiver must be approved by Congress.

      ISHA wanted the membership to be aware of Secretary DeVos’ request as it will impact school-based services and the EI providers should Congress approve the appeal.

 Supervision (Students, Clinical Fellows, and SLPA)
  • Current Status: In the state of Illinois, telepractice supervision is approved for graduate students, clinical fellows, and speech-language pathology assistants when supervised by licensed SLPs and audiologists.  These rules are in effect until March 6, 2021. 
  • Policies below:
    • Executive Orders related to COVID-19 have been extended until March 6, 2021. 
    • The issue of tele-supervision was within the emergency rules issued by the Governor on September 15, 2020. These rules supersede the recent variance and are in effect until February 12, 2021. 
      • Section 1465.35 Supervision:
      a) Pursuant to Section 3.5(a) of the Act, supervision of students in speech-language pathology and audiology programs means that the supervisor is either on-site (but not necessarily in the same room as the student) or available remotely using video-conference technology tools whenever the student is performing practices normally done by a licensed speech-language pathologist or audiologist. Supervision of students requires that direct supervision must be done no less than 25% of the time for treatment and 25% of the time for diagnostics. The supervisor is directly responsible to the client for all actions of that student. For purposes of this Part, direct supervision means the student is on site and, in view of the supervisor, or the supervisor remotely uses video-conference technology tools that are in view of the student. This Part does not apply to students in speech-language pathology assistant programs.
    • ISHA has conveyed the SLPAs' concerns to IDFPR. The Department is aware of the issue and is addressing it with others in the Administration.
    • ASHA has released an updated statement for guidance of telesupervision for graduate students and clinical fellowships during the Coronavirus pandemic.
    • The Council on Academic Accreditation has also released an updated statement for guidance in supervising students in teletherapy during the Coronavirus pandemic.  Please note that Illinois currently does not allow for telesupervision.  ISHA President-Elect, Angela Beckman-Anthony has also sent a message to the Illinois University Department Chairs, Program Directors, and Clinic Directors regarding telepractice and telesupervision.
    • On July 30, 2020, IDFPR has granted a variance on behalf of students pursuing either a speech-language pathology or audiology license. This variance is granted based upon the particular facts surrounding the Illinois Gubernatorial Disaster Proclamation issued on March 9, 2020, April 1, 2020, April 30, 2020, May 29, 2020, June 26, 2020 and again on July 24, 2020. The purpose of this variance is to allow licensed speech-language pathologists and audiologists to supervise their students remotely using video or audio technology as appropriate, rather than on-site.  Remote supervision may be performed telephonically or using video technology.  The supervisor should be available and prepared to offer assistance as needed when a student is providing services to a client. This variance is hereby granted and expires December 31, 2020.
    • On May 1, 2020, the Governor issued an Executive Order.  In section 15 of this order it states, "The provision of the Illinois Speech-Language Pathology and Audiology Practice Act, 225 ILCS 110/8.8(e), defining "direct supervision" of speech-language pathology assistants as "on-site, in-view observation and guidance by a speech-language pathologist" is suspended for the limited purpose of allowing speech-language pathology assistants to receive supervision by speech-language pathologists by way of video conferencing technology."
    • On April 6, 2020, IDFPR has granted a variance on behalf of students pursuing either a speech-language pathology or audiology license.  This variance is granted based upon the particular facts surrounding the Illinois Gubernatorial Disaster Proclamation issued on March 9, 2020.  The purpose of this variance is to allow licensed speech-language pathologists and audiologists to supervise their students remotely using video or audio technology as appropriate, rather than on-site.  Remote supervision may be performed telephonically or using video technology.  The supervisor should be available and prepared to offer assistance as needed when a student is providing services to a client.  This variance is hereby granted and expires July 31, 2020.
Practice and Supervision Across State and Country Lines
  • Current Status within the U.S.: In the state of Illinois, both the client and the SLP must be physically located within the state or the SLP must be licensed in their state and the state of the client's geographic location.  For example, if a client is in Indiana, and an Illinois SLP wants to see that client, the SLP must be licensed in Indiana and in Illinois.  There is one exception for the state license requirement.  If a clinician works for a federal agency (e.g., Department of Veterans Affairs [VA] and the Department of Defense), the clinician may not have to meet the same licensing requirements.  For example, if part of the employment at the VA involves telepractice with other VA sites acrose the country, the clinician may not have to be licensed in each state.  These requirements should be confirmed with the employer before proceeding. 
  • ASHA has stated the following: "Current guidance in medical and legal practices indicates that the client's location determines the site of service. We remind readers that ASHA guidelines assert that telepractioners must be licensed in both the state from which they provide services and the state where the client is located at the time of service. " (Telepractice Professional Issues, located under Key Issues, then Licensure and Teacher Certification)
  • Current Status outside of the U.S.: (from ASHA)  ASHA-certified audiologists and speech-language pathologists who deliver telepractice services to individuals in other countries are bound by ASHA's Code of Ethics (ASHA, 2016a), Scope of Practice in Audiology (ASHA, 2016a), Scope of Practice in Speech-Language Pathology (ASHA, 2016a), Preferred Practice Patterns for the Profession of Audiology (ASHA, 2006), and Preferred Practice Patterns for the Profession of Speech-Language Pathology (ASHA, 2004). 
 COVID-19 Vaccination Information
  • ISHA President along with the ISHA Executive Board have released a letter related to priorization of the COVID-19 vaccine for audiologists and speech-language pathologists.  ISHA supports the priority access to COVID-19 vaccines approved by the Food and Drug Administration for audiologists and speech-language pathologists who provide in-person assessment and treatment services.  You can read the entire letter here.

    As the COVID-19 vaccine distribution continues, ISHA encourages members to review the distribution phases in Illinois to determine when eligibility for the vaccine will occur.  The Centers for Disease Control (CDC) has a link to each stat vaccination distribution plan, which can be accessed here.

    ISHA will continue to advocate for priority vaccine access for our members recognizing that effective communication is essential and that our members will continue to provide needed services regardless of personal risk.

  • This is some information on how non-hospital healthcare providers in Chicago can register for an appointment to receive a COVID-19 vaccination.  As information becomes available for other areas outside of Chicago, ISHA will post that information as well. 

 Executive Orders and Legislation

  • The issue of tele-supervision was within the emergency rules issued by the Governor on September 15, 2020. These rules supersede the recent variance and are in effect until February 12, 2021. 
    • Section 1465.35 Supervision:
    a) Pursuant to Section 3.5(a) of the Act, supervision of students in speech-language pathology and audiology programs means that the supervisor is either on-site (but not necessarily in the same room as the student) or available remotely using video-conference technology tools whenever the student is performing practices normally done by a licensed speech-language pathologist or audiologist. Supervision of students requires that direct supervision must be done no less than 25% of the time for treatment and 25% of the time for diagnostics. The supervisor is directly responsible to the client for all actions of that student. For purposes of this Part, direct supervision means the student is on site and, in view
    of the supervisor, or the supervisor remotely uses video-conference technology tools that are in view of the student. This Part does not apply to students in speech-language pathology assistant programs.

Source: Amended by emergency rulemaking at 44 Ill. Reg. 16242, effective September 15, 2020, for a maximum of 150 days.   2020 Illinois Register Rules of Governmental Agencies Volume 44, Issue 40, October 2, 2020

  • On July 30, 2020, IDFPR has granted a variance on behalf of students pursuing either a speech-language pathology or audiology license. This variance is granted based upon the particular facts surrounding the Illinois Gubernatorial Disaster Proclamation issued on March 9, 2020, April 1, 2020, April 30, 2020, May 29, 2020, June 26, 2020 and again on July 24, 2020. The purpose of this variance is to allow licensed speech-language pathologists and audiologists to supervise their students remotely using video or audio technology as appropriate, rather than on-site.  Remote supervision may be performed telephonically or using video technology.  The supervisor should be available and prepared to offer assistance as needed when a student is providing services to a client. This variance is hereby granted and expires December 31, 2020.
  • The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) gave Secretary of Education DeVos the power to appeal to Congress if she believes waivers should be made to provide flexibility concerning IDEA. 

    This is her recommendation to Congress where she requests a waiver solely to address transition timelines for students turning 3 and receiving services in Early Intervention. Her request is to extend the transition evaluation timelines to accommodate for delays while FTF evaluations cannot be conducted. This specifically allows for evaluations to be delayed until FTF meetings and assessments are permitted. Her request also provides for toddlers to continue receiving EI services after their 3 birthday until evaluations can be completed and eligibility determinations made on the part of the receiving school district.  This waiver must be approved by Congress.

    ISHA wanted the membership to be aware of Secretary DeVos’ request as it will impact school-based services and the EI providers should Congress approve the appeal. 
  • On May 1, 2020, the Governor issued an Executive Order.  In section 15 of this order it states, "The provision of the Illinois Speech-Language Pathology and Audiology Practice Act, 225 ILCS 110/8.8(e), defining "direct supervision" of speech-language pathology assistants as "on-site, in-view observation and guidance by a speech-language pathologist" is suspended for the limited purpose of allowing speech-language pathology assistants to receive supervision by speech-language pathologists by way of video conferencing technology." 
  • On April 30, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that audiologists and speech-language pathologists are now allowed to provide telehealth services to Medicare Part B (outpatient) beneficiaries.  Read more here.
  • On Friday, April 23, 2020, the Governor’s Office has released a DRAFT version of the next stay at home Order, which he intends to file on April 30th.  Changes from the Order currently in effect are indicated by underscored and stricken language.
  • On April 6, 2020, IDFPR has granted a variance on behalf of students pursuing either a speech-language pathology or audiology license.  This variance is granted based upon the particular facts surrounding the Illinois Gubernatorial Disaster Proclamation issued on March 9, 2020.  The purpose of this variance is to allow licensed speech-language pathologists and audiologists to supervise their students remotely using video or audio technology as appropriate, rather than on-site.  Remote supervision may be performed telephonically or using video technology.  The supervisor should be available and prepared to offer assistance as needed when a student is providing services to a client.  This variance is hereby granted and expires July 31, 2020.
  • On March 19, 2020, Governor JB Pritzker issued an Executive Order to temporarily expand the availability of telehealth services to protect health care providers in Illinois during the COVID-19 pandemic.  In response to that Executive Order, the Illinois Department of Insurance has issued a memo detailing the requirements for insurance coverage of telehealth services.
  • ORIGINAL EXECUTIVE ORDER RELATING TO TELEHEALTH SERVICES