An aging population, rising health-care costs, increased prevalence of chronic diseases and lack of providers in some areas are among the issues driving the momentum for increasing patient access to care through telehealth services — real-time, face-to-face audio/visual communication with a health-care provider. A new report from Transparency Market Research estimates the global telemedicine market could reach $36.3 billion by 2020. However, the future of telehealth and telepsychology is dependent on reimbursement and regulatory policies at both the federal and state levels.
An increasing number of states are enacting mandates that call for insurance companies to cover services provided by telehealth if those same services would be covered when provided in person. Currently, 29 states plus Washington, D.C., have such requirements, and three other states prohibit insurers from imposing restrictions on telehealth services that are covered. Similarly, bills have been introduced in Congress that would increase the use of telehealth in federal systems, including Medicare.
A growing number of states have also instituted telepractice policies — either through statutes that govern the delivery of health-care services or through state laws that include remote services within the scope of practice. Psychology licensing boards have issued advisory opinions on telepractice, indicating that those who provide services via electronic means to consumers within the state must be licensed in that state.
APA has been actively involved in developing guidelines on telepsychological practice and supporting other related initiatives that promote lawful, ethical telepractice. Our first step was creating a task force to evaluate the need for guidelines on telepsychological practice and to develop guidance with representatives from APA, the Association of State and Provincial Psychology Boards (ASPPB) and The Trust. This is the first time APA has jointly developed professional practice guidelines with other organizations.
At its meeting during APA's 2013 Annual Convention, APA's Council of Representatives approved the Guidelines for the Practice of Telepsychology. The guidelines are intended to both educate and inform practicing psychologists in applying current standards of professional practice when using telecommunication technologies. The new guidelines are not intended to change or define psychologists' scope of practice. Rather, they are intended to guide psychologists on issues to consider before they provide telepsychology services.
Step two involves the development of regulatory guidance for psychology licensing boards to oversee telepractice — both intrastate and interstate. ASPPB developed standards and principles consistent with the Telepsychology Guidelines to assist licensing boards in appropriate telepractice.
At the same time, ASPPB began working on a regulatory mechanism to facilitate interjurisdictional telepractice while maintaining the licensing board's mission to protect consumers. PSYPACT is a multistate compact that would allow for telepsychological practice and temporary in-person practice across state lines up to 30 days in participating states. More information on PSYPACTopens in new window is available online.
APA Practice has been involved in this development, with APA Director of Legal and Regulatory Policy Deborah Baker, JD, participating in ASPPB's ongoing workgroup. Because implementation of the PSYPACT will require a minimum of seven states to enact the legislation, collaboration between the licensing boards and state, provincial and territorial psychological associations will be important. The APA Board of Directors has endorsed PSYPACT, and it is also supported by the Committee for the Advancement of Professional Practice, the governing body of the APA Practice Organization (which reports to the APAPO Board of Directors). APA and the Practice Organization are supporting efforts at the state level to operationalize PSYPACT to standardize requirements among licensing boards and protect psychologists and consumers.
For more information, contact Deborah Baker. The APAPO, a companion organization to APA, advocates on behalf of practicing psychologists.
