Telehealth - Frequently Asked Questions
Q. What is telehealth?
A. Telehealth, as defined by Business and Professions Code 2290.5 (a)(6), is the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient's health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.
Q. What are the Standards of Practice for Telehealth?
A. An occupational therapist or occupational therapy assistant providing occupational therapy services via telehealth must exercise the same standards of care and same ethical standards (as set forth in Section 4170) as with any other mode of delivery of occupational services and consistent with Section 2570.2(k) of the Code.
Q. What is required to provide occupational therapy services via telehealth in California?
A. An occupational therapist or occupational therapy assistant providing occupational therapy services via telehealth to a client in California must have a valid and current license issued by the California Board of Occupational Therapy.
Q. I am from out of state. Do I need a California license to provide occupational therapy services to a client in California?
A. Yes, a licensed by the California Board of Occupational Therapy is required.
Q. Do I need to reside within the state of California in order to provide telehealth services to a client who resides in California?
A. No, you are not required to reside in California but you are required to have a California license and follow all the provisions of laws and regulations governing occupational therapy.
Q. What is “consent”?
A. Consent is the process (and document) by which an occupational therapist discloses appropriate information to a competent client so that the client may make a voluntary choice to accept or refuse treatment. It originates from the legal and ethical right the patient has to direct what happens to his or her body and from the ethical duty of the occupational therapist to involve the patient in his or her health care.
Q. What else must be considered before providing occupational therapy services via telehealth?
A. Section 4172(c)(1) of the regulations requires the occupational therapist to determine whether an in-person evaluation is necessary and ensures that a therapist be available if an onsite visit is required. Section 4172 (c)(1) requires an occupational therapist be onsite to conduct an evaluation, when considering the criteria set forth in Section 4172(d), an in-person evaluation is warranted and necessary.
Section 4172(c)(2) of the regulations requires that an occupational therapist or occupational therapy assistant provide interventions in-person only if, after considering the criteria set forth in Section 4172(d), it is determined that in-person interventions are necessary.
Q. How does an occupational therapist determine if an in-person evaluation or in-person interventions are necessary?
A. Section 4172(d) requires the occupational therapist to consider a variety of factors in making these decisions, including all of the following:
1. the complexity of the patient’s/client’s condition;
2. his or her own knowledge, skills and abilities;
3. the nature and complexity of the intervention;
4. the requirements of the practice setting; and
5. the patient’s/client’s context and environment.
Q. Do evaluations and interventions have to take place in person?
A. No. Section 4172(c) does not require an occupational therapist to be present, with the client, unless a determination is made that an in-person evaluation or interventions are warranted and necessary . Section 4172(c) requires the occupational therapist, consider the factors set forth in 4172(d) to determine whether services, including the evaluation or interventions can be (safely and appropriately) delivered via telehealth or whether the evaluation or interventions should be provided in-person. The occupational therapist that is considering rendering services, including providing an evaluation or interventions via telehealth, must make the determination whether services must be provided in-person or services can be safely delivered via telehealth.
Q. After considering the criteria in Section 4172(d), what if a therapist is not available to perform an onsite evaluation or interventions?
A. Delivering services via telehealth may increase access to care, however, that care cannot be at the risk of a patient’s safety. The occupational therapist must determine whether the evaluation or interventions can be (safely and appropriately) delivered via telehealth or whether services, the evaluation or interventions must be provided in-person. If an “on-site” occupational therapist is not available, alternative options may be provided, such as referring the patient to an out-patient rehabilitation clinic, another local occupational therapist, home health services, etc.
Q. What else must an occupational therapist or occupational therapy assistant consider when providing services via telehealth?
A. Section 4172(e) requires OTs and OTAs to:
Exercise the same standard of care when providing occupational therapy services via telehealth as with any other mode of delivery of occupational therapy services, including
- Providing services consistent with section 2570.2(k) of the code (the occupational therapy scope of practice), and
- Comply with all other provisions of the OT practice act and regulations, including ethical standards set forth in section 4170 as well as any other applicable provisions of the law.
Q. What is Section 4170 and how does that impact OT services provided via telehealth?
A. Section 4170, the ethical standards of practice, are designed to ensure consumer protection by setting forth certain responsibilities of occupational therapists and occupational therapy assistants. Section 4172(e)(3) reiterates that Section 4170 applies to services provided via telehealth.
Q. Are there additional qualifications needed to provide telehealth services?
A. Consistent with other laws and regulations, it is the responsibility of the occupational therapist or assistant to ensure they possess the knowledge, skills, and ability to treat their patients; they must obtain and maintain appropriate educational and professional development activities consistent with the delivery of occupational therapy services.
Q. What resources are there for supervision of students, occupational therapy assistants, and occupational therapy aides within the delivery of services via telehealth?
A. The Occupational Therapy Practice Act and the California Code of Regulations set forth supervision and practice requirements. These standards should be followed regardless of method of delivery of services.
For additional resources regarding telehealth, contact American Occupational Therapy Association or the Occupational Therapy Association of California via their websites at www.aotoa.org or www.otaconline.org