(a) Applicability.
  (1) Except where noted, this subchapter applies to speech-language pathologists, speech-language pathology interns, speech-language pathology assistants, audiologists, audiology interns, audiology assistants, and dual speech-language pathologist and audiologist license holders, as authorized under this subchapter.
  (2) Except to the extent it imposes additional or more stringent requirements, this subchapter does not affect the applicability of any other requirement or provision of law to which an individual is otherwise subject under this chapter or other law.
(b) Licensure and Scope of Practice.
  (1) An individual shall not provide telehealth services to a client in the State of Texas, unless the individual is licensed by the department and qualifies as a provider as that term is defined in this subchapter, or is otherwise legally authorized to do so.
  (2) A provider may provide only those telehealth services that are within the course and scope of the provider's license and competence, and delivered in accordance with the requirements of that license and pursuant to the terms and conditions set forth in this chapter.
  (3) A provider who is a speech-language pathology assistant may provide services through telehealth, as directed by their supervisor, according to the speech-language pathology assistant supervision requirements and the practice and duties under 16 TAC §111.51 and §111.52. A provider who is an audiology assistant may provide services through telehealth, as directed by their supervisor, according to the audiology assistant supervision requirements and the practice and duties under 16 TAC §111.91 and §111.92.
(c) Competence and Standard of Practice (Code of Ethics).
  (1) A provider of telehealth services shall be competent in both the type of services provided and the methodology and equipment used to provide the service.
  (2) A provider shall comply with the code of ethics and scope of practice requirements in this chapter when providing telehealth services.
  (3) The scope, nature, and quality of the services provided via telehealth shall be the same as the services provided in-person.
  (4) A provider shall determine whether a particular service or procedure is appropriate to be provided via telehealth. A provider shall not provide a service or procedure via telehealth if it is not appropriate or cannot be provided at the same standard of care as if it were provided in-person.
  (5) As pertaining to liability and malpractice issues, a provider providing telehealth services shall be held to the same standards of practice as if the services were provided in person.
(d) Facilitators.
  (1) Subject to the requirements and limitations of this subchapter, a provider may utilize a facilitator at the client site to assist the provider in providing telehealth services.
  (2) A provider shall document whether a facilitator is used in providing telehealth services. If a facilitator is used, the provider shall document the tasks in which the facilitator provided assistance.
  (3) Before allowing a facilitator to assist the provider in providing telehealth services, the provider shall ascertain and document the facilitator's qualifications, training, and competence, as appropriate and reasonable, in:
    (A) each task the provider directs the facilitator to perform at the client site; and
    (B) the methodology and equipment the facilitator is to use at the client site.
  (4) The facilitator may perform at the client site only the following tasks:
    (A) a task for which the facilitator holds and acts in accordance with any license, permit, authorization, or exemption required by law to perform the task; and
    (B) those physical, administrative, and other tasks for which a provider determines a facilitator is competent to perform in connection with the provision of audiology or speech-language pathology services, for which no form of license, permit, authorization, or exemption is required by law.
  (5) A provider is responsible for the actions of the facilitator and shall monitor the client and oversee and direct the facilitator at all times during the telehealth session.
  (6) A provider shall not provide telehealth services to a client if the presence of a facilitator is required for safe and effective service to the client and no qualified facilitator is available.
(e) Technology and Equipment.
  (1) The provider shall use only telecommunications technology, as defined in this subchapter, to provide telehealth services. Modes of communication that do not utilize such telecommunications technology, including analog telephone, facsimile, and email, may be used only as adjuncts.
  (2) A provider shall only utilize telecommunications technology and other equipment that the provider is competent to use as part of the provider's telehealth services.
  (3) The provider shall not provide telehealth services unless the telecommunications technology and equipment located at the client site and at the provider site:
    (A) are appropriate to the telehealth services to be provided;
    (B) are properly calibrated, if appropriate, and in good working order; and
    (C) are of sufficient quality to allow the provider to deliver equivalent service and quality to the client as if those services were provided in person at the same physical location.
(f) Client Contacts and Communications.
  (1) The initial contact between a provider and client may be at the same physical location or through telehealth, as determined appropriate by the provider. For a provider who is a speech-language pathology assistant, the initial contact with a client must be made by the assistant's supervisor.
  (2) A provider shall consider relevant factors including the client's behavioral, physical, and cognitive abilities in determining the appropriateness of providing services via telehealth.
  (3) A provider shall be aware of the client's level of comfort with the technology being used as part of the telehealth services.
  (4) A provider shall be sensitive to cultural and linguistic variables that affect the identification, assessment, treatment, and management of the clients.
  (5) Notification of telehealth services shall be provided to the client, the guardian, the caregiver, and the multi-disciplinary team, if appropriate. The notification shall include, but not be limited to: the right to refuse telehealth services, options for service delivery, and instructions on filing and resolving complaints.
(g) Records and Billing.
  (1) A provider of telehealth services shall comply with all laws, rules, and regulations governing the maintenance of client records, including client confidentiality requirements.
  (2) Documentation of telehealth services shall include documentation of the date and nature of services performed by the provider through telehealth and the assistive tasks of the facilitator, if used.
  (3) A provider is allowed to provide telehealth services in accordance with this subchapter, but reimbursement of telehealth services is subject to the reimbursement policies of the entity being billed.
(h) Hearing Instruments. Hearing instruments may be adjusted digitally through the use of telecommunications technology by a provider who is an audiologist or an audiology intern and who provides telehealth services under this subchapter.

Source Note: The provisions of this §111.212 adopted to be effective December 30, 2021, 46 TexReg 9021