LSBME OT advisory committee reviews proposed telehealth rules, seeks OT-specific clarifications

The Louisiana State Board of Medical Examiners Occupational Therapy Advisory Committee reviewed proposed statewide telehealth rules and related advisory guidance at a Dec. 13, 2024, virtual meeting, urging changes to make the language more applicable to occupational therapists and to clarify how out‑of‑state practitioners could lawfully deliver telehealth to Louisiana residents.

Committee members focused on three practical points: replacing physician‑specific wording with a broader "health care provider" term where appropriate; standardizing the committee's advisory opinion language (for example, using the term "patient presenter"); and whether a telehealth permitting pathway should be added or clarified for out‑of‑state occupational therapists.

The rules the committee reviewed add a detailed definition of telehealth, require documentation that an encounter occurred via telehealth, and list minimum disclosures (provider name and license number, specialty, follow‑up/emergency procedures, how to obtain records and how to proceed if technology fails). The draft also cross‑references federal privacy standards: "Only secure communication technology shall be used for telehealth," the draft states, and it excludes non‑HIPAA‑compliant email or text messages.

Patricia Wilton, executive counsel for the Board, told the committee the draft originated from work intended to provide a single telehealth section applicable across disciplines and acknowledged the draft currently contains physician‑specific language in places. "We'll have one telehealth section that applies to everyone. But it's not a perfect template because not everything applies to everything," Wilton said, noting she would work with the drafter to mark language that applies only to physicians.

Committee members pressed for explicit inclusion of several clinical‑practice considerations recommended by the American Occupational Therapy Association (AOTA), including assessing each client on a case‑by‑case basis for telehealth suitability based on client complexity and intervention complexity. "You can advise on best practices, and so that's perfectly fine to enhance and explain and expand upon what the bare minimum is that's in the rules," Wilton said in response to that request.

The draft requires that telehealth not be used "in the absence of a provider‑patient relationship," while also stating a provider need not conduct an in‑person exam before a telehealth encounter. Members discussed this apparent tension and agreed the intent is that a provider‑patient relationship may be established by referral or other documented pathway, and that telehealth providers must facilitate in‑state follow‑up care when clinically necessary.

The committee also discussed a permitting scheme in the draft that currently exists for out‑of‑state physicians who deliver telehealth to Louisiana patients without opening a Louisiana office. Committee members asked whether a similar telehealth permit should be created for out‑of‑state occupational therapists. Wilton said the board has permitting procedures for out‑of‑state physicians and that the committee could recommend creating a similar pathway for allied health professionals if desired: "If they got a telehealth permit, that person would not be allowed to open a physical office or meet in person with patients in the state," she said.

Members noted physician‑specific prohibitions pulled into the draft (for example, restrictive language on treatment of non‑cancer chronic pain and obesity) that may not be appropriate for occupational therapists. The committee asked staff to flag those provisions for discipline‑specific review.

The board staff reported the proposed telehealth rules and related documents had been submitted to the Office of the State Register for publication; Wilton said the materials were expected to appear in the December register or, at latest, the January register. Once published, the draft will be open for a public comment period of roughly 30 days during which the board will accept comments and may hold a public hearing if requested.

Committee members also noted an unrelated pending statutory change about temporary permits that could affect rule language (the statute currently uses "shall" and the legislature intends to change it to "may"); staff advised the committee that if the law changes the board could later make a minor, targeted rule amendment.

The committee agreed to continue its review of the rules at its next meeting and to align the advisory opinion language with the published rules (for example, using the term "patient presenter" consistently). The committee's next meeting is scheduled for Jan. 31, 2025, at 10:00 a.m. via Zoom.

Why it matters: The proposed rules define obligations for telehealth encounters (disclosures, records, privacy and follow‑up), set boundaries for out‑of‑state practice, and could require new permitting pathways. Those details affect how occupational therapists can provide remote care and how patients in Louisiana access follow‑up services.