Counselors

Counseling, Marriage and Family Therapists and Licensed Substance Abuse Treatment Practitioners

Virginia Board of Counseling

Source

The Board’s regulations for Standards of Practice (18VAC115-20-130) are prefaced by the following:

The protection of the public health, safety, and welfare and the best interest of the public shall be the primary guide in determining the appropriate professional conduct of all persons whose activities are regulated by the board. Regardless of the delivery method, whether in person, by phone or electronically, these standards shall apply to the practice of counseling.

Therefore, the standards of practice set forth in section 130 of the regulations and in the Code of Virginia apply regardless of the method of delivery.  The Board of Counseling recommends the following when a licensee uses technology-assisted counseling as the delivery method:

1. Counseling is most commonly offered in a face-to-face relationship. Counseling that from the outset is delivered in a technology-assisted manner may be problematic in that the counseling relationship, client identity, and other issues may be compromised.

2. The counselor must take steps to protect client confidentiality and security.

3. The counselor should seek training or otherwise demonstrate expertise in the use of technology-assisted devices, especially in the matter of protecting confidentiality and security.

4. When working with a client who is not in Virginia, counselors are advised to check the regulations of the state board in which the client is located. It is important to be mindful that certain states prohibit counseling by an individual who is unlicensed by that state.

5. Counselors must follow the same code of ethics for technology-assisted counseling as they do in a traditional counseling setting.

Guidance for Technology-assisted Supervision

The Board of Counseling recommends the following when a licensee uses technology-assisted supervision:

1. Supervision is most commonly offered in a face-to-face relationship. Supervision that from the outset is delivered in a technology-assisted manner may be problematic in that the supervisory relationship, client identity, and other issues may be compromised.

2.  The counselor must take steps to protect supervisee's confidentiality and security.

3. The counselor should seek training or otherwise demonstrate expertise in the use of technology-assisted devices, especially in the matter of protecting supervisee confidentiality and security.

4. Counselors must follow the same code of ethics for technology-assisted supervision as they do in a traditional counseling/supervision setting.

5. The Board of Counseling governs the practice of counseling in Virginia.  Counselors who are working with a client who is not in Virginia are advised to check the regulations of the state board in which a supervisee is located. It is important to be mindful that certain states may regulate or prohibit supervision by an individual who is unlicensed by that state. 

Social Workers

Social Work:
The Virginia Social Work Board requires a clinician to be a licensed social worker in the state if the client is located in Virginia.
The board issued "Guidance on Technology-Assisted Therapy and the Use of Social Media":

Marriage and Family Therapists

Counseling, Marriage and Family Therapists and Licensed Substance Abuse Treatment Practitioners

Virginia Board of Counseling

Source

The Board’s regulations for Standards of Practice (18VAC115-20-130) are prefaced by the following:

The protection of the public health, safety, and welfare and the best interest of the public shall be the primary guide in determining the appropriate professional conduct of all persons whose activities are regulated by the board. Regardless of the delivery method, whether in person, by phone or electronically, these standards shall apply to the practice of counseling.

Therefore, the standards of practice set forth in section 130 of the regulations and in the Code of Virginia apply regardless of the method of delivery.  The Board of Counseling recommends the following when a licensee uses technology-assisted counseling as the delivery method:

1. Counseling is most commonly offered in a face-to-face relationship. Counseling that from the outset is delivered in a technology-assisted manner may be problematic in that the counseling relationship, client identity, and other issues may be compromised.

2. The counselor must take steps to protect client confidentiality and security.

3. The counselor should seek training or otherwise demonstrate expertise in the use of technology-assisted devices, especially in the matter of protecting confidentiality and security.

4. When working with a client who is not in Virginia, counselors are advised to check the regulations of the state board in which the client is located. It is important to be mindful that certain states prohibit counseling by an individual who is unlicensed by that state.

5. Counselors must follow the same code of ethics for technology-assisted counseling as they do in a traditional counseling setting.

Guidance for Technology-assisted Supervision

The Board of Counseling recommends the following when a licensee uses technology-assisted supervision:

1. Supervision is most commonly offered in a face-to-face relationship. Supervision that from the outset is delivered in a technology-assisted manner may be problematic in that the supervisory relationship, client identity, and other issues may be compromised.

2.  The counselor must take steps to protect the supervisee's confidentiality and security.

3. The counselor should seek training or otherwise demonstrate expertise in the use of technology-assisted devices, especially in the matter of protecting supervisee confidentiality and security.

4. Counselors must follow the same code of ethics for technology-assisted supervision as they do in a traditional counseling/supervision setting.

5. The Board of Counseling governs the practice of counseling in Virginia.  Counselors who are working with a client who is not in Virginia are advised to check the regulations of the state board in which a supervisee is located. It is important to be mindful that certain states may regulate or prohibit supervision by an individual who is unlicensed by that state. 

Psychologists

Source

Virginia is a PSYPACT PARTICIPATING STATE- VA SB 760 (Enacted 4/11/2020)

"To practice telepsychology under the authority of PSYPACT, you will need to apply for and obtain an E.Passport from the Association of State and Provincial Psychology Boards (ASPPB) and apply for and obtain an Authority to Practice Interjurisdictional Telepsychology (APIT) from the PSYPACT Commission."

Refer to the source provided for all requirements and limitations.

Psychiatrists

Source

Virginia Board of Medicine Telemedicine Guidance document: 85-12

Licensure:

“The practice of medicine occurs where the patient is located at the time telemedicine services are

used, and insurers may issue reimbursements based on where the practitioner is located. Therefore,

a practitioner must be licensed by, or under the jurisdiction of, the regulatory board of the state

where the patient is located and the state where the practitioner is located. Practitioners who treat

or prescribe through online service sites must possess appropriate licensure in all jurisdictions

where patients receive care. To ensure appropriate insurance coverage, practitioners must make

certain that they are compliant with federal and state laws and policies regarding reimbursements.”

Establishing the Practitioner-Patient Relationship.

“The practitioner-patient relationship is fundamental to the provision of acceptable medical care. It

is the expectation of the Board that practitioners recognize the obligations, responsibilities, and

patient rights associated with establishing and maintaining a practitioner-patient relationship.

Where an existing practitioner-patient relationship is not present,1

a practitioner must take

appropriate steps to establish a practitioner-patient relationship consistent with the guidelines

identified in this document, with Virginia law, and with any other applicable law.2 While each

circumstance is unique, such practitioner-patient relationships may be established using

telemedicine services provided the standard of care is met.

A practitioner is discouraged from rendering medical advice and/or care using telemedicine

services without (1) fully verifying and authenticating the location and, to the extent possible,

confirming the identity of the requesting patient; (2) disclosing and validating the practitioner’s

identity and applicable credential(s); and (3) obtaining appropriate consents from requesting

patients after disclosures regarding the delivery models and treatment methods or limitations,

including any special informed consents regarding the use of telemedicine services. An appropriate

practitioner-patient relationship has not been established when the identity of the practitioner may

be unknown to the patient.

Establishing the Practitioner-Patient Relationship.

The practitioner-patient relationship is fundamental to the provision of acceptable medical care. It

is the expectation of the Board that practitioners recognize the obligations, responsibilities, and

patient rights associated with establishing and maintaining a practitioner-patient relationship.

Where an existing practitioner-patient relationship is not present,1

a practitioner must take

appropriate steps to establish a practitioner-patient relationship consistent with the guidelines

identified in this document, with Virginia law, and with any other applicable law.2 While each

circumstance is unique, such practitioner-patient relationships may be established using

telemedicine services provided the standard of care is met.

A practitioner is discouraged from rendering medical advice and/or care using telemedicine

services without (1) fully verifying and authenticating the location and, to the extent possible,

confirming the identity of the requesting patient; (2) disclosing and validating the practitioner’s

identity and applicable credential(s); and (3) obtaining appropriate consents from requesting

patients after disclosures regarding the delivery models and treatment methods or limitations,

including any special informed consents regarding the use of telemedicine services. An appropriate

practitioner-patient relationship has not been established when the identity of the practitioner may

be unknown to the patient.”

Refer to the source provided for all requirements and limitations.

Virginia Professional Regulation/Health & Safety Online Prescribing

Source

House Bill 1987 (2020-2021 Session)

Newly Passed (Effective July 1, 2021)

A practitioner who has established a bona fide practitioner-patient relationship with a patient in accordance with the provisions of this subsection may prescribe Schedule II through VI controlled substances to that patient via telemedicine if such prescribing is in compliance with federal requirements for the practice of telemedicine and, in the case of the prescribing of a Schedule II through V controlled substance the prescriber maintains a practice at a physical location in the Commonwealth or is able to make appropriate referral of patients to a licensed practitioner located in the Commonwealth in order to ensure an in-person examination of the patient when required by the standard of care.

Adds to the conditions a prescriber must meet for a bona fide practitioner-patient relationship for the purpose of prescribing Schedule II through VI controlled substances by an examination through face-to-face interactive, two-way, real-time communications services or store-and-forward technologies. Includes:

The establishment of a bona fide practitioner-patient relationship via telemedicine is consistent with the standard of care, and the standard of care does not require an in-person examination for the purpose of diagnosis; and

The establishment of a bona fide practitioner patient relationship via telemedicine is consistent with federal law and regulations and any waiver thereof.

Source

VA Board of Medicine. Telemedicine Guidance Document: 85-12. p. 4

"Prescribing controlled substances requires the establishment of a bona fide practitioner-patient relationship in accordance with § 54.1-3303 (A) of the Code of Virginia. Prescribing controlled substances, in-person or via telemedicine services, is at the professional discretion of the

prescribing practitioner. The indication, appropriateness, and safety considerations for each prescription provided via telemedicine services must be evaluated by the practitioner in accordance with applicable law and current standards of practice and consequently carries the same professional accountability as prescriptions delivered during an in-person encounter."

"Prescriptions must comply with the requirements set out in Virginia Code § 54.1-3408.01 and § 54.1-3303(A). Prescribing controlled substances in Schedule II through V via telemedicine also requires compliance with federal rules for the practice of telemedicine. Practitioners issuing prescriptions as part of telemedicine services should include direct contact for the prescriber or the prescriber’s agent on the prescription. This direct contact information ensures ease of access by pharmacists to clarify prescription orders, and further facilitates the prescriber-patient-pharmacist relationship."

Refer to the source provided for all requirements and limitations.

Nurses

“As a party state to the Nurse Licensure Compact (NLC), Virginia issues multistate licenses to nurses and applicants who reside in the state and recognizes multistate licenses issued by other party states, for practice in Virginia. A nurse holding a multistate license is entitled to practice in any NLC party state, but must comply at all times with the laws of the state where he or she is currently practicing.”

“It should be noted that not every state in the US is an NLC party state; a map of participating states, as well as further resources related to the NLC, are available on the Nurse Licensure Compact website.”

Refer to the source provided for all requirements and limitations.

Virginia Professional Regulation/Health & Safety Online Prescribing

Source

House Bill 1987 (2020-2021 Session)

Newly Passed (Effective July 1, 2021)

“A practitioner who has established a bona fide practitioner-patient relationship with a patient in accordance with the provisions of this subsection may prescribe Schedule II through VI controlled substances to that patient via telemedicine if such prescribing is in compliance with federal requirements for the practice of telemedicine and, in the case of the prescribing of a Schedule II through V controlled substance the prescriber maintains a practice at a physical location in the Commonwealth or is able to make appropriate referral of patients to a licensed practitioner located in the Commonwealth in order to ensure an in-person examination of the patient when required by the standard of care.”

“Adds to the conditions a prescriber must meet for a bona fide practitioner-patient relationship for the purpose of prescribing Schedule II through VI controlled substances by an examination through face-to-face interactive, two-way, real-time communications services or store-and-forward technologies. Includes:The establishment of a bona fide practitioner-patient relationship via telemedicine is consistent with the standard of care, and the standard of care does not require an in-person examination for the purpose of diagnosis; andThe establishment of a bona fide practitioner patient relationship via telemedicine is consistent with federal law and regulations and any waiver thereof.”

Source

VA Board of Medicine. Telemedicine Guidance Document: 85-12. p. 4

"Prescribing controlled substances requires the establishment of a bona fide practitioner-patient relationship in accordance with § 54.1-3303 (A) of the Code of Virginia. Prescribing controlled substances, in-person or via telemedicine services, is at the professional discretion of the

prescribing practitioner. The indication, appropriateness, and safety considerations for each prescription provided via telemedicine services must be evaluated by the practitioner in accordance with applicable law and current standards of practice and consequently carries the same professional accountability as prescriptions delivered during an in-person encounter."

"Prescriptions must comply with the requirements set out in Virginia Code § 54.1-3408.01 and § 54.1-3303(A). Prescribing controlled substances in Schedule II through V via telemedicine also requires compliance with federal rules for the practice of telemedicine. Practitioners issuing prescriptions as part of telemedicine services should include direct contact for the prescriber or the prescriber’s agent on the prescription. This direct contact information ensures ease of access by pharmacists to clarify prescription orders, and further facilitates the prescriber-patient-pharmacist relationship."

Refer to the source provided for all requirements and limitations.

Private Pay Telehealth Parity Law

Source: VA Code Annotated Sec. 38.2-3418.16(D). (2012)

D. An insurer, corporation, or health maintenance organization shall not be required to reimburse the treating provider or the consulting provider for technical fees or costs for the provision of telemedicine services; however, such insurer, corporation, or health maintenance organization shall reimburse the treating provider or the consulting provider for the diagnosis, consultation, or treatment of the insured delivered through telemedicine services on the same basis that the insurer, corporation, or health maintenance organization is responsible for coverage for the provision of the same service through face-to-face consultation or contact.

Refer to the source provided for all requirements and limitations.

Medicaid Telehealth Parity Law

Source: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and
Limitations, p. 14 (Feb. 2019)

All providers utilizing telemedicine and billing for services must be enrolled with DMAS. All coverage requirements described in the DMAS provider manuals apply when the service is delivered via telemedicine. The use of telemedicine must be noted in the service documentation of the patient record.

Equipment utilized for telemedicine must be of sufficient audio quality and visual clarity as to be functionally equivalent to a face-to-face encounter for professional medical services. Staff must be proficient in the operation and use of the telemedicine equipment. Telephone calls, e-mail, facsimile transmissions and similar electronic measure are not considered part of the telemedicine coverage and are not to be billed to DMAS.

Telemedicine encounters must be conducted in a confidential manner, and any information sharing must be consistent with applicable federal and state laws and regulations and DMAS policy. Health Information Portability and Accountability Act of 1996 (HIPAA) confidentiality requirements are applicable to telemedicine encounters.

A description of services that may be delivered via telemedicine is included in Chapter V. The services include: evaluation and management, psychiatric care, specialty medical procedures, speech therapy, and radiology services and procedures. The remote provider groups
recognized by DMAS for these services are also listed.

Refer to the source provided for all requirements and limitations.

Originating Site Reimbursement: We are not aware of mention of the patient/client's home or office setting being approved as an originating site.

Payment Parity

We are not aware of any explicit payment parity.

*Clinicians who have had an experience with telehealth reimbursement in this state are invited to share their experiences in the comments section below: a) type of service provided; b) insurance provider; c) payment parity, payment issues, or insurance requirements. 

Permission for the Temporary Practice of Clinicians Licensed Outside the State

We are not aware of any permission that allows for services delivered by out-of-state providers.