Telemedicine law: Act 442 http://www.legis.la.gov/Legis/ViewDocument.aspx?d=913612
Louisiana State Board of Examiners of Psychologists
Louisiana Telepsychology Guidelines
Purpose of guidelines:
To facilitate the process for licensed psychologists to provide telepsychology services to residents of Louisiana.
The practice of psychology which includes assessment, diagnosis, intervention, consultation or information by psychologist using interactive telecommunication technology that enables a psychologist and a client, at two different locations separated by distance to interact via two-way video and audio transmissions simultaneously. Telepsychology is not a separate specialty. If the use of technology is clearly administrative purposes, it would not constitute telepsychology under these guidelines.
The Appropriate Use of Telepsychology
Psychologists recognize that telepsychology is not appropriate for all problems and that the specific process of providing professional services varies across situation, setting and time, and decisions regarding the appropriate delivery of telepsychology services are made on a case-by-case basis. Psychologists have the necessary professional and technical training, experience, and skills to provide the type of telepsychology that they provide. Psychologists are encouraged to maintain their competence in this area via appropriate continuing education. They also can adequately assess whether involved participants have the necessary knowledge and skills to benefit from those services. If the psychologist determines that telepsychology is not appropriate, they inform those involved of appropriate alternatives
Legal and Ethical Requirements
Psychologists recognize that the provision of Telepsychology is not legally prohibited by local or state laws and regulations (supplements 2002 APA Ethics Code Sec. 1.02). Psychologists are aware of and in compliance with Louisiana psychology licensure laws and rules.
Responsibilities of the Licensed Psychologist:
Professional and Patient Identity and Location: at the beginning of a Telepsychology service with a client, the following essential information shall be verified by the psychologist: Psychologist and Client Identify Verification: The name and credentials of the professional and the name of the patient shall be verified. Provider and Patient Location Documentation: The location where the patient will be receiving services shall be confirmed and documented by the psychologist. Documentation should at least include the date, location, duration and type of service. Effective: January 1, 2015 2 Secure Communications/Electronic Transfer of Client: Psychologists, use secure HIPAA/HITECH compliant communications. Non-secured communications: Obtain consent for use of non-secured communications. In cases of emergency, non-secured communications may be used with the consent of the patient and/or at the discretion of the psychologist based on clinical judgment Informed Consent: A thorough informed consent at the start of all services shall be performed. The consent should be conducted in real-time. Local, regional and national laws regarding verbal or written consent shall be followed. The consent should include all information contained in the consent process for in-person care including confidentiality and the limits to confidentiality in electronic communication; an agreed upon emergency plan, particularly in settings without clinical staff immediately available; the potential for technical failure, process by which patient information will be documented and stored; a protocol for contact between sessions; and conditions under which telepsychology services may be terminated and a referral made to in-person care. Privacy: Efforts shall be made to ensure privacy so clinical discussion cannot be overheard by others either inside or outside of the room where the service is provided. Further, psychologists review with clients their policy and procedure to insure privacy of communications via physical, technical, and administrative safeguards.
Psychologists shall have an Emergency Management plan in case of emergency in a telepsychology session. The psychologist’s plan should include such things as: patient safety, information for patient support person, uncooperative patients and identifying local emergency personnel. In an emergency situation with a patient, psychologists will follow the normal clinical emergency protocols. In the event of an emergency, a patient has to consent to a voluntary support system. In cases where a patient refuses to consent, emergency procedures will be followed using the pre-identified resources available at the remote site and permitted by prior consent / agreement of the client.
Psychologists insure that documentation of service delivery via telepsychology is appropriately included in the clinical record (paper or electronic). Further, psychologists insure the secure destruction of any documents maintained in any media of telepsychology sessions and in accordance with APA guidelines, and all federal, state, and local laws and regulations. Effective: January 1, 2015 3
Psychologists are responsible for insuring that any services provided via electronic media are appropriate to be delivered through such media without affecting the relevant professional standards under which those services would be provided if delivered in person. It is recommended that the initial interview/assessment occur in-person. However if conducted via telepsychology then the psychologist is responsible for meeting the same standard of care. This also includes but is not limited to reliability and validity of psychometric tests and other assessment methods; and consideration of normative data for such psychometric / assessment tools; maintaining conditions of administration. When providing therapeutic interventions, psychologists insure that the modality being used is appropriate for delivery through electronic media and is appropriate for delivery to individuals, groups, and/or families/couples as indicated. Psychologists reassess appropriateness of the use of telepsychology throughout the course of contact with the patient.
Any service that would require the psychologist to personally interact with, touch, and/or examine the client may not be suitable for telepsychology. Examples may include but not be limited to the sensory-perceptual examinations of some neuropsychological assessments; and examination of the client for signs of movement disorders like the AIMS and Simpson-Angus exams. Psychologists must insure that the integrity of the examination procedure is not compromised through the use of telepsychology.
Psychologists are encouraged to reflect on multicultural issues when delivering telepscyhology services to diverse clients.
If any complaint arises and the psychologist was using telepsychology, then whether they used it properly would be part of the investigation of the overall complaint. References: APA Ethical Principles and Code of Conduct (2010). APA (2013). Guidelines for the practice of telepsychology, American Psychologist, 68, 791–800. doi: 10.1037/a0035001. American Telemedicine Association (2013). Practice guidelines for video-based online mental health services. (Available at www.americantelemed.org).
LPC, Licensed Professional Counselors, Mental Health Counseling, Marriage and Family Therapy
Rules, Standards and Procedures
Chapter 5 § 505. Teletherapy Guidelines for Licensees (Formerly Diagnosing for Serious Mental Illnesses)
- This Chapter defines and establishes minimum standards for the delivery of mental health counseling, psychotherapy, and marriage and family therapy services using technology-assisted media. Teletherapy references the provision of counseling and psychotherapy services from a distance which is consistent with the same standards of practice as in-person counseling settings.
- Teletherapy is defined as a method of delivering mental health counseling, psychotherapy, and marriage and family therapy services as prescribed by R.S. 37:1101 and R.S. 37:1116 using interactive technology-assisted media to facilitate prevention, assessment, diagnosis, and treatment of mental, emotional, behavioral, relational, and addiction disorders to individuals, groups, organizations, or the general public that enables a licensee and a client(s) separated by distance to interact via synchronous video and audio transmission.
- The board recognizes that safe and effective practices in teletherapy require specific training, skills, and techniques and has set forth the following regulatory standards to ensure competence and safety. This Rule shall not be construed to alter the scope of practice of any licensee or authorize the delivery of services in a setting, or in a manner, not otherwise authorized by law. Nothing in this Section shall preclude a client from receiving in-person counseling, psychotherapy, and marriage and family therapy services after agreeing to receive services via telemental health. Teletherapy shall be delivered in real-time (synchronous) using technology-assisted media such as telephonic and video conferencing through computers and mobile devices. The use of asynchronous modalities (e-mail, chatting, texting, and fax) is not appropriate and shall not be used for teletherapy, except in a crisis to ensure the client’s safety and stability.
- Licensees shall provide services consistent with the jurisdictional licensing laws and rules in both the jurisdiction in which licensee is physically located and where the client is physically located. Licensees providing teletherapy services to clients outside of Louisiana must comply with the regulations in the state in which the client is located at the time of service. The licensee shall contact the licensing board in the state where the client is located and document all relevant regulations regarding teletherapy. A nonresident of Louisiana who wishes to provide teletherapy health services in Louisiana must be licensed by the board.
- Teletherapy is a specialty area and requires board approval. Licensees who may provide teletherapy must meet the following requirements.
- The licensee must be licensed in Louisiana.
- The licensee must be licensed in the state where the client is located if licensing is required.
- The licensee must have been practicing for at least one year.
- The licensee must complete either option below.
- Graduate-Level Academic Training. At least one graduate-level academic course in telemental health counseling. The course must have included at least 45 clock hours (equivalent to a three-credit hour semester course).
- Professional Training with a minimum of nine synchronous clock hours in teletherapy. The presenter shall meet continuing education standards established by the board. Teletherapy education/training shall include but is not limited to:
- appropriateness of teletherapy;
- teletherapy theory and practice;
iii. theory integration;
- modes of delivery;
- risk management;
- managing emergencies;
vii. legal/ethical issues.
- Licensees privileged in teletherapy must accrue three clock hours of continuing education during each renewal period.
- At the onset of teletherapy, the licensee shall obtain verbal and/or written informed consent from the client and shall document such consent in the client’s record.
- Electronic signature(s) and date may be used in the documentation of informed consent.
- Provisions of informed consent for teletherapy services shall include:
- mode and parameter of technology-assisted media(s), and technical failure;
- scheduling and structure of teletherapy;
- risks of teletherapy;
- privacy and limits of confidentiality;
- contact between sessions;
- emergency plan;
- consultation and coordination of care with other professionals;
- referrals and termination of services;
- information and record keeping;
- billing and third-party payors;
- ethical and legal rights, responsibilities, and limitations within and across state lines and/or international boundaries.
- The licensee shall provide each client with his/her declaration or statement of practice on file with the board office.
- At the onset of each session the licensee shall verify and document the following:
- The identity and location of the licensee and the client. If the client is a minor, the licensee must also verify the identity of the parent or guardian consenting to the minor’s treatment. In cases were conservatorship, guardianship, or parental rights of the minor client have been modified by the court, the licensee shall obtain and review a copy of the custody agreement or court order before the onset of treatment.
- The location and contact information of the emergency room and first responders nearest to the client’s location.
- The licensee shall determine if the client may be properly diagnosed and/or treated via teletherapy; and shall affirm that technology-assisted media are appropriate for clients with sensory deficits. The licensee shall affirm the client’s knowledge and use of selected technology-assisted media(s) (i.e., software and devices). Clients who cannot be diagnosed or treated properly via teletherapy services shall be dismissed and treated in-person, and/or properly terminated with appropriate referrals. The licensee shall use technology assisted media(s) that is in compliance with HIPPA and HiTECH standards. The licensee shall not use social media platforms or functions (tweets, blogs, networking sites, etc.) in the delivery of teletherapy, and shall not reference clients generally or specifically on such formats.
- Policies and procedures for the documentation, maintenance, access, transmission and destruction of record and information using technology assisted media shall be consistent with the same ethical and regulatory standards for in-person services. Services must be accurately documented in teletherapy services, denoting the distance between the licensee and the client. Documentation shall include verification of the licensee’s and client’s location, type of service(s) provided the date of service, and duration of service. The licensee shall inform clients of how records are maintained, type of encryption and security assigned to the records, and how long archival storage is maintained.
- Telesupervision is defined as a method delivering clinical mental health and marriage and family therapy supervision as prescribed by R.S 37:1101 and R.S. 37:1116 using technology-assisted media that enables a supervisor and a supervisee separated by distance to interact via synchronous video and audio transmissions. Up to 25 percent of total supervision hours may be used within a telesupervision format.
- Teletherapy supervision may include but is not limited to, the review of case presentation, audio tapes, video tapes, and observation to promote the development of the practitioner's clinical skills.
- Teletherapy supervision shall be provided in compliance with the same ethical and regulatory standards as in-person supervision.
- The supervisor shall inform supervisees of the potential risks and benefits associated with telesupervision.
- The supervisor shall determine if the supervisee may be properly supervised via teletherapy supervision. Supervisees who cannot be supervised via teletherapy supervision shall be restricted to in-person supervision, and/or properly terminated with appropriate referrals.
- The supervisor shall affirm the supervisee’s knowledge and use of selected technology-assisted media(s) (i.e., software and devices).
- The supervisor shall use technology assisted media(s) that is in compliance with HIPPA and HiTECH standards.
- The supervisor shall not use social media platforms or functions (tweets, blogs, networking sites, etc.) in the delivery of teletherapy supervision, and shall not reference supervisee generally or specifically on such formats.
AUTHORITY NOTE: Promulgated in accordance with R.S. 37:1101-1123.
HISTORICAL NOTE: Promulgated by the Department of Health, Licensed Professional Counselors Board of Examiners, LR 45:438 (March 2019).
PROFESSIONAL AND OCCUPATIONAL STANDARDS
Part LX. Licensed Professional Counselors Board of Examiners, Subpart 1. Licensed Professional Counselors. 2103.12
12. Technology Applications
a. Benefits and Limitations. Licensees inform clients of the benefits and limitations of using information technology applications in the counseling process and in business/billing procedures. Such technologies include, but are not limited to:
i. computer hardware and software;
iii. the world wide web;
iv. the internet;
v. online assessment instruments; and
vi. other communication devices.
b. Technology-Assisted Services. When providing technology-assisted distance counseling services, licensees determine that clients are intellectually, emotionally, and physically capable of using the application and that the application is appropriate for the needs of clients.
c. Inappropriate Services. When technology-assisted distance counseling services are deemed inappropriate by the licensee or client, licensees consider delivering services face-to-face.
d. Access. Licensees provide reasonable access to computer applications when providing technology-assisted distance counseling services.
e. Laws and Statutes. Licensees ensure that the use of technology does not violate the laws of any local, state, national, or international entity and observe all relevant statutes.
f. Assistance. Licensees seek business, legal, and technical assistance when using technology applications, particularly when the use of such applications crosses state or national boundaries.
g. Technology and Informed Consent. As part of the process of establishing informed consent, licensees do the following:
i. address issues related to the difficulty of maintaining the confidentiality of electronically transmitted communications;
ii. inform clients of all colleagues, supervisors, and employees, such as informational technology (IT) administrators, who might have authorized or unauthorized access to electronic transmissions;
iii. urge clients to be aware of all authorized or unauthorized user,s including family members and fellow employees who have access to any technology clients may use in the counseling process;
iv. inform clients of pertinent legal rights and limitations governing the practice of a profession over state lines or international boundaries;
v. use encrypted websites and email communications to help ensure confidentiality when possible;
vi. when the use of encryption is not possible, licensees notify clients of this fact and limit electronic transmissions to general communications that are not client specific;
vii. inform clients if and for how long archival storage of transaction records are maintained;
viii. discuss the possibility of technology failure and alternate methods of service delivery;
ix. inform clients of emergency procedures, such as calling 911 or a local crisis hotline, when the licensee is not available;
x. discuss time zone differences, local customs, and cultural or language differences that might impact service delivery;
xi. inform clients when technology-assisted distance counseling services are not covered by insurance.
h. Sites on the World Wide Web. Licensees maintaining sites on the world wide web (the internet) do the following:
i. regularly check that electronic links are working and professionally appropriate;
ii. establish ways clients can contact the licensee in case of technology failure;
iii. provide electronic links to relevant state licensure and professional certification boards to protect consumer rights and facilitate addressing ethical concerns;
iv. establish a method for verifying client identity;
v. obtain the written consent of the legal guardian or other authorized legal representative prior to rendering services in the event the client is:
(a). a minor child;
(b). an adult who is legally incompetent; or
(c). an adult incapable of giving informed consent;
vi. strive to provide a site that is accessible to persons with disabilities;
vii. strive to provide translation capabilities for clients who have a different primary language while also addressing the imperfect nature of such translations;
viii. assist clients in determining the validity and reliability of information found on the world wide web and other technology applications.
AUTHORITY NOTE: Promulgated in accordance with R.S. 37:1101-1123.
HISTORICAL NOTE: Promulgated by the Department of Health and Hospitals, Licensed Professional Counselors Board of Examiners, LR 15:622 (August 1989), amended LR 24:438 (March 1998), LR 29:142 (February 2003), LR 39:1792 (July 2013), LR 41:725 (April 2015).
Louisiana provides the following information to consumers.
Electronic Social Work Practice
The Louisiana State Board of Social Work Examiners (LABSWE) recognizes that face-to-face contact for the purposes of psychotherapy is optimal but that it is not always possible. The LABSWE provides the following information to Louisiana consumers who choose to seek therapy or counseling using telephonic or other electronic means (Distance Therapy).
Individuals who provide social work services, including psychotherapy or counseling, either in person, over the Internet or by telephone are required by Louisiana law to be licensed and credentialed by the LABSWE. The licenses or credentials issued by the LABSWE to Louisiana social workers who have met and maintained legally required qualifications are intended to safeguard Louisiana consumers against unauthorized, unqualified and improper social work practices and also to identify the scope and limitations of authorized practices. In Louisiana, the Licensed Clinical Social Worker (LCSW), the Licensed Master Social Worker (LMSW) and the Certified Social Worker (CSW) are authorized to practice Distance Therapy. A LMSW or CSW who engages in Distance Therapy must be an employee in an agency setting (or under contract with a governmental agency) and practice with supervision from a LCSW.
The licenses and credentials issued by the LABSWE only authorize Louisiana social workers to practice social work within the State of Louisiana. A Louisiana social worker may, on a limited basis, engage in Distance Therapy with an established Louisiana client who is temporarily outside of Louisiana. However, a Louisiana social worker who otherwise engages in Distance Therapy with a non-Louisiana client in another state or country, must also be authorized to practice social work where that client is located. Because the licensing laws and regulations for practicing social work will vary from one state to another, non-Louisiana consumers seeking Distance Therapy should require confirmation from their therapist that he or she is authorized in that particular location to provide Distance Therapy.
A social worker who uses electronic means to provide services shall abide by all regulations of their professional practice, understanding that their practice may be subject to regulation in both the jurisdiction in which the client receives services and the jurisdiction in which the social worker provides those services.
Cautious consumers seeking therapy over the telephone or the internet should consider the following:
Verify that the practitioner has a current and valid license in the State of Louisiana.
A social worker who provides Distance Therapy using the Internet shall have a web site which must include information relative to the credential the social worker holds, their physical location, their contact information, contact information for the licensing Board(s) that have issued the social worker a credential, the Professional Disclosure Statement and this Consumer Information Regarding Distance Therapy.
Distance Therapy may not be conducted through the exchange of typed or printed data, E-mails or instant messages and may not be used for group therapy or counseling.
The LMSW or CSW must be an employee in an agency setting (or under contract with a governmental agency) and practice with supervision from a LCSW.
Understand the fee that you will be charged for the services rendered.
Fully comprehend how and to whom the fee is paid.
Be satisfied with the methods used to ensure communication with and by the therapist will be confidential.
Make yourself aware of the risks and benefits of doing therapy so you can make an informed choice about the therapy or counseling to be provided.
According to Louisiana Social Work Practice Act, Rules, Standards and Procedures Rule 111 Section F, social workers should provide services to clients only in the context of a professional relationship with a valid informed consent. Social workers should use clear and understandable language to inform clients of the plan for services, relevant costs, reasonable alternatives, the client’s right to refuse or withdraw consent, and the timeframe covered by the consent. Social workers shall provide clients with an opportunity to ask questions.
If the client does not have the capacity to provide consent, the social worker shall obtain consent for the services from the client’s legal guardian or other authorized representative.
If the client, the legal guardian or authorized representative does not consent, the social worker shall, at the earliest opportunity, discuss with the client that a referral to other resources may be in the client’s best interest.
Two resources to review: Standards for Technology and Social Work Practice and Model Regulatory Standard for Technology and Social Work Practice