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North Carolina

Counselors

Counseling:

Source

Provision of Services via Electronic, Distance Professional Counseling Services, and Supervision

Effective Date: February 2, 2017

In response to inquiries from licensees, supervisors, and other interested parties, the North Carolina Board of Licensed Professional Counselors has confirmed that it has no separate view per se with regard to the provision of services via electronic means as long as a licensee is practicing in a manner consistent with his/her training and experience, is receiving supervision as is appropriate, and the medium for doing so is not an issue. Counselors consider the differences between face-to-face and electronic communication (nonverbal and verbal cues) and how these may affect the counseling process. Counselors educate clients on how to prevent and address potential misunderstandings arising from the lack of visual cues and voice intonations when communicating electronically.

The Board considers that the practice of counseling occurs both where the counselor who is providing counseling services is located and where the individuals (clients) who are receiving services are located. In order for an individual to provide counseling services in North Carolina, that individual must be licensed by the North Carolina Board of Licensed Professional Counselors or be exempt under the Licensed Professional Counselors Act. On this basis, if an individual licensed in North Carolina renders services electronically to an out-of-state client, it is the responsibility of the counselor to ensure that the counselor is complying with the laws and rules in the other state. Licensees are advised to review the North Carolina Licensed Professional Counselors Act and Section H of the ACA Code of Ethics (2014).

Delivery of clinical services via technology-assisted media such as telephones, the use of video, or the internet requires the counselor to be sensitive to various issues. The counselor must consider and address a multitude of issues in the areas of structuring the relationship to include: informed consent, confidentiality, acquiring required signatures on intake forms (consent to treat, release of information, professional disclosure forms, consent to treat minors, consent to tape, etc.), determining the basis for professional judgments, boundaries of competence, computer security, avoiding harm dealing with fees and financial arrangements, and advertising. Other specific challenges include, but are not limited to verifying the identity of the client, determining if the client is a minor, explaining to the clients the procedures for contacting the counselor when he or she is off-line, discussing the possibility of technology failure and alternate means of communication if technology failure occurs, exploring how to cope with potential misunderstandings when visual cues do not exist, identifying an appropriately trained professional who can provide local assistance (including crisis intervention), if needed. It is imperative that when providing services through electronic methods, the client and counselor be knowledgeable regarding emergency services available in the communities where their clients live.

It is necessary for counselors to use encrypted technology. Because changes in technology are constantly evolving, the Board cannot provide advice regarding the specific technology to use. Clients should be informed of the encryption methods used to help ensure the security of communications and be made aware of the potential hazards of unsecured communication on the internet. Also, counselors should inform clients as to whether session data is being preserved and if so, in what manner and for how long. In addition, clients need to be informed regarding the procedures that will be in place in receiving and releasing client information received through the internet and other electronic sources

Licensees are advised to review the following:
NC General Statutes - Chapter 90 Article 24
American Counseling Association (2014). ACA Code of Ethics. Alexandria, VA: Author. (Specifically Section H: Distance Counseling, Technology, and Social Media and F.2.c.).
North Carolina Administrative Code Chapter 53 - Board of Licensed Professional Counselors

Social Workers

Social Work:
Source

Position Statement on Technology Facilitate Services 2011.8.5; Amended 2012.2.4 1 N.C. Social Work Certification and Licensure Board

POSITION STATEMENT ON TECHNOLOGY FACILITATED SERVICES Purpose: Pursuant to N.C. Gen. Stat. § 90B-2, it is the purpose of the North Carolina Social Work Certification and Licensure Board (hereafter Board) to protect the public by setting standards for qualification, training, and experience for those who seek to represent themselves to the public as certified social workers or licensed clinical social workers and by promoting high standards of professional performance for those engaged in the practice of social work. While the Board strongly encourages in-person interactions, we recognize that advancement in technology has impacted social work practice both in the delivery of services and obtaining information. As the definition of general social work practice and clinical social work practice in North Carolina includes the phrase “by whatever means of communications,” it is the position of the Board that technology-facilitated services are one of several means of providing professional services, and as such, remain fully subject to the statutes and rules governing social work practice as outlined in N.C.G.S. § 90B and Title 21, Chapter 63 of the NC Administrative Code. North Carolina practitioners are reminded that pursuant to NCAC 63 .0211, appropriate supervision of provisional licensees providing clinical social work services to satisfy the requirements for LCSW, shall not be acceptable by any means other than in person. The Board does NOT consider delivery of supervision via telemed, webcasting, skype, or other similar audio/video broadcast to be acceptable in satisfying the requirement for in-person supervision. Technology facilitated services (e.g. technology-assisted services between participants in different locations ) are increasingly used in meeting professional social work functions, including clinical and supervisory interactions. The purpose of this position statement is to clearly define the standards of expectation the Board has for social workers with regard to the use of technology-facilitated services in professional social work practice, including supervision and the delivery of social work services to consumers. While this applies to more mature technologies (such as telephone and facsimiles) this position statement expands to address the use of recent and emerging technologies, such as telepractice, electronic therapy, distance therapy, electronic supervision, Webconferencing, Video-conferencing, Webcasts, etc. Practitioner Responsibility: A certified or licensed social worker who uses these means to provide services shall abide by the provisions set forth in the Social Worker Certification and Licensure Act [N.C.G.S. § 90B] and Title 21, Chapter 63 of the N.C. Administrative Code. It is the social worker’s responsibility to Position Statement on Technology Facilitate Services 2011.8.5; Amended 2012.2.4 2 ensure that professional and ethical standards are upheld, and the following practice considerations are addressed: 1. Accurate representation of clinician and services offered: a) Credential type and number is identified for each state where credentialed b) Specify nature and extent of services offered c) Location of practice d) Clinician’s contact information for use in case of technology failure e) Emergency contact information for clinician and client f) Contact information for the regulatory boards from which the clinician is credentialed 2. Compliance with regulatory/licensure requirements for the jurisdiction in which the social worker provides services as well as the jurisdiction in which the client receives services. 3. Knowledge of professional liability requirements/limitations. 4. Clinical Competence: a) Safe, ethical, and appropriate use of technology-facilitated services for the specific need, to ensure the use of the most appropriate intervention modality, b) Crisis plan c) Provider’s cultural, clinical and technological competence, to include assessment of the client’s needs, willingness and ability to engage in technology-facilitated services d) Awareness and assessment of non-verbal/non-written behavior e) Setting and review of goals, intervention modalities and schedules f) Any expectation for face-to-face contact 5. Augmented Informed Consent to address the additional risks associated with services rendered through the use of technology. 6. Confidentiality: a) Clear identification of what is confidential and the limits of confidentiality b) Knowledge of and adherence to HIPAA requirements c) Documentation adequate to meet professional responsibilities d) Security of confidential information transmitted and stored, including security software, potential risks, ethical considerations, data record storage, etc. 7. Administrative Issues: a) Clear business practices, including service-specific billing b) Administrative record keeping c) Technology availability, and technical support 8. Practitioner’s maintenance of professional boundaries in public media, such as social networking.

Marriage and Family Therapists

Marriage and Family Therapy:

Source

"Provision of Services via Electronic Means Adopted by North Carolina Marriage and Family Therapy Licensure Board August 30, 2012

In response to inquiries from licensees and other interested parties, the Board has confirmed that it has no separate view per se with regard to the provision of services via electronic means. As long as a licensee is practicing in a manner consistent with his/her training and experience, and is receiving supervision as is appropriate, the medium for doing so is not at issue. However, it is incumbent upon any licensed marriage and family therapist (LMFT or LMFTA) to recognize that as he or she moves away from direct contact with clients, the therapist incrementally loses much of the richness of interaction which, as any therapist knows, comes with traditional face-to-face contact in an individual session with a client.

Delivery of clinical services by technology-assisted media such as telephone, use of video, and the internet obligate the therapist in the areas of structuring the relationship, informed consent, confidentiality, determining the basis for professional judgments, boundaries of competence, computer security, avoiding harm, dealing with fees and financial arrangements, and advertising. Specific challenges include, but are not limited to, verifying the identity of the client, determining if a client is a minor, explaining to clients the procedure for contacting the therapist when he or she is off-line, discussing the possibility of technology failure and alternative modes of communication if that failure occurs, exploring how to cope with potential misunderstandings when visual cues do not exist, identifying an appropriately trained professional who can provide local assistance (including crisis intervention) if needed, informing internet clients of encryption methods used to help ensure the security of communications, informing clients of the potential hazards of unsecured communication on the internet, telling internet clients whether session data are being preserved (and if so, in what manner and for how long), and determining and communicating procedures regarding the release of client information received through the internet with other electronic sources.

The Board considers that the practice of marriage and family therapy occurs both where the therapist who is providing therapeutic services is located and where the individual (patient/client) who is receiving the service is located.

In order for an individual to provide marriage and family therapy services in North Carolina, that individual must be licensed by the North Carolina Marriage and Family Therapy Licensure Board or be exempt under the North Carolina Marriage and Family Therapy Licensure Act. On this basis, if a North Carolina licensee renders marriage and family therapy services electronically to an out-of-state client, it is recommended that the licensee contact the marriage and family therapy licensing board in the state in which the patient/client resides to determine whether or not such practice is permitted in that jurisdiction.

Licensees are advised to review the North Carolina Licensure Act and the AAMFT Ethics Codes (adopted by the North Carolina Marriage and Family Therapy Licensure Board.

Psychologists

Source

North Carolina is a PSYPACT PARTICIPATING STATE- NC 361 (Enacted 7/1/2020)

"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."

Source

North Carolina Psychology Board

March, 2005

Provision of Services Via Electronic Means

"In response to inquiries from licensees and other interested parties, the Board has confirmed that it has no separate view per se with regard to provision of services via electronic means. As long as a licensee is practicing in a manner consistent with his/her training and experience, and is receiving supervision as is appropriate, the medium for doing so is not at issue. However, it is incumbent upon any psychologist to recognize that as he or she moves away from direct contact with clientele, the psychologist incrementally loses much of the richness of interaction which, as any psychologist knows, comes with traditional face-to-face contact in an individual session with a client."

"Delivery of clinical services by technology-assisted media such as telephone, use of video, and the internet obligate the psychologist to carefully consider and address a myriad of issues in the areas of structuring the relationship, informed consent, confidentiality, determining the basis for professional judgments, boundaries of competence, computer security, avoiding harm, dealing with fees and financial arrangements, and advertising. Specific challenges include, but are not limited to, verifying the identity of the client, determining if a client is a minor, explaining to clients the procedure for contacting the psychologist when he or she is off-line, discussing the possibility of technology failure and alternative modes of communication if that failure occurs, exploring how to cope with potential misunderstandings when visual cues do not exist, identifying an appropriately trained professional who can provide local assistance (including crisis intervention) if needed, informing internet clients of encryption methods used to help ensure the security of communications, informing clients of the potential hazards of unsecured communication on the internet, telling internet clients whether session data are being preserved (and if so, in what manner and for how long), and determining and communicating procedures regarding the release of client information received through the internet with other electronic sources." 

 

"The Board considers that the practice of psychology occurs both where the psychologist who is providing therapeutic services is located and where the individual (patient/client) who is receiving the service is located. In order for an individual to provide psychological services in North Carolina, that individual must be licensed by the Psychology Board or be exempt under the Psychology Practice Act. On this basis, if a North Carolina licensee renders psychological services electronically to an out-of-state client, it is recommended that the licensee contact the psychology licensing board in the state in which the patient/client resides to determine whether or not such practice is permitted in that jurisdiction. Licensees are advised to review the North Carolina Psychology Practice Act, specifically the Code of Conduct, and the APA Ethical Principles of Psychologists and Code of Conduct (Standards 3.10(a), 4.02(c), 5.01(a), and 5.04 specifically address electronic transmissions)."

Refer to the source provided for all requirements and limitations.

Psychiatrists

Source

North Carolina Medical Board

“ “Telemedicine” is the practice of medicine using electronic communication, information technology, or other means between a licensee in one location and a patient in another location with or without an intervening health care provider. The term telemedicine incorporates the practices of telehealth.

The Board recognizes that technological advances have made it possible for licensees to provide medical care to patients who are separated by some geographical distance. As a result, telemedicine is a useful practice model that, if employed appropriately, can provide important benefits to patients, including: increased access to health care, expanded utilization of specialty expertise, rapid availability of patient records, and the potential of reduced healthcare costs, increased efficiency, and improved overall healthcare outcomes. The call for ongoing research and formal training in the care models and technologies associated with telemedicine reflects the evolving nature of telemedicine practice.

The Board cautions, however, that licensees providing care to North Carolina patients via telemedicine will be held to the same established standard of care as those practicing in traditional in-person medical settings. The Board does not endorse a separate standard of care for telemedicine. Licensees, who fail to conform to the North Carolina statewide standard of care, may be subject to discipline by this Board.”

“The Board provides the following considerations to its licensees as guidance in providing medical services via telemedicine:

Training of Staff

Staff involved in the telemedicine visit should be trained in the use of the technology being used to deliver care and competent in its operation.

Evaluations and Examinations

Licensees using telemedicine technologies to provide care to patients located in North Carolina must provide, or rely upon, an appropriate evaluation prior to diagnosing and/or treating the patient. This evaluation need not be in-person if the licensee employs technology sufficient to accurately diagnose and treat the patient in conformity with the applicable standard of care. A diagnosis should be established using accepted medical practices, i.e., a patient history, mental status evaluation, physical examination, and appropriate diagnostic and laboratory testing.

Evaluations may also be considered appropriate if a licensed health care professional is able to facilitate aspects of the patient assessment needed to render reasonable diagnostic possibilities and care plans. On the other hand, a simple questionnaire without an appropriate evaluation may be a violation of law and/or subject the licensee to discipline by the Board.”

Licensee-Patient Relationship

“The Board stresses the importance of proper patient identification prior to any telemedicine encounter. Failure to verify the patient’s identity may lead to fraudulent activity or the improper disclosure of confidential patient information. The licensee using telemedicine should verify the identity and location of the patient. Furthermore, the licensee’s name, location, and professional credentials should be provided to the patient. Licensees using telemedicine should also ensure the availability for appropriate follow-up care and maintain a complete medical record that is available to the patient and other treating health care providers.”

Prescribing

“Licensees are expected to practice in accordance with the Board’s Position Statement “Contact with Patients Before Prescribing.” It is the position of the Board that it is not consistent with the current standard of care to prescribe controlled substances for the treatment of pain in which the only patient encounter is by means of telemedicine and there are no other licensed healthcare providers involved in the initial and ongoing evaluations of the patient. Licensees prescribing controlled substances by means of telemedicine for other conditions should comply with all relevant federal and state laws and are expected to participate in the Controlled Substances Reporting System.”

Medical Records

“The licensee treating a patient via telemedicine must maintain a complete record of the telemedicine patient’s care consistent with the prevailing medical record standards. The medical record should clearly document all aspects of care including email, text, photos, phone contact, and other forms of communication. HIPAA and related privacy and security documents should be present and signed where appropriate. Appropriate informed consent documents acknowledging the risks, limitations, alternatives, and benefits of the telemedicine encounter should be included.

The licensee must maintain the medical record’s confidentiality and provide a copy of the medical record to the patient in a manner consistent with state and federal law. If the patient has a primary care provider and a telemedicine provider for the same ailment, then the primary care provider’s medical record and the telemedicine provider’s medical record constitute one complete patient record. Licensees practicing via telemedicine will be held to the same standards of professionalism concerning the transfer of medical records and communications with the patient’s primary care provider and medical home as those licensees practicing via traditional means.”

Disclaimers

“Practitioners of telemedicine should consider providing a statement identifying any unique limitations of the electronic model by which care is being provided. Such patient notification can be distributed prior to providing services and included in all direct advertising to the public.”

Licensure

“The Board deems the practice of medicine to occur in the state where the patient is located. Therefore, any licensee using telemedicine to regularly provide medical services to patients located in North Carolina should be licensed to practice medicine in North Carolina. Licensees need not reside in North Carolina if they have a valid, current North Carolina license.

North Carolina licensees intending to practice medicine via telemedicine technology to treat or diagnose patients outside of North Carolina should check with other state licensing boards. Most states require physicians to be licensed, and some have enacted limitations on telemedicine practice or require or offer a special registration. A directory of all U.S. medical boards may be accessed at the Federation of State Medical Boards web site: http://www.fsmb.org/directory_smb.html.

Refer to the source provided for all requirements and limitations.

North Carolina Professional Regulation/Health & Safety Online Prescribing

No reference found.

Nurses

“As a party state to the Nurse Licensure Compact (NLC), North Carolina issues multistate licenses to nurses and applicants who reside in the state and recognizes multistate licenses issued by other party states, for practice in North Carolina. 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.

North Carolina Professional Regulation/Health & Safety Online Prescribing

No reference found.

Medicaid Telehealth Parity Law

Source: NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and
Telepsychiatry, p. 4, April 15, 2019

3.2.1 Specific criteria covered by both Medicaid and NCHC
Medicaid and NCHC shall cover Telemedicine and Telepsychiatry services when medically necessary under ALL the following conditions:


a. The beneficiary shall be present at the time of consultation.
b. The medical examination of the beneficiary must be under the control of the consulting provider.
c. The distant site of the service(s) must be of a sufficient distance from the originating site to provide service(s) to a beneficiary who does not have readily available access to such specialty services.
d. The consultation must take place by two-way real-time interactive audio and video telecommunications system.

Note: The licensed provider using Telemedicine or Telepsychiatry Services shall ensure the availability for appropriate follow-up care and maintain a complete health record that is available to the beneficiary and other treating providers.

Refer to the source provided for all requirements and limitations.

Originating Site Reimbursement: 

Private Pay Telehealth Parity Law

We are not aware of any explicit payment parity law.

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.

Note: As this is a free resource and Rules and Regulations regarding Telehealth are always changing, we appreciate any updates or corrections. They can be emailed to us at This email address is being protected from spambots. You need JavaScript enabled to view it. with a link to the source or a citation of the rule or regulation.

THTC Program Button

Telemental health is not a separate service from mental health services. All state licensing boards require that licensed clinicians follow all the regulations for practicing under their license no matter what medium of communication is used. All licensing boards also require that clinicians only practice within the boundaries of their competence. This usually requires education, continuing education, and/or supervision in telemental health. Complete our telehealth training program to cover all the essential competencies of providing telemental health services and earn the THTC (Telemental Health Training Certificate).

 

9 comments

  • Comment Link Beth Vanbeek Wednesday, 23 June 2021 08:34 posted by Beth Vanbeek

    @Mary Flora,
    Unfortunately, there's no straightforward answer regarding international counseling. The location of the client (Czech Republic) is where you need to investigate a number of things to ensure legality, cultural competency, emergency management, etc. We go over all of these steps in our Legal Aspects of TeleMental Health course.
    However, the summary is to investigate whether the services you offer are regulated in the Czech Republic to an extent that you would be violating their laws. Insurance, of course, is a completely different investigation.
    Below are 2 resources that should be helpful:
    https://telementalhealthtraining.com/summary-of-international-telemedicine-guidelines
    https://personcenteredtech.com/2016/06/30/international-online-therapy-know-go-start/

  • Comment Link Mary Flora Tuesday, 22 June 2021 09:59 posted by Mary Flora

    I am a licensed clinical mental health counselor in both NC and GA in the USA. If I want to provide mental health telehealth services to individuals in the Czech Republic is there a Telehealth training or certification that addresses the international telehealth service provider and where can I find international law/regulations pertaining to this situation?

    Thank you,

    Mary Flora

  • Comment Link Telehealth Support Tuesday, 23 June 2020 11:11 posted by Telehealth Support

    @Phara Gladden, Thanks for joining our training and for the positive remarks!
    In answer to your question: There was a waiver in NC allowing out-of-state clinicians to practice telehealth with NC residents from April through June 7th. it is important to check with the SW board in NC to see if they have extended it. If you go to the following link and select the 8th FAQ listed, it has answers regarding temporary permission to practice without a NC license: https://www.ncswboard.org/files/COVID-19%20Info%20and%20FAQ's%2005-05-2020.pdf

  • Comment Link Phara Gladden Wednesday, 17 June 2020 10:29 posted by Phara Gladden

    Hello
    My name is Phara Gladden and I took the two-day Telemental Health Certificate course with Ray and not only enjoyed it ,but learned a lot about providing telehealth.
    I'm currently a licensed SW in the state os NY,and I have a client that I currently see who is planning on vacationing in North Carolina for a couple of weeks, and wants to continue his weekly telehealth sessions. My question is can I continue to provide teletherapy while he is out of state? and are there any restrictions with seeing a client that is out of state temporarily or vacationing. I'm hoping someone can help me with this question ..not sure where to look.

  • Comment Link Telehealth Support Wednesday, 27 May 2020 17:05 posted by Telehealth Support

    @Mary J Prinz, our course list with pricing can be found through the link below. The Live courses include in the title "Live Online Webinar" or "Live In Person": https://telementalhealthtraining.com/thtc-certificate-courses/product/listing

  • Comment Link Mary J Prinz Tuesday, 26 May 2020 13:53 posted by Mary J Prinz

    Please give me a lost of on line live ceu's for LCSW in NC

  • Comment Link David Boyle Wednesday, 25 March 2020 11:59 posted by David Boyle

    If I am a part-time resident of NC and wish to offer telemental health services from there to clients in Georgia where I am fully licensed and already meet the training requirements for telemental health, is there any issue?

  • Comment Link Telehealth Support Wednesday, 12 February 2020 11:29 posted by Telehealth Support

    @Eve H Quesada
    Thanks for asking. We cover this in our Legal Aspects of TeleMental Health course, but we do not provide legal advice. Your best bet will be to contact the NC board governing social workers. Here's a link to their site: http://www.ncswboard.org/

  • Comment Link Eve H Quesada Friday, 07 February 2020 14:57 posted by Eve H Quesada

    I am a LCSW practicng and licensed in California. I had a client move to North Carolina and would like to do some sessions via teletherapy. Is that possible with North Carolina's policies?

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