LPC, Licensed Professional Counselors, Mental Health Counseling, Marriage and Family Therapy
Telemedicine law: Act 442 http://www.legis.la.gov/Legis/ViewDocument.aspx?d=913612
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).
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).