States' Rules and Regualtions

TeleMental Health services by state:

This page is for giving guidance on the rules, regulations, and ethics of providing telemental health services, telebehavioral health, e-counseling, virtual counseling, technology-assisted counseling, cyber-counseling, and distance counseling.
Telehealth is a rapidly changing field.  We cannot guarantee the accuracy of any of the content shared on this site or any of the sites referenced.  This information is not intended to give any legal advice.  When practicing telehealth it is important to contact your own attorney and the state licensing board of both your location and the location of the client!  
Below is a spreadsheet that can be used as a starting point before you call the individual licensing boards to verify their rules and regulations.  Below the spreadsheet is a list of states and corresponding information from their websites.  Again, it is your responsibility to ensure the accuracy of the information provided here.
Since most states require the following requirements when providing telebehavioral health services they are not included in this spreadsheet:
  • Obtaining an adequate informed consent including such items as: the risks and benefits; the clinician's license information; backup plans; how to contact the clinician; an emergency management plan; and the process of receiving services.
  • Verifying the client’s identity.
  • Assessing for fit.
  • Protect confidentiality by using secure means of communication.
  • Be licensed by or approved by the licensing board of the state in which the client is physically located during the time of the session.
If you are aware of any updated information please leave a comment so that I can update this information.

Alabama

Alabama

Counselors

CODE OF ETHICS AND STANDARDS OF PRACTICE   http://abec.alabama.gov/PDFs/Code_Ethics_Nov-09.pdf

A.12. TECHNOLOGY APPLICATIONS

a. Use of Technology. When technology applications are used in counseling services, licensed professional counselors must ensure that: (1) the client is intellectually, emotionally, and physically capable of using the technology application; (2) the technology application is appropriate for the needs of the client; (3) the client understands the purpose and operation of the technology applications; and (4) a follow-up of client use of a technology application is provided to correct possible misconceptions, discover inappropriate use, and assess subsequent needs.   

b. Explanation of Limitations. Licensed professional counselors ensure that clients are provided information as a part of the counseling relationship that adequately explains the limitations of technology applications.  

c. Access to Technology Applications. Licensed professional counselors provide for equal access to technology applications in counseling services. (See A.2.a.).  

d. Distance Technology Counseling Services. Licensed professional counselors who employ distance technology for counseling services must observe and demonstrate all aspects of client rights and welfare, client confidentiality, professional responsibility (including relationships with other professionals), procedures for assessment, and resolution of ethical issues reflected in the Code of Ethics and Standards of Practice adopted by the Alabama Board of Examiners in Counseling. Addressing and resolving any disparities between ethical or legally-mandated practices required in face-to-face counseling services versus distance technology counseling services is the ethical duty of the licensed professional counselor. Ethical standards for a licensed professional counselor who employs distance technology counseling services shall apply to client care and public protection regardless of the destination point of such counseling services, unless otherwise prohibited by law. (See A.3.a.). 

 

Alaska

Alaska

Counselors

https://www.commerce.alaska.gov/web/cbpl/professionallicensing/professionalcounselors/distancecounseling.aspx

Board of Professional Counselors

Distance Counseling

The Board of Professional Counselors wants to provide direction for Licensed Professional Counselors who engage in the practice of technology assisted distance counseling.

The Board recommends the NBCC guidelines as a resource for technology assisted distance counseling.

NBCC Guidelines

ACA Code of Ethics, Section A12

 

MFT

https://www.commerce.alaska.gov/web/cbpl/ProfessionalLicensing/BoardofMaritalFamilyTherapy.aspx

Notice Regarding e-Therapy

Anyone considering utilizing e-therapy, or online therapy needs to know that if you are living in Alaska and receiving e-therapy, or online therapy, from a therapist outside of Alaska, there is no process available for the regulation of that therapist. Please inquire with the therapist as to their credentials and license.

Arizona

Arizona

We are not aware of any specific rules and regulations of the practice of telemental health services.
Arkansas

Arkansas

Psychologists

Are to follow APA’s guidelines.

CHAPTER 97 OF THE ARKANSAS PSYCHOLOGY BOARD http://www.psychologyboard.arkansas.gov/Websites/psychology/images/2008_Chapter_97.pdf

17-97-203. Powers and duties.

The Arkansas Psychology Board shall:

(5) Adopt the code of ethics of the American Psychological Association to

govern appropriate practices or behavior as referred to in this chapter and file the code

with the Secretary of State within thirty (30) days prior to the effective date of the code of

ethics.

ARKANSAS PSYCHOLOGY BOARD RULES AND REGULATIONS 2009

http://www.psychologyboard.arkansas.gov/Websites/psychology/images/Rules_and_Regulations.pdf

SECTION 16. CODE OF ETHICS.

16.1. The Arkansas Psychology Board adopts the Ethical Principles of Psychologists and Code of Conduct of the American Psychological Association as part of these Rules and Regulations. The principles shall constitute one standard by which appropriate professional practices are determined.

 

Social Workers

Arkansas Social Work Licensing Board Code

http://www.arkansas.gov/swlb/laws_regs.html

Chapter 103 Subchapter 3

17-103-309. Practice by electronic, telephonic, or other means.

The provision of social work services to a client within this state through any means, including without limitation electronic means or by telephone, regardless of the location of the social worker, constitutes the practice of social work and is subject to this chapter and to rules adopted under this chapter.

STATE OF ARKANSAS

SOCIAL WORK LICENSING BOARD

THE SOCIAL WORK LICENSING REGULATIONS

 

Counselors and Marriage and Family Therapists

http://abec.myarkansas.net/links/1470164176-abec-link.pdf

The Technology Assisted Counseling Specialization is required.

ARKANSAS BOARD OF EXAMINERS IN COUNSELING RULES AND REGULATIONS

Section 3.6

(7)        Technology-Assisted Distance Counseling or Marriage and Family Therapy

Specialization license standards for issue for Counseling or Marriage and Family Therapy or Supervision being:

(A)       A licensed LPC/LAC or LMFT/LAMFT in good standing with the

Board must apply for the Technology-assisted Distance Counseling or Marriage Family Therapy specialization license and submit documentation of training for approval by the Board. As training sources are developed, the responsibility for seeking Board endorsement for the training rests with the provider of the training, The provider must submit a written request with materials documenting the training content for Board review and approval prior to endorsement of the training.

(B)       The written submission of a detailed plan that delineates how the applicant will meet provisions of the Board adopted American Counseling Association Code of Ethics and the Standards regulating Technology Assisted Distance Counseling or Marriage and Family Therapy for Board approval.

(C)       Revised Statement of Intent (scope of practice) that includes a description of the Technology-Assisted Distance Counseling or Marriage and Family Therapy.

(D)       The Board may require an oral examination if there are unresolved questions about requirements (9) (A-F).

(E)       The submitted materials must be approved by the Board prior to the Technology-Assisted Distance Counseling or Marriage and Family Therapy Specialization license being issued.

(F)       Any Technology-Assisted Distance Counseling or Marriage and Family Therapy that occurs within the State of Arkansas, whether by an Arkansas counselor or by an out of state Counselor or Marriage and Family Therapist, is deemed to have occurred in Arkansas. All providers of services whether traditional or Technology-Assisted who may offer or provide Counseling or Marriage and Family Therapy services to individuals or groups must hold a valid Arkansas license to provide such services.

(G)       Specialization requests not already specified will be reviewed by the Board and standards established as needed.

(H)       Licensed Counselors or Therapist who apply for a specialization license will be issued such license upon completion of the application for a specialization, documentation of a valid national or required credential

(certificate, registry, or license), pass on the oral examination (if required), payment of the specialization fee and approval by majority vote of the Board.

California

California

Marriage and Family Therapy, Clinical Social Work, Educational Psychology, Clinical Counseling

California Code of Regulations 
Title 16. Professional and Vocational Regulations
Division 18. Board of Behavioral Sciences
Article 1. General Provisions 

16 CCR § 1815.5. Standards of Practice for Telehealth.

https://govt.westlaw.com

(a) All persons engaging in the practice of marriage and family therapy, educational psychology, clinical social work, or professional clinical counseling via telehealth, as defined in Section 2290.5 of the Code, with a client who is physically located in this State must have a valid and current license or registration issued by the Board.
(b) All psychotherapy services offered by board licensees and registrants via telehealth fall within the jurisdiction of the board just as traditional face-to-face services do. Therefore, all psychotherapy services offered via telehealth are subject to the board's statutes and regulations.
(c) Upon initiation of telehealth services, a licensee or registrant shall do the following:
(1) Obtain informed consent from the client consistent with Section 2290.5 of the Code.
(2) Inform the client of the potential risks and limitations of receiving treatment via telehealth.
(3) Provide the client with his or her license or registration number and the type of license or registration.
(4) Document reasonable efforts made to ascertain the contact information of relevant resources, including emergency services, in the patient's geographic area.
(d) Each time a licensee or registrant provides services via telehealth, he or she shall do the following:
(1) Verbally obtain from the client and document the client's full name and address of present location, at the beginning of each telehealth session.
(2) Assess whether the client is appropriate for telehealth, including, but not limited to, consideration of the client's psychosocial situation.
(3) Utilize industry best practices for telehealth to ensure both client confidentiality and the security of the communication medium.
(e) A licensee or registrant of this state may provide telehealth services to clients located in another jurisdiction only if the California licensee or registrant meets the requirements to lawfully provide services in that jurisdiction, and delivery of services via telehealth is allowed by that jurisdiction.
(f) Failure to comply with these provisions shall be considered unprofessional conduct.
Note: Authority cited: Sections 4980.60 and 4990.20, Business and Professions Code. Reference: Sections 2290.5, 4980, 4989.50, 4996, 4999.30 and 4999.82, Business and Professions Code.

 

For all behavioral health professionals

BPC - 2290.5.    https://leginfo.legislature.ca.gov

(a) For purposes of this division, the following definitions shall apply:

(1) “Asynchronous store and forward” means the transmission of a patient’s medical information from an originating site to the health care provider at a distant site without the presence of the patient.

(2) “Distant site” means a site where a health care provider who provides health care services is located while providing these services via a telecommunications system.

(3) “Health care provider” means either of the following:

(A) A person who is licensed under this division.

(B) A marriage and family therapist intern or trainee functioning pursuant to Section 4980.43.

(4) “Originating site” means a site where a patient is located at the time health care services are provided via a telecommunications system or where the asynchronous store and forward service originates.

(5) “Synchronous interaction” means a real-time interaction between a patient and a health care provider located at a distant site.

(6) “Telehealth” means the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.

(b) Prior to the delivery of health care via telehealth, the health care provider initiating the use of telehealth shall inform the patient about the use of telehealth and obtain verbal or written consent from the patient for the use of telehealth as an acceptable mode of delivering health care services and public health. The consent shall be documented.

(c) Nothing in this section shall preclude a patient from receiving in-person health care

delivery services during a specified course of health care and treatment after agreeing to receive services via telehealth.

(d) The failure of a health care provider to comply with this section shall constitute unprofessional conduct. Section 2314 shall not apply to this section.

(e) This section shall not be construed to alter the scope of practice of any health care provider or authorize the delivery of health care services in a setting, or in a manner, not otherwise authorized by law.

(f) All laws regarding the confidentiality of health care information and a patient’s rights to his or her medical information shall apply to telehealth interactions.

(g) This section shall not apply to a patient under the jurisdiction of the Department of Corrections and Rehabilitation or any other correctional facility.

(h) (1) Notwithstanding any other provision of law and for purposes of this section, the governing body of the hospital whose patients are receiving the telehealth services may grant privileges to, and verify and approve credentials for, providers of telehealth services based on its medical staff recommendations that rely on information provided by the distant-site hospital or telehealth entity, as described in Sections 482.12, 482.22, and 485.616 of Title 42 of the Code of Federal Regulations.

(2) By enacting this subdivision, it is the intent of the Legislature to authorize a hospital to grant privileges to, and verify and approve credentials for, providers of telehealth services as described in paragraph (1).

(3) For the purposes of this subdivision, “telehealth” shall include “telemedicine” as the term is referenced in Sections 482.12, 482.22, and 485.616 of Title 42 of the Code of Federal Regulations.

(Amended by Stats. 2015, Ch. 50, Sec. 1. Effective January 1, 2016.)

Colorado

Colorado

For all behavioral health professionals.

State Board of Psychologist Examiners: Laws, Rules and Policies

https://drive.google.com/file/d/0B-K5DhxXxJZbT3I3aWJITVl1YnM/view

30-1 TELETHERAPY POLICY – GUIDANCE REGARDING PSYCHOTHERAPY

THROUGH ELECTRONIC MEANS WITHIN THE STATE OF COLORADO

When listed, certified, registered, or licensed and treating clients within the State of Colorado, it is at the discretion of the mental health professional as to the type of modality of treatment format that is appropriate for the client. Regardless of the modality chosen, the mental health professional must comply with all provisions as outlined in the Mental Health Practice Act, Title 12 Article 43.

It is recommended that the initial therapeutic contact be in person and adequate to provide a conclusive diagnosis and therapeutic treatment plan prior to implementing any psychotherapy through electronic means. The mental health professional is expected to establish an ongoing therapeutic relationship including face-to-face visits on a periodic basis thereafter.

Once a mental health professional chooses to provide psychotherapy via electronic means, the mental health professional is expected to carefully identify and address issues that involve:

1) The agreed upon therapeutic means of communication between the client and the

mental health professional. (i.e. when will face-to-face contact be appropriate, what method(s)

of electronic communication will be utilized, what is the structure of the contractual

relationship);

2) Implementing written consent form(s) and proper disclosure(s) including, but not

limited to the client’s knowledge regarding security issues, confidentiality, structure, etc.;

State Board of Psychologist Examiners Policies

7

3) Ensuring that the therapeutic means of communication includes confidentiality and

computer/cyber security;

4) Determining the basis and ability for the mental health professional to support the

rationale for the decision to choose a particular therapeutic method;

5) Ensuring that the mental health professional is practicing within his/her scope of

practice;

6) Ensuring that the therapeutic means of communication that is chosen does not cause

any potential harm to the client.

The mental health professional may encounter specific challenges while providing psychotherapy through electronic means. The mental health professional must realize that these challenges may include, but are not limited to:

1) Verifying the identity of the client and determining if they are a minor;

2) Providing the client with procedures for alternative modes of communication when

there is possible technology failure;

3) Assessing how to cope with potential misunderstandings when the visual cues that

would normally occur during face-to-face visits do not exist;

4) Assessing how to address crisis intervention when necessary;

5) Ensuring that clients are knowledgeable with regard to encryption methods, firewall,

and backup systems to help secure communication and educate clients on the risk of unsecured

communications;

6) Establishing a means to retain and preserve data;

7) Upon request, have the ability to capture and provide client treatment notes,

summaries or other information that is received via the electronic technology;

8) Disclosing that health insurance coverage may not exist for psychotherapy service that is

provided through technological means.

Disclaimer

This policy applies only to Mental Health professionals listed, certified, registered, or licensed, and

treating clients within the State of Colorado.

Date Adopted by Program:

12/13/12—State Board of Addiction Counselor Examiners

04/22/11—State Board of Registered Psychotherapists

03/18/11—State Board of Licensed Professional Counselor Examiners

02/25/11—State Board of Marriage & Family Therapist Examiners

04/08/11—State Board of Psychologist Examiners

01/28/11—State Board of Social Work Examiners

Connecticut

Connecticut

For all behavioral health professionals.

https://www.cga.ct.gov/2015/ACT/PA/2015PA-00088-R00SB-00467-PA.htm

Substitute Senate Bill No. 467

Public Act No. 15-88

AN ACT CONCERNING THE FACILITATION OF TELEHEALTH.

Be it enacted by the Senate and House of Representatives in General Assembly convened:

Section 1. (NEW) (Effective October 1, 2015) (a) As used in this section:

(1) "Asynchronous" means any transmission to another site for review at a later time that uses a camera or other technology to capture images or data to be recorded.

(2) "Health record" means the record of individual, health-related information that may include, but need not be limited to, continuity of care documents, discharge summaries and other information or data relating to a patient's demographics, medical history, medication, allergies, immunizations, laboratory test results, radiology or other diagnostic images, vital signs and statistics.

(3) "Facility fee" has the same meaning as in section 19a-508c of the general statutes.

(4) "Medical history" means information, including, but not limited to, a patient's past illnesses, medications, hospitalizations, family history of illness if known, the name and address of the patient's primary care provider if known and other matters relating to the health condition of the patient at the time of a telehealth interaction.

(5) "Originating site" means a site at which a patient is located at the time health care services are provided to the patient by means of telehealth.

(6) "Peripheral devices" means the instruments a telehealth provider uses to perform a patient exam, including, but not limited to, stethoscope, otoscope, ophthalmoscope, sphygmomanometer, thermometer, tongue depressor and reflex hammer.

(7) "Remote patient monitoring" means the personal health and medical data collection from a patient in one location via electronic communication technologies that is then transmitted to a telehealth provider located at a distant site for the purpose of health care monitoring to assist the effective management of the patient's treatment, care and related support.

(8) "Store and forward transfer" means the asynchronous transmission of a patient's medical information from an originating site to the telehealth provider at a distant site.

(9) "Synchronous" means real-time interactive technology.

(10) "Telehealth" means the mode of delivering health care or other health services via information and communication technologies to facilitate the diagnosis, consultation and treatment, education, care management and self-management of a patient's physical and mental health, and includes (A) interaction between the patient at the originating site and the telehealth provider at a distant site, and (B) synchronous interactions, asynchronous store and forward transfers or remote patient monitoring. Telehealth does not include the use of facsimile, audio-only telephone, texting or electronic mail.

(11) "Telehealth provider" means any physician licensed under chapter 370 of the general statutes, physical therapist licensed under chapter 376 of the general statutes, chiropractor licensed under chapter 372 of the general statutes, naturopath licensed under chapter 373 of the general statutes, podiatrist licensed under chapter 375 of the general statutes, occupational therapist licensed under chapter 376a of the general statutes, optometrist licensed under chapter 380 of the general statutes, advanced practice registered nurse licensed under chapter 378 of the general statutes, physician assistant licensed under chapter 370 of the general statutes, psychologist licensed under chapter 383 of the general statutes, marital and family therapist licensed under chapter 383a of the general statutes, clinical social worker or master social worker licensed under chapter 383b of the general statutes, alcohol and drug counselor licensed under chapter 376b of the general statutes, professional counselor licensed under chapter 383c of the general statutes or dietitian-nutritionist certified under chapter 384b of the general statutes, who is providing health care or other health services through the use of telehealth within such person's scope of practice and in accordance with the standard of care applicable to the profession.

(b) (1) A telehealth provider shall only provide telehealth services to a patient when the telehealth provider: (A) Is communicating through real-time, interactive, two-way communication technology or store and forward technologies; (B) has access to, or knowledge of, the patient's medical history, as provided by the patient, and the patient's health record, including the name and address of the patient's primary care provider, if any; (C) conforms to the standard of care applicable to the telehealth provider's profession and expected for in-person care as appropriate to the patient's age and presenting condition, except when the standard of care requires the use of diagnostic testing and performance of a physical examination, such testing or examination may be carried out through the use of peripheral devices appropriate to the patient's condition; and (D) provides the patient with the telehealth's provider license number and contact information.

(2) At the time of the telehealth provider's first telehealth interaction with a patient, the telehealth provider shall inform the patient concerning the treatment methods and limitations of treatment using a telehealth platform and, after providing the patient with such information, obtain the patient's consent to provide telehealth services. The telehealth provider shall document such notice and consent in the patient's health record.

(c) Notwithstanding the provisions of this section or title 20 of the general statutes, no telehealth provider shall prescribe schedule I, II or III controlled substances through the use of telehealth.

(d) Each telehealth provider shall, at the time of each telehealth interaction, ask the patient whether the patient consents to the telehealth's provider disclosure of records concerning the telehealth interaction to the patient's primary care provider. If the patient consents to such disclosure, the telehealth provider shall provide such records to the patient's primary care provider, in a timely manner, in accordance with the provisions of sections 20-7b to 20-7e, inclusive, of the general statutes.

(e) The provision of telehealth services and health records maintained and disclosed as part of a telehealth interaction shall comply with the provisions of the Health Insurance Portability and Accountability Act of 1996 P. L. 104-191, as amended from time to time.

(f) Nothing in this section shall prohibit: (1) A health care provider from providing on-call coverage pursuant to an agreement with another health care provider or such health care provider's professional entity or employer; (2) a health care provider from consulting with another health care provider concerning a patient's care; or (3) orders of health care providers for hospital outpatients or inpatients. For purposes of this subsection, "health care provider" means a person or entity licensed or certified pursuant to chapter 370, 372, 373, 375, 378 or 379 of the general statutes or licensed or certified pursuant to chapter 368d or 384d of the general statutes.

(g) No telehealth provider shall charge a facility fee for telehealth services.

 

Delaware

Delaware

Psychology

http://regulations.delaware.gov/AdminCode/title24/3500.shtml

Delaware General Assembly : Delaware Regulations : Administrative Code : Title 24

3500 Board of Examiners of Psychologists

18.0     Telepsychology

18.1     “Telepsychology” means the practice of psychology by distance communication technology such as but not necessarily limited to telephone, email, Internet-based communications, and videoconferencing.

18.2     In order to practice telepsychology one must hold a current, valid license issued by the Board.

18.3     Licensees understand that this rule does not provide licensees with authority to practice telepsychology in service to clients domiciled in any jurisdiction other than Delaware, and licensees bear responsibility for complying with laws, rules, and/or policies for the practice of telepsychology set forth by other jurisdictional boards of psychology.

18.4     Licensees practicing telepsychology shall comply with all of these rules of professional conduct and with requirements incurred in state and federal statutes relevant to the practice of psychology.

18.5     Licensees establish and maintain current competence in the professional practice of telepsychology through continuing education, consultation, or other procedures, in conformance with prevailing standards of scientific and professional knowledge. Licensees establish and maintain competence in the appropriate use of the information technologies utilized in the practice of telepsychology.

18.6     Licensees recognize that telepsychology is not appropriate for all psychological problems and clients, and decisions regarding the appropriate use of telepsychology are made on a case-by-case basis. Licensees practicing telepsychology are aware of additional risks incurred when practicing psychology through the use of distance communication technologies and take special care to conduct their professional practice in a manner that protects the welfare of the client and ensures that the client’s welfare is paramount. Licensees practicing telepsychology shall:

18.6.1  Conduct a risk-benefit analysis and document findings specific to:

18.6.1.1           Whether the client’s presenting problems and apparent condition are consistent with the use of telepsychology to the client’s benefit; and

18.6.1.2           Whether the client has sufficient knowledge and skills in the use of the technology involved in rendering the service or can use a personal aid or assistive device to benefit from the service.

18.6.2  Not provide telepsychology services to any person or persons when the outcome of the analysis required in paragraphs 18.6.1.1 and 18.6.1.2 of this rule is inconsistent with the delivery of telepsychology services, whether related to clinical or technological issues.

18.6.3  Upon initial and subsequent contacts with the client, make reasonable efforts to verify the identity of the client;

18.6.4  Obtain alternative means of contacting the client;

18.6.5  Provide to the client alternative means of contacting the licensee;

18.6.6  Establish a written agreement relative to the client’s access to face-to-face emergency services in the client’s geographical area, in instances such as, but not necessarily limited to, the client experiencing a suicidal or homicidal crisis;

18.6.7  Licensees, whenever feasible, use secure communications with clients, such as encrypted text messages via email or secure websites and obtain and document consent for the use of non-secure communications.

18.6.8  Prior to providing telepsychology services, obtain the written informed consent of the client, in language that is likely to be understood and consistent with accepted professional and legal requirements, relative to:

18.6.8.1           The limitations and innovative nature of using distance technology in the provision of psychological services;

18.6.8.2           Potential risks to confidentiality of information due to the use of distance technology;

18.6.8.3           Potential risks of sudden and unpredictable disruption of telepsychology services and how an alternative means of re-establishing electronic or other connection will be used under such circumstances;

18.6.8.4           When and how the licensee will respond to routine electronic messages;

18.6.8.5           Under what circumstances the licensee and service recipient will use alternative means of communications under emergency circumstances;

18.6.8.6           Who else may have access to communications between the client and the licensee;

18.6.8.7           Specific methods for ensuring that a client’s electronic communications are directed only to the licensee or supervisee;

18.6.8.8           How the licensee stores electronic communications exchanged with the client;

18.6.9  Ensure that confidential communications stored electronically cannot be recovered and/or accessed by unauthorized persons when the licensee disposes of electronic equipment and data;

18.6.10            If in the context of a face-to-face professional relationship the following are exempt from this rule:

18.6.10.1         Electronic communication used specific to appointment scheduling, billing, and/or the establishment of benefits and eligibility for services; and,

18.6.10.2         Telephone or other electronic communications made for the purpose of ensuring client welfare in accord with reasonable professional judgment.

District of Columbia

District of Columbia

We are not aware of any specific rules and regulations of the practice of telemental health services.
Florida

Florida

We are not aware of any specific rules and regulations of the practice of telemental health services by licensed LPCs, MFTs, or Psychologists in Florida.

However, this is an important time for TeleMental Health policy in Florida.

Florida passed the CS/CS/HB 7087: Health Care bill which created a Telehealth Advisory Council within Florida’s Agency for Health Care Administration (AHCA).  This new advisory council is tasked with reporting policy recommendations to the Governor and the Legislature on how to increase the use and accessibility of telehealth services. 

I recommend all Florida mental health clinicians get involved by becoming knowledgeable in telemental health competencies, and filling out the survey on http://floridasmentalhealthprofessions.gov/

 

 

Georgia

Georgia

Here is Georgia's code of ethics that addresses confidentiality when storing information electronically.  

Proposed rule amendment to allow professional counselors' supervision to be done from a distance (TeleSupervison, Technology Assisted Clinical Supervision)

From the rules and regulations of the GEORGIA COMPOSITE BOARD OF PROFESSIONAL COUNSELORS, SOCIAL WORKERS AND MARRIAGE AND FAMILY THERAPISTS:

Rule 135-11-.01 TeleMental Health

Purpose: The purpose of this rule is to define TeleMental Health and to establish minimum standards for the delivery of services by a licensed Professional Counselor, Social Worker, or Marriage and Family Therapist using technology-assisted media.

(a)       Definitions:

  1. Asynchronous store and forward - means the transmission of a client's information from an originating site to a licensee at a distant site without the presence of the client.
  2. Distant site - means a site or location from which services are delivered by a licensee via a technology-assisted media.
  3. Licensee - means a person licensed in the state of Georgia as a Professional Counselor, Social Worker or Marriage and Family Therapist, including Associate licensees.
  4. Originating site - means a site where a client is located at the time TeleMental Health services are provided via technology-assisted media or where the asynchronous store and forward services originates.
  5. Synchronous interaction - means a real-time interaction between a client and a licensee located at a distant site.
  6. TeleMental Health - means the mode of delivering services via technology-assisted media, such as but not limited to, a telephone, video, internet, a smartphone, tablet, PC desktop system or other electronic means using appropriate encryption technology for electronic health information. TeleMental Health facilitates client self-management and support for clients and includes synchronous interactions and asynchronous store and forward transfers.
  7. TeleMental Health Supervision - means the delivery of supervision via technology-assisted media by a supervisor at one site while the supervisee is located at a distant site. Telemental health supervision may include, without being limited to, the review of case presentation, audio tapes, video tapes, and observation in order to promote the development of the practitioner's clinical skills.

(b)       Provisions

  1. Training for Licensee:

(i)        Prior to the delivery of clinical TeleMental Health, the licensee shall have obtained a minimum of six (6) continuing education hours. The continuing education hours may include but are not limited to the following, in the discretion of the Board:

(I)        Internet use dependency and psychological problems - an overview of how Internet users become dependent upon the Internet to such an extent that their Internet use is causing serious problems in their lives.

(II)       Research in Telemental Health - review of evidence base for mental health practice conducted using telemental health.

(III)     Intake and Assessment- initial intake and assessment necessary to determine a client's suitability for telemental health, including informed consent.

(IV)     Delivery Methods - recognize appropriate use of telecounseling, asynchronous email/message posting, synchronous digital chat, video-assisted therapy and other electronically supported modes of delivery.

(V)       Theory Integration - understand how to adapt counseling/therapy theory and effective in-person techniques to telemental health.

(VI)     Termination - recognize similarities and differences between in-person and telemental health closure while providing technology-assisted strategies for reestablishing contact if and/or when necessary.

(VII)    Risk Management - understanding privacy and security standards of applicable laws such as Health Insurance Portability and Accountability Act ensuring high quality practices and procedures that are legally sound and ethically protect clients and safeguard against litigation, including protection of electronic information.

(VIII)   Business of Telemental Health - review of ethically sound ways to advertise and incorporate telemental health into an existing suite of therapeutic/clinical services.

(ii)       If the licensee has taken the hours required in this section within the last 5 years, those hours do not need to be repeated in order to meet requirements in this section.

  1. Supervision:

(i)        Training of the TeleMental Health Supervisor: Prior to the delivery of supervision via telemental health, the supervisor shall have obtained a minimum of nine (9) hours of continuing education. The continuing education hours may include the same eight (8) categories identified under "Training for Licensee", rule section (b)(1)(i)(I-VIII) above, plus, must also include three (3) hours in the category of: Supervising TeleMental Health Therapy - understanding the key components necessary to supervise effective, and efficient delivery of telemental health therapy.

(ii)       If the supervisor has taken the hours required in this section within the last 5 years, those hours do not need to be repeated in order to meet requirements in this section.

(iii)      Board rules 135-5 define the acceptable requirements for a Board recognized supervisor and supervision for the Counselor, Social Work and Marriage and Family Therapy professions. Supervisors and supervision must meet the requirements of the specialty found in the applicable section of Board rules 135-5 that define supervisor and supervision for the Counselor, Social Work and Marriage and Family Therapy professions.

(iv)      Informed Consent: Prior to the delivery of supervision via TeleMental Health, the supervisor at the distant site shall inform the supervisee that TeleMental Health will be used and obtain verbal and written consent from the supervisee for this use.

  1. Informed Consent - Prior to the delivery of TeleMental Health services by a licensee via technology-assisted media, the licensee at the distant site shall inform the client that TeleMental Health services via technology-assisted media will be used, and the licensee shall obtain verbal and written consent from the client for this use. The verbal and written consent shall be documented in the client's record. Consent must include disclosure of the use of any third party vendor such as a record keeping, billing service or legal counsel.
  2. Client Assessment - Careful assessment using assessment instruments referenced in Rule 135.-7-.05 as appropriate is required in order to determine whether an individual may be properly assessed and/or treated via TeleMental Health services through technology-assisted media. Clients who cannot be treated properly via TeleMental Health services should be treated in person, or else they should not be accepted as clients or, if already accepted, properly terminated with appropriate referrals.
  3. Code of Ethics -The failure of a licensee to comply with these requirements shall constitute unprofessional conduct under the Code of Ethics as described in Board rule 135-7. A licensee delivering health care services via TeleMental Health shall comply with all Code of Ethics requirements as described in Board rule 135-7.
  4. Scope of Practice - 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.
  5. Out-of-State Clients - Licensees who want to offer TeleMental Health services outside the state are advised to check with the state board in which the client resides for information about telemental health regulations outside of Georgia.

(c)       Continuing education hours obtained pursuant to this rule within a two year licensure cycle may be applied to the required thirty-five (35) hours for that licensure cycles renewal/expiration date.

Cite as Ga. Comp. R. & Regs. R. 135-11-.01

Authority: O.C.G.A. §§43-1-19, 43-1-24, 43-1-25, 43-10A-2, 43-10A-5, 43-10A-16, 43-10A-17.

History. Original Rule entitled "TeleMental Health" adopted. F. Sep. 17, 2015; eff. Oct. 7, 2015.

 

Psychologists:

http://rules.sos.ga.gov/nllxml/georgiacodesGetcode.aspx?urlRedirected=yes&data=admin&lookingfor=510-4-.02

Georgia Administrative Code

Department 510. STATE BOARD OF EXAMINERS OF PSYCHOLOGISTS

Chapter 510-4. CODE OF ETHICS

3.10 Informed Consent.

1.         When psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code. (See also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and 10.01, Informed Consent to Therapy.)          

Hawaii

Hawaii

We are not aware of any specific rules and regulations of the practice of telemental health services.
Idaho

Idaho

For all behavioral health professionals

Taken from:

https://legislature.idaho.gov/idstat/Title54/T54CH57SECT54-5704.htm

TITLE 54
PROFESSIONS, VOCATIONS, AND BUSINESSES
CHAPTER 57
IDAHO TELEHEALTH ACCESS ACT
54-5704.  SCOPE OF PRACTICE. A provider offering telehealth services must at all times act within the scope of the provider's license and according to all applicable laws and rules, including, but not limited to, this chapter and the community standard of care.
 

https://legislature.idaho.gov/statutesrules/idstat/Title54/T54CH57/SECT54-5705/

TITLE 54

PROFESSIONS, VOCATIONS, AND BUSINESSES

CHAPTER 57

IDAHO TELEHEALTH ACCESS ACT

54-5705.  PROVIDER-PATIENT RELATIONSHIP. (1) If a provider offering telehealth services in his or her practice does not have an established provider-patient relationship with a person seeking such services, the provider shall take appropriate steps to establish a provider-patient relationship by use of two-way audio and visual interaction; provided however, that the applicable Idaho community standard of care must be satisfied. Nothing in this section shall prohibit electronic communications:

(a)  Between a provider and a patient with a preexisting provider-patient relationship;

(b)  Between a provider and another provider concerning a patient with whom the other provider has a provider-patient relationship;

(c)  Between a provider and a patient where the provider is taking call on behalf of another provider in the same community who has a provider-patient relationship with the patient; or

(d)  In an emergency.

(2)  As used in this section, "emergency" means a situation in which there is an occurrence that poses an imminent threat of a life-threatening condition or severe bodily harm.

History:

[(54-5705) 54-5605, added 2015, ch. 121, sec. 1, p. 308; am. and redesig. 2016, ch. 47, sec. 30, p. 122.]

 
Telehealth guidelines from IDAHO LICENSING BOARD OF PROFESSIONAL COUNSELORS AND MARRIAGE AND FAMILY THERAPISTS 

https://ibol.idaho.gov/ibol/cou/documents/Telehealth%20Guidelines.pdf

 
Telehealth Guidelines for Professional Counselors and Marriage and Family Therapists
All Idaho licensed counselors and therapists, and those practicing under supervision are required to be
knowledgeable and comply with Idaho statutes and rules governing their profession, including the 2015
Telehealth Access Act and their profession’s Code of Ethics. These guidelines do not supersede and
are subordinate to those laws and rules and Codes of Ethics. They are intended to provide information
and clarification and do not take the place of education or training necessary to engage in telehealth
practice. They may be periodically reviewed and modified by the Board.
Reviewed and approved by the Board of Professional Counselors and Marriage and Family Therapists
on May 6, 2016.
I. Competency and Training
Counselors and therapists provide telehealth services only after they take reasonable steps to ensure
their competence with the issues pertaining to this method of service delivery. Specifically counselors
and therapists need to obtain education, training and supervision in the unique clinical, technical and
administrative challenges which arise in telehealth service delivery. Telehealth services include any
written, video or audio transmission of client information for clinical or supervisory purposes using any
form or format of electronic technology. These include, but are not limited to, telephones, smartphones
and applications, telephone answering machines, faxes, email, social media and internet-based
applications, and data storage devices or media. Counselors and therapists keep current with emerging
knowledge, technology, and research in telehealth and insure their competency in the delivery of
telehealth services through continuing education, consultation, or supervision.
II. Competency and Training - Supervisors
The use of technology for providing supervision falls into three categories:
• Distance supervision of non-telehealth services.
• Distant supervision of telehealth services.
• Traditional supervision of telehealth services.
These three categories create different issues that need to be addressed in the supervisor/supervisee
agreement. The responsibility to be competent in the delivery of telehealth lies with the supervisor when
working with supervisees who are employing telehealth services. Similar to other emerging services
and methods of treatment, if the supervisor chooses not to provide technology assisted services they
are ethically bound to refer their supervisee or recommend they receive additional supervision for that
area of their work.
Those providing supervision of telehealth services review the types of telehealth services being
provided to ensure appropriateness for client care. The supervisor should review the supervisee’s
policies to ensure that telehealth delivery risks and benefits are adequately addressed and there are
adequate safety plans for both client emergencies and technology failures.
III. Informed Consent and Disclosure
Prior to commencing telehealth treatment, counselors and therapists provide clients with a professional
disclosure statement and obtain verbal and written informed consent from the individuals seeking their
services. In addition to following informed consent laws and rules currently in place, telehealth
providers inform clients of their level of competency, experience and training in telehealth, and the
specific benefits and risks associated with technology-assisted services. They review their policies
regarding the use of e-mail, internet messaging, phone texting and social media.
They verify the identity of the client/s and attempt to obtain information about alternative means to
contact them in case of emergency situations. They clearly state their policies regarding response time
to routine electronic messages and to emergencies.
IV. Confidentiality and Security of Client Information
Counselors and therapists inform clients about their responsibilities regarding maintaining
confidentiality, including legally required reporting situations, and the potential risks to confidentiality
when using technology. They use secure electronic transmissions in all telehealth communications and 
make reasonable efforts to secure the confidentiality of information transmitted to other parties.
Counselors and therapists notify clients as soon as possible of any breach of confidentiality as a result
of electronic transmission of confidential information, and document it in the client file.
V. Appropriate Use of Telehealth and Client Assessment
Counselors and therapists recognize that telehealth services are not appropriate for every client. They
establish a relationship with new clients by use of two-way audio and visual interaction. They assess
whether potential clients have the capacity to benefit from online and remote services, including
intellectual, emotional, and physical ability to use electronic technology. They consider the potential
benefits from treatment via telehealth services and the potential risks to the individual, couple, family or
group. If they determine a client/s cannot be provided appropriate treatment through technology
assisted services, and the client/s cannot be seen in person, they provide appropriate referrals.
VI. Referral to Other Services
Counselors and therapists are responsible for monitoring the effectiveness of telehealth services
throughout the treatment, and evaluate the client/s need for in person services or an appropriate
referral. They are responsible for ensuring and documenting that the quality of the telehealth services
meet the appropriate standard of care. Counselors and therapists providing telehealth services shall be
familiar with and have appropriate contact information for available medical resources, including
emergency resources near the client's location, in order to make appropriate client referrals when
medically indicated. “911” may not provide direct access to emergency services in the client’s location.
VII. Records and Documentation
Counselors and therapists providing telehealth services maintain records in compliance with any
applicable state and federal laws, rules and regulations, including the health insurance portability and
accountability act (HIPAA). Such records shall be accessible to other providers and to the client in
accordance with applicable laws, rules and regulations. Counselors and therapists inform clients that
digital and non-digital communications will be included in the clients’ record (including email messages,
text messages, instant messages). Clients are informed of the type of security assigned to the records
and the length of time records will be stored. Counselors and therapists take steps to ensure that
confidential information stored electronically cannot be recovered or accessed by unauthorized persons
when they dispose of or destroy computers and other information storage devices. They have
documentation that such disposal has occurred.
VIII. Jurisdiction/State Boundaries
Idaho licensees who want to offer telehealth services outside the state of Idaho are advised to research
the legal and regulatory requirements of the state or country in which the potential client resides.
Telehealth service is deemed to occur where the client is located at the time of service, the originating
site. The provider’s location (distant site) is not considered the location where the services occur.
Guidelines adapted from: Idaho Board of Psychologist Examiners Guidelines for Electronic
Transmission and Telepsychology in the State of Idaho (2012), Georgia Composite Board of
Professional Counselors, Social Workers and Marriage and Family Therapists Rule 135-11-.01
TeleMental Health (2015), 2014 ACA Code of Ethics, 2015 AAMFT Code of Ethics, Model Regulatory
Standards for Technology and Social Work Practice, 2013-2014,
Further Resources
It is the Board's opinion that any licensed counselor or therapist who wishes to engage in telehealth
services needs to do his/her research to understand the clinical benefits and risks, best practices, and
logistical requirements. The Board has developed this list as a way to assist counselors and therapists
in this endeavor. Listing by the Board does not mean endorsement and exclusion from this list does not
mean rejection.
National Board for Certified Counselors (NBCC) Policy Regarding the Provision of Distance
Professional Services
American Counseling Association (ACA) 2014 Code of Ethics, Section H, Distance Counseling,
Technology and Social Media
American Mental Health Counselors Association (AMHCA), (2000). Code of Ethics of the American
Mental Health Counselors Association, Principle 14, Internet On-Line Counseling
American Association of Marriage and Family Therapists (AAMFT) Code of Ethics 2014, Principle II
Confidentiality and Principle III Professional Competence and Integrity
American Psychological Association (APA) (July/2013). Guidelines For The Practice of Telepsychology
Guidelines for Electronic Transmission and Telepsychology in the State of Idaho
American Telemedicine Association. (ATA)
Practice Guidelines for Video-Based Online Mental Health Services (May/2013)
Quick Guide to Store-Forward and Live-Interactive Teledermatology for Referring Providers (April/2012)
Telemental and Behavioral Health (August 2013)
Canadian Psychological Association (2006). Ethical Guidelines for Psychologists Providing
Psychological Services via Electronic Media
National Board for Certified Counselors and Center for Credentialing and Education (2012). The NBCC
Policy Regarding the Provision of Distance Professional Services
Ohio Psychological Association (2010). Telepsychology Guidelines
New Zealand Psychological Association (2011). Draft Guidelines: Psychology services delivered via the
Internet and other electronic media
Training Resources
Renewed Vision Counseling Services www.renewedvisiontraining.com
Zur Institute www.zurinstitute.com/
Telehealth Certification Institute at https://telementalhealthtraining.com/
Illinois

Illinois

We are not aware of any specific rules and regulations of the practice of telemental health services.
Indiana

Indiana

We are not aware of any specific rules and regulations of the practice of telemental health services.
Iowa

Iowa

We are not aware of any specific rules and regulations of the practice of telemental health services.
Kansas

Kansas

We are not aware of any specific rules and regulations of the practice of telemental health services.
Kentucky

Kentucky

Psychologists

Kentucky regulations:

http://www.lrc.ky.gov/kar/201/026/310.htm

201 KAR 26:310. Telehealth and telepsychology.

      RELATES TO: KRS 319.140, 29 U.S.C. 794(d)

      STATUTORY AUTHORITY: KRS 319.032(2); KRS 319.140(2)

      NECESSITY, FUNCTION, AND CONFORMITY: KRS 319.140 requires a treating psychologist utilizing telehealth to ensure a patient’s informed consent and to maintain confidentiality. This administrative regulation protects the health and safety of the citizens of Kentucky and establishes procedures for preventing abuse and fraud through the use of telehealth, prevents fee-splitting through the use of telehealth, and utilizes telehealth in the provision of psychological services and in the provision of continuing education.

      Section 1. Definitions. (1) "Client" is defined by 201 KAR 26:145, Section 2;

      (2) "Telehealth" is defined by KRS 319.140(3);

      (3) "Telepsychology" means "practice of psychology" as defined by KRS 319.010(7) between the psychologist and the patient:

      (a) Provided using an electronic communication technology; or

      (b) Two (2) way, interactive, simultaneous audio and video.

      Section 2. Client Requirements. A credential holder using telehealth to deliver psychological services or who practices telepsychology shall, upon initial contact with the client:

      (1) Make reasonable attempts to verify the identity of the client;

      (2) Obtain alternative means of contacting the client other than electronically;

      (3) Provide to the client alternative means of contacting the credential holder other than electronically;

      (4) Document if the client has the necessary knowledge and skills to benefit from the type of telepsychology provided by the credential holder;

      (5) Use secure communications with clients, including encrypted text messages via e-mail or secure Web sites, and not use personal identifying information in non-secure communications;

      (6) Inform the client in writing about:

      (a) The limitations of using technology in the provision of telepsychology;

      (b) Potential risks to confidentiality of information due to technology in the provision of telepsychology;

      (c) Potential risks of disruption in the use of telepsychology;

      (d) When and how the credential holder will respond to routine electronic messages;

      (e) In what circumstances the credential holder will use alternative communications for emergency purposes;

      (f) Who else may have access to client communications with the credential holder;

      (g) How communications can be directed to a specific credential holder;

      (h) How the credential holder stores electronic communications from the client; and

      (i) The reporting of clients required by 201 KAR 26:145, Section 7.

      Section 3. Competence, Limits on Practice, Maintenance, and Retention of Records. A credential holder using telehealth to deliver psychological services or who practices telepsychology shall:

      (1) Limit the practice of telepsychology to the area of competence in which proficiency has been gained through education, training, and experience;

      (2) Maintain current competency in the practice of telepsychology through continuing education, consultation, or other procedures, in conformance with current standards of scientific and professional knowledge;

      (3) Document the client’s presenting problem, purpose, or diagnosis;

      (4) Follow the record-keeping requirements of 201 KAR 26:145, Section 6; and

      (5) Ensure that confidential communications obtained and stored electronically cannot be recovered and accessed by unauthorized persons when the credential holder disposes of electronic equipment and data.

      Section 4. Compliance with Federal, State, and Local Law. A credential holder using telehealth to deliver psychological services or who practices telepsychology shall comply with:

      (1) State law where the credential holder is credentialed and be licensed to practice psychology where the client is domiciled; and

      (2) Section 508 of the Rehabilitation Act, 29 U.S.C. 794(d), to make technology accessible to a client with disabilities;

      Section 5. Representation of Services and Code of Conduct. A credential holder using telehealth to deliver psychological services or who practices telepsychology:

      (1) Shall not by or on behalf of the credential holder engage in false, misleading, or deceptive advertising of telepsychology;

      (2) Shall comply with 201 KAR 26:145. (37 Ky.R. 1597; Am. 1987; eff. 3-4-2011.)

Kentucky statutes

http://www.lrc.ky.gov/Statutes/statute.aspx?id=31252

319.140 Duty of treating psychologist utilizing telehealth to ensure patient's

informed consent and maintain confidentiality -- Board to promulgate

administrative regulations -- Definition of "telehealth".

(1) A treating psychologist or psychological associate who provides or facilitates the

use of telehealth shall ensure:

(a) That the informed consent of the patient, or another appropriate person with

authority to make the health care treatment decision for the patient, is obtained

before services are provided through telehealth; and

(b) That the confidentiality of the patient's medical information is maintained as

required by this chapter and other applicable law. At a minimum,

confidentiality shall be maintained through appropriate processes, practices,

and technology as designated by the board and that conform to applicable

federal law.

(2) The board shall promulgate administrative regulations in accordance with KRS

Chapter 13A to implement this section and as necessary to:

(a) Prevent abuse and fraud through the use of telehealth services;

(b) Prevent fee-splitting through the use of telehealth services; and

(c) Utilize telehealth in the provision of psychological services and in the

provision of continuing education.

(3) For purposes of this section, "telehealth" means the use of interactive audio, video,

or other electronic media to deliver health care. It includes the use of electronic

media for diagnosis, consultation, treatment, transfer of health or medical data, and

continuing education.

Effective: July 14, 2000

History: Created 2000 Ky. Acts ch. 376, sec. 16, effective July 14, 2000.

 

Social Workers

Kentucky statutes.

http://www.lrc.ky.gov/Statutes/statute.aspx?id=31935

335.158 Duty of treating clinical social worker utilizing telehealth to ensure

patient's informed consent and maintain confidentiality -- Board to

promulgate administrative regulations -- Definition of "telehealth".

(1) A treating clinical social worker who provides or facilitates the use of telehealth

shall ensure:

(a) That the informed consent of the patient, or another appropriate person with

authority to make the health care treatment decision for the patient, is obtained

before services are provided through telehealth; and

(b) That the confidentiality of the patient's medical information is maintained as

required by this chapter and other applicable law. At a minimum,

confidentiality shall be maintained through appropriate processes, practices,

and technology as designated by the board and that conform to applicable

federal law.

(2) The board shall promulgate administrative regulations in accordance with KRS

Chapter 13A to implement this section and as necessary to:

(a) Prevent abuse and fraud through the use of telehealth services;

(b) Prevent fee-splitting through the use of telehealth services; and

(c) Utilize telehealth in the provision of clinical social work services and in the

provision of continuing education.

(3) For purposes of this section, "telehealth" means the use of interactive audio, video,

or other electronic media to deliver health care. It includes the use of electronic

media for diagnosis, consultation, treatment, transfer of health or medical data, and

continuing education.

Effective: July 14, 2000

History: Created 2000 Ky. Acts ch. 376, sec. 20, effective July 14, 2000.

 

Marriage and Family Therapists

Kentucky statutes.

http://www.lrc.ky.gov/Statutes/statute.aspx?id=31954

335.380 Duty of treating marriage and family therapist utilizing telehealth to

ensure patient's informed consent and maintain confidentiality -- Board to

promulgate administrative regulations -- Definition of "telehealth".

(1) A treating marriage and family therapist who provides or facilitates the use of

telehealth shall ensure:

(a) That the informed consent of the patient, or another appropriate person with

authority to make the health care treatment decision for the patient, is obtained

before services are provided through telehealth; and

(b) That the confidentiality of the patient's medical information is maintained as

required by this chapter and other applicable law. At a minimum,

confidentiality shall be maintained through appropriate processes, practices,

and technology as designated by the board and that conform to applicable

federal law.

(2) The board shall promulgate administrative regulations in accordance with KRS

Chapter 13A to implement this section and as necessary to:

(a) Prevent abuse and fraud through the use of telehealth services;

(b) Prevent fee-splitting through the use of telehealth services; and

(c) Utilize telehealth in the provision of marriage and family therapy services and

in the provision of continuing education.

(3) For purposes of this section, "telehealth" means the use of interactive audio, video,

or other electronic media to deliver health care. It includes the use of electronic

media for diagnosis, consultation, treatment, transfer of health or medical data, and

continuing education.

Effective: July 14, 2000

History: Created 2000 Ky. Acts ch. 376, sec. 21, effective July 14, 2000.

Louisiana

Louisiana

Telemedicine law:  Act 442 http://www.legis.la.gov/Legis/ViewDocument.aspx?d=913612

Psychologists

Louisiana State Board of Examiners of Psychologists

http://www.lsbep.org/wp-content/uploads/Final-Telepsych-Guidelines-1-15-6.0.pdf

Louisiana Telepsychology Guidelines

Purpose of guidelines:

To facilitate the process for licensed psychologists to provide telepsychology services to residents of Louisiana.

Telepsychology:

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.

Emergency Management:

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.

Recordkeeping

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

Service Delivery

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.

Limitations

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.

Cultural Competence

Psychologists are encouraged to reflect on multicultural issues when delivering telespscyhology services to diverse clients.

Complaints

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).

Counselors

http://www.doa.la.gov/osr/lac/46v60/46v60.doc

Practice regulations.

Title 46

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;

            ii.         telephones;

            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).

Social Workers

Louisiana provides the following information to consumers.

https://www.labswe.org/page/electronic-social-work-practice

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

Maine

Maine

We are not aware of any specific rules and regulations of the practice of telemental health services.
Maryland

Maryland

We are not aware of any specific rules and regulations of the practice of telemental health services.
Massachusetts

Massachusetts

Psychologists

Massachusetts Board of Registration in Psychology’s current thinking with regard to provision of services via electronic means.

Consumer Affairs and Business Regulation

http://www.mass.gov/ocabr/licensee/dpl-boards/py/regulations/board-policies/provision-of-services-via-electronic-means.html

Provision of Services Via Electronic Means

Originally adopted in March 2005

Updated October 2015

In response to inquiries from licensees and other interested parties, the Board would like to share its current thinking with regard to provision of services via electronic means. The Board recognizes that this is an evolving practice issue, and its policy may be updated from time to time.  However, there are some issues and policies that the Board believes are important to share, even as this area evolves.  The Board believes that psychologists should recognize that as he or she loses the kind of direct contact with a patient/client that occurs in an in-person, face-to-face office, the psychologist incrementally loses much of the richness of interaction which, as any psychologist knows, comes with traditional face-to-face contact. For this reason, a psychologist should seriously consider conducting the initial evaluation of a client in-person before beginning electronic provision of services, and holding sessions in-person periodically thereafter.  A psychologist should also recognize that without such in-person, face-to-face interaction, patients/clients may misinterpret or feel injured by a psychologist’s statements, tone of voice, or other perceived empathic failures, and the psychologist may fail to observe the signs of this in a timely way.  This may lead to the patient filing a complaint, prematurely terminating the therapy, or both.

In addition, 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 or are insufficient, identifying appropriately trained professionals 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’s current position is that the practice of psychology occurs where the patient/client who is receiving the services is physically located at the time of service. In order for a psychologist to provide psychological services to a patient in Massachusetts, that individual must be licensed by the Massachusetts Board of Registration of Psychologists or be exempt under the provisions of M.G.L. c. 112 §.123. If the patient/client is in Massachusetts at the time of service, and files a complaint against the treating psychologist, that complaint will be heard in Massachusetts.  

A Massachusetts psychologist who renders psychological services electronically to a client who is not in Massachusetts is advised to contact the psychology licensing board in the state in which the patient is at time of service, to determine whether or not such practice is permitted in that jurisdiction.

 Licensees are advised to review the following:

M.G.L. ch. 112, s. 118-129b

https://malegislature.gov/Laws/GeneralLaws/Search

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).

http://www.apa.org/ethics/code/index.aspx

APA/ASPPB/APAIT Joint Task Force Telepsychology Guidelines

(http://www.apa.org/practice/guidelines/telepsychology.aspx)

Social Workers

Massachusetts Board of Registration of Social Workers

Practice Advisory regarding social work services by electronic means

Adopted by the Massachusetts Board of Registration of Social Workers on October 22, 2013.

http://www.mass.gov/ocabr/licensee/dpl-boards/sw/regulations/board-policies/adv-sw-services-electronic-means.html

The Board of Registration of Social Workers (“the Board”) voted today to adopt the following practice advisory about providing social worker services by electronic means.

This practice advisory does not have the force of law or regulation, but is intended to provide social workers and the public with a recommended protocol to follow in situations where social work services are not provided in the traditional face-to-face practice setting.  The Board will look to this practice advisory in considering matters within its scope.

Scope:

This Practice Advisory addresses the provision of social worker services by electronic means of communication (“e-practice”), which includes but is not limited to:  telephone calls, internet video conferencing , texting, and electronic mail.

Practice Guidance:

In response to inquiries from licensees and other interested parties about providing social work services by e-practice, the Board has reviewed and considered appropriate protocols for providing such services.  Social workers must recognize that as he or she moves away from direct contact with clients, the social worker loses the value of interacting with the client which comes with traditional face-to-face practice setting.  While e-practice is not encouraged by the Board, the Board recongnizes that in certain circumstances e-practice can be used as a complement to an existing face-to-face therapeutic relationship OR when warranted by extenuating circumstances.

Licensees are reminded that all of the statutes and regulations that govern traditional Social Work are still applicable when treating a client via e-practice.  The Board, therefore, recommends that licensees conduct the initial evaluation of a client in person before treating a client via e-practice, and conduct subsequent sessions in person periodically thereafter to best service the needs of their clients.

Treating clients via e-practice obligates licensees to carefully consider and address diverse issues such as structuring the relationship, obtaining informed consent, maintaining confidentiality, determining the basis for professional judgments, determining boundaries of competence, maintaining computer security, avoiding harm, dealing with fees and financial arrangements, and advertising.

License:

In order to provide social work services in Massachusetts, you must be licensed by the Board or be exempt under the provisions of M.G.L. c. 112, §134.  In determining whether social work services are being rendered in Massachusetts, the Board considers licensure with the Board necessary when the Patient/Client is located within the Commonwealth.  If a Massachusetts licensee renders social work services via e-practice to an out-of-state client, the Board recommends that the licensee contact the social worker licensing board in the state where the client is located  to determine whether such practice is permitted in that jurisdiction. 

Confidentiality:

Licensees are advised to review M.G.L. c. 112, s. 130-137, 258 CMR s. 22.00 (Confidentiality of Client Communications and Records), and the NASW Code of Ethics (Ethical Standards 1.07(i) and (m) addressing assuring confidentiality of communications with clients).  The NASW Code of Ethics can be found here:  http://www.socialworkers.org/pubs/code/code.asp.

Counselors and Marriage and Family Therapists

Policy on Distance, Online, and Other Electronic-Assisted Counseling

http://www.mass.gov/ocabr/licensee/dpl-boards/mh/regulations/board-policies/policy-on-distance-online-and-other.html

The Board of Registration of Allied Mental Health and Human Services Professionals ("the Board") voted at its meeting on November 16, 2007 to adopt the following Policy Guideline. This policy guideline is intended as a recommended protocol for the profession to follow. The guideline set forth below does not have the full force and effect of law, as would a Massachusetts General Law or a Board rule or regulation. However, the Board uses policy guidelines as an internal management tool in formulating decisions that relate to issues in the practice of allied mental health and human services.

Policy No. 07-03

Purpose:

The Board acknowledges that therapy and counseling are increasingly being provided at a distance, making use of the internet, telephone and other electronic means of communication. The emergence of new clinical procedures is necessarily accompanied by uncertainty about legal and ethical obligations. The purpose of this policy statement is to offer guidance to Licensees regarding the ethical obligations and standards of conduct in the use of distance, on-line, and other electronic assisted counseling.

Policy:

The Board's policy with regard to all distance or electronic-assisted provision of clinical services is as follows:

1. The services offered by licensees of this Board across a distance by electronic means, fall within the jurisdiction of the Board just as traditional, face-to-face services do. Therefore all Board policies and regulations will apply to these services.

2. Distance delivery of counseling and therapy is considered to occur in two locations: where the client is located and where the clinician is located.

3. Therefore, the provision of counseling and/or therapy to individuals located within Massachusetts at the time services are occurring, are considered to fall under the jurisdiction of the Board, regardless of the location of the provider.

4. Mental health professionals licensed by any jurisdiction other than Massachusetts, and not licensed by any Massachusetts Board or not eligible for an exception to Massachusetts licensure, are considered unlicensed by this Board for practice in Massachusetts.

5. Mental health professionals licensed by other jurisdictions who wish to provide services to clients within Massachusetts, are encouraged to apply for Massachusetts licensure. Some, licensees may find the following helpful:

a. Mental Health Counselors: 262CMR 2.03, (1) Licensure for CCMHC's in good standing with NBCC

b. MFT's: 262 CMR 3.04 Licensure by Reciprocity for MFT's.

6. Board licensees who wish to provide services via electronic means to clients located outside of Massachusetts are urged to ensure that they meet the requirements for practice within the jurisdiction where the client is located.

7. Licensees are encouraged to carefully review the way in which the structure of their relationships with clients will be impacted by distance-therapy or counseling to ensure compliance with Board regulations and standards of practice.

8. The following are some areas of practice that licensees should carefully consider:

a. Informed consent

b. Confidentiality

c. Basis for making clinical judgments

d. Areas of competence

e. Avoiding harm

f. Fees and financial arrangements

g. Advertising

h. Abandonment of clients

i. Handling requests for obtaining clinical records

9. The Board expects licensees to understand and overcome the significant challenges inherent in providing counseling and therapy without face-to-face contact with the client.

10. Some of the challenges that licensees are expected to manage include, but are not limited to:

a. Full disclosure with regard to potential risks to confidentiality, including computer hacking and/or archiving of communications.

b. Full disclosure of the limits to confidentiality in the jurisdictions where the client, and where the clinician are located.

c. Full disclosure of mandated reporting requirements in the jurisdictions where the client, and where the clinician are located.

d. Full disclosure with regard to the potential disadvantages or limitations of electronic-assisted clinical services.

e. Redirection and/or referral of clients for whom electronic services will not be adequate or appropriate.

f. Full disclosure with regard to fees and billing practices.

g. Full disclosure with regard to licensing, credentials and areas of expertise.

h. Screening and local referral for critical and urgent problems.

i. Verification of the identity and age of the client.

j. Obtaining consent to provide services by a guardian for minors or other vulnerable clients.

k. Management of any misunderstanding or compensation for any missing information, resulting from the lack of visual or auditory cues.

l. Managing the problem of incomplete or inaccurate diagnoses that may result from electronic-assisted services.

m. Managing the potential for technology failure

n. Procedures for contacting the clinician when he/she is offline

11. The Board expects that licensees providing any form of distance counseling will comply with all of the guidelines of ethical practice that apply to traditional, face-to-face counseling.

12. The Board expects that licensees will practice distance counseling in a manner that is consistent with any existing guidelines provided by their professional associations.

13. The Board expects that licensees providing any form of distance counseling will ensure that they are properly trained to manage the specific challenges of this form of counseling and will regularly participate in sufficient continuing education activities that maintain and update the required skills.

14. Unlicensed providers of electronic-assisted counseling will be treated by the Board in the same manner as providers of unlicensed counseling in traditional settings.

Authority:

M.G.L. Chapter 13, Section 90; and 262 CMR 8.00 et seq.

Michigan

Michigan

We are not aware of any specific rules and regulations of the practice of telemental health services.
Minnesota

Minnesota

We are not aware of any specific rules and regulations of the practice of telemental health services.
Mississippi

Mississippi

We are not aware of any specific rules and regulations of the practice of telemental health services.
Missouri

Missouri

We are not aware of any specific rules and regulations of the practice of telemental health services.
Montana

Montana

Psychologists

Board of Psychologists

Definition of professional relationship.

http://www.mtrules.org/gateway/RuleNo.asp?RN=24%2E189%2E301

Rule: 24.189.301    DEFINITIONS

(1) "Defined professional relationship" means a relationship in which a licensee or license applicant provides diagnostic, assessment and/or therapeutic services to a client. A defined professional relationship shall be initially established in a context where services are provided:

(a) in person and face-to-face; or

(b) transmitted via electronic or related methods. If provided under this subsection, the context must also be:

(i) two-way;

(ii) interactive;

(iii) real-time;

(iv) simultaneous;

(v) continuous; and

(vi) providing for both audio and visual interaction.

Nebraska

Nebraska

We are not aware of any specific rules and regulations of the practice of telemental health services.
Nevada

Nevada

Social workers

Bd. of Exam’rs for Social Workers’ regulations.

CHAPTER 641B - SOCIAL WORKERS

GENERAL PROVISIONS

https://www.leg.state.nv.us/NAC/NAC-641B.html

   NAC 641B.124  Practice by electronic, telephonic or other means. (NRS 641B.160)  The provision of social work services to a client within this State through any means, including, without limitation, electronic means or by telephone, regardless of the location of the social worker, constitutes the practice of social work and is subject to the provisions of chapter 641B of NRS and any regulations adopted pursuant to that chapter.

     (Added to NAC by Bd. of Exam’rs for Social Workers by R113-98, eff. 1-13-99)

New Hampshire

New Hampshire

We are not aware of any specific rules and regulations of the practice of telemental health services.
New Jersey

New Jersey

We are not aware of any specific rules and regulations of the practice of telemental health services.
New Mexico

New Mexico

Psychologists

Over a phone call to the board’s office, it was stated that as of now (2/7/17) since telehealth services are not mentioned in the scope of practice it is not allowed.

http://www.rld.state.nm.us/boards/default.aspx

Counseling, Marriage and Family Therapy, Art Therapy, Alcohol and Drug Abuse Counseling

Over a phone call to the board’s office, it was stated that as of now (2/7/17) since telehealth services are not mentioned in the scope of practice it is not allowed.

http://www.rld.state.nm.us/boards/default.aspx

Social Workers

TITLE 16             OCCUPATIONAL AND PROFESSIONAL LICENSING

CHAPTER 63     SOCIAL WORKERS

PART 16               CODE OF CONDUCT

http://164.64.110.239/nmac/parts/title16/16.063.0016.htm

16.63.16.8

(5)     Social workers who provide services via electronic media (such as computer, telephone, radio, and television) shall inform recipients of the limitations and risks associated with such services.

New York

New York

All Behavioral Health Professionals

From the Office of Professions:

http://www.op.nysed.gov/prof/psych/psychtelepracticealert.htm

Advisory Notice: The following advisory constitutes a general discussion of the issues that may arise when a licensee provides professional services. The discussion is intended to alert practitioners to questions and concerns that they may want to consider with their legal counsel, if necessary, and are not to be construed as a directive or other requirement to take any particular action. The Advisory cannot be used as the basis for a charge of professional misconduct. The statements are generally based upon statutory and regulatory provisions relating to the practice of psychology, social work, creative arts therapy, marriage and family therapy, mental health counseling, and psychoanalysis, but are not legal interpretations of any of these provisions. The citations to the provisions of law, regulation and Regents Rules are included to add clarity to the discussion.

Telepractice

Advisory Notice: The following advisory constitutes a general discussion of the issues that may arise when a licensee provides professional services. The discussion is intended to alert practitioners to questions and concerns that they may want to consider with their legal counsel, if necessary, and are not to be construed as a directive or other requirement to take any particular action. The Advisory cannot be used as the basis for a charge of professional misconduct. The statements are generally based upon statutory and regulatory provisions relating to the practice of psychology, social work, creative arts therapy, marriage and family therapy, mental health counseling, and psychoanalysis, but are not legal interpretations of any of these provisions. The citations to the provisions of law, regulation and Regents Rules are included to add clarity to the discussion.

What is Telepractice?

Telepractice includes the use of telecommunications and web-based applications to provide assessment, diagnosis, intervention, consultation, supervision, education and information across distance. It may include providing non-face-to-face psychological, mental health, marriage and family, creative arts, psychoanalytic, psychotherapy and social work services via technology such as telephone, e-mail, chat and videoconferencing.

Telecommunications and Electronic Medical Records (EMRs) may include computer files, documents, e-mails, interactive media sessions, CD’s, audio-tapes, video-tapes, fax images, phone messages and text messages.

Telepractice Issues

Telepractice issues of concern to practitioners include the therapeutic relationship, specifically, one’s ability to maintain an effective working relationship in spite of physical distance. Potential licensure and jurisdiction issues mean that practitioners should become familiar with and abide by competency and licensure requirements when practicing across state and national borders. In order to practice in a safe, legal, and confidential manner, it is important for licensed mental health professionals to understand the technology and potential limitations to confidentiality of both the software and hardware they are using. In order to ensure confidentiality, encryption and other technologies should be used whenever possible. Guidance regarding specific telepractice issues appears below.

To the extent it involves providing professional services in a jurisdiction other than the one in which the practitioner is physically located, telepractice raises the issue of the jurisdiction or jurisdictions in which the practitioner must be licensed. In New York State, a practitioner must hold a New York license, or be otherwise authorized to practice, when providing professional services to a patient located in New York or when the practitioner is located in New York.

EMRs: Same Responsibilities as any Other Medical Record

EMRs are subject to the same confidentiality and privilege as any other medical record. Privacy and security should be maintained and, to ensure this, encryption or password-restricted access may be necessary. It is necessary that EMRs can be reproduced if requested by patients or by court order and that fees charged for such reproduction are consistent with New York laws and regulations. Practitioners should also be aware that they are responsible for maintaining the confidentiality of the records of their patients and, therefore, must ensure that the billing or storage vendors engaged by them agree to follow all relevant privacy and security rules regarding medical records, and that the records will not be destroyed or released unless so directed by the licensee.

Cautions Regarding e-Data

One must remain cognizant of the fact that cell phones, e-mail, and text messages may not be secure modes of communication, specifically recognizing the question of who has access to the communication device and/or communication. Web-based applications vary in the level of security that is provided. In addition, digital storage devices (including computer hard drives) and fax and copy machines can retain images unless they are electronically wiped. Before disposing of a computer, it is the licensed professional’s responsibility to ensure that all patient information is securely deleted. It is strongly recommended that once the memory is cleared of patient information, the device should be destroyed in a secure manner. It is important that patients are informed that there are risks to electronic communication. In addition, one should have a contingency plan in the event that telecommunications fail (i.e., another way to contact patient). Finally, one must be aware that there is always a potential for an individual to misrepresent his/her name, presenting problem or other information when engaging in electronic communications and the licensee bears responsibility for assuring the identity of the client.

Social Media Telecommunications

Social Media has great potential as a public education tool that can be used to reach a wide audience with information about mental health. One should, however, remain aware that a professional web presence must be consistent with laws and regulations related to advertising and engaging in professional relationships. A personal web presence can potentially involve issues of boundary violations and should not allow client access.

Example: Friend requests on social media sites should be confined to friends and colleagues, while not accepting such requests from clients or potential clients.

An individual licensed under Title VIII of the Education Law may be charged with unprofessional conduct under section 29.1 of the Rules of the Board of Regents for advertising that is not in the public interest if he/she engages in advertising on web-postings that are fraudulent, false, deceptive or misleading, to the same extent as advertising in more traditional media.

While a licensed professional cannot be responsible for the client’s social media interactions, when appropriate, the licensee should provide information to patients or discuss with them some of the pitfalls of social media as it may relate to the receipt of professional services. Due to the persistent stigma about mental illness and treatment, the licensed professional may want to point out to the client that certain activities may provide more information than the client is comfortable with sharing in the social media community, such as:

  • posting a status update of "waiting in Dr. Smith’s office for my weekly psychotherapy session" or
  • allowing the GPS device in his/her smart-phone, tablet or computer to identify his/her location as the office of "Dr. Jones, Psychotherapist."

The licensee may be wise to consider including similar examples as a cautionary note to be discussed as part of the informed consent process, to avoid unfortunate, accidental disclosures of information.

Videoconferencing

Videoconferencing includes varied points of delivery, including hospitals/ER’s, Community Mental Health Centers (CMHCs), doctors’ offices, institutional settings (e.g., nursing homes, prisons, schools), and clients’ homes

Clinical applications of videoconferencing include clinical interviews for intake and diagnosis, consultation with other providers including the referring provider and with family members, emergency pre- and post-hospitalization evaluations, outpatient psychotherapy (scheduled and crisis), medication management or consultation, and professional consultation.

Videoconferencing may include supervision and consultation. A licensed professional who is consulting with other health professionals or, if allowed by State law and regulation, receiving supervision through video technology, should exercise caution in these interactions, in order to ensure the confidentiality of patient information. A licensed professional remains responsible for the security of patient communications and information to the same extent as if the session or consultation were occurring with all parties in the practitioner’s office. Prior to using any videoconferencing technology, the licensed professional should verify the encryption and security of data to protect the confidentiality of patient information.

Potential benefits of videoconferencing may include that it:

  • can reduce costs to both client and practitioner,
  • can reach individuals who might not otherwise have access to treatment,
  • has overall empirical support for outcomes similar to traditional psychotherapies, and
  • clients report positive experiences with videoconferencing.

Concerns regarding videoconferencing include whether practitioners are:

  • ensuring that clients are able to adequately participate and understand the appropriate uses of videoconferencing (Informed Consent);
  • whether videoconferencing technologies that are used are secure;
  • whether the empirical validation of this methodology is sufficient; and
  • whether individual states require that practitioners are qualified and licensed to practice within that state.

If using telecommunications, it is recommended that patients are informed there are risks to electronic communications. Clinicians should also have a contingency plan for telecommunications failures (e.g., a back-up way of contacting the patient). Patients should be informed as to how they can verify the clinician’s professional license (the license status of all New York licensees can be ascertained here), and clinicians should be aware of the potential for patient misrepresentation.

Avatars & Virtual Environments (VE)

Avatars and virtual environments (VE) are increasingly being researched for clinical application possibilities. Applications being investigated include treatment of depression, eating disorders, social anxiety and other phobias, autism spectrum disorders, PTSD and schizophrenia.

Avatars are used to create a virtual representation of the client, the practitioner (agent) or both; however, it may be unclear whether the "agent" is an actual trained clinician or a computer programmer. Professional services must be rendered only by those authorized to do so. VEs are used to create planned and controlled environments that allow the client to be exposed to a situation or to explore an environment that relates to the issues of focus.

The potential benefits of avatars and VEs include some empirical support for the effectiveness of these techniques, reduction of costs to both client and practitioner, and greater accessibility to environments for exposure therapies.

Concerns regarding avatars and VEs include determining who the virtual therapeutic agents are, ensuring that they are authorized to provide professional services, ; defining the roles and training of virtual therapeutic agents; and determining whether these techniques are safe and effective, whether the technologies used are secure, and whether each client knows how to exit the program if under duress (e.g., during an immersion).

Effective & Legal Telepractice

Telepractice should be considered a modality and applied only as appropriate to address the client’s needs. In order to engage in telepractice in an effective, safe and legal manner, licensed mental health professionals should:

  • Develop procedures for and obtain informed consent prior to providing remote services.
  • Ensure that informed consent includes both benefits and risks.
  • Conduct an initial assessment of each client to determine whether the telepractice modality is appropriate, given the client’s treatment needs. If not, determine available alternatives and consider referrals.
  • Learn relevant telepractice laws across all jurisdictions in which they will be providing online services before such services are provided.
  • Not practice outside the scope of their license and training.
  • Attend to issues of danger to self or others in duty to warn and protect situations, and to mandated reporting requirements in accordance with law.
  • Make arrangements, as appropriate, in the consumer’s local area to address emergency and crisis situations that may arise, and be knowledgeable of community resources that may be accessed in such situations.
  • Ensure the accuracy of advertising and public statements about telephone and online services offered without making statements that imply a level of treatment or effectiveness that is beyond what is actually provided.
  • Remain aware of the limitations of the online services provided and the technology used to offer these services.
  • Evaluate online services offered to ensure their effectiveness and to modify them, as needed, on the basis of outcome data to most effectively meet client needs.
  • Stay within one’s scope of practice and limits of competence. As with all emerging areas of practice, one should use caution to ensure competence of the practitioner and the protection of clients.
  • Attend to cultural, ethnic, language and other differences that may impact on their ability to effectively communicate with and treat clients.
  • Employ professional standards of practice that include adequate documentation and record keeping, adherence to termination and abandonment guidelines, and appropriate practices for fees and financial arrangements.
  • Verify the client’s state of residence prior to providing telepractice services, as this may dictate those states in which a practitioner must be licensed.
  • Possess the technological competence and clinical competence necessary to provide services via the online modality offered.
  • Consult knowledgeable colleagues, relevant statutes, applicable ethical codes and available professional standards when unsure of any of the above.
  • Consult with an attorney specifically experienced in these matters when legal questions arise.

From the Office of Professions practice guidelines.

Guideline: Engaging in Telepractice

http://www.op.nysed.gov/prof/psych/psychtelepracticeguide.htm

"Telepractice" is providing service that is not "in person" and is facilitated through the use of technology. Such technology may include, but is not limited to, telephone, telefax, e-mail, internet, or videoconference. It is considered a mode of practice and the same standards that apply to all forms of practice in psychology would apply to telepractice.

Practice as a licensed professional in New York State, even through telepractice, requires the practitioner to be licensed or otherwise authorized to practice in New York. Telepractice, when used as a form of mental health practice, is subject to all practice and ethical considerations discussed in this document and in the law, rules and regulations governing licensed practice in New York State. If you are licensed in New York State and wish to provide services in another jurisdiction, you should determine the qualifications for practice and any requirements for licensure imposed by that jurisdiction.

You should consider the particular impact of telepractice on dimensions of mental health practice, including, but not limited to:

awareness and assessment of non-verbal behavior by the patient;

ensuring the privacy of patients and protection of confidential information through the transmission of information;

relational and transferential issues;

access issues such as distribution of computers and familiarity with technology;

temporal factors such as simultaneous communication, time between responses, and formalized "sessions";

provisions for emergencies; and

development of technological proficiencies and on-line culture/language.

Last Updated: March 14, 2011

North Carolina

North Carolina

Counseling:

North Carolina Board of Licensed Professional Counselors

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

http://www.ncblpc.org/

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-toface 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, 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

Marriage and Family Therapy:

Take from North Carolina Marriage and Family Therapy Licensing Board http://www.nclmft.org/position_statements

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 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.

Social Work:

Take from North Carolina Social Work Certification and Licensure Board http://www.ncswboard.org/page/helpful-links

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.

Psychology:

Take from North Carolina Psychology Board http://www.ncpsychologyboard.org/office/ElectronicServices.htm

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).

North Dakota

North Dakota

Psychologists

http://ndsbpe.org/uploads/3/4/2/2/34222756/faq_telepsychology_4-14-15.pdf

ND STATE BOARD OF PSYCHOLOGIST EXAMINERS 1

BOARD STATEMENT ON TELEPSYCHOLOGY IN NORTH DAKOTA

 The use of technology to provide psychological services via remote means, sometimes known as

telepsychology, is a bourgeoning part of our profession. While telepsychology can increase efficiencies and make mental health services more accessible, it is not without its own complexities. For example, psychologists practicing telepsychology must adhere not only to guidelines related to the utilization of new methods in the delivery of services  APA/ASPPB/APAIT Joint Telepsychology Guidelines), but must also follow the laws of multiple jurisdictions as those laws apply to their practice of telepsychology. This

statement is meant to briefly orient psychologists to some of the issues they may encounter related to telepsychological practice.

 First, there is no special licensure status or credential within North Dakota for the practice of

telepsychology. As a result, a psychologist licensed in North Dakota may be permitted to provide

telepsychology services to recipients located either inside or outside North Dakota. When doing so, the psychologist must comply with the laws and regulations of a) North Dakota, including NDCC 43-32 and 43-51, b) the jurisdiction in which the psychologist is located, and c) the jurisdiction in which the recipient is located. The psychologist should specifically be aware of whether each jurisdiction permits telepsychology and how they regulate it.

 A psychologist licensed in another jurisdiction, but who is not licensed in North Dakota may also be permitted to provide telepsychology services in North Dakota. If the psychologist or the recipient is located in North Dakota, the psychologist must comply with North Dakota laws, including NDCC 43-32 and 43-51.

These laws require, in part, that the services of the psychologist be within the scope of practice and title of the license of psychologist. In situations where the recipient is located in North Dakota, the law also requires that the services be a continuation of a professional relationship with the recipient that was formed first in the jurisdiction which the provider is licensed, as long as the foreign jurisdiction permits remote practice. This psychologist must also comply with the laws of the jurisdictions where a) the psychologist is licensed, b) the psychologist is located, and c) the recipient is located. This psychologist should specifically be aware of whether each jurisdiction permits telepsychology and how they regulate it.

A psychologist’s failure to follow the laws of any of the jurisdictions in which they are licensed or located, or where the recipient of their services is located, may result in discipline of the psychologist by all of the relevant jurisdictions. Psychologists are strongly encouraged to regularly review the applicable laws to ensure their practices, including their provision of telepsychology, are compliant.

Permutations:

ND Licensed Psychologist/Applied Behavior Analyst providing telepsychology services:

1. Psychologist/BA in ND; Recipient in ND

a. A licensee located in ND may provide remote services to individuals in ND within

their competence of the scope of practice and title of the license. Licensees doing so

should be aware of regulations related to this practice, including (but not limited to):

NDCC 43-32 and 43-51. There is no special licensure status or credential within ND

for telepractice.

2. Psychologist/BA in ND; Recipient out of ND

a. A licensee located in ND may provide remote services to individuals in another

jurisdiction if such a practice is authorized in that jurisdiction. However, if such

practice would be illegal, or the licensee violates a law of that other jurisdiction, or of

ND, they would be subject to disciplinary action in ND (and likely the other

jurisdiction). Licensees doing so should be aware of regulations related to this

practice, including (but not limited to): NDCC 43-32 and 43-51.There is no special

licensure status or credential within ND for telepractice.

3. Psychologist/BA out of ND; Recipient in ND

a. AND licensee traveling in another state at the time of providing remote services to

individuals located in ND, must additionally ensure compliance with the laws of the

jurisdiction in which they are located at the time of practice (see number 2).

4. Psychologist/BA out of ND; Recipient out of ND

a. A ND licensee traveling in another state at the time of providing remote services to

individuals located outside ND, the licensee must additionally ensure compliance with

ND STATE BOARD OF PSYCHOLOGIST EXAMINERS 2

the laws of the jurisdiction in which they are located at the time of service as well as

the jurisdiction that the recipient is located at the time of services.

Non-ND Psychologist/BA providing telepsychology services INTO ND:

1. Non-ND Psychologist/BA in licensed state; recipient in ND

a. A non-ND licensed provider may provide remote services to individuals within ND

within their competence and scope of practice and title of the license of psychologist,

as long as this is a continuation of a professional relationship with the

recipient that was formed first in the jurisdiction which the provider is licensed

and as long as the foreign jurisdiction permits remote practice. Foreign

licensees doing so should be aware of regulations related to this practice, including

(but not limited to): NDCC 43-32 and 43-51.

2. Non-ND Psychologist/BA in ND; recipient in ND

a. A non-ND licensed provider may NOT provide remote services to individuals in ND if

they are located in ND at the time of services, as they would not be licensed to

practice within this jurisdiction. Foreign licensees doing so should be aware that any

person who violates any of the provision of NDCC 43-32 is guilty of a class B

misdemeanor, and civil remedies may also apply.

3. Non-ND Psychologist/BA in state not licensed in; recipient in ND

a. A non-ND licensed provider may not initiate services from a jurisdiction in which they

are not licensed and provide these services to a recipient in ND. Foreign licensees

doing so should be aware that any person who violates any of the provision of NDCC

43-32 is guilty of a class B misdemeanor, and civil remedies may also apply.

Final draft edits by MAL 10/17/2014

Social Workers

From the Code of Ethics.

http://www.legis.nd.gov/information/acdata/pdf/75.5-02-06.1.pdf

CHAPTER 75.5-02-06.1

CODE OF ETHICS

3.e.  Social workers who provide services via electronic media such as computer, telephone,

radio, and television shall inform recipients of the limitations and risks associated with

such services.

Ohio

Ohio

Psychologists

Ohio State Board of Psychology

Chapter 4732-17 Rules of Professional Conduct

http://codes.ohio.gov/oac/4732-17

(I) Telepsychology.

(1) "Telepsychology" means the practice of psychology or school psychology as those terms are defined in divisions (B) and (E) of section 4732.01 of the Revised Code, including psychological and school psychological supervision, by distance communication technology such as but not necessarily limited to telephone, email, Internet-based communications, and videoconferencing.

(2) In order to practice telepsychology in the state of Ohio one must hold a current, valid license issued by the Ohio board of psychology or shall be a registered supervisee of a licensee being delegated telepsychology practices in compliance with paragraphs (B) and (C) of rule 4732-13-04 of the Administrative Code.

(3) License holders understand that this rule does not provide licensees with authority to practice telepsychology in service to clients domiciled in any jurisdiction other than Ohio, and licensees bear responsibility for complying with laws, rules, and/or policies for the practice of telepsychology set forth by other jurisdictional boards of psychology.

(4) License holders practicing telepsychology shall comply with all of these rules of professional conduct and with requirements incurred in state and federal statutes relevant to the practice of psychology and school psychology.

(5) License holders shall establish and maintain current competence in the professional practice of telepsychology through continuing education, consultation, or other procedures, in conformance with prevailing standards of scientific and professional knowledge. License holders shall establish and maintain competence in the appropriate use of the information technologies utilized in the practice of telepsychology.

(6) License holders recognize that telepsychology is not appropriate for all psychological problems and clients, and decisions regarding the appropriate use of telepsychology are made on a case-by-case basis. License holders practicing telepsychology are aware of additional risks incurred when practicing psychology or school psychology through the use of distance communication technologies and take special care to conduct their professional practice in a manner that protects the welfare of the client and ensures that the client's welfare is paramount. License holders practicing telepsychology shall:

(a) Conduct a risk-benefit analysis and document findings specific to:

(i) Whether the client's presenting problems and apparent condition are consistent with the use of telepsychology to the client's benefit; and

(ii) Whether the client has sufficient knowledge and skills in the use of the technology involved in rendering the service or can use a personal aid or assistive device to benefit from the service.

(b) Not provide telepsychology services to any person or persons when the outcome of the analysis required in paragraphs (I)(6)(a)(i) and (I)(a)(ii) of this rule is inconsistent with the delivery of telepsychology services, whether related to clinical or technological issues.

(c) Upon initial and subsequent contacts with the client, make reasonable efforts to verify the identity of the client;

(d) Obtain alternative means of contacting the client;

(e) Provide to the client alternative means of contacting the licensee;

(f) Establish a written agreement relative to the client's access to face-to-face emergency services in the client's geographical area, in instances such as, but not necessarily limited to, the client experiencing a suicidal or homicidal crisis;

(g) Licensees, whenever feasible, use secure communications with clients, such as encrypted text messages via email or secure websites and obtain and document consent for the use of non-secure communications.

(h) Prior to providing telepsychology services, obtain the written informed consent of the client, in language that is likely to be understood and consistent with accepted professional and legal requirements, relative to:

(i) The limitations and innovative nature of using distance technology in the provision of psychological or school psychological services;

(ii) Potential risks to confidentiality of information due to the use of distance technology;

(iii) Potential risks of sudden and unpredictable disruption of telepsychology services and how an alternative means of re-establishing electronic or other connection will be used under such circumstances;

(iv) When and how the licensee will respond to routine electronic messages;

(v) Under what circumstances the licensee and service recipient will use alternative means of communications under emergency circumstances;

(vi) Who else may have access to communications between the client and the licensee;

(vii) Specific methods for ensuring that a client's electronic communications are directed only to the licensee or supervisee;

(viii) How the licensee stores electronic communications exchanged with the client;

(7) Ensure that confidential communications stored electronically cannot be recovered and/or accessed by unauthorized persons when the licensee disposes of electronic equipment and data;

(8) If in the context of a face-to-face professional relationship the following are exempt from this rule:

(a) Electronic communication used specific to appointment scheduling, billing, and/or the establishment of benefits and eligibility for services; and,

(b) Telephone or other electronic communications made for the purpose of ensuring client welfare in accord with reasonable professional judgment.

Counselors, Social Workers, and Marriage and Family Therapists

Ohio Counselor, Social Worker, and Marriage and Family Therapist Board

4757-5-13 Standards of practice and professional conduct: electronic service delivery (internet, email, teleconference, etc.).

http://codes.ohio.gov/oac/4757-5-13

Electronic service delivery is defined in paragraph (EE) of rule 4757-3-01 of the Administrative Code. Licensees are reminded that standards of ethical practice and professional conduct rules 4757-5-01 to 4757-5-12 of the Administrative Code apply to electronic service delivery.

(A) These standards govern the practice of electronic service delivery and address practices that are unique to electronic service delivery and electronic service delivery practitioners.

(1) All practitioners providing counseling, social work or marriage and family therapy via electronic service delivery to persons physically present in Ohio shall be licensed in Ohio.

(2) All licensees of this board providing services to clients outside the state of Ohio shall comply with the laws and rules of that jurisdiction.

(3) Electronic service delivery shall require an initial face-to-face meeting, which may be via video/audio electronically, to verify the identity of the electronic service delivery client. At that meeting steps shall be taken to address impostor concerns, such as by using passwords to identify the client in future electronic contacts.

(4) Informed consent shall include information defining electronic service delivery as practiced by the licensee and the potential risks and ethical considerations per paragraph (B) of rule 4757-5-02 of the Administrative Code.

(a) Licensees shall obtain written informed consent.

(b) Licensees shall not provide services without client signed informed consent.

(5) Licensees shall provide links to websites for all of their certification bodies and licensure boards to facilitate consumer protection.

(6) Licensees shall identify an appropriately trained professional who can provide local assistance, including crisis intervention, if needed. Licensees shall provide electronic service delivery clients the local crisis hotline telephone number and the local emergency mental health telephone number.

(7) Licensees shall provide a link to the board's online license verification site on their web page.

(B) Confidentiality in electronic service delivery shall be maintained by the licensee:

(1) Licensees shall use encryption methods for electronic service delivery , except for treatment reminders, scheduling contacts or other information provided outside of a therapeutic context; and

(2) Shall inform electronic service delivery clients details of data record storage.

Effective: 7/1/2016

Five Year Review (FYR) Dates: 09/20/2017

Promulgated Under: 119.03

Statutory Authority: 4757.11

Rule Amplifies: 4757.11

Prior Effective Dates: 10/18/09

Oklahoma

Oklahoma

We are not aware of any specific rules and regulations of the practice of telemental health services.
Oregon

Oregon

Counselors and Marriage and Family Therapists

Administrative Rules.

http://arcweb.sos.state.or.us/pages/rules/oars_800/oar_833/833_090.html

BOARD OF LICENSED PROFESSIONAL COUNSELORS AND THERAPISTS

DIVISION 90

DISTANCE COUNSELING

833-090-0010

Technology-Assisted Services

(1) When providing technology-assisted distance counseling services, licensees must:

(a) Use secure web sites and e-mail communications to help ensure confidentiality;

(b) Determine that technology-assisted services are appropriate, available, and meets the needs of the particular client; and

(c) Have a working knowledge of the particular technology used to meet the needs of clients.

(d) Conduct due diligence in confirming the identity of potential clients.

(2) When the use of encryption is not possible, limit electronic transmissions to general communications that are not client specific.

Stat. Auth.: ORS 675.785 - 675.835 & 676.160 - 676.180

Stats. Implemented: ORS 675.785 - 675.835

Hist.: BLPCT 1-2010, f. & cert. ef. 1-5-10

833-090-0020

Inappropriate Services

When technology-assisted distance counseling services are deemed inappropriate for any reason by the counselor or client, counselors must ensure that a professional and clinically sound referral is made to counseling resources in the client’s geographic area.

Stat. Auth.: ORS 675.785 - 675.835 & 676.160 - 676.180

Stats. Implemented: ORS 675.785 - 675.835

Hist.: BLPCT 1-2010, f. & cert. ef. 1-5-10

833-090-0030

Laws and Statutes

Licensees providing Distance Services must ensure that the use of technology is consistent with the Board’s laws and rules.

Stat. Auth.: ORS 675.785 - 675.835 & 676.160 - 676.180

Stats. Implemented: ORS 675.785 - 675.835

Hist.: BLPCT 1-2010, f. & cert. ef. 1-5-10

833-090-0040

Technology and Informed Consent

(1) Licensees must give all potential clients access to the licensee’s Professional Disclosure Statement (PDS) prior to service delivery with a means of confirming receipt and acknowledgement of the PDS.

(2) Licensees must inform clients of the benefits and limitations of distance service delivery, including:

(a) Issues related to the difficulty of maintaining the confidentiality of electronically transmitted communications;

(b) Names of colleagues, supervisors, and employees, such as Informational Technology (IT) administrators, who may have authorized or unauthorized access to electronic transmissions;

(c) The risks of all authorized or unauthorized people who have access to any technology clients may use in the counseling process. This includes family members, friends, acquaintances, and fellow employees;

(d) Limitations governing the practice of the LPC or LMFT profession in the State of Oregon, including that the laws and statutes regarding the practice of professional counseling and marriage and family therapy differ from state-to-state;

(e) Contact information and alternate methods of contact in case of technology failure; and

(f) Emergency procedures for situations when the counselor is not available.

Stat. Auth.: ORS 675.785 - 675.835 & 676.160 - 676.180

Stats. Implemented: ORS 675.785 - 675.835

Hist.: BLPCT 1-2010, f. & cert. ef. 1-5-10

Pennsylvania

Pennsylvania

We are not aware of any specific rules and regulations of the practice of telemental health services.
Rhode Island

Rhode Island

We are not aware of any specific rules and regulations of the practice of telemental health services.
South Carolina

South Carolina

PROFESSIONAL COUNSELORS, MARRIAGE AND FAMILY THERAPISTS, AND PSYCHO-EDUCATIONAL SPECIALISTS 

Board of Examiners for Licensure of Professional Counselors, Marriage and
Family Therapists, and Psycho-Educational Specialists 

Provision of Services via Electronic, Distance Professional Services

http://www.llr.state.sc.us/POL/Counselors/PDFS/Provision_of_Services_via_Electronic_Distance_Prof_Services.pdf


Effective Date: November 17, 2015
In response to inquiries from licensees, supervisors and other interested parties, the SC
Licensure 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, is receiving supervision as is appropriate, and the medium for
doing so is not an issue. However, it is incumbent upon any licensed counselor, therapist or
psycho-educational specialist to recognize that as he or she moves away from direct face to
face contact with clients, there are losses to the processes and interactions.
The Board considers that the practice of counseling, marriage and family therapy occurs both
where the therapist who is providing therapeutic services is located and where the individuals
(patients/clients) who are receiving services are located. In order for an individual to provide
counseling and therapy services in South Carolina, that individual must be licensed by the South
Carolina Board for Counselors, Marriage and Family Therapists and Psycho-educational
Specialist. On this basis, if an individual licensed in South Carolina renders services
electronically to an out-of-state client, it is recommended that the licensee contact the
licensure board for counselors, marriage and family therapist or psycho-educational specialist
in the state in which the clients resides to determine whether or not such practices are
permitted in that jurisdiction. Licensees are advised to review the South Carolina Licensure Law
and the Code of Ethics.
Delivery of clinical services via technology assisted media such as telephones, use of video, or
the internet requires the therapist to be sensitive to various issues. These areas include:
confidentiality, acquiring required signatures on intake forms (consent to treat, release of
information, professional disclosure forms, consent to treat minors, consent to tape, etc.).
Other issues include: confidentiality, 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 therapist/counselor when he
or she is off-line, discussing the possibility of technology failure and alternate means of
communication if technology occurs. It is important for counselors and therapists to use
encrypted technology as required by HIPPA. Clients should be informed of the encryption
methods used to help ensure the security of communications. Also, counselors and therapists
should inform clients as to whether session data is being preserved and if so, for 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.
Last of all, it is important that when providing services through electronic methods, the
counselor and therapist be knowledgeable regarding emergency services available in the
communities where their clients live.CHAPTER 36.

DEPARTMENT OF LABOR, LICENSING AND REGULATION-- BOARD OF EXAMINERS FOR THE LICENSURE OF PROFESSIONAL COUNSELORS, MARRIAGE AND FAMILY THERAPISTS, AND PSYCHO-EDUCATIONAL SPECIALISTS
Code of Ethics for Professional Counselors: Chapter 36-19, Article 7, (B) Counseling Relationship, 12, 13, 14.
http://www.llr.state.sc.us/POL/Counselors/index.asp?file=laws.htm

(12) Professional Counselors who employ electronic means in which the counselor and client are not in immediate proximity must present clients with local sources of care before establishing a continued short or long-term relationship. 

(13) Professional Counselors shall obtain legal authorization to practice in any jurisdiction in which they maintain an electronic presence via the internet or other
electronic means.

(14) Professional Counselors shall ensure that clients are intellectually, emotionally, and physically compatible with computer applications used by the counselor and understand
their purpose and operation.

South Dakota

South Dakota

Counselors are to follow ACA’s Code of Ethics.

Marriage and Family Therapists are to follow AAMFT’s Code of Ethics.

Tennessee

Tennessee

Tennessee Board For Professional Counselors, Marital And Family Therapists, And Clinical Pastoral Therapists

0450-02-.13 PROFESSIONAL ETHICS. The AAMFT code of ethics shall govern the conduct of marital and family therapists registered with the board.

http://share.tn.gov/sos/rules/0450/0450-02.20151210.pdf

In addition to the other requirements of this rule, all licensees and certificate holders who

practice marital and family therapy electronically shall comply with the Online Ethical

Advisory Opinions adopted by the AAMFT, www.aamft.org, except to the extent that they

conflict with the laws of the state of Tennessee or the rules of the Board. If the standards for

the ethical practice of marital and family therapy over the Internet conflict with state law or

rules, the state law or rules govern the matter. Violation of the standards for the ethical

practice of marital and family therapy over the Internet or state law or rules may subject a

licensee or certificate holder to disciplinary action.

AAMFT Code of Ethics

http://www.aamft.org/iMIS15/AAMFT/Content/Legal_Ethics/Code_of_Ethics.aspx

STANDARD VI

TECHNOLOGY-ASSISTED PROFESSIONAL SERVICES

Therapy, supervision, and other professional services engaged in by marriage and family therapists take place over an increasing number of technological platforms.  There are great benefits and responsibilities inherent in both the traditional therapeutic and supervision contexts, as well as in the utilization of technologically-assisted professional services. This standard addresses basic ethical requirements of offering therapy, supervision, and related professional services using electronic means.

6.1 Technology Assisted Services.

Prior to commencing therapy or supervision services through electronic means (including but not limited to phone and Internet), marriage and family therapists ensure that they are compliant with all relevant laws for the delivery of such services.  Additionally, marriage and family therapists must: (a) determine that technologically-assisted services or supervision are appropriate for clients or supervisees, considering professional, intellectual, emotional, and physical needs; (b) inform clients or supervisees of the potential risks and benefits associated with technologically-assisted services; (c) ensure the security of their communication medium; and (d) only commence electronic therapy or supervision after appropriate education, training, or supervised experience using the relevant technology.

6.2 Consent to Treat or Supervise.

Clients and supervisees, whether contracting for services as individuals, dyads, families, or groups, must be made aware of the risks and responsibilities associated with technology-assisted services.  Therapists are to advise clients and supervisees in writing of these risks, and of both the therapist’s and clients’/supervisees' responsibilities for minimizing such risks.

6.3 Confidentiality and Professional Responsibilities.

It is the therapist’s or supervisor’s responsibility to choose technological platforms that adhere to standards of best practices related to confidentiality and quality of services, and that meet applicable laws. Clients and supervisees are to be made aware in writing of the limitations and protections offered by the therapist’s or supervisor’s technology.

6.4 Technology and Documentation.

Therapists and supervisors are to ensure that all documentation containing identifying or otherwise sensitive information which is electronically stored and/or transferred is done using technology that adhere to standards of best practices related to confidentiality and quality of services, and that meet applicable laws.  Clients and supervisees are to be made aware in writing of the limitations and protections offered by the therapist’s or supervisor’s technology.

6.5 Location of Services and Practice.

Therapists and supervisors follow all applicable laws regarding location of practice and services, and do not use technologically-assisted means for practicing outside of their allowed jurisdictions. 

6.6 Training and Use of Current Technology.

Marriage and family therapists ensure that they are well trained and competent in the use of all chosen technology-assisted professional services.  Careful choices of audio, video, and other options are made in order to optimize quality and security of services, and to adhere to standards of best practices for technology-assisted services.  Furthermore, such choices of technology are to be suitably advanced and current so as to best serve the professional needs of clients and supervisees.

Texas

Texas

Psychologists

Texas State Board of Examiners of Psychologists

Telepractice Policy Statement

http://www.tsbep.texas.gov/files/newsletters/1999Fall.pdf

Vol 12 No.2

December 1999

• Telepractice Policy Statement

• Policy on Licensees Working in Exempt Facilities

• No Duty to Warn: Says Texas Supreme Court

Telepractice Policy Statement

The delivery of psychological services by telephone, teleconferencing, and the Internet is a

rapidly evolving area. Board rules do not specifically address telepractice, teletherapy,

teleconferencing, or electronically providing services. No rules currently prohibit such services.

However, it is important for psychologists to be aware of a number of concerns about

telecommunication-based service delivery including the following:

1. The increased potential that a therapist will have limited knowledge of a distant community’s

resources in times of crisis.

2. Problems associated with obtaining informed consent.

3. The lack of standards for training providers in the use of technology as well as the special

therapeutic considerations in the use of the medium.

4. The lack of vocal, visual, and other sensory cues.

5. The potential that equipment failures may lead to undue patient anxiety particularly in crisis

situations.

6. The potential inability of patients in crisis or those unfamiliar with technology to adequately

access and use the technology.

7. The lack of full disclosure of provider credentials.

8. The lack of definition of professional relationships.

9. The lack of confidentiality and privacy.

All of these issues are actively being explored, discussed, and debated at both state and national

levels. It is important to remember that the

Psychologists’ Licensing Act and all other laws affecting the delivery of psychological services

apply to all psychological services delivered anywhere within the state of Texas, regardless of

whether or not they are provided via electronic media.

Complaints received by the Board regarding psychological services delivered through electronic

media, including telephone, teleconferencing, electronic mail and Internet, will be evaluated by

the Board on a case-by-case basis. However, the following general principles apply.

An individual who is physically located in another state shall be considered to be practicing

psychology in Texas and, therefore, subject to the Act, if a recipient of psychological services provided by the individual is physically located in the state of Texas. Licensees should also be aware that services they offer to consumers in other states may similarly be regulated by the laws of the state in which the consumers are located.

The Board currently considers the use of non-traditional media to deliver psychological services,

including telephone, teleconferencing, e-mail, and the Internet, as “emerging areas” as set forth

in Board rule 465.9(e), Competency. That rule states: “in those emerging areas in which generally recognized standards for preparatory training do not exist, psychologists nevertheless take reasonable steps to ensure the competence of their work and to protect patients, clients, students, research participants, and other affected individuals from the potential for harm.” Board rule 465.9(d) requires that licensees who provide services in new areas or involving new techniques do so only after undertaking appropriate study, training, supervision, and/or consultation from persons who are competent in those areas or techniques.

Other Board rules that licensees should also consider include:

465.1. Definitions

465.6. Listings and Advertisements

465.8. Psychological Services Are Provided within a Defined Relationship

465.10. Basis for Scientific and Professional Judgments

465.11. Informed Consent/Describing

Psychological Services

465.12. Privacy and Confidentiality

465.15. Fees and Financial Arrangements

465.16. Evaluation, Assessment, Testing, and Reports

465.17. Therapy and Counseling

465.36. Code of Ethics.

Other rules may also apply depending on the type of services involved.

It is important for licensees considering such services to review the characteristics of the

services, the service delivery method, and the provisions for confidentiality to ensure compliance

with the rules of the Board and the acceptable standards of practice

Policy on Licensees Working in Exempt Facilities

In compliance with Section 501.004 of the Act, persons who are licensed with this Board and

who work in exempt settings are exempt from the Act if their “activities and services” are a part

of the duties of their positions with the exempt agencies.

Section 501.004 states that persons who are employed in exempt facilities as psychologists or

psychological associates are not required to be licensed with this Board. However, this section

does require that persons who are employed by an exempt agency and who provide services to

the public for added compensation above their salary from the exempt agency have to be

licensed with the Board.

Therefore, any “activities and services” regarding the practice of psychology and licensure with

this Board outside the context of the exempt setting are subject to the requirements of the Act

and the rules and to the discipline of the Board. For example, a licensee may work part-time in

an exempt facility and part-time in private practice. The private practice would be subject to all

the rules regarding supervision, record keeping, confidentiality, etc. However, the work in the

exempt facility would be exempt from such rules of the Board.

Since activities such as renewal, payment of fees, submission of mandatory continuing

education, etc. are not considered “activities and services” performed in the context of an exempt

setting, the licensee would have to adhere to these provisions of the Act and rules to keep the

license in good standing.

Complaints received by the Board concerning the “activities and services” of a licensee in an

exempt setting are referred to the appropriate exempt agency so that the matter can be resolved in

the most expedient and proper manner. Complaints pertaining to the “activities and services”

occurring outside of the exempt setting by a licensee who is employed by an exempt agency will

be investigated and resolved by the Board.

No Duty to Warn: Says Texas Supreme Court

On June 24, 1999, the Supreme Court of Texas delivered its opinion concerning mental health professionals’ duty to warn third parties as to specific threats of harm made by a patient of the professional. In Thapar v. Zezulka, a psychiatrist had been treating a patient for approximately three years for post-traumatic stress disorder, alcohol abuse, and various delusional beliefs about his stepfather. After being admitted to the hospital, the patient stated to his psychiatrist that he  had felt like killing his stepfather. A few weeks after being released from the hospital, the patient did, in fact, shoot and kill his stepfather.

The specific issue before the court was whether or not the psychiatrist was negligent in failing to

disclose the patient’s threats to the family or to law enforcement officials. Chapter 611 of the

Texas Health and Safety Code provides that mental health information is confidential and

permits disclosure of mental health information only in limited circumstances.

Section 611.004 lists these exceptions and specifically states in 611.004(a)(2) that,

(a) A professional may disclose confidential information only:

(2) to medical or law enforcement personnel if the professional determines that there is a

probability of imminent physical injury by the patient to the patient or others or there is a

probability of immediate mental or emotional injury to the patient.” Texas Health and Safety

Code Ann. 611.004(a)(2).

Because Section 611.004 does not provide an exception for disclosure to third parties threatened

by the patient (such as the potential victim or their family members), the court concluded that the

psychiatrist could not have legally warned the patient’s stepfather or his family without violating

the confidentiality statute. As such, the doctor in Thapar was prohibited from warning the

patient’s family members as to the threat and, therefore, had no duty to warn potential third party

victims as a result.

However, Section 611.004 does allow disclosure of serious threats to medical or law

enforcement personnel. Nevertheless, the court determined that this disclosure was permissive on

the part of the professional rather than mandatory. Consequently, a mental health professional

has no legal duty to warn a third party of a patient’s threat but may contact the appropriate

officials in the event that the professional has determined that there is a probability of imminent

injury by the patient to himself or others, or mental or emotional injury to the patient.

The current law will not penalize a mental health professional for failing to disclose threats to the

proper officials even if he or she truly believes that some type of harm is imminent. However,

professionals who do choose to disclose threats are not immune from civil liability for improper

disclosure of confidential communications. This is true even if the disclosure was made in good

faith. While there are circumstances where a patient’s right to confidentiality may be legally

compromised, it will be incumbent on the mental health professional to show why the disclosure

was permissible and made pursuant to the exception stated in 611.004(a)(2).

Copies of the Texas Supreme Court opinion in this Thapar v. Zezulka can be obtained at the

Court’s website at http://www.supreme.courts.state.tx.us on the June 1999 “Opinions” page.

Texas State Board Of Examiners Of Psychologists’ Rules Of Practice.

Texas Administrative Code

TITLE 22        EXAMINING BOARDS

PART 21         TEXAS STATE BOARD OF EXAMINERS OF PSYCHOLOGISTS

CHAPTER 465           RULES OF PRACTICE

RULE §465.9  Competency

(a) Licensees provide only services for which they have the education, skills, and training to perform competently.

(b) Competency includes the ability to provide services concerning a specific individual that takes into account characteristics of that individual including age, gender, ethnicity, national origin, disability, language, and socio-economic status.

(c) Licensees maintain current knowledge of scientific and professional information that ensures competency in every area in which they provide services.

(d) Licensees provide services in an unfamiliar area or involving new techniques only after first undertaking appropriate study and training, including supervision, and/or consultation from a professional competent to provide such services.

(e) In emerging areas in which generally recognized standards for preparatory training do not exist, licensees take reasonable steps to ensure the competence of their work and to protect patients, clients, research participants, and other affected individuals from the potential for harm.

(f) Licensees are responsible for ensuring that all individuals practicing under their supervision are competent to perform those services.

(g) Licensees who delegate performance of certain services such as test scoring are responsible for ensuring that the entity to whom the delegation is made is competent to perform those services.

(h) Licensees who lack the competency to provide particular psychological services to a specific individual must withdraw and refer the individual to a competent appropriate service provider.

(i) Emergency Situations. In emergencies, when licensees are asked to provide services to individuals for whom appropriate mental health services are not available and for which the licensee has not obtained the necessary competence, licensees may provide such services only to the extent necessary to ensure that services are not denied. If ongoing services are provided, licensees must comply with subsection (d) of this section as soon as practicable or refer the patient as per subsection (h) of this section.

(j) Licensees refrain from initiating or continuing to undertake an activity when they know or should know that there is a substantial likelihood that personal problems or conflicts will prevent them from performing their work-related activities or producing a psychological report in a competent and timely manner. When licensees become aware of such conflicts, they must immediately take appropriate measures, such as obtaining professional consultation or assistance in order to determine whether they should limit, suspend, or terminate the engagement in accordance with Board rule §465.21 of this title (relating to Termination of Services).

Source Note: The provisions of this §465.9 adopted to be effective June 3, 1999, 24 TexReg 4017; amended to be effective September 12, 2002, 27 TexReg 8479; amended to be effective June 5, 2005, 30 TexReg 3099; amended to be effective May 30, 2007, 32 TexReg 2864; amended to be effective September 19, 2012, 37 TexReg 7289

Social Workers

Texas State Board Of Social Worker Examiners

Code Of Conduct And Professional Standards Of Practice

http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=34&ch=781&rl=204

Texas Administrative Code

TITLE 22        EXAMINING BOARDS

PART 34         TEXAS STATE BOARD OF SOCIAL WORKER EXAMINERS

CHAPTER 781           SOCIAL WORKER LICENSURE

SUBCHAPTER B      CODE OF CONDUCT AND PROFESSIONAL STANDARDS OF PRACTICE

RULE §781.204          Relationships with Clients

(k) Electronic practice may be used judiciously as part of the social work process and the supervision process. Social workers engaging in electronic practice must be licensed in Texas and adhere to provisions of this chapter.

LICENSES AND LICENSING PROCESS

http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=34&ch=781&rl=414

RULE §781.414          Issuance of License Certificates

(e) A licensee who offers social work services on the Internet must include a statement that the licensee is licensed by the State of Texas and provide a copy of the Code of Conduct with the information on how to contact this board by mail or telephone.

Counselors

Texas State Board Of Examiners Of Professional Counselors

Code Of Ethics

http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=30&ch=681&rl=41

Texas Administrative Code

TITLE 22        EXAMINING BOARDS

PART 30         TEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS

CHAPTER 681           PROFESSIONAL COUNSELORS

SUBCHAPTER C      CODE OF ETHICS

RULE §681.41            General Ethical Requirements

(g) Technological means of communication may be used to facilitate the therapeutic counseling process. Counselors engaging in interactive distance counseling must adhere to each provision of the rules and statutes of the board.

Marriage and Family Therapists

TEXAS STATE BOARD OF EXAMINERS OF MARRIAGE AND FAMILY THERAPISTS TEXAS STATE BOARD OF EXAMINERS OF MARRIAGE AND FAMILY THERAPISTS http://texreg.sos.state.tx.us/public/readtac$ext.TacPage?sl=R&app=9&p_dir=&p_rloc=&p_tloc=&p_ploc=&pg=1&p_tac=&ti=22&pt=35&ch=801&rl=44

Texas Administrative Code

TITLE 22        EXAMINING BOARDS

PART 35         TEXAS STATE BOARD OF EXAMINERS OF MARRIAGE AND FAMILY THERAPISTS

CHAPTER 801           LICENSURE AND REGULATION OF MARRIAGE AND FAMILY THERAPISTS

SUBCHAPTER C      TEXAS STATE BOARD OF EXAMINERS OF MARRIAGE AND FAMILY THERAPISTS

RULE §801.44            Relationships with Clients

(q) A licensee who engages in interactive therapy via the telephone or internet must provide the client with his/her license number and information on how to contact the board by telephone, electronic communication, or mail, and must adhere to all other provisions of this chapter.

Utah

Utah

We are not aware of any specific rules and regulations of the practice of telemental health services.
Vermont

Vermont

We are not aware of any specific rules and regulations of the practice of telemental health services by licensed SWs, LMHCs, or MFTs in Vermont.

 

Psychological Examiners

Taken from  https://www.sec.state.vt.us/professional-regulation/list-of-professions/psychological-examiners/telepractice.aspx

A Word on Telepractice

Supervision and New Rules

Professionals who provide service via the Internet or other electronic means should provide as much information as possible to individuals who access their services. At a minimum, the psychologist should prominently disclose:

  • Name and location of the psychologist
  • Type of license and jurisdiction where licensed
  • What the psychologist is licensed and trained to do
  • To whom the client may make a complaint and how
  • The limits and limitations of Internet practice/service delivery

This is not unlike the disclosure we require of psychologists and other mental health providers in face-to-face settings, and it is just as important.

 

Administrative Rules of the Board of Psychological Examiners

Effective: January 15, 2015

 https://www.sec.state.vt.us/media/649337/Psych-RulesAdopted-Clean-1229-2014.pdf

6.4 Telepractice

(a) Telepractice is governed by statute, 26 V.S.A. § 3018. Professionals who provide service via the Internet or other electronic means should provide as much information as possible to individuals who access their services.

(b) Psychologists from other jurisdictions providing telepractice services to persons in Vermont are deemed to be practicing in Vermont. They must be licensed by the Board and must comply with the disclosure requirements of Rule 6.8.

(c) Vermont licensed psychologists who provide telepractice services to clients outside of Vermont remain under the jurisdiction of the Board. They shall comply with the disclosure requirements of Rule 6.8 and shall specifically disclose:

(1) Name, location, and telephone number of the psychologist; (2) What the psychologist is licensed and trained to do; and (3) The limits and limitations of Internet practice and service delivery.

 

Greater opportunities for telemental health services in Vermont.

In  2013, Vermont was awarded a State Innovation Model (SIM) testing grant in order to implement a statewide plan for health reform. Read about Vermont’s plan for health reform at:  http://healthcareinnovation.vermont.gov/sites/hcinnovation/files/HIE/Telehealth_Strategy_Report_Final_9-16-15.pdf

One challenge in the implementation of telehealth services in Vermont has been insurance reimbursement.  However, Vermont has had a telehealth parity law since 2012 (Act 107), and S 139 – removes the facility restrictions from Medicaid primary care services via telemedicine, and S 243 – established a telemedicine pilot program for substance abuse treatment. Also, bill H 543 may require insurance coverage for telemedicine services when they are delivered in or outside a health care facility.  Telepsychiatry has been one of the most utilized telehealth services provided in Vermont, and I expect it to greatly increase do to Vermont’s health reform efforts. One of my desires is the ALL licensed mental health professionals are included in the list of providers covered by the telehealth laws.  

Virginia

Virginia

Social Work:

We are not aware of any specific rules and regulations of the practice of telemental health services by Social Workers in Virginia.

Psychology:

We are not aware of any specific rules and regulations of the practice of telemental health services by Psychologists in Virginia.

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

Counselors

Virginia Board of Counseling

Guidance on Technology-Assisted Counseling and Technology-Assisted Supervision, 2015

https://www.dhp.virginia.gov/counseling/guidelines/115-1.4%20Technology-Assisted.doc

Guidance on Technology-Assisted Counseling and Technology-Assisted Supervision

 

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 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. 

Washington

Washington

We are not aware of any specific rules and regulations of the practice of telemental health services.
West Virginia

West Virginia

Psychologists

The West Virginia Board of Examiners of Psychologists

Policy Statements

http://www.wvpsychbd.org/policy_statements.htm

TELE-PSYCHOLOGY – SKYPE

In July 2011, the APA Division 29 task force on tele-psychology observed that internet and cell phone communication do not have the same security as a land line phone. The task force accurately comments that "The Internet is not regulated and not currently protected by privacy laws.  Skype, for example, is not an encrypted site and is, therefore, not a confidential means of communication. "The task force further comments that providing psychotherapy on unencrypted sites is ‘ill advised’".  The WV Board of Examiners agrees.

 Because this does not completely preclude providing such services, extreme caution is advised. For those holding a license to practice in a given jurisdiction, clinical judgment and common sense must be vigorously employed in the choice to use such venue. In such a case, based on the APA's conclusions and recommendations, the WV Board of Examiners believes the psychologist would need to:

1. Contact their malpractice insurance carrier to determine if skype work is covered.

2. Contact the patient's insurance to determine coverage.

3. Use skype with an established patient determined not to be a high risk patient.

4. Make certain the patient fully understands that skype is NOT the same as a phone conversation and is not protected by federal privacy law. It is an open/public forum and anything on skype can be published/used/broadcast/etc. Signed consent would be needed before using skype.

It is somewhat doubtful that all of the above would be approved once the full nature of skype is known, but even then skype should be used on a limited basis, not as a complete substitute for in person treatment.

Social Workers

http://www.wvsocialworkboard.org/Ethics.aspx

The WV Board of Social Work has adopted, by legislative process, the National Association of Social Workers (NASW) Code of Ethics for professional social workers.

Counselors and Marriage and Family Therapists

West Virginia Board of Examiners in Counseling

Advisory opinion regarding the practice of distance counseling.

http://www.wvbec.org/distancecounseling.html

As recorded in the October 22, 2010 minutes, The West Virginia Board of Examiners in Counseling (“The Board”) hereby issues the following advisory opinion regarding the practice of distance counseling:

Under the provisions of W.Va. Code § 30-31-1, it is unlawful for any person to practice or

offer to practice professional counseling or marriage and family therapy in this state without a

license.   Be advised, it is the opinion of the Board that the requirements of W.Va. Code

§ 30-31-1, and all other rules and regulations governing the practice of professional counseling or marriage and family therapy, shall be applicable to the practice of distance counseling and shall expressly apply to any person providing distance counseling, as defined herein, to a person who resides, or is domiciled, in the State of West Virginia. 

Distance counseling is defined as any counseling, including marriage and family therapy that

is provided by any means other than direct in person services and is facilitated by the use of

technology  including, but not limited to, U.S. mail, telephone, telefax, email, internet or

videoconference.

Please note, current licensing rules do not include specific provisions for distance counseling, however, please note the following:

The WV LPC providing distance counseling in WV is required to adhere to the distance counseling requirements detailed in the 2014 ACA Code of Ethics. Please click the title to download your copy. In addition, the board recommends the LPC review the NBCC Policy Regarding the Provision of Distance Professional Services  to provide further guidance and ethical considerations when providing distance counseling. Please click the title to download your copy. 

The WV LMFT providing distance counseling in WV is required to adhere to the requirements included in the AAMFT Code of Ethics, revised January 1, 2015. Please click the title to download your copy. The LMFT will also benefit from reviewing the NBCC Policy Regarding the Provision of Distance Counseling Services.  

Wisconsin

Wisconsin

We are not aware of any specific rules and regulations of the practice of telemental health services.