Texas
Counselors The following is a list of the rules which have been added, amended, or repealed since the last update to these rules. Online Act and Rules of the Council – August 2022 882.2. General Application File Requirements (amended) 882.22. Reinstatement of a License (amended) 884.20. Disciplinary Guidelines and General Schedule of Sanctions (amended) Online Act and Rules of the Council – February 2022 881.33. Family Leave Pool (new) 882.21. License Statuses (amended) 882.37. COVID-19 Vaccine Passport Prohibited (new) 882.60. Special Provisions Applying to Military Service Members, Veterans and Spouses (amended) 882.61. Special Licensing Provisions for Military Spouses (amended) 882.70. Emergency Temporary License (amended) 884.4. Special Requirements for Complaints Alleging Violations Related to Court Ordered Therapy or Parenting Facilitator Services (new) 885.1. Executive Council Fees (amended) Online Act and Rules of the Council – October 2021 883.1. Renewal of a License (amended) Online Act and Rules of the Council – August 2021 881.21. Petition for Rulemaking (amended) 882.11. Applicants with Foreign Degrees (amended) 885.1. Executive Council Fees (amended) For any official listing of a rule, a licensee, applicant, or member of the public may consult the Texas Administrative Code on the Secretary of State’s website: http://www.sos.state.tx.us/tac/. When accessing this website: (1) click on the TAC viewer, (2) scroll down and click on Title 22 Examining Boards, (3) scroll down and click on Part 41, Texas Behavioral Health Executive Council. To view rules that have been proposed but not finally adopted by the Board, access the following website: https://texreg.sos.state.tx.us/public/regviewctx Texas State Board of Examiners of Marriage and Family Therapists new, amended, repealed rules. The following is a list of the rules which have been added, amended, or repealed since the last update to these rules. Online Act and Rules of the Board – February 2022 Online Act and Rules of the Board – August 2021 Online Act and Rules of the Board – February 2021 Online Act and Rules of the Board – October 2020 For any official listing of a rule, a licensee, applicant, or member of the public may consult the Texas Administrative Code on the Secretary of State’s website: http://www.sos.state.tx.us/tac/. When accessing this website: https://www.sos.texas.gov/tac/index.shtml (1) click on the TAC viewer, (2) scroll down and click on Title 22 Examining Boards, (3) scroll down and click on Part 35, Texas State Board of Examiners of Marriage and Family Therapists. The following is a list of the rules which have been added, amended, or repealed since the last update to these rules. Online Act and Rules of the Council – August 2022 882.2. General Application File Requirements (amended) 882.22. Reinstatement of a License (amended) 884.20. Disciplinary Guidelines and General Schedule of Sanctions (amended) Online Act and Rules of the Council – February 2022 881.33. Family Leave Pool (new) 882.21. License Statuses (amended) 882.37 COVID-19 Vaccine Passport Prohibited (new) 882.60. Special Provisions Applying to Military Service Members, Veterans and Spouses (amended) 882.61 Special Licensing Provisions for Military Spouses (amended) 882.70. Emergency Temporary License (amended) 884.4. Special Requirements for Complaints Alleging Violations Related to Court Ordered Therapy or Parenting Facilitator Services (new) 885.1. Executive Council Fees (amended) Online Act and Rules of the Council – October 2021 883.1. Renewal of a License (amended) Online Act and Rules of the Council – August 2021 881.21. Petition for Rulemaking (amended) 882.11. Applicants with Foreign Degrees (amended) 885.1. Executive Council Fees (amended) Online Act and Rules of the Council – June 2021 882.21. License Statuses (amended) 882.50. Continuing Education and Audits (amended) Online Act and Rules of the Council – February 2021 881.21. Petition for Rulemaking (amended) 885.1. Executive Council Fees (amended) Online Act and Rules of the Council – September 2020 For any official listing of a rule, a licensee, applicant, or member of the public may consult the Texas Administrative Code on the Secretary of State’s website: http://www.sos.state.tx.us/tac/. When accessing this website: (1) click on the TAC viewer, (2) scroll down and click on Title 22 Examining Boards, (3) scroll down and click on Part 21, Texas State Board of Examiners of Psychologists. To view rules that have been proposed but not finally adopted by the Board, access the following website: https://texreg.state.tx.us/public/regviewctx TEXAS STATE BOARD OF EXAMINER "Sec. 111.007. STANDARD OF CARE FOR TELEMEDICINE MEDICAL SERVICES, TELEDENTISTRY DENTAL SERVICES, AND TELEHEALTH SERVICES. (a) A health professional providing a health care service or procedure as a telemedicine medical service, a teledentistry dental service, or a telehealth service is subject to the standard of care that would apply to the provision of the same health care service or procedure in an in-person setting." Refer to the source provided for all requirements and limitations OCCUPATIONS CODE TITLE 3. HEALTH PROFESSIONS SUBTITLE A. PROVISIONS APPLYING TO HEALTH PROFESSIONS GENERALLY CHAPTER 111. TELEMEDICINE AND TELEHEALTH ""Telehealth service" means a health service, other than a telemedicine medical service, delivered by a health professional licensed, certified, or otherwise entitled to practice in this state and acting within the scope of the health professional's license, certification, or entitlement to a patient at a different physical location than the health professional using telecommunications or information technology." ""Telemedicine medical service" means a health care service delivered by a physician licensed in this state, or a health professional acting under the delegation and supervision of a physician licensed in this state, and acting within the scope of the physician's or health professional's license to a patient at a different physical location than the physician or health professional using telecommunications or information technology." Refer to the source provided for all requirements and limitations. OCCUPATIONS CODE TITLE 3. HEALTH PROFESSIONS SUBTITLE A. PROVISIONS APPLYING TO HEALTH PROFESSIONS GENERALLY CHAPTER 111. TELEMEDICINE AND TELEHEALTH Sec. 111.005 “A valid practitioner-patient relationship is present between a practitioner providing a telemedicine medical service and a patient receiving the telemedicine medical service as long as the practitioner complies with the same standard of care as would apply in an in-person setting, and complies with one of the following scenarios: “A practitioner who provides telemedicine medical services to a patient shall provide the patient with guidance on appropriate follow-up care and with the patient's consent, forward the report of the encounter to the patient's primary care physician within 72 hours.” “A practitioner-patient relationship is not present for purposes of prescribing an abortifacient or other drug or device to terminate a pregnancy.” “The Texas Medical Board, Texas Board of Nursing, Texas Physician Assistant Board and the Texas Pharmacy Board are required to adopt joint rules that establish the determination of a valid prescription, which must allow for the establishment of the practitioner-patient relationship through telemedicine if it meets the standards outlined above.” Texas Administrative Code Title 22 Part 9 Chapter 174 SubChapter A Rule 174.5 “(a) The validity of a prescription issued as a result of a telemedicine medical service is determined by the same standards that would apply to the issuance of the prescription in an in-person setting. (b) This rule does not limit the professional judgment, discretion or decision-making authority of a licensed practitioner. A licensed practitioner is expected to meet the standard of care and demonstrate professional practice standards and judgment, consistent with all applicable statutes and rules when issuing, dispensing, delivering, or administering a prescription medication as a result of a telemedicine medical service. (c) A valid prescription must be: (1) issued for a legitimate medical purpose by a practitioner as part of patient-practitioner relationship as set out in §111.005, of Texas Occupations Code; and (2) meet all other applicable laws before prescribing, dispensing, delivering or administering a dangerous drug or controlled substance. (d) Any prescription drug orders issued as the result of a telemedicine medical service, are subject to all regulations, limitations, and prohibitions set out in the federal and Texas Controlled Substances Act, Texas Dangerous Drug Act and any other applicable federal and state law. (e) Limitation on Treatment of Chronic Pain. Chronic pain is a legitimate medical condition that needs to be treated but must be balanced with concerns over patient safety and the public health crisis involving overdose deaths. The Legislature has already put into place laws regarding the treatment of pain and requirements for registration and inspection of pain management clinics. Therefore, the Board has determined clear legislative intent exists for the limitation of chronic pain treatment through a telemedicine medical service. (1) For purposes of this rule, chronic pain has the same definition as used in §170.2(4) of this title (relating to Definitions). (2) For purposes of this rule, acute pain has the same definition as used in §170.2(2) of this title. (A) Treatment of chronic pain with scheduled drugs through use of telemedicine medical services is prohibited, unless otherwise allowed under federal and state law. (B) Treatment of acute pain with scheduled drugs through use of telemedicine medical services is allowed, unless otherwise prohibited under federal and state law.” Refer to the source provided for all requirements and limitations. “As a party state to the Nurse Licensure Compact (NLC), Texas issues multistate licenses to nurses and applicants who reside in the state and recognizes multistate licenses issued by other party states, for practice in Texas. A nurse holding a multistate license is entitled to practice in any NLC party state, but must comply at all times with the laws of the state where he or she is currently practicing.” “It should be noted that not every state in the US is an NLC party state; a map of participating states, as well as further resources related to the NLC, are available on the Nurse Licensure Compact website.” Refer to the source provided for all requirements and limitations. OCCUPATIONS CODE TITLE 3. HEALTH PROFESSIONS SUBTITLE A. PROVISIONS APPLYING TO HEALTH PROFESSIONS GENERALLY CHAPTER 111. TELEMEDICINE AND TELEHEALTH Sec. 111.005 “A valid practitioner-patient relationship is present between a practitioner providing a telemedicine medical service and a patient receiving the telemedicine medical service as long as the practitioner complies with the same standard of care as would apply in an in-person setting, and complies with one of the following scenarios: “A practitioner who provides telemedicine medical services to a patient shall provide the patient with guidance on appropriate follow-up care and with the patient's consent, forward the report of the encounter to the patient's primary care physician within 72 hours.” “A practitioner-patient relationship is not present for purposes of prescribing an abortifacient or other drug or device to terminate a pregnancy.” “The Texas Medical Board, Texas Board of Nursing, Texas Physician Assistant Board and the Texas Pharmacy Board are required to adopt joint rules that establish the determination of a valid prescription, which must allow for the establishment of the practitioner-patient relationship through telemedicine if it meets the standards outlined above.” Texas Administrative Code Title 22 Part 9 Chapter 174 SubChapter A Rule 174.5 “(a) The validity of a prescription issued as a result of a telemedicine medical service is determined by the same standards that would apply to the issuance of the prescription in an in-person setting. (b) This rule does not limit the professional judgment, discretion or decision-making authority of a licensed practitioner. A licensed practitioner is expected to meet the standard of care and demonstrate professional practice standards and judgment, consistent with all applicable statutes and rules when issuing, dispensing, delivering, or administering a prescription medication as a result of a telemedicine medical service. (c) A valid prescription must be: (1) issued for a legitimate medical purpose by a practitioner as part of patient-practitioner relationship as set out in §111.005, of Texas Occupations Code; and (2) meet all other applicable laws before prescribing, dispensing, delivering or administering a dangerous drug or controlled substance. (d) Any prescription drug orders issued as the result of a telemedicine medical service, are subject to all regulations, limitations, and prohibitions set out in the federal and Texas Controlled Substances Act, Texas Dangerous Drug Act and any other applicable federal and state law. (e) Limitation on Treatment of Chronic Pain. Chronic pain is a legitimate medical condition that needs to be treated but must be balanced with concerns over patient safety and the public health crisis involving overdose deaths. The Legislature has already put into place laws regarding the treatment of pain and requirements for registration and inspection of pain management clinics. Therefore, the Board has determined clear legislative intent exists for the limitation of chronic pain treatment through a telemedicine medical service. (1) For purposes of this rule, chronic pain has the same definition as used in §170.2(4) of this title (relating to Definitions). (2) For purposes of this rule, acute pain has the same definition as used in §170.2(2) of this title. (A) Treatment of chronic pain with scheduled drugs through use of telemedicine medical services is prohibited, unless otherwise allowed under federal and state law. (B) Treatment of acute pain with scheduled drugs through use of telemedicine medical services is allowed, unless otherwise prohibited under federal and state law.” Refer to the source provided for all requirements and limitations. Source: TTX Admin. Code, Title 1, Sec. 354.1432(2)(A & E) (A) The telehealth services must be designated for reimbursement by HHSC. Designated telehealth services will be listed in the Texas Medicaid Provider Procedures Manual. (E) Before receiving a telehealth service, the patient must receive an initial evaluation for the same diagnosis or condition by a physician or other qualified healthcare professional licensed in Texas. (i) A required initial evaluation must be performed in-person or as a telemedicine visit that conforms to 22 TAC Chapter 174 (relating to Telemedicine). Refer to the source provided for all requirements and limitations. Originating Site Reimbursement: According to TX Medicaid Telecommunication Services Handbook, pg. 8 & 10 (Sept. 2019). (Accessed Sept. 2019). & TX Admin. Code, Refer to the section on the state's response to COVID-19 Source: TX Insurance Code 1455.004(a) (a) A health benefit plan: (1) must provide coverage for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service or telehealth service on the same basis and to the same extent that the plan provides coverage for the service or procedure in an in-person setting; and (2) may not: (A) exclude from coverage a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service or a telehealth service solely because the covered health care service or procedure is not provided through an in-person consultation; and (B) subject to Subsection (c), limit, deny, or reduce coverage for a covered health care service or procedure delivered as a telemedicine medical service or telehealth service based on the health professional's choice of platform for delivering the service or procedure. Refer to the source provided for all requirements and limitations. Refer to the section on the state's response to COVID-19 Source: TX Insurance Code 1455.004(b) (b) A health benefit plan may require a deductible, a copayment, or coinsurance for a covered health care service or procedure delivered by a preferred or contracted health professional to a covered patient as a telemedicine medical service or a telehealth service. The amount of the deductible, copayment, or coinsurance may not exceed the amount of the deductible, copayment, or coinsurance required for the covered health care service or procedure provided through an in-person consultation. (b-1) Subsection (b) does not authorize a health benefit plan to charge a separate deductible that applies only to a covered health care service or procedure delivered as a telemedicine medical service or telehealth service. Refer to the source provided for all requirements and limitations. Originating Site Reimbursement: According to TX Medicaid Telecommunication Services Handbook, pg. 8 & 10 (Sept. 2019). (Accessed Sept. 2019). & TX Admin. Code, *Clinicians who have had an experience with telehealth reimbursement in this state are invited to share their experiences in the comments section below: a) type of service provided; b) insurance provider; c) payment parity, payment issues, or insurance requirements. We are not aware of any permission that allows for services delivered by Counselors, Social Workers, or MFT's. Psychologists: Texas is a Member of the Psychology Interjurisdictional Compact of the Association of State and Provincial Refer to the source provided for all requirements and limitations. Click here to view the state’s response to COVID-19 in regard to Counselors. Click here to view the state’s response to COVID-19 in regard to Social Workers. Click here to view the state’s response to COVID-19 in regard to Marriage and Family Therapists. Click here to view the state’s response to COVID-19 in regard to Psychologists Source: Texas Department of Insurance: Telemedicine emergency rule Under the emergency rule, state-regulated health insurers and health maintenance organizations must: Governor Greg Abbott also suspended a law limiting coverage for medical services or consultations by phone. By suspending the law, insurers must pay for covered visits or consultations provided over the phone. In addition, the Texas Medical Board (TMB) issued guidance March 14 to allow physicians and other health-care professionals to use phone consultations to establish a physician-patient relationship. Before the change, telemedicine services could be provided only after the physician-patient relationship had been established during an in-person visit. For provider questions on what types of care can be provided by telephone or telemedicine, documentation, and billing, providers should see the Texas Medical Board FAQ, which includes billing guidance, or check with the agency that issued your license. The emergency rule applies to fully funded health plans regulated by the state. This accounts for about 15% of the Texas market and includes plans purchased through Healthcare.gov. It doesn’t apply to Medicare or Medicaid. (The federal government also has issued information expanding access to telemedicine for Medicare services.) It also doesn’t apply to the state employee or teacher retirement systems or self-funded employer-sponsored health plans. For these plans, contact the health plan administrator. State-regulated plans include: TDI’s emergency rule uses the definition of health professional from Insurance Code 1455.001. This definition includes licensed physicians and others, such as: Please see the Texas Medical Board FAQ. If you still have questions, call 800-248-4062. For providers not licensed by the Texas Medical Board, please contact the regulatory agency that issued your license. The U.S. Centers for Medicare and Medicaid Services also has issued guidance on Medicare billing for telemedicine. The rule, extended in June, will remain in effect through September 12. The Texas Department of Insurance, Texas Medical Board, and other relevant state agencies will investigate allegations of fraud and take action as warranted. Violations of law will be subject to civil or criminal penalties.Counselors
Marriage and Family Therapists
Online Act and Rules of the Board – July 2022
801.44. Relationships with Clients (amended)
801.58. Technology-Assisted Services (amended)
801.143. Supervisors Requirements (amended)
801.261. Requirements for Continuing Education (new)
801.263. Requirements for Continuing Education (repeal)
801.264. Types of Acceptable Continuing Education (repeal)
801.266. Determination of Clock Hour Credits and Credit Hours Granted (repeal)
801.2. Definitions (amended)
801.74. Application Take Licensure Examination (amended)
801.205. Remedy for Incomplete License Requirements (amended)
801.204. Licensing of Military Service Members, Military Veterans, and Military Spouses (new) 801.206. Licensing of Persons with Criminal Convictions (new)
801.305. Schedule of Sanctions (amended)Psychologists
Psychiatrists
Texas Professional Regulation/Health & Safety Online Prescribing
Nurses
Texas Professional Regulation/Health & Safety Online Prescribing
Medicaid Telehealth Parity Law
(ii) If the patient is receiving the telehealth services to treat a mental health diagnosis or condition, the patient is not required to receive an initial evaluation.
Title 1, Sec. 354.1432(1)(C): A client's home can be an originating site for service.Private Pay Telehealth Parity Law
Payment Parity
Title 1, Sec. 354.1432(1)(C): A client's home can be an originating site for service.Permission for the Temporary Practice of Clinicians Licensed Outside the State
Psychology Boards (PSYPACT)Response to COVID-19
What does the emergency rule require?
What health insurers must comply with this rule?
How do I know if someone has state-regulated coverage?
What providers are included in TDI’s emergency rule on telemedicine?
How will health-care professionals code claims for telemedicine services?
How long does the emergency rule last?
Are there concerns these temporary changes could create opportunities for fraud?
Note: As this is a free resource and Rules and Regulations regarding Telehealth are always changing, we appreciate any updates or corrections. They can be emailed to us at This email address is being protected from spambots. You need JavaScript enabled to view it. with a link to the source or a citation of the rule or regulation.
Telemental health is not a separate service from mental health services. All state licensing boards require that licensed clinicians follow all the regulations for practicing under their license no matter what medium of communication is used. All licensing boards also require that clinicians only practice within the boundaries of their competence. This usually requires education, continuing education, and/or supervision in telemental health. Complete our telehealth training program to cover all the essential competencies of providing telemental health services and earn the THTC (Telemental Health Training Certificate).
