Counselors
Counseling, Marriage and Family Therapists and Licensed Substance Abuse Treatment Practitioners
Virginia Board of Counseling
Guidance on Technology-Assisted Counseling and Technology-Assisted Supervision, 2015
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.
Marriage and Family Therapists
Counseling, Marriage and Family Therapists and Licensed Substance Abuse Treatment Practitioners
Virginia Board of Counseling
Guidance on Technology-Assisted Counseling and Technology-Assisted Supervision, 2015
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.
Psychologists
We are not aware of any specific rules and regulations of the practice of telemental health services for Psychologists.
Psychiatrists
Virginia Board of Medicine Telemedicine Guidance document: 85-12
Licensure:
The practice of medicine occurs where the patient is located at the time telemedicine services are
used, and insurers may issue reimbursements based on where the practitioner is located. Therefore,
a practitioner must be licensed by, or under the jurisdiction of, the regulatory board of the state
where the patient is located and the state where the practitioner is located. Practitioners who treat
or prescribe through online service sites must possess appropriate licensure in all jurisdictions
where patients receive care. To ensure appropriate insurance coverage, practitioners must make
certain that they are compliant with federal and state laws and policies regarding reimbursements.
Establishing the Practitioner-Patient Relationship.
The practitioner-patient relationship is fundamental to the provision of acceptable medical care. It
is the expectation of the Board that practitioners recognize the obligations, responsibilities, and
patient rights associated with establishing and maintaining a practitioner-patient relationship.
Where an existing practitioner-patient relationship is not present,1
a practitioner must take
appropriate steps to establish a practitioner-patient relationship consistent with the guidelines
identified in this document, with Virginia law, and with any other applicable law.2 While each
circumstance is unique, such practitioner-patient relationships may be established using
telemedicine services provided the standard of care is met.
A practitioner is discouraged from rendering medical advice and/or care using telemedicine
services without (1) fully verifying and authenticating the location and, to the extent possible,
confirming the identity of the requesting patient; (2) disclosing and validating the practitioner’s
identity and applicable credential(s); and (3) obtaining appropriate consents from requesting
patients after disclosures regarding the delivery models and treatment methods or limitations,
including any special informed consents regarding the use of telemedicine services. An appropriate
practitioner-patient relationship has not been established when the identity of the practitioner may
be unknown to the patient.
Establishing the Practitioner-Patient Relationship.
The practitioner-patient relationship is fundamental to the provision of acceptable medical care. It
is the expectation of the Board that practitioners recognize the obligations, responsibilities, and
patient rights associated with establishing and maintaining a practitioner-patient relationship.
Where an existing practitioner-patient relationship is not present,1
a practitioner must take
appropriate steps to establish a practitioner-patient relationship consistent with the guidelines
identified in this document, with Virginia law, and with any other applicable law.2 While each
circumstance is unique, such practitioner-patient relationships may be established using
telemedicine services provided the standard of care is met.
A practitioner is discouraged from rendering medical advice and/or care using telemedicine
services without (1) fully verifying and authenticating the location and, to the extent possible,
confirming the identity of the requesting patient; (2) disclosing and validating the practitioner’s
identity and applicable credential(s); and (3) obtaining appropriate consents from requesting
patients after disclosures regarding the delivery models and treatment methods or limitations,
including any special informed consents regarding the use of telemedicine services. An appropriate
practitioner-patient relationship has not been established when the identity of the practitioner may
be unknown to the patient.
Refer to the source provided for all requirements and limitations.
Private Pay Telehealth Parity Law
Source: VA Code Annotated Sec. 38.2-3418.16(D). (2012)
D. An insurer, corporation, or health maintenance organization shall not be required to reimburse the treating provider or the consulting provider for technical fees or costs for the provision of telemedicine services; however, such insurer, corporation, or health maintenance organization shall reimburse the treating provider or the consulting provider for the diagnosis, consultation, or treatment of the insured delivered through telemedicine services on the same basis that the insurer, corporation, or health maintenance organization is responsible for coverage for the provision of the same service through face-to-face consultation or contact.
Refer to the source provided for all requirements and limitations.
Medicaid Telehealth Parity Law
Source: VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and
Limitations, p. 14 (Feb. 2019)
All providers utilizing telemedicine and billing for services must be enrolled with DMAS. All coverage requirements described in the DMAS provider manuals apply when the service is delivered via telemedicine. The use of telemedicine must be noted in the service documentation of the patient record.
Equipment utilized for telemedicine must be of sufficient audio quality and visual clarity as to be functionally equivalent to a face-to-face encounter for professional medical services. Staff must be proficient in the operation and use of the telemedicine equipment. Telephone calls, e-mail, facsimile transmissions and similar electronic measure are not considered part of the telemedicine coverage and are not to be billed to DMAS.
Telemedicine encounters must be conducted in a confidential manner, and any information sharing must be consistent with applicable federal and state laws and regulations and DMAS policy. Health Information Portability and Accountability Act of 1996 (HIPAA) confidentiality requirements are applicable to telemedicine encounters.
A description of services that may be delivered via telemedicine is included in Chapter V. The services include: evaluation and management, psychiatric care, specialty medical procedures, speech therapy, and radiology services and procedures. The remote provider groups
recognized by DMAS for these services are also listed.
Refer to the source provided for all requirements and limitations.
Originating Site Reimbursement: We are not aware of mention of the patient/client's home or office setting being approved as an originating site.
Payment Parity
We are not aware of any explicit payment parity.
*Clinicians who have had an experience with telehealth reimbursement in this state are invited to share their experiences in the comments section below: a) type of service provided; b) insurance provider; c) payment parity, payment issues, or insurance requirements.
Permission for the Temporary Practice of Clinicians Licensed Outside the State
We are not aware of any permission that allows for services delivered by out-of-state providers.
Social Workers
Social Work:
The Virginia Social Work Board requires a clinician to be a licensed social worker in the state if the client is located in Virginia.
The board issued "Guidance on Technology-Assisted Therapy and the Use of Social Media":