TELEBEHAVIORAL HEALTH INFORMATION AND COUNSELORS IN HEALTH CARE
Do you have any undated information on the delivery of services using technology, such Telebehavioral Health services?
- Telebehavioral health is the use of a digital platform that provides secure, encrypted, real-time audio-video conferencing to communicate with a client. There are many factors to consider before using telebeahvioral health services.
- Demystifying Law and the Ethics for Telebehavioral Health is a four-part course which teaches professional counselors how to practice telebehavioral health legally and ethically (CE available). ACA online continuing professional development courses and videos cover additional related topics, such as cybersecurity, technology assisted distance supervision, selecting an EHR, HPAA/HITECH compliance, etc.
Considerations:
- The use of telebehavioral health services does not eliminate the requirement for licensure;
- Carefully review the 2014 ACA Code of Ethics, FAQ’s on ethical practices with technology, and specifically review Section §H (Distance Counseling, Technology, and Social Media), which outlines standards of care for professional counselors who use technology;
- Review ACA’s COVID-19 State Resources: State Actions on Telebehavioral Health and then double-check your state regulatory boards’ policies and laws regarding your scope of practice and ability to offer telebehavioral health services;
- Research if any declaration of a public health emergency impacts on your scope of practice;
- Ensure your informed consent documents are updated and discuss these updates with each client;
- Contact the health insurance plan of each client to verify coverage and confirm the health insurance plan will reimburse claims (or that the client can be reimbursed);
- Note the physical location of each client, as well as local community resources which may need to be contacted in the event of an emergency or circumstances requiring a mandated report; and,
- Ensure your professional liability insurance covers telehealth services.
STUDENTS AND TELEBEHAVIORAL HEALTH
Does the ACA Student Group Liability policy insure training by supervised master-level practicum and internship students who facilitate counseling via telebehavioral health services?
Master-level students with HPSO liability insurance may be covered for telebehavioral health counseling sessions if they are a counselor-in-training (masters level intern) and if they meet the following conditions:
1) The scope of practice of the licensed site supervisor permits the practice of telebehavioral health;
2) The site supervisor is trained to provide both clinical services and supervision for this type of service delivery;
3) The counselor-in-training receives proper training to facilitate telebehavioral sessions;
4) The site supervisor is available for the trainee or client; as needed, and
5) Funding sources for each client session allows the trainee to provide counseling (i.e., the supervisor or agency should make sure the trainee is authorized to provide counseling services based on the funding source or contract).
• Note that if items 1-5 above are met, and if supervision by both the university and site supervisors are fulfilled, the trainee would presumably be training within their “scope of practice” as an intern. Therefore, HPSO would likely cover their clinical work at an approved site. Volunteering at another unapproved site or “moonlighting” on their initiative, however, would not be covered.
TRANSITIONING TO TELEBEHAVIORAL HEALTH SERVICES
My clients are no longer able to come to the office for counseling sessions. How do I transition my practice to a telebehavioral health service delivery system?
Consider the following when engaging in an ethical decision-making model:
a) Review the ACA Code of Ethics on telebehavioral health (or “distance counseling”) and the use of technology;
b) Ensure you’re trained and competent to provide telebehavioral health services (this includes understanding the nuances of providing this services in this delivery form such as the informed consent, HIPAA compliance, ensuring that this service delivery appropriate for the client, etc.)
c) Ensure the client is appropriate to engage in counseling via telebehavioral health services, complete informed consent with the client, and that they understand how to use the technology;
d) If a client declines to telebehavioral health services respect client autonomy;
e) Check your state regulatory boards regarding scope of practice where you’re licensed and where professional services are delivered;
f) Contacting the health insurance plans for each client to verify coverage, confirm reimbursement issue and related claims issues; and
g) Ensure your professional liability insurance covers the use of technology.
TECHNOLOGIES I MIGHT USE FOR TELEBEHAVIORAL HEALTH SERVICES
Does ACA have list of HIPAA compliant technologies that I can use with clients?
ACA partner, SimplePractice, is a cloud-based EHR which includes an optional feature that integrates telebehavioral health technology into the account. The U.S. Department of Health & Human Services lists technologies that likely allow a practitioner to conduct HIPAA compliant services.
What resources does ACA offer to help me engage in telebehavioral health practices?
This is a difficult time for the profession. ACA offers numerous telebehavioral health learning opportunities, as well as providing ethics consults, and other resources.
BUSINESS ASSOCIATE AGREEMENT (BAA)
What are business associate agreements and do we need them to engage in telebehavioral health?
A “business associate” is a person or entity that performs certain functions or activities that involve the use or disclosure of protected health information on behalf of, or provides services to, a covered entity. Business associate agreements usually cover services provided by third party entities who handle protected health information such as the technologies used to provide telebehavioral health. These agreements are necessary to protect both you as the clinician and the client.
TEMPORARILY ASSISTING IN ANOTHER STATE
I’m a licensed professional counselor who has volunteered to provide (telebehavioral health) services in another state, which has declared a “state of emergency.” The Order allows practitioners to offer counseling support services as unlicensed practitioners during the pandemic. What happens when the governor proclaims the “state of emergency” has ended?
Typically, once a Governor ends the “state of emergency,” the Order allowing unlicensed, volunteer professional counselors will no longer be active. Provisions to offer telebehavioral health services, for example, as permitted by the “state of emergency” Order cease immediately.
CONTINUITY OF CARE ISSUES
What should I do if I’m temporarily helping clients in a state that will eventually end a “state of emergency” Order? May I continue working with these clients as they transition to another practitioner?
No. Professional counselors volunteering in a state as an unlicensed volunteer practitioner should make arrangements now for the continuation of client care once the “state of emergency” is lifted. The 2014 ACA Code of Ethics requires professional counselors to facilitate continuity of care. Furthermore, the abandonment of a client is prohibited.