Agencies and private practitioners may want to identify in advance an information technology (IT) person who is familiar with the telemental health system and can help when there is a problem. Clients using technology at home may want to do the same on their end. Licensure and Legislation Licensing and certification requirements for telemental health are evolving; therefore, it is important to read up-to-date state requirements yearly. The provision of telemental health across state borders continues to be refined from ethical and practical perspectives, particularly since the expansions and waivers seen during the COVID-19 pandemic. Professional licensing requirements are typically tied to where the client and the professional are physically located at the time the telemental health services are provided (Johnson, 2014; Swenson et al., 2016). Currently, no state licensing boards expressly prohibit the provision of telemental health practice (Swenson et al., 2016). However, many states lack cooperative licensure reciprocity (Lustgarten, 2017). Clinicians should check the legal requirements in their and their clients’ states for conducting assessments and providing telemental health treatment (Luxton, Nelson, & Maheu, 2016). For example, when a telemental health provider is traveling outside of the state where they practice, it is necessary to be aware of the requirements and restrictions for providing telemental health in the state they are visiting before engaging in a telemental health session with a client. The National Association of Social Workers (NASW, 2021a) advises clinicians to follow the laws of both jurisdictions (where the client is located and where the professional is located) that apply to their service provision. Most jurisdictions have adopted the position that electronic social work practice takes place in both the jurisdiction where the client is receiving such services (irrespective of the location of the practitioner) and in the jurisdiction where the social worker is licensed and located at the time of providing such electronic services (irrespective of the location of the client). In some states, face-to-face assessments have been required within six months of initial contacts and on a yearly basis. However, there are still temporary Medicare changes that allow patients to receive telehealth services in their home and remove the requirements for in-person appointments. Some COVID-19 practices have transitioned to permanent Medicare changes for telemental health, including no geographical restrictions for originating site, the ability to receive telemental health in the home, and the allowance of audio-only communication platforms (telehealth policy changes). Clinicians should ensure that they comply with the federal HIPAA regulations and the Health Information Technology for Economic and Clinical Health Act (HIPAA Rules for Telehealth Technology).
One way to do this is to set up a test call with a client prior to intake to ensure the technology is adequate to move forward with the telemental health intake and subsequent sessions.
Staff providing telemental health sessions must be trained before providing services. This is not unique to telemental health—all licensed individuals must be trained in the therapy they are providing or must receive training, consultation, and/or supervision when delivering a new service. In addition, many agencies require verifications of credentialing before allowing individuals to provide telemental health services (Johnson, 2014; Lustgarten, 2017). Some organizations, such as Distance Certified Counselors, the American Distance Counseling Association, the American Telemedicine Association, the International Society for Mental Health Online, and the Office for the Advancement of Telehealth, offer certifications and guidance for practitioners who want to receive training (Swenson et al., 2016). Practitioners should be aware of the parameters of local licensure and practice jurisdiction. At this time, providers in most states have limitations on routinely delivering care to individuals outside of the states in which they are licensed, with the exception of working in a federal capacity that allows for licensure in any state. However, licensure regulations are evolving. Some states with large rural and/or underserved populations are starting to have licensing reciprocity across state lines to allow providers in other states to practice within state lines (Psychology Interjurisdictional Compact), and many states are developing practices for interstate telemental health such as telepsychology via PSYPACT (Psychology Interjurisdictional Compact). Practitioners who use telemental health services have the same duty to care for their clients as if they had face-to-face sessions. However, issues related to legal liability and malpractice have not been thoroughly studied (Daniel & Sulmasy, 2015). Many professional organizations are only now developing professional ethical guidelines for clinicians who have telemental health practices, as discussed in greater detail later in the course. Agencies often establish memoranda of understanding and service agreements between locations before implementing telemental health services. In addition, an agency may want to include a privacy officer or technology expert in the staffing plan, especially if telemental health services are provided frequently. Box 1 provides an example of a memorandum of understanding between the distant and originating sites providing telemental health services. Before a client comes to an agency’s office to receive telemental health, the two agencies should develop a memorandum of understanding that outlines the specific responsibilities of each agency. In such an agency-to-agency agreement, there would be further agreements related to liability risks (e.g., insurance agreements and other liabilities).
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Book Code: SWFL1825
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