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California Requirements for Telehealth
Q: As an MFT, what are the California regulations that I should know regarding the provision of Telehealth?
A: In 2016, the BBS published regulations for the Standard of Practice for Telehealth. To read more about the regulations and what the BBS requires of LMFTs, LCSWs, and LPCCs in the provision of Telehealth services, read CAMFT’s article Regulatory and Legal Considerations for Telehealth. You can also view our Checklist for Telehealth.
Q: What is the new telehealth training/coursework requirement for BBS Licensees and Pre-Licensees?
A: Any applicants for licensure and current licensees renewing on or after July 1, 2023 are subject to the new telehealth training coursework requirements. This means in preparation for an application submission or license renewal occurring on or after July 1, 2023, applicants for licensure and current licensees must complete the one-time three (3) hour training or coursework in the provision of mental health services via telehealth. The coursework may be obtained as follows:
Registered associates and other future applicants for MFT licensure whose Application for Licensure is received on or after July 1, 2023, will need to submit the certification documents showing that they meet the requirement, before they are approved to take the MFT Clinical Exam. Individuals who submit their Applications for Licensure received by the BBS any time before July 1, 2023 will be able to obtain approval to to take MFT Clinical Exam without meeting this requirement, but will be required to certify compliance in their first license renewal.
Q: Do I need a written informed consent form to provide Telehealth services?
A: No. The law does not require written informed consent from clients to participate in telehealth sessions. Therapists must, however, obtain either verbal (and documented) informed consent or written informed consent for telehealth services from their patients. If you would like to obtain a written Telehealth Informed Consent, CAMFT offers a sample form here.
Q: Will my malpractice carrier still cover me if I’m using Telehealth?
A: CAMFT has been in touch with our affinity partner for malpractice insurance, CPH. CPH has reassured us that they will cover the practitioners they insure even when they are utilizing Telehealth to provide therapy services as long as the services are provided in accordance with the law. We believe most insurers will provide coverage as well, but if your malpractice insurer is not CPH, CAMFT recommends that you check with your insurer to clarify.
Telehealth & HIPAA
A: HIPAA requires that “covered entities” (see next bullet point) follow the Security Rule, including obtaining a Business Associate Agreement (BAA) from the utilized Telehealth provider. However, given the pandemic, as of March 17, 2020, the Office for Civil Rights (OCR) which enforces HIPAA, issued a Notice, that throughout the course of the declared national public health emergency, which remains in effect, the OCR will not impose penalties against covered providers for the lack of a BAA or for any other noncompliance with the HIPAA rules that relate to provision of Telehealth services during this time.
This means that a provider who needs to provide Telehealth services to their patients during this time may use platforms that would otherwise not be “HIPAA-compliant” such as Facetime or Skype. Providers may use other popular applications that allow for private video chats, including Facebook Messenger video chat, Skype, or Google Hangouts video to provide Telehealth without risk that the OCR will penalize the provider. The Biden Administration has indicated that the Public Health Emergency will expire on May 11, 2023, and this Notice will also expire.
Important Notes:
Q: If I provide Telehealth services to my patients, will that make me a “covered entity” under HIPAA?
A: HIPAA only applies to organizations and providers who qualify as “covered entities” The mere use of electronic technology to provide Telehealth services does not transform a health care provider into a covered entity. Therapists who are not covered entities do not have to comply with HIPAA requirements.
“Covered entities” refers to health care providers who transmit protected health information (“PHI”) in connection with certain administrative or financial transactions (“covered transactions”) Examples of typical covered transactions by health care providers include the use of the Internet to electronically transmit insurance claims, conduct benefit eligibility inquiries, or to make referral authorization requests with insurance plans. To read more about covered entities, view CAMFT’s article Are You a Covered Entity.
Q: What are the HIPAA regulations pertaining to the provision of Telehealth that I should be familiar with if I want to learn more?
A: Although the restrictions regarding HIPAA compliance are being eased during the COVID-19 pandemic, many providers, even those who are not covered entities, may still want to follow industry best-practice and utilize HIPAA compliant Telehealth platforms. Please read the CAMFT article, Telehealth, HIPAA, and Compliant Telehealth Platforms, for more information about relevant HIPAA regulations.
Q: I want to use a HIPPA complaint Telehealth service provider. Is there a list?
A: There are several HIPAA compliant Telehealth companies out there. The OCR mentions these vendors in their Notice
Note: The OCR has not reviewed the BAAs offered by these vendors, and this list does not constitute an endorsement, certification, or recommendation of specific technology, software, applications, or products.
Here are some additional HIPAA compliant Telehealth vendors that are popular with psychotherapists:
Disclaimer: CAMFT has an affinity partnership with Simple Practice. CAMFT does not endorse or have a partnership with the other listed vendors.
Out-of-State Telehealth
Q: Can I provide out-of-state Telehealth to my patients?
A: It depends. Your California license only permits you to lawfully practice with those patients who are physically in California. At the height of the pandemic, many governors chose to waive state licensing requirements to allow for more interstate healthcare assistance), though most of those provisions have now since expired. Some states have since modified to their licensure requirements to permit temporary practice by clinicians licensed outside of that state.
CAMFT recommends against actively seeking new clients in other states where a therapist is not licensed to practice, if you have a client who is temporarily in another state and is in crisis, you should: ·
Q. Can I continue lawfully seeing my California patients via telehealth if I travel outside of California?
A. Possibly. California law takes the position that psychotherapy services are rendered where the patient is physically located. For example, a therapist visiting California would not need to hold a California license if they are practicing with their out-of-state patients. However, if the out-of-state patient were visiting California, the treating therapist is required to comply to California's licensing requirements. Other states may claim licensing jurisdiction over psychotherapy services by looking to where either the therapist or patient is located, rather than solely the patient. For example, if a California therapist travels to New Hampshire and continues to see their California patients, using their California license, and doing everything California requires of a therapist who is providing telehealth services to patients, New Hampshire requires that therapist to also hold a license issued by New Hampshire.
If you are traveling out-of-state, CAMFT recommends you contact the state’s licensing board to determine whether you must additionally hold a license issued by that state to continue lawfully practicing with your California patients.
Pre-Licensee Registration & Supervision
Q. Videoconferencing Supervision: Are Supervisees working in Non-Exempt settings able to receive videoconferencing supervision?
A. Yes. AB 1758 (Aguiar-Curry) allows for remote supervision to occur in non-exempt settings, including private practices and professional corporations through January 1, 2026.
Within 60 days of the commencement of supervision, the supervisor must conduct a meeting with the supervisee during which the supervisor is required to assess the appropriateness of allowing the supervisee to receive videoconferencing supervision, and to document the results of that assessment.
To review the allowable practice settings for pre-licensees, including exempt and non-exempt settings, please review these charts.
Q: Can MFT Trainees count services provided via telehealth toward their 150 of face-to-face training requirements for practicum hours?
A: It depends. MFT Trainees can only count clinical work towards their 150 hours of face-to-face practicum requirements if services are provided in-person or via videoconferencing with both audio and visual engaged. MFT Trainees can count client work provided over the phone towards licensure, but that work would not count towards their 150 face-to-face training requirements for practicum.