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The following resources and FAQs are intended to offer members information and resources on relevant laws. This information does not serve as legal advice nor as a substitute for legal advice. Members who have additional questions may contact the CAMFT Legal Department.
I. GENERAL RESOURCES FOR COVID-19 INFORMATION
II. TELEHEALTH RESOURCES FOR THERAPISTS DURING THE COVID-19 PANDEMIC
III. EMPLOYMENT RESOURCES
IV. SMALL BUSINESS RESOURCES
V. BBS PRE-LICENSEE AND LICENSEE RESOURCES & FAQ’S
VI. ADDITIONAL LEGAL AND ETHICAL ISSUES FOR THERAPISTS
VII. BUILDING YOUR BACK-TO-BUSINESS PLAN
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VIII. HOW CAMFT MEMBERS CAN HELP
I. GENERAL RESOURCES FOR COVID-19 INFORMATION
II. TELEHEALTH RESOURCES FOR THERAPISTS DURING THE COVID-19 PANDEMIC
Government officials and health care entities continue to announce emergency policies regarding the use of Telehealth during the COVID-19 crisis. Below are the most prominent considerations for therapists who want to utilize Telehealth platforms to safely continue client care. If you work in a hospital or clinic setting, be sure to follow your organization’s protocols for safety and readiness, including their protocols for Telehealth.
Q: Can I do interstate Telehealth with my patient right now?
A: Your California license only permits you to lawfully practice with those patients who are physically in California. As a result of the pandemic and based on a directive from Alex Azar with the U.S. Department of Health and Human Services (asking all governors to waive state licensing requirements to allow for more interstate medical assistance), some states have made modifications to their licensure requirements that may permit temporary practice outside of California. While we of course recommend against actively seeking new clients in other states, if you have a client who is temporarily in another state and is in crisis, you should:
Q: Does CAMFT have any video recordings on Telehealth?
A: Yes, CAMFT has two recordings that members can access immediately! Members can view the educational content for FREE, and have the option to purchase the test for CEs:
Q: As an LMFT, 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: Do I need training to provide Telehealth?
A: California law does not require training to provide Telehealth services. As with all psychotherapy services, it is important that you are competent and knowledgeable about using technology in providing treatment. It is also important to recognize the risks and benefits of providing Telehealth services for your clients. The U.S. Department of Health and Human Services offers healthcare providers general resources on things to consider as you incorporate telehealth into your practice.
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. Additionally, the Governor’s Executive Order, N-43-20, suspended the requirement that therapists providing Telehealth services must obtain either written or verbal consent for the use of telehealth from the client. Still, if you would like to use a 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 most prominent malpractice insurer, CPH. CPH has reassured us that they will cover the practitioners they insure even when they are utilizing Telehealth. 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.
Q: I don’t think Telehealth is appropriate for my patient. Can I still see my patient in person if I think it is medically necessary?
A: Governor Newsom’s recent Shelter in Place Executive Order does give exemptions for mental health providers as essential workers. It is up to each provider to determine if they need to continue to do in-person therapy or whether Telehealth is a better option.
Q: What should I know about HIPAA laws in the provision of Telehealth during the COVID-19 emergency? Can I use Skype or Facetime now since I have not had time to vet any Telehealth platforms?
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 COVID-19 outbreak, as of March 17, 2020, the Office for Civil Rights (OCR) who enforces HIPAA issued a Notice, that effective immediately, 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. That 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 video chats, including Facebook Messenger video chat, Skype, or Google Hangouts video to provide Telehealth without risk that the OCR will penalize.
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. Further, the OCR does not endorse any of the applications that allow for video chats listed above.
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.
Q: What CPT Codes do I use to bill for Telehealth services?
A: Some plans may vary. However, most plans are using the CPT code modifier for “synchronous telemedicine” via videoconferencing, which is currently 95 or GT depending on the plan. Synchronous telemedicine refers to services which are rendered via real-time interactive audio and video. As an example, the CPT code for telemedicine, 45 minutes, is 90834 with modifier 95 (or 90834 with modifier GT).
Effective January 1, 2017, the place of service (POS) code for Telehealth is 02. (Previously, POS code 11 was used for Telehealth). POS code 02 refers to the location where health services are provided or received through telecommunications technology.
Q: Have any regulatory agencies taken action to help ensure insurance plans will reimburse for Telehealth services?
A: Yes, several agencies have announced plans and mandates to help secure Telehealth reimbursements. Here are the most recent developments:
Q: Still, what do providers do if health care plans are not waiving certification requirements and refuse to reimburse?
A: The federal government, as well as Governor Newsom, have encouraged Telehealth and social distancing. The Department of Managed Health Care and the Department of Insurance have encouraged all health plans to expedite or relax their pre-certification requirements. CAMFT and other mental health stakeholders have reached out to the Governor, the DMHC, the Department of Insurance, and the California Association of Health Plans to enforce a 60-day freeze requiring all plans to reimburse Telehealth with no pre-certification requirements.
If a provider is in the situation where it is unsafe to provide in-person therapy, they should act in the spirit of the law, fully document their decision-making on why they utilized Telehealth with their clients prior to obtaining pre-certification, and request full reimbursement. There is a risk that if the contract with the health plan does not include Telehealth, you might not be paid. If that occurs, CAMFT recommends that the appropriate appeal steps be taken with the Department of Managed Health Care or the Department of Insurance.
A: :Your California license only permits you to lawfully practice with those patients who are physically in California. As a result of the pandemic and based on a directive from Alex Azar with the U.S. Department of Health and Human Services (asking all governors to waive state licensing requirements to allow for more interstate medical assistance), some states have made modifications to their licensure requirements that may permit temporary practice outside of California. While we of course recommend against actively seeking new clients in other states, 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 California licensing purposes, a therapist visiting California would not need to hold a California license if they were practicing with their out-of-state patients, but if the patient were visiting California, the treating therapist is required to comply with California’s licensing requirements. However, California cannot dictate to other states how to approach licensing in that jurisdiction.
Other states 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 (N.H. Rev. Stat. Ann. Ch. 330-A).
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.
Information For Employees
IV. SMALL BUSINESS RESOURCES
On Friday, March 27th, 2020, the Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law. Among other forms of economic relief supplied by the law, the CARES Act allocates billions of dollars of funding to two loan programs operated by the U.S. Small Business Administration (SBA):
These programs make loans available to small businesses, nonprofit organizations, sole proprietors, independent contractors, and other entities affected by the coronavirus.
Q: What is the Economic Injury Disaster Loan (EIDL) Program?
A: The EIDL program allows certain entities and individuals that are economically impacted by disasters, such as the coronavirus, to receive loans from the SBA. These entities and individuals include, but are not limited to:
For more information about the EIDL Program: Click Here
Q: How Do I Apply for an EIDL Program Loan?
A: To apply for an EIDL program loan: Click Here
If you have questions about the application process or other issues related to the EIDL program, contact the SBA Disaster Assistance Customer Service Center via phone at 1-800-659-2955 (TTY: 1-800-877-8339) or via email at DisasterCustomerService@sba.gov.
Q: What is the Paycheck Protection Program?
A: The Paycheck Protection Program is designed to provide employers with an incentive to keep their workers on payroll during the coronavirus crisis. The program allows eligible employers to receive federally-backed loans through local lenders. The SBA will forgive an employer’s Paycheck Protection Program loan if the employer:
The Paycheck Protection Program will be available through June 30, 2020.
Q: Which Entities and Individuals Are Eligible to Receive Paycheck Protection Program Loans?
A: Entities and individuals eligible to receive loans through the Paycheck Protection Program include, but are not limited to:
For more information about the Paycheck Protection Program: Click Here
Q: How Can I Apply for a Paycheck Protection Program Loan?
A: Eligible employers can apply for Paycheck Protection Program loans through:
Eligible employers should reach out to their local lenders to determine whether the lenders are participating in the Paycheck Protection Program.
V. BBS PRE-LICENSEE & LICENSEE RESOURCES & FAQ’S
View the main page for Board of Behavioral Sciences COVID 19 information here, including license/registration renewal information.
For license/registration renewals and retired/inactive license activation, the Department of Consumer Affairs (DCA) has issued two waivers:
Q. I was enrolled in a practicum course this Autumn, but my school will not be in session this coming Spring. Can I continue to see patients and count hours?
A. Possibly. On November 25,, 2020, the Department of Consumer Affairs issued a waiver to permit those “students last enrolled in a practicum course between Spetember 1, 2020, and December 31, 2020” to counsel clients even if the student is not enrolled in a practicum course within 90 days. This waiver pertains to what CAMFT often refers to as the “First 90 Day Rule,” which requires a student to either be enrolled in a practicum course or have less than 90 days between the last practicum course and either the next practicum course or graduation for those hours to count. Under this waiver, a student who previously was enrolled in a practicum course now has a period of up to “180 days in order to counsel clients while not enrolled” in a practicum course. For example, if your last date of enrollment in a practicum course was December 15, 2020, instead of needing to be re-enrolled in a practicum course by March 15, 2021, you now may continue to work and count your hours so long as you either graduate or re-enroll in practicum by June 13, 2021. To find out more, review the BBS’ FAQ regarding this waiver.
Q. I need to apply for a subsequent registration number, but I have not yet passed the Law & Ethics exam. Can I still apply for a subsequent registration number?
A. Yes. On December 15, 2020, the Department of Consumer Affairs issued a waiver extension permitting the BBS to issue subsequent registration numbers to AMFTs who had not yet passed the California Law & Ethics exam. This waiver extension only applies to those AMFTs whose registration expired or will expire between January 1, 2021 and February 28, 2021. The associate must then pass the Law & Ethics exam within one year in order to renew their subsequent registration number. To find out more, please review the BBS’ FAQ regarding this waiver.
Q. If I cannot register to take the Law & Ethics exam to renew my registration number, does the waiver mean I no longer have to take the exam?
A. No. The temporary waiver gives Associates whose registration number expires between March 31, 2020 and December 31, 2020, a six-month extension to attempt the Law & Ethics exam as follows:
For additional information on whether exam rescheduling is available log into your Pearson VUE account.
Q. What if my registration number is delinquent because I was unable to take the Law & Ethics exam before it expired. Can I renew my registration?
A. Yes. If your registration expires between January 1, 2021 and February 28, 2021, you may renew your registration without having taken the Law & Ethics exam. You can renew your registration online via your BreEZe account.
Q. It is nearly one year since I became eligible to take the clinical exam and I have not yet had an opportunity to take the exam. What are my options?
A. On November 25, 2020, the Department of Consumer Affairs issued a waiver extension to permit AMFTs who were unable to either take or retake the clinical examination, and whose one-year eligibility to take or re-take the examination expired between March 31, 2020 and January 31, 2021 20-months from their date of eligibility to take the clinical exam. For Example, you became eligible to take the clinical exam on December 15, 2019. Typically, you would only have until December 2015, 2020 to attempt the clinical exam before your application would be deemed abandoned. This waiver permits you 20 months instead of 12 months for your date of eligibility to attempt the clinical exam. In this example, the AMFT would now have until August 15, 2021 to attempt the exam. For more information please review the BBS FAQ.
Q. What if my registration is expiring soon and I am required to complete continuing education or training as a result of a disciplinary order?
A. The temporary waivers issued by the Department of Consumer Affairs do not apply to any requirements in a disciplinary order taken against a licensee. If you are required to complete any continuing education, training, or examinations as a term or condition of your probation those requirements remain in effect. For further guidance please contact your attorney or the BBS.
Q: What about Pre-licensees who wish to provide Telehealth during this time?
A: Trainees, Registered Associates and supervisors should follow California law as outlined in the BBS’s Statement on Coronavirus Disease 2019 (COVID-19) and Telehealth. Trainees are permitted to provide telehealth services if permitted in the agreement between their school and their workplace and telehealth services are performed under supervision of their supervisor(s). Additionally, on December 15, 2020, the Department of Consumer Affairs issued a waiver extension clarifying that student trainees are not required to provide “face-to-face” mental health services in order to complete their required training. Further, all Registered Associates are permitted to perform services via telehealth with clients located in California under the supervision of their supervisor(s). For more information see the BBS FAQ regarding this waiver.
Q. Videoconferencing Supervision: Are Registered Associates working in Non-Exempt settings able to receive videoconferencing supervision?
A. Yes. On October 22, 2020, the Department of Consumer Affairs issued a waiver extension permitting all Registered Associates, regardless of the setting in which they are working, to obtain supervision via two-way, real-time videoconferencing. This waiver does not permit telephonic supervision of any pre-licensee under any circumstances. The original waiver has been extended to now expire on February 28, 2021. For more information see the BBS FAQ regarding this waiver.
Q. If I am counting my hours under Option 2, can I count telehealth sessions as “in-person” sessions rather than “telehealth counseling”?
A. It depends. If you intend to submit your hours by December 31, 2020, you have the option of submitting your hours under either Option 1 or Option 2. If you are providing telehealth sessions due to recommendations and orders issued in response to the COVID-19 pandemic, we recommend that you track your hours under both Option 1 and Option 2 to minimize any potential loss of hours and see which option works better for your situation.
If you are counting your hours under Option 2, the 375-hour maximum for “telehealth counseling” remains in effect. BBS has clarified that if, for example, you are seeing a couple via telehealth then you are able to log those hours under the couples category, making that time eligible for the incentive doubling up to 150 hours. If you are logging telehealth hours under a unique category other than “telehealth counseling” you cannot also log those hours under the “telehealth counseling” category (i.e., you cannot double count your hours). Let’s look at an example of what is permitted versus not permitted:
Jane, an AMFT, sees the same 8 patients each week. She sees her individual patient face-to-face (adhering to all social distancing guidelines) and her 7 child patients via telehealth. In the week of September 7, 2020, Jane counted her 7 child hours correctly under the Couples, Families, Children category because she was still 100 hours short of the 375 telehealth counseling cap. Unfortunately, Jane made the mistake of double counting those child hours provided via telehealth by also logging the same time under the Telehealth Counseling category.
The following week, Jane recognized that she could still count the child hours provided via telehealth under the Couples, Families, Children because she was still below the 375 telehealth cap. She also, appropriately, did not double count those hours. Jane’s log from the week of September 14, 2020, is correct while her log from the week of September 7, 2020, is incorrect and should be revised to accurately reflect the hours earned as not 16, but 9.
BBS recommends that if you are logging telehealth counseling under the Couples/Children/Families category that you include a note on the form that makes clear to the evaluator that the time was earned via telehealth counseling. Remember that regardless of what category you are logging telehealth sessions under, you are only able to log a maximum of 375 hours gained via the provision of telehealth counseling.
Q. What if my license expires between January 1, 2021, and February 28, 2021, and I am unable to finish my required continuing education units?
A. All continuing education units may be obtained online. In person coursework is not required. CAMFT offers on-demand continuing education. A list of CAMFT approved CE Providers is also available on our website. If you are unable to complete your required CEU’s online by the time you renew your license you must complete any outstanding continuing education units within six months of your license expiration:
Q. What if I am required to complete continuing education or training as a result of a disciplinary order?
Q. What if I recently retired my license and want to reinstate it, can I?
A. Yes. If you have placed your license in an inactive, retired, or canceled status in the last five years you are permitted to reactivate or restore your license. You will not have to complete the any continuing education requirements that would otherwise apply. If you do choose to reactivate your license under this waiver it will be valid for either a maximum of six months or the date the State of Emergency ceases to exist, whichever occurs sooner. This waiver does not permit the reinstatement of a license that was surrendered, revoked, or cancelled pursuant to a disciplinary action.
VI. ADDITIONAL LEGAL AND ETHICAL ISSUES FOR THERAPISTS DURING COVID-19
We encourage therapists to adopt sensitive, clinically appropriate approaches to situations where patients who are sick are being asked to stay home or to engage in services via Telehealth. Therapists should also be careful not to engage in racial profiling or nationality-based discrimination in these situations. And remember, psychotherapists are required to keep patient communications and clinical records confidential and may only release information according to a patient’s valid authorization or as required or permitted by law.
Q: Can I terminate with my patients or postpone my services during this time?
A: It is important to be mindful of your ethical duties to patients even during this time of nationwide emergency. We urge that you use sound clinical judgment when terminating services with a patient. It is encouraged that you offer referrals to the patient. Please refer to the relevant CAMFT Code of Ethics below:
Q: I’ve received a court order signed by a judge or a search warrant issued by a judge requesting confidential patient information. Do I have to release?
A: Court Order—You must disclose patient confidential information as requested by a court pursuant to an order of that court. The court order must be signed by a judge. (Civil Code §56.10(b)(1).)
Search Warrant—You must disclose patient confidential information as requested by a search warrant lawfully issued to a governmental law enforcement agency. (Civil Code §56.10(b)(6).)
Q: My patient passed away and I just received a request for patient information from the coroner’s office. Do I have to release?
A: You must disclose confidential information of a deceased patient as requested by a medical examiner, forensic pathologist, or coroner, when requested in the following:
In the course of an investigation by such persons for the purpose of identifying the deceased patient or locating next of kin;
When investigating the patient’s death that may involve public health concerns, organ or tissue donation, child abuse, elder abuse, suicides, poisonings, accidents, sudden infant deaths, suspicious deaths, unknown deaths, or criminal deaths;
Upon notification of, or investigation of, imminent deaths that may involve organ or tissue donation. (Civil Code §56.10(b)(8).)
Q: A medical professional at a hospital treating my patient is requesting confidential patient information. Must I disclose?
A: Diagnosis and Treatment—You may (but are not required to) disclose patient confidential information to providers of health care and health care facilities for limited purposes of diagnosis or treatment of the patient. (Civil Code §56.10(c)(1).) We recommend, if practicable, that you obtain the patient’s authorization prior to disclosing confidential information. When disclosing information, therapists should make reasonable efforts to limit the information disclosed to that which is the “minimum necessary” to accomplish the purpose.
Q: The local county health department has requested my patient’s information. Do I have to release?
A: Prevention or Controlling Disease—You may (but are not required to, unless there is a court order or search warrant) disclose confidential information to a local health department for the purpose of preventing or controlling disease, injury, or disability and for the purpose of public health surveillance, interventions, or investigations. (Civil Code §56.10(c)(18).) As discussed above, we recommend to obtain the patient’s authorization prior to disclosing patient information. When disclosing information, therapists should make reasonable efforts to limit the information disclosed to that which is the “minimum necessary” to accomplish the purpose.
Q: The Red Cross is asking for my patient’s information. Do I have to release?
A: Disclosures for Disaster Relief Efforts—You may (but are not required to) disclose patient confidential information to a public or private entity to assist in disaster relief efforts, for the purpose of coordinating the notification to family members (or those involved in the patient’s care) of the patient’s location, general condition, or death. (Civil Code §56.1007(e).) As discussed above, we recommend if practicable, to obtain the patient’s authorization prior to disclosing confidential information. When disclosing information, therapists should make reasonable efforts to limit the information disclosed to that which is the “minimum necessary” to accomplish the purpose.
Q: I am concerned about a patient who is ill and reports exposure to Coronavirus, can I refuse to see the patient?
A: If you work in a hospital, clinic, or other setting, be sure to follow your employer’s protocols for safety and readiness. If a patient reports that they are ill or may have been exposed to any communicable illness, including but not limited to Coronavirus, you may request the patient not come in for session until they are feeling well (or after consultation with a healthcare provider which can give you reasonable assurances that they are not contagious). If practicable and suitable for the patient, you may consider offering Telehealth sessions.
Q. I have been notified that I have been diagnosed with coronavirus. What is my obligation to tell my staff or clients?
A. For patients, we highly recommend you notify any patients (that you have physically interacted with over the last 14 days) that there has been a diagnosis of an individual that they have come into contact with at your office. For staff, we recommend you tell them immediately and follow CDC recommendations on isolation and testing. Liability in these cases has not yet been fully tested, but knowingly exposing your patients or staff to a virus and/or not alerting them to that fact could be very problematic.
Q. I have been notified that my client/staff has been diagnosed with coronavirus. What is my obligation to tell my staff and other clients?
A: If you work in a hospital, clinic, or other setting, be sure to follow your employer’s protocols for safety and readiness. If a patient/staff reports that they have been exposed to any communicable illness, including but not limited to Coronavirus, and have been in your office within the last 14 days, it would be prudent to let any staff or patients who have also been physically in your office during that same time period that an individual who has been in your office has tested positive. You do not need to give additional personal information. If practicable and suitable for your patients, you may consider offering Telehealth sessions and/or remote work to your staff.
VII. BUILDING YOUR BACK-TO-BUSINESS PLAN
CAMFT encourages members to ensure the transition back to providing in-person sessions is done in a thoughtful and conscientious manner. As discussed above, CAMFT has interpreted Governor Newsom’s Shelter in Place Executive Order to mean that therapists are essential workers. This means that therapists can see patients in-person. While therapists can practice with patients in-person it is important to first consider whether you should. The decision of whether and when to resume in-person sessions will be unique to each therapist.
At this time, CAMFT recommends therapists exercise their best professional judgment in considering whether they should offer in-person psychotherapy. Therapists should be familiar with and apply relevant guidance from the federal, state, and local levels of government. This guidance, including guidance regarding potential liability issues, can be found in the links below. As a therapist, it is always important to consider the potential risks to self, patients, and family members in deciding whether to provide in-person sessions. Additionally, you should consult with your physician regarding any medical concerns you may have before resuming in-person sessions.
If you plan to see patients in your office, CAMFT recommends that you clearly communicate your expectations regarding your safety protocols. You may want to create written guidelines for your clients aboutexpectations to wear facial coverings in the office, use hand sanitizer or disinfectant wipes, maintain a certain distance within the room, etc. If you have patients who do not wish to comply with the safety standards you have outlined, you can ask those clients to continue with Telehealth services or, as is the case with non-compliant patients in any context, you can offer referrals for them to see another provider.
By receiving services in person, you will be mindful of the risks to yourself, your therapist, and your family members. I request the following from you:
Counties across California have implemented their own public health orders. These orders have included guidance of face covering requirements, criteria that should be met for those individuals considering returning to work after suspected or confirmed COVID--19, or social distancing protocols that are required to be posted in open businesses. Before providing in-person sessions, therapists should be familiar with their county's applicable public health orders and recommendations.
B. COVID-19 Vaccines
Q. When and how will MFTs obtain their COVID-19 vaccines?
A. The CA Department of Public Health (CDPH) is prioritizing vaccine distribution according to Centers for Disease Control (CDC) guidelines, which can be found here. The CDPH has received prioritization requests from almost all professional advocacy groups, including mental health groups. According to their recommendations above, the initial priority will be workers required to work directly with the general public (i.e., hospitals), as well as workers in locations most likely to spread COVID or where there are high risk individuals (i.e., long term care facilities).
As of January 7, 2021, California has given vaccinators and county agencies greater leeway to immunize those in lower priority groups. CAMFT has learned that several agency and private practice MFTs from several counties throughout the state who have clients they must see in-person, including clients struggling with substance use disorders (SUD), are now eligible for vaccination; however, there are variations depending on county and supply availability. Vaccine distribution is still being organized by county, so you must contact your county health department to see if you can schedule an appointment to receive the vaccine.
If you do not fall into one of the current tiers based on your work setting/employers, but are over 65 and/or have immune compromised health problems, speak to your family doctor immediately to make sure they are aware of your desire for a vaccine as this category of individual will likely be given priority in the near future. It is projected that the average adult (under 65 years without a compromised immune system) who does not work directly with high-risk groups and/or is not required to do in-person work, will receive their vaccine by summer 2021.
C. Liability Considerations
Therapists can minimize the potential for liability related to COVID-19 by educating themselves on the recommendations and orders that pertain to their specific practice. The easiest way to open the door for potential liability related to COVID-19 is by violating public health orders/recommendations. Additionally, if therapists advertise that they have taken certain precautions in following the public health orders/recommendations they should ensure compliance with those advertised precautions.
If a claim is filed against you related to COVID-19 exposure (e.g., from either a patient or employee), the circumstances and allegations surrounding the claim will be examined by your insurance carrier. In determining whether or not to cover the claim, your insurance provider will review the facts and circumstances surrounding the claim as well as the terms and conditions of your policy. Given that most LMFTs are still practicing via Telehealth and claims have not yet begun to be filed against therapists, CAMFT has been told that carriers are still assessing how COVID-19 fits into general and malpractice policies. We will keep you updated once we receive further clarity on how COVID-19 may impact your liability.
D. Concerns and Sample Agreements for Seeing Patients In-Person
Q. My client is requesting to be seen in person. If I agree to see this patient in person, what are some specific considerations I can relay to the patient if they come into my office?
A. At this time CAMFT recommends seeing patients via Telehealth unless the patient is not clinically-appropriate for Telehealth services. If a therapist provides in person sessions, that therapist should comply with all recommendations and requirements applicable to their practice as detailed above to minimize the chance of exposure to COVID-19. If a therapist agrees to see a patient in person, CAMFT recommends you consider whether you may want to have your patient sign an agreement addressing some of the following issues.
Q. If I am seeing patients in person, what are some tips to protect the health of therapists and their patients?
A. Our understanding of COVID-19 changes daily. As a result, what might be recommended today to mitigate transferability of the virus might not be recommended next week. For this reason, CAMFT is not offering specific tips as we do not want to inadvertently subject our members to liability for following out-of-date guidance. When considering what steps a therapist should take to protect the health and safety of themselves, their patients, and employees, CAMFT recommends therapists look to the specific guidance that is put out by the Centers for Disease Control and follow any and all health orders in place in your city or county that pertain to your practice. For example, at this time, the Centers for Disease Control (CDC) recommendations include, but are not limited to:
Q. I have begun to see patients in my office. Can I give my patients the option to remove their face covering during session?
A. Most likely no. As of June 18, Californians are required to wear face coverings in all indoor public settings with limited exceptions. One notable exception permits persons who are either hearing impaired or communicating with someone who is hearing impaired to avoid wearing a mask as being able to see the mouth is essential for communication. Other exceptions include persons with a medical condition for whom wearing a face covering could obstruct breathing (e.g., COPD) or children under two years old. Finally, some patients may have a mental health condition for which they are seeking treatment that prevents wearing a face covering. In such a case, the therapist should document their professional opinion as to why the patient’s mental health condition prevents them from wearing a face covering. CAMFT recommends against a therapist participating in or allowing a patient to violate any executive orders due to the possibility of liability if your patient contracts COVID-19.
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Resources to Provide Mental Health Services
CAMFT continues to be inspired by our many members who have called in and asked, “How can I help? Below you will find local and statewide initiatives that are calling for mental health professionals to support front-line healthcare workers and first responders as well as the public at large during the COVID-19 crisis.
(Please note: CAMFT is not directly affiliated with any of these initiatives and is not responsible for their actions or CAMFT member interactions with these organizations.)
THROUGHOUT CALIFORNIA—THE CALIFORNIA HEALTH CORPS
THROUGHOUT CALIFORNIA—THE COVID-19 COUNSELING CALIFORNIA INITIATIVE
THROUGHOUT CALIFORNIA—CA DISASTER HEALTHCARE VOLUNTEERS PROGRAM
THROUGHOUT CALIFORNIA—GIVE AN HOUR
BAY AREA ONLY—THE COVID-19 PRO BONO COUNSELING PROJECT