Resources for Members During COVID-19
X

Resources for Members During COVID-19

HELPFUL RESOURCES DURING COVID-19

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

  1. California-Specific Updates
  2. National Updates
  3. Safety and Mental Wellness Resources for Clinicians and Consumers

II. TELEHEALTH RESOURCES FOR THERAPISTS DURING THE COVID-19 PANDEMIC 

  1. BBS Telehealth Statements
  2. General Telehealth FAQs
  3. Telehealth & HIPAA FAQs
  4. Telehealth & Insurance FAQs
  5. Out-of-State Telehealth

III. EMPLOYMENT RESOURCES

  1. Employee Benefits
  2. Family Leave & Disability Information
  3. Unemployment Benefits

IV. SMALL BUSINESS RESOURCES

  1. Information for Small Business Assistance
  2. Small Business Loan Opportunities
  3. The Economic Injury Disaster Loan Program FAQs
  4. The Paycheck Protection Program FAQs

V. BBS PRE-LICENSEE AND LICENSEE RESOURCES & FAQ’S

  1. BBS Registration/License Renewal Statements
  2. Waivers & BBS Statements for Pre-Licensees
  3. Pre-Licensee Registration & Supervision FAQs
  4. Licensee Renewal FAQs 

VI. ADDITIONAL LEGAL AND ETHICAL ISSUES FOR THERAPISTS

  1. Treatment Disruption
  2. Responding to Court Orders
  3. Releasing Patient Information to Health Officials
  4. If You or a Patient is Diagnosed with COVID-19

VII. BUILDING YOUR BACK-TO-BUSINESS PLAN

  1. Federal, State and Local Safety Guidance
  2. Liability Considerations
  3. Concerns and Sample Agreements for Seeing Patients In-Person

VIII. HOW CAMFT MEMBERS CAN HELP

  1. Paid Positions
  2. Volunteer Positions

I. GENERAL RESOURCES FOR COVID-19 INFORMATION

  1. California-Specific Updates
    1. For state-wide information and orders view the Newsom Administration’s new COVID-19 website.
    2. For daily updates on COVID-19 view the California Department of Public Health COVID-19 Updates webpage
    3. For the latest COVID-19 news releases from the California Department of Public Health visit the CDPH News Releases webpage.
  2. National Updates
    1. For updates on nationwide COVID-19 information and guidance, view the Centers for Disease Control and Prevention – COVID-19 Coronavirus Updates
  3. Safety and Mental Wellness Resources for Clinicians and Consumers
    1. For COVID-19 safety tips view the Red Cross Safety and Readiness Guide.
    2. Click here for a free resource book containing 24 practical stress-reduction exercises for parents, educators, and children developed by the Disastershock Team at Oxford Symposium in School-based Family Counseling. Also available in Spanish, Mandarin, and more.
    3. An extensive list of Behavioral Health resources for both clinicians and consumers from the CDC, SAMHSA, CSTS, WHO and more can be found on the CAMFT CRERC website or by clicking here.
    4. Blogs regarding coping in abusive homes, physical distancing in multi-generational homes, and encouraging safe community connections can be found at Each Mind Matters.  
    5. CAMFT’s PSA Video: Tips for Reducing Anxiety and Stress During the COVID-19 Coronavirus Global Pandemic
​Back to top

II. TELEHEALTH RESOURCES FOR THERAPISTS DURING THE COVID-19 PANDEMIC

  1. BBS Telehealth Statements
​Back to top
  1. General Telehealth FAQs

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:

  • Contact the state’s licensing board to see if temporary practice is allowed during this time of crisis;
  • If temporary practice is not permitted by the other state’s law, document in your file why working with your patient was a medical necessity.

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. 

Back to top
  1. Telehealth & HIPAA FAQs

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. 

Important Notes: 

  • The OCR Notice encourages providers to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications. 
  • The OCR Notice does state that “Facebook Live, Twitch, TikTok, and similar video communication applications that are public facing should not be used in the provision of Telehealth by covered health care providers.”

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

  • Skype for Business
  • Updox
  • VSee
  • Zoom for Healthcare
  • Doxy.me
  • Google G Suite Hangouts Meet

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. 

​Back to top
  1. Telehealth & Insurance FAQs

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:

  1. The Department of Managed Healthcare (DMHC) released their All Plan Letter on March 18, 2020, stating that all health plans shall, effective immediately, comply with the following:
    • Health plans shall reimburse providers at the same rate, whether a service is provided in-person or through Telehealth, if the service is the same regardless of the modality of delivery, as determined by the provider’s description of the service on the claim. For example, if a health plan reimburses a mental health provider $100 for a 50-minute therapy session conducted in-person, the health plan shall reimburse the provider $100 for a 50-minute therapy session done via Telehealth.
    • For services provided via Telehealth, a health plan may not subject enrollees to cost-sharing greater than the same cost-sharing if the service were provided in-person.
    • Health plans shall provide the same amount of reimbursement for a service rendered via telephone as they would if the service is rendered via video, provided the modality by which the service is rendered (telephone versus video) is medically appropriate for the enrollee.
  2. The Insurance Commissioner from the Department of Insurance (DOI), which mainly authorizes PPOs, released this statement on Plan Filing Requirements for Telehealth on March 18, 2020, stating that insurers’ plans should maximize the use of Telehealth in all appropriate settings, reflecting the federal government’s request on March 17 that private insurers remove barriers to Telehealth, consistent with the federal government’s actions in Medicare.
  3. On March 30, DOI clarified that insurers must allow their contracted providers to provide care through the use of Telehealth and specified that health plans must:
    • Allow all network providers to use all available and appropriate modes of Telehealth delivery including, but not limited to, synchronous video, and telephone-based service delivery
    • Immediately implement reimbursement rates for Telehealth services that mirror payment rates for an equivalent office visit
    • Eliminate barriers to providing medically and clinically appropriate care using appropriate Telehealth delivery models.
  4. The Center for Medicare and Medicaid Services (CMS) adjusted Medicare payment restrictions, allowing Medicare to pay for office, hospital, and other visits furnished via Telehealth across the country and including in patient’s places of residence starting March 6, 2020.
  5. For Medi-Cal recipients, on March 18, 2020, the Department of Health Care Services (DHCS) sent an All Plan Letter (APL) to Medi-Cal Managed Care Plans (MCPs) requiring they take steps to allow their enrolled members to obtain health care via Telehealth when medically appropriate to do so. All Medi-Cal managed care plans must, effective immediately:
    • Reimburse providers at the same rate, whether the service is provided in-person or through Telehealth, if the service is the same regardless of the modality of the delivery (unless otherwise agreed to by the provider and the MCP); and
    • Provide the same amount of reimbursement for a service rendered via telephone as they would if the service is rendered via video, provided the modality by which the service is rendered (telephone versus video) is medically appropriate for the member. Read more about the requirements for Telehealth services rendered by MCP providers.
  6. In response to  DHCS’s Request for Section 1135 Waiver Flexibilities, CMS approved some of the DHCS’s requests, including but not limited to, temporarily suspending Medi-Cal Fee-for-Service prior authorization requirements, extending pre-existing authorizations, and waiving certain provider enrollment requirements. CMS continues to work on the additional waiver requests that are not currently reflected in the most recent approval. CAMFT is monitoring for updates.

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.

  1. Out-of-State 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:

  • Contact the state’s licensing board to see if temporary practice is allowed during this time of crisis;
  • If temporary practice is not permitted by the other state’s law, document in your file why working with your patient was a medical necessity.
  • ​Back to top

    III. EMPLOYMENT RESOURCES

    Information For Employees

    1. The California Labor Board’s COVID19 Benefits matrix outlines which benefits are available for employees impacted by COVID19
    2. The California Labor Board’s COVID 19 Benefit FAQs outlines Family Leave, Disability Insurance and Unemployment Insurance 
    3. The federal CARES Act includes the Pandemic Unemployment Assistance Program, which helps individuals who may not typically qualify for state unemployment insurance benefits
    4. To file a claim for Unemployment Benefits, click here
    ​Back to top

    IV.  SMALL BUSINESS RESOURCES

    1. Information for Small Business Assistance
      1. For continually updated information regarding the Coronavirus Aid, Relief, and Economic Security Act (The CARES Act) and how it can help small businesses, view the U.S. Chamber of Commerce website here.
      2. Access general small business loan information from the U.S. Small Business Administration (SBA)
      3. If your business is experiencing economic injury due to COVID-19, apply for a low-interest loan from the SBA Disaster Loan Assistance Program
      4. If you already have a business relationship with SBA, access up to $25,000 with less paperwork by applying to the SBA Express Bridge Loan Pilot Program
    2. Small Business Loan Opportunities

    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):

    1. The Economic Injury Disaster Loan Program; and
    2. The Paycheck Protection Program.

    These programs make loans available to small businesses, nonprofit organizations, sole proprietors, independent contractors, and other entities affected by the coronavirus.

    1. The Economic Injury Disaster Loan Program FAQ

    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:

    1. Small businesses;
    2. Nonprofit organizations;
    3. Individuals operating as sole proprietors; and
    4. Individuals operating as independent contractors.

    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.

    1. The Paycheck Protection Program FAQs

    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:

    1. Keeps all of its employees on payroll for eight weeks; AND
    2. Uses the loan to cover payroll, rent, mortgage interest, or utilities.

    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:

    • Small businesses;
    • Private nonprofit organizations;
    • Individuals operating as sole proprietors; and
    • Individuals operating as independent contractors.

    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:

    • Any existing SBA 7(a) lender;
    • Federally insured depository institutions;
    • Federally insured credit unions; and
    • Farm Credit System institutions that are participating in the Paycheck Protection Program.

    Eligible employers should reach out to their local lenders to determine whether the lenders are participating in the Paycheck Protection Program.

    Back to top

    V.  BBS PRE-LICENSEE & LICENSEE RESOURCES & FAQ’S

    1. BBS Registration/License Renewal Statements

    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: 

    • For individuals who have retired or inactivated their California license in the last five years, the DCA Director issued a Reissuance of License Waiver in order to increase the number of health professional available to provide care and treatment.  A license reactivated pursuant to this waiver expires the sooner of January 1, 2021 or when the State of Emergency ceases to exist.
    • For individuals whose active license expires between March 31, 2020 and October 31, 2020, the DCA Director has issued a waiver permitting those licensees to renew their license without having completed the required CE’s. These CE’s must be completed within 6 months of the August 27, 2020 waiver. Remember, all CE’s may be completed online so there is no need to attend an in-person course to receive your required CE’s.
    1. Waivers & BBS Statements for Pre-Licensees
    • BBS Updated Statement on Telehealth: Reiterates existing law that MFT Trainees and Associates are permitted to provide telehealth services to clients in California when receiving appropriate supervision and (for Trainees) if authorized by their school. This is a statement of existing law with no expiration date.
    • Video Supervision Waiver Extension: Extends the waiver permitting trainees and AMFTs, regardless of the work setting, to be supervised via real-time videoconferencing until November 2, 2020.
    • BBS FAQ Statement
    • Registration Renewal Waiver Extension: Permits AMFT’s to renew their Registration without passing the Law & Ethics exam if their Registration expired between March 31, 2020 and October 31, 2020.
    • Updated BBS FAQ Statement
    • Practicum Enrollment Waiver: Extends the 90-day period between enrollment in a practicum course for MFT Trainees to 180 days if the trainee was enrolled in a practicum course between May 2, 2020 and August 31, 2020.
    • BBS FAQ Statement
    • Clinical Examination Waiver: Extends eligibility period to retake examinations to 18 months from notification of eligibility if the one-year eligibility period expires between March 31, 2020 and July 1, 2020.
    • BBS FAQ Statement

    ​Back to top
    1. Pre-Licensee Registration & Supervision FAQs

    Q. I was enrolled in a practicum course this Summer, but my school will not be in session this coming fall. Can I continue to see patients and count hours?

    A. Possibly. On August 29, 2020, the Department of Consumer Affairs issued a waiver to permit those “students last enrolled in a practicum course between May 2, 2020, and August 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 May 7, 2020, instead of needing to be re-enrolled in a practicum course by August 5, 2020, you now may continue to work and count your hours so long as you either graduate or re-enroll in practicum by November 3, 2020. 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 August 27, 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 only applies to those AMFTs whose registration expired or will expire between September 1, 2020 and October 31, 2020. 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, 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 October 31, 2020, a six month extension to attempt the Law & Ethics exam as follows:  

    • If your registration expired between March 31,2020 and June 30, 2020, you must attempt the exam by September 30, 2020.
    • If your registration expires between July 1, 2020 and August 31, 2020, you must attempt the exam by January 1, 2021.
    • If your registration expires between September 1, 2020 and October 31, 2020, you must attempt the exam by March 1, 2021.

    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 September 1, 2020 and October 31, 2020, you may renew your registration without having taken the Law & Ethics exam. You can renew your registration online via your BreEZe account.

    Q. What if my registration is expiring soon and I need to take the clinical exam. Does the waiver apply to me?

    A. No. Taking the clinical exam is not a condition to renewal of your registration. Whether you need to maintain a current and active registration number depends on the type of setting you are working in. If you are in private practice you are required to maintain a current Associate registration until your license is issued.

    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 August 27, 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 August 27, 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 November 2, 2020. 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:
     

    Counting Hours

     

    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. I became eligible to take the clinical exam on May 1, 2019. I was unable to take the clinical exam due to the pandemic. Will my application be abandoned?

    A.  No. If your one-year period of eligibility to take the clinical exam expired between March 1, 2020 and July 1, 2020, you have an additional 6 months from the expiration of your eligibility. This means that if your eligibility to take the clinical exam expired on May 1, 2020, in order to avoid abandonment of your application, you must take the clinical exam by November 1, 2020.

    ​Back to top
    1. Licensee Renewal FAQs

    Q. What if my license expires between September 1, 2020, and October 31, 2020, 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 the waiver dated August 27, 2020. 

    Q. What if 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 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.

    ​Back to top

    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.

    1. Treatment Disruption

    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:

    • 1.3 TREATMENT DISRUPTION: Marriage and family therapists are aware of their professional and clinical responsibilities to provide consistent care to clients/patients and to maintain practices and procedures that are intended to provide undisrupted care. Such practices and procedures may include, but are not limited to, providing contact information and specified procedures in case of emergency or therapist absence, conducting appropriate terminations, and providing for a professional will.
    • 1.4 TERMINATION: Marriage and family therapists use sound clinical judgment when terminating therapeutic relationships. Reasons for termination may include, but are not limited to, the client/patient is not benefiting from treatment, continuing treatment is not clinically appropriate, the therapist is unable to provide treatment due to the therapist’s incapacity or extended absence, or due to an otherwise unresolvable ethical conflict or issue. (See also sections 3.8 Client/Patient Benefit and 5.11 Scope of Competence.)
    1. Responding to Court Orders

    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).)

    1. Releasing Patient Information to Health Officials

    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.

    1. If You or a Patient is Diagnosed with COVID-19

    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.

    ​Back to top

    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:

    • You will only attend in person sessions if you are free of COVID-19 symptoms. I am happy to provide you with Telehealth services if you are feeling unwell.
    • You will adhere to the public health orders addressing requirements for facial coverings and social distancing.
    1. Federal, State and Local Safety Guidance
    1. FEDERAL GUIDELINES
    1. STATE GUIDELINES
    1. LOCAL GUIDELINES

    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.

    • City Guidance    Many cities across the state have instituted their own public health orders on topics ranging from notifications that must be posted in open businesses and more stringent face-covering requirements. Prior to resuming in-person sessions therapists should check the website (if available) of the city in which the practice operates to determine whether any such guidelines exist in that city.

    B. 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.  

    C.  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.

    • You are not required to receive psychotherapy in person.  By coming to the office, you assume the risk of exposure to COVID-19 (or any other health risk). If you are concerned about possible risks to your health, consult with your physician before attending in person meetings.
    • I will respect your decision should you at any time choose to return to Telehealth services. If at any time it becomes unsafe due to a resurgence of COVID-19 or other health reason, I may require we resume Telehealth sessions. If I determine a return to Telehealth services is necessary, I will attempt to share that decision with you as soon as practicable.
    • 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:
      • You will only attend in person sessions if you are free of COVID-19 symptoms. I am happy to provide you with Telehealth services if you are feeling unwell.
      • You will adhere to the public health orders addressing requirements for facial coverings and social distancing to the extent they exist.
      • You will wash your hands and/or use hand sanitizer prior to entering my office.
      • If you touch your face during session, it is recommended that you immediately wash or sanitize your hands.
      • If you are working in a job that exposes you to individuals who may be infected, I request that you please let me know. I do not recommend attending in person sessions if you are exposed to anyone who may be infected with COVID-19.
      • If you or a member of your immediate household tests positive for COVID-19, you should not attend in person sessions. You agree that if this is the case, you will inform me (and my staff) immediately so that we may resume Telehealth sessions.
      • There are certain circumstances under which I may be required to notify health authorities that you have been in the office. This typically would only occur if someone who had been seen in my office were to test positive for COVID-19. If this situation arises, and in accordance with applicable privacy laws, I will provide the minimum information necessary for the health authorities to perform their duties.

    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:

    • Following state and local health department recommendations on social distancing.
    • Encouraging sick employees to stay home.
    • Routinely clean and disinfect all frequently touched surfaces, such as work areas, countertops, handrails, and doorknobs.
    • Providing tissues, no-touch trash cans, soap and water, and hand sanitizer with at least 60% alcohol.
    • Following the CDC guidelines for cleaning and disinfecting areas a sick individual may have visited. 

     

    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.

    Back to top


    VIII. HOW CAMFT MEMBERS CAN HELP

    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.)

    1. Paid Positions

    THROUGHOUT CALIFORNIA—THE CALIFORNIA HEALTH CORPS

    • To prepare for the increased number of individuals who will need health care during COVID-19, California is opening additional health care sites and hiring additional licensed staff. 
    • To sign-up for the California Health Corps, click here.
    1. Volunteer Positions

    THROUGHOUT CALIFORNIA—THE COVID-19 COUNSELING CALIFORNIA INITIATIVE

    • Offering mental health support for Frontline Health Professionals, First Responders, and Essential Workers
    • Sponsored by a collaboration between CAMFT, CALPCC, CA Psychiatric Association, CA Psychological Association, and NASW-CA. Contact community@covid19counselingca.org
    • To volunteer, click here.

    THROUGHOUT CALIFORNIA—CA DISASTER HEALTHCARE VOLUNTEERS PROGRAM

    • Serve as a volunteer health professional during duly declared emergencies of disaster in California
    • Founded by the Emergency Medical Services Authority of California
    • To volunteer, click here.

    THROUGHOUT CALIFORNIA—GIVE AN HOUR

    • Serving Military populations during COVID-19 and always
    • Currently experiencing shortages of providers in the San Diego and rural CA areas
    • To volunteer, click here.

    BAY AREA ONLY—THE COVID-19 PRO BONO COUNSELING PROJECT

    • Pro Bono Counseling for Front-line Healthcare Workers Facing COVID-19
    • Founded by Elizabeth Rawson and Michael Levin in concert with UCSF
    • To volunteer, click here.
    Back to top