Michigan telehealth and the limited licensed counselor
COVID 19 changed all of our lives in 2020. In many ways, it made life harder, scarier and more challenging. I also see a lot of positive changing beginning in the world of mental health, especially care that is delivered virtually. Virtual services has the opportunity to break transportation, childcare and scheduling barriers. Therapy online allows our services to travel into more remote area’s of the states we’re licensed in, gives us the opportunity to see how our client’s live and respond in their own environment, AND opens us up for the potential to trip into a few more ethical/procedural pitfalls.
An exert from the Michigan Mental Health Code reads “Telemedicine means the use of an electronic media to link patients with health care professionals in different locations. To be considered telemedicine under this section, the health care professional must be able to examine the patient via a [HIPAA] compliant, secure, interactive audio or video or both telecommunications system or through the use of store and forward online messaging.”
HIPAA compliant mediums
Everyone is using Zoom or Doxy these days. I recently heard from one my my supervisee’s that a BAA is needed from Zoom in order to truly make the service compliant with HIPAA. Zoom certainly falls under a “business associate (entity)” which is an (in this case) entity who performs a function on behalf of a covered entity that involves access by the business associate to protected health information (your client’s sessions while using their service). Zoom’s website lists contacting Sales to get a BAA signed. If you’re using another platforms, I’d love to know.
Disclosure and intake
There are no differences with what is needing to be shared with the client, and received in return during telehealth sessions. As a Limited Licensed Counselor (LLPC if you’re old school) in Michigan, you must provide each of your clients a copy of your professional disclosure statement and have a form they sign agreeing that they were offered a copy. At “intake” or your first session, I recommend gathering bio-psycho-social information on your client’s current and historical strengths, struggles and living environment. Having each client fill out a form with their contact information, emergency contact (and release of information), insurance information etc. is also recommended. Typically in an office, I’d take copies of their drivers license and insurance cards - I’d recommend transitioning that into the client holding up these cards to the screen and you snap a “screen shot" and then add those photo’s directly to your HIPAA compliant note keeping system. Which leads me to…
Note keeping
Only one additional recommendation for telehealth sessions here - keep track of which sessions are in person, which sessions are telehealth.
Risk/Safety
Assessing for risk can be a little more tricky when your client is not physically present in your space. However, it does give you the opportunity to see the client in their own environment. It’s important to ask the client where they are having their session from (location, address) as your session is getting started. This way if there is a safety issue, you know where you can locate them. I recommend asking privacy questions as well - are you in a space where you can have privacy during this session?
Keeping up to date as mental health rules/regulations rapidly change over the next couple of years will be imperative. Due to the rising need for counselors (limited licensed, fully licensed - ALL of us), some states are allowing counselors licensed in other states to provide services to residents. Some states are considering an interstate compact. There will be lots of focus on the growth of mental health services in the coming years, ensure you stay up to date following Telehealth.hhs.gov, nbcc.org and other national agencies you can trust.
