Going Back to Work: What should I consider?
By: Richard S. Leslie, Attorney at Law
Practitioners have changed the way they practice as a result of the pandemic, which seems to be moderating, and once again, practitioners will be returning to practice in their offices. Innumerable issues surely will arise as a result of the transition back to in-person treatment. A continued and likely increase in the use of telehealth is to be expected, but the return to the office is certain. Because all of this is new, unique and ever-changing, it is sometimes difficult for practitioners to navigate. It is important for practitioners to be aware of the resources available online – which comes from the several state and national professional associations representing the various mental health professions, as well as from governmental entities, both state and local, including licensing and public health authorities. This information is likely to change over time.
As stated above, innumerable issues can arise. For example, suppose a practitioner decides to return to an office setting. Is the practitioner vaccinated? Must the practitioner disclose to patients that they have been vaccinated or that they are unvaccinated? If unvaccinated, is it necessary for the practitioner to wear a mask? Is it permissible to require patients to present proof that they have been vaccinated? If a patient says that they have been vaccinated and that they have lost their proof, is it permissible for the practitioner to refuse to provide in-person treatment or would that impermissibly impugn the character of the patient?
There is no end to the questions that may or will arise. Some circumstances may require legal consultation. Other circumstances may be resolved by the exercise of sound judgment (perhaps after conversations with colleagues), which should be informed, at a minimum, by the resources referred to above. Hopefully, these extraordinary conditions for patients and practitioners alike, will soon end, or at least significantly lessen.
Managing Risk for Private Practitioners Returning to In-Person Treatment
By: Todd C. Atkins, Licensed Attorney in California
One of the hottest COVID-19 topics of the day for psychotherapists is how to handle returning to in-person treatment with patients in your private practice. While there are, as yet, no concrete answers to all the questions, there are a number of steps that psychotherapists can take to minimize their risk.
Whether and how to return to in-person treatment will be a personal decision for each psychotherapist.
Vaccine Status and Treatment
Perhaps the biggest issue to be confronted is whether to require a vaccination and do you ask for proof. The short answer is that, unless your state or local government prohibits it, you can likely offer in-person treatment to patients who are vaccinated, while offering telehealth treatment to patients who are either not vaccinated/don’t want to share that information/won’t provide proof of vaccination.
Each psychotherapist will have to navigate their own comfort level on this delicate issue. As you are no doubt aware, there are very strong feelings surrounding vaccinations and whether to get one.
Some questions to ask yourself as you determine how you want to proceed:
- Are you comfortable asking a client if they are vaccinated?
- Do you trust your clients to be honest and truthful?
- Will organic conversations naturally occur as people discuss their excitement about being vaccinated or disdain for the vaccine culture?
- Would you be comfortable asking to see their vaccine card?
- Would you be able to spot a fake vaccine card?
- If you are not comfortable asking about vaccine status/proof of vaccine, would you be comfortable moving forward with masks?
- Are you applying your policy consistently?
- What do the federal/state/local laws say regarding businesses, as well as vaccine requirements?
Regardless of where you land on your in-person policy, it is important to remember that no one is being denied services based on their vaccine status– patients can always have services rendered via telehealth.
In some areas of the country, masking requirements are still in effect in settings that may include in-person treatment of unvaccinated patients. This will heavily impact treatment of minors under the age of 12 who are not currently vaccine eligible. If you have unvaccinated clients, it is best to talk with them (or their parents) about whether to proceed with masks, via telehealth, or utilizing mask alternatives allowed under state/local laws (i.e., clear face shields, plexiglass, outdoor therapy, etc.)
In navigating this hopefully soon to be post-Covid landscape, there are a number of important things to keep in mind to help you manage risk. Attached to this article are a couple of tools: 1 – The Nuts and Bolts of Reopening your Practice after Covid-19 Checklist prepared by the American Professional Agency; and, 2 – a Sample Informed Consent for In-Person Services during Covid-19 prepared by the American Psychological Association. These tools will not uniformly apply to all psychotherapists and should be modified based on your practice as well as your state and local rules.
While this article discusses private practice psychotherapists, the return-to-work issue of course comes into play with employers, supervisors and employees of agencies, government entities, etc. If you fall into this category, it is important to review federal, state and local rules regarding employees, as the governing laws can often be different than the general guidance on businesses with customers.
The single best thing you can do to manage risk of treatment during the Covid pandemic is to keep yourself informed of local, state and federal guidelines. As many of us have experienced these guidelines are rapidly changing and can be confusing or even conflicting. Nonetheless, it is recommended that you put in a good-faith effort to stay apprised of the various guidelines and make changes to your policies when indicated. It is also crucially important to talk to your colleagues about how they are handling in-person treatment. Share your policies with others as well as give each other feedback. Also take advantage of state or national associations that provide resources and guidance to members. As always, make sure you are documenting all the steps you are taking.
Practicing psychotherapy in the COVID world is likely to continue to be a bumpy ride at least for the near term. For a variety of reasons, both known and un-known, the pandemic has coincided with an unprecedented surge in need for mental health treatment. Mitigating the risk of practicing is best accomplished by putting in the time to stay abreast of those ever-changing guidelines and then implementing/following the policies and procedures that work best for your practice.
As you think about continuing or reintroducing in-person sessions into your practice, you should consider the following, among other things:
- Follow CDC, state and city guidelines for reopening and operating your place of business safely
- Should a claim be filed against you related to Covid-19, or any other matter, the circumstances and allegations surrounding the claim will be examined by the carrier. While CPH is hesitant to address hypothetical claims scenarios, coverage will be determined, as always, according to the terms and conditions of the policy
- Consult with your professional association and/or local attorneys regarding legal guidance and actions you should consider taking as you navigate the reopening of your office (waivers/consents, protocols, etc)
Whether you deliver services in person or via telehealth, the coverage is the same, as long as services are being provided legally within the scope of your state licensing laws.
Below is a list of resources providers should closely consider as they safely progress through this time:
- CDC guidance on face-to-face interactions
- CAMFT: Building Your Back-To-Business Plan
- World Heath Organization: Getting your workplace ready for COVID-19
Coronavirus & Telehealth: Am I Covered?
With growing concerns of Coronavirus, many therapists are exploring the idea of telehealth as a means of continuing therapy sessions safely during this evolving situation. We understand how important it is as providers to continue your practice with as little disruption as possible and that the safety of your clients and yourself is of utmost priority. It is our priority to support you in this.
Telehealth is a growing and prominent platform for therapists today. We are pleased to assure you that the policy with CPH & Associates does cover services provided via telehealth, as long as such services are permitted under your state’s law. You should also confirm with your professional association and/or state licensing board on if they permit this service.
- U.S. Department of Health & Human Services (HHS): Emergency Preparedness
- HHS: FAQ’s on Telehealth and HIPPA
- Informed Consent for Teletherapy Sample
- BBS Order Waiving Face-To-Face Training and Supervision Requirements
Important Notice about NY Regulations for Customers
Thank you for your service on the front lines of engagement with COVID-19 while continuing to address our community’s ongoing healthcare needs. Please be assured we are here to support you, as your insurance agent, during this difficult time. We realize the challenges you face are evolving with each new day and we are working hard to assist you with your insurance and risk needs.
We specifically want to inform you that on March 30, 2020, following Executive Order No. 202.13 by the Governor of New York, the New York Department of Financial Services (DFS) issued an Emergency Regulation requiring insurers to grant premium payment relief to New York consumers and small businesses experiencing financial hardship due to COVID-19. That Emergency Regulation affords you certain protections, including the following:
Section 229.5. Premium repayment, demonstration of financial hardship, and voluntary cancellation
(a) An insurer shall permit a policyholder who did not make a timely premium payment due to financial hardship as a result of the COVID-19 pandemic, including a policyholder to whom the insurer issued a non-payment cancellation notice prior to the effective date of the Executive Order, and who can still demonstrate financial hardship as a result of the COVID-19 pandemic, to pay such premium over a 12-month period. An insurer also shall:
(1) within ten business days following the promulgation of this Part, provide notice with each insurance premium bill of the provisions of this Part and a toll-free number that the policyholder may call to discuss billing and make alternative payment arrangements; and
(2) notify insurance producers and any third-party administrators with whom or which the insurer does business of the provisions of this Part.
(b) A licensed insurance producer who services an in-force life insurance policy, annuity contract, or fraternal benefit society certificate or who procured the property/casualty insurance policy for the property policyholder shall mail or deliver notice to the policyholder of the provisions of this Part and section 405.6 of Part 405 of Title 3 within ten business days following the promulgation of this Part.
(c) Solely for the purposes of this Part, an insurer shall accept a written attestation from a policyholder as proof of financial hardship as a result of the COVID-19 pandemic.
(d) Nothing shall prohibit a policyholder from voluntarily cancelling an insurance policy or annuity contract.In addition, if you financed your premium through a premium finance agency, that premium finance agency is also required to make certain accommodations under the Emergency Regulation via a new section 405.6 which has been added to Part 405 of Title 3.
We stand ready to answer any questions you might have and address any payment issues you are experiencing as a result of the COVID-19 pandemic. Again, we thank you for your service