Counselors
PROFESSIONAL COUNSELORS, MARRIAGE AND FAMILY THERAPISTS, AND PSYCHO-EDUCATIONAL SPECIALISTS
Board of Examiners for Licensure of Professional Counselors, Marriage and
Family Therapists, and Psycho-Educational Specialists
Provision of Services via Electronic, Distance Professional Services
Effective Date: November 17, 2015
In response to inquiries from licensees, supervisors, and other interested parties, the SC Licensure Board has confirmed that it has no separate view per se with regard to the provision of services via electronic means as long as a licensee is practicing in a manner consistent with his/her training and experience, is receiving supervision as is appropriate, and the medium for doing so is not an issue. However, it is incumbent upon any licensed counselor, therapist, or psycho-educational specialist to recognize that as he or she moves away from direct face to face contact with clients, there are losses to the processes and interactions. The Board considers that the practice of counseling, marriage and family therapy occurs both where the therapist who is providing therapeutic services is located and where the individuals (patients/clients) who are receiving services are located. In order for an individual to provide counseling and therapy services in South Carolina, that individual must be licensed by the South Carolina Board for Counselors, Marriage and Family Therapists, and Psycho-educational Specialist. On this basis, if an individual licensed in South Carolina renders services electronically to an out-of-state client, it is recommended that the licensee contact the licensure board for counselors, marriage and family therapist, or psycho-educational specialist in the state in which the clients reside to determine whether or not such practices are permitted in that jurisdiction. Licensees are advised to review the South Carolina Licensure Law and the Code of Ethics.
Delivery of clinical services via technology-assisted media such as telephones, the use of video, or the internet requires the therapist to be sensitive to various issues. These areas include: confidentiality, acquiring required signatures on intake forms (consent to treat, release of information, professional disclosure forms, consent to treat minors, consent to tape, etc.). Other issues include: confidentiality, boundaries of competence, computer security, avoiding harm dealing with fees and financial arrangements, and advertising. Other specific challenges include, but are not limited to verifying the identity of the client, determining if the client is a minor, explaining to the clients the procedures for contacting the therapist/counselor when he or she is off-line, discussing the possibility of technology failure and alternate means of communication if technology occurs. It is important for counselors and therapists to use encrypted technology as required by HIPAA. Clients should be informed of the encryption methods used to help ensure the security of communications. Also, counselors and therapists should inform clients as to whether session data is being preserved and if so, for in what manner and for how long. In addition, clients need to be informed regarding the procedures that will be in place in receiving and releasing client information received through the internet and other electronic sources.
Last of all, it is important that when providing services through electronic methods, the
counselor and therapist be knowledgeable regarding emergency services available in the
communities where their clients live.
CHAPTER 36.
DEPARTMENT OF LABOR, LICENSING AND REGULATION-- BOARD OF EXAMINERS FOR THE LICENSURE OF PROFESSIONAL COUNSELORS, MARRIAGE AND FAMILY THERAPISTS, AND PSYCHO-EDUCATIONAL SPECIALISTS
Code of Ethics for Professional Counselors: Chapter 36-19, Article 7, (B) Counseling Relationship, 12, 13, 14.
(12) Professional Counselors who employ electronic means in which the counselor and client are not in immediate proximity must present clients with local sources of care before establishing a continued short or long-term relationship.
(13) Professional Counselors shall obtain legal authorization to practice in any jurisdiction in which they maintain an electronic presence via the internet or other
electronic means.
(14) Professional Counselors shall ensure that clients are intellectually, emotionally, and physically compatible with computer applications used by the counselor and understand
their purpose and operation.
Social Workers
We are not aware of any specific rules and regulations of the practice of telemental health services for Social Workers.
Marriage and Family Therapists
PROFESSIONAL COUNSELORS, MARRIAGE AND FAMILY THERAPISTS, AND PSYCHO-EDUCATIONAL SPECIALISTS
Board of Examiners for Licensure of Professional Counselors, Marriage and
Family Therapists, and Psycho-Educational Specialists
Provision of Services via Electronic, Distance Professional Services
Effective Date: November 17, 2015
In response to inquiries from licensees, supervisors, and other interested parties, the SC Licensure Board has confirmed that it has no separate view per se with regard to the provision of services via electronic means as long as a licensee is practicing in a manner consistent with his/her training and experience, is receiving supervision as is appropriate, and the medium for doing so is not an issue. However, it is incumbent upon any licensed counselor, therapist, or psycho-educational specialist to recognize that as he or she moves away from direct face to face contact with clients, there are losses to the processes and interactions. The Board considers that the practice of counseling, marriage and family therapy occurs both where the therapist who is providing therapeutic services is located and where the individuals (patients/clients) who are receiving services are located. In order for an individual to provide counseling and therapy services in South Carolina, that individual must be licensed by the South Carolina Board for Counselors, Marriage and Family Therapists, and Psycho-educational Specialist. On this basis, if an individual licensed in South Carolina renders services electronically to an out-of-state client, it is recommended that the licensee contact the licensure board for counselors, marriage and family therapist, or psycho-educational specialist in the state in which the clients reside to determine whether or not such practices are permitted in that jurisdiction. Licensees are advised to review the South Carolina Licensure Law and the Code of Ethics.
Delivery of clinical services via technology-assisted media such as telephones, the use of video, or the internet requires the therapist to be sensitive to various issues. These areas include: confidentiality, acquiring required signatures on intake forms (consent to treat, release of
information, professional disclosure forms, consent to treat minors, consent to tape, etc.). Other issues include: confidentiality, boundaries of competence, computer security, avoiding harm dealing with fees and financial arrangements, and advertising. Other specific challenges include, but are not limited to verifying the identity of the client, determining if the client is a minor, explaining to the clients the procedures for contacting the therapist/counselor when he or she is off-line, discussing the possibility of technology failure and alternate means of communication if technology occurs. It is important for counselors and therapists to use encrypted technology as required by HIPAA. Clients should be informed of the encryption methods used to help ensure the security of communications. Also, counselors and therapists should inform clients as to whether session data is being preserved and if so, for in what manner and for how long. In addition, clients need to be informed regarding the procedures that will be in place in receiving and releasing client information received through the internet and other electronic sources.
Last of all, it is important that when providing services through electronic methods, the
counselor and therapist be knowledgeable regarding emergency services available in the
communities where their clients live.
CHAPTER 36.
DEPARTMENT OF LABOR, LICENSING AND REGULATION-- BOARD OF EXAMINERS FOR THE LICENSURE OF PROFESSIONAL COUNSELORS, MARRIAGE AND FAMILY THERAPISTS, AND PSYCHO-EDUCATIONAL SPECIALISTS
Code of Ethics for Professional Counselors: Chapter 36-19, Article 7, (B) Counseling Relationship, 12, 13, 14.
(12) Professional Counselors who employ electronic means in which the counselor and client are not in immediate proximity must present clients with local sources of care before establishing a continued short or long-term relationship.
(13) Professional Counselors shall obtain legal authorization to practice in any jurisdiction in which they maintain an electronic presence via the internet or other
electronic means.
(14) Professional Counselors shall ensure that clients are intellectually, emotionally, and physically compatible with computer applications used by the counselor and understand
their purpose and operation.
Psychologists
We are not aware of any specific rules and regulations of the practice of telemental health services for Psychologists.
Psychiatrists
SC Code SECTION 40-47-37. Practice of telemedicine requirements.
“(A) A licensee who establishes a physician-patient relationship solely via PrevioustelemedicineNext as defined in Section 40-47-20(52) shall adhere to the same standard of care as a licensee employing more traditional in-person medical care and be evaluated according to the standard of care applicable to the licensee's area of specialty. A licensee shall not establish a physician-patient relationship by PrevioustelemedicineNext pursuant to Section 40-47-113(B) for the purpose of prescribing medication when an in-person physical examination is necessary for diagnosis. The failure to conform to the appropriate standard of care is considered unprofessional conduct under Section 40-47-110(B)(9).”
“(B) A licensee who establishes a physician-patient relationship solely via PrevioustelemedicineNext as defined in Section 40-47-20(52) shall generate and maintain medical records for each patient using such PrevioustelemedicineNext services in compliance with any applicable state and federal laws, rules, and regulations, including this chapter, the Health Insurance Portability and Accountability Act (HIPAA), and the Health Information Technology for Economic and Clinical Health Act (HITECH). Such records shall be accessible to other practitioners and to the patient in a timely fashion when lawfully requested to do so by the patient or by a lawfully designated representative of the patient.”
“(C) In addition to those requirements set forth in subsections (A) and (B), a licensee who establishes a physician-patient relationship solely via PrevioustelemedicineNext as defined in Section 40-47-20(52) shall:
(1) adhere to current standards for practice improvement and monitoring of outcomes and provide reports containing such information upon request of the board;
(2) provide an appropriate evaluation prior to diagnosing and/or treating the patient, which need not be done in-person if the licensee employs technology sufficient to accurately diagnose and treat the patient in conformity with the applicable standard of care; provided, that evaluations in which a licensee is at a distance from the patient, but a practitioner is able to provide various physical findings the licensee needs to complete an adequate assessment, is permitted; further, provided, that a simple questionnaire without an appropriate evaluation is prohibited;
(3) verify the identity and location of the patient and be prepared to inform the patient of the licensee's name, location, and professional credentials;
(4) establish a diagnosis through the use of accepted medical practices, which may include patient history, mental status evaluation, physical examination, and appropriate diagnostic and laboratory testing in conformity with the applicable standard of care;
(5) ensure the availability of appropriate follow-up care and maintain a complete medical record that is available to the patient and other treating health care practitioners, to be distributed to other treating health care practitioners only with patient consent and in accordance with applicable law and regulation;
(6) prescribe within a practice setting fully in compliance with this section and during an encounter in which threshold information necessary to make an accurate diagnosis has been obtained in a medical history interview conducted by the prescribing licensee; provided, however, that Schedule II and Schedule III prescriptions are not permitted except for those Schedule II and Schedule III medications specifically authorized by the board, which may include, but not be limited to, Schedule II-nonnarcotic and Schedule III-nonnarcotic medications; further, provided, that licensees prescribing controlled substances by means of PrevioustelemedicineNext must comply with all relevant federal and state laws including, but not limited to, participation in the South Carolina Prescription Monitoring Program set forth in Article 15, Chapter 53, Title 44; further, provided, that prescribing of lifestyle medications including, but not limited to, erectile dysfunction drugs is not permitted unless approved by the board; further, provided, that prescribing abortion-inducing drugs is not permitted; as used in this article "abortion-inducing drug" means a medicine, drug, or any other substance prescribed or dispensed with the intent of terminating the clinically diagnosable pregnancy of a woman, with knowledge that the termination will with reasonable likelihood cause the death of the unborn child. This includes off-label use of drugs known to have abortion-inducing properties, which are prescribed specifically with the intent of causing an abortion, such as misoprostol (Cytotec), and methotrexate. This definition does not apply to drugs that may be known to cause an abortion, but which are prescribed for other medical indications including, but not limited to, chemotherapeutic agents or diagnostic drugs. Use of such drugs to induce abortion is also known as "medical", "drug-induced", and/or "chemical abortion";
(7) maintain a complete record of the patient's care according to prevailing medical record standards that reflect an appropriate evaluation of the patient's presenting symptoms; provided that relevant components of the PrevioustelemedicineNext interaction be documented as with any other encounter;
(8) maintain the patient's records' confidentiality and disclose the records to the patient consistent with state and federal law; provided, that licensees practicing PrevioustelemedicineNext shall be held to the same standards of professionalism concerning medical records transfer and communication with the primary care provider and medical home as licensees practicing via traditional means; further, provided, that if a patient has a primary care provider and a PrevioustelemedicineNext provider for the same ailment, then the primary care provider's medical record and the PrevioustelemedicineNext provider's record constitute one complete medical record;
(9) be licensed to practice medicine in South Carolina; provided, however, a licensee need not reside in South Carolina so long as he or she has a valid, current South Carolina medical license; further, provided, that a licensee residing in South Carolina who intends to practice medicine via PrevioustelemedicineNext to treat or diagnose patients outside of South Carolina shall comply with other state licensing boards; and
(10) discuss with the patient the value of having a primary care medical home and, if the patient requests, provide assistance in identifying available options for a primary care medical home.”
“(D) A licensee, practitioner, or any other person involved in a PrevioustelemedicineNext encounter must be trained in the use of the PrevioustelemedicineNext equipment and competent in its operation.”
“(E) Notwithstanding any of the provisions of this section, the board shall retain all authority with respect to PrevioustelemedicineNext practice as granted in Section 40-47-10(I) of this chapter.”
HISTORY: 2016 Act No. 210 (S.1035), § 2, eff June 3, 2016.
Refer to the source provided for all requirements and limitations.
South Carolina Professional Regulation/Health & Safety Online Prescribing
“A licensee shall not establish a physician-patient relationship by telemedicine for the purpose of prescribing medication when an in-person physical examination is necessary for diagnosis.”
“Schedule II and Schedule III prescriptions are not permitted except for those Schedule II and Schedule III medications specifically authorized by the board, which may include, but not be limited to, Schedule II-nonnarcotic and Schedule III-nonnarcotic medications.”
“To establish a physician-patient relationship via telemedicine, the provider must:
- Comply with state and federal laws on patient confidentiality
- Adhere to current standards of practice improvement and monitoring of outcomes and provide reports containing such information upon the request of the board;
- Provide an appropriate evaluation prior to diagnosing and/or treating the patient, which need not be done in-person if the licensee employs technology sufficient to accurately diagnose and treat the patient in conformity with the applicable standard of care; provided, that evaluations in which a licensee is at a distance from the patient, but a practitioner is able to provide various physical findings the licensee needs to complete an adequate assessment, is permitted; further, provided, that a simple questionnaire without an appropriate evaluation is prohibited;
- Verify the identity and location of the patient and be prepared to inform the patient of the licensee’s name, location, and professional credentials;
- Establish a diagnosis through the use of accepted medical practices, which may include patient history, mental status evaluation, physical examination, and appropriate diagnostic and laboratory testing in conformity with the applicable standard of care;
- Ensure availability of follow-up care and maintain a complete medical record that is available to the patient and other treating health care practitioners, to be distributed to other treating health care practitioners only with patient consent and in accordance with applicable law and regulation;
- Prescribe within a practice setting fully in compliance with the law and during an encounter in which threshold information necessary to make an accurate diagnosis has been obtained in a medical history interview conducted by the prescribing licensee. See Code for specific information on controlled substances.”
- “Maintain a complete record of the patient’s care according to prevailing medical record standards that reflects an appropriate evaluation of the patient's presenting symptoms; provided that relevant components of the telemedicine interaction be documented as with any other encounter;
- Maintain the patient’s records’ confidentiality and disclose the records to the patient consistent with state and federal law; provided, that licensees practicing telemedicine shall be held to the same standards of professionalism concerning medical records transfer and communication with the primary care provider and medical home as licensees practicing via traditional means; further, provided, that if a patient has a primary care provider and a telemedicine provider for the same ailment, then the primary care provider's medical record and the telemedicine provider's record constitute one complete medical record;
- Be licensed to practice in South Carolina provided, however, a licensee need not reside in South Carolina so long as he or she has a valid, current South Carolina medical license; further, provided, that a licensee residing in South Carolina who intends to practice medicine via telemedicine to treat or diagnose patients outside of South Carolina shall comply with other state licensing boards; and
- Discuss with the patient the value of having a primary care medical home and, if the patient requests, provide assistance in identifying available options for a primary care medical home.”
“A licensee, practitioner, or any other person involved in a telemedicine encounter must be trained in the use of the telemedicine equipment and competent in its operation.”
“Schedule II and III prescriptions are not permitted except as specifically authorized by the board.”
Source:
SC Code Annotated Sec. 40-47-37. (Accessed Feb. 2020).
Refer to the source provided for all requirements and limitations.
Nurses
“As a party state to the Nurse Licensure Compact (NLC), South Carolina issues multistate licenses to nurses and applicants who reside in the state and recognizes multistate licenses issued by other party states, for practice in South Carolina. A nurse holding a multistate license is entitled to practice in any NLC party state, but must comply at all times with the laws of the state where he or she is currently practicing.”
“It should be noted that not every state in the US is an NLC party state; a map of participating states, as well as further resources related to the NLC, are available on the Nurse Licensure Compact website.”
Refer to the source provided for all requirements and limitations.
South Carolina Professional Regulation/Health & Safety Online Prescribing
“A licensee shall not establish a physician-patient relationship by telemedicine for the purpose of prescribing medication when an in-person physical examination is necessary for diagnosis.”
“Schedule II and Schedule III prescriptions are not permitted except for those Schedule II and Schedule III medications specifically authorized by the board, which may include, but not be limited to, Schedule II-nonnarcotic and Schedule III-nonnarcotic medications.”
“To establish a physician-patient relationship via telemedicine, the provider must:
- Comply with state and federal laws on patient confidentiality
- Adhere to current standards of practice improvement and monitoring of outcomes and provide reports containing such information upon the request of the board;
- Provide an appropriate evaluation prior to diagnosing and/or treating the patient, which need not be done in-person if the licensee employs technology sufficient to accurately diagnose and treat the patient in conformity with the applicable standard of care; provided, that evaluations in which a licensee is at a distance from the patient, but a practitioner is able to provide various physical findings the licensee needs to complete an adequate assessment, is permitted; further, provided, that a simple questionnaire without an appropriate evaluation is prohibited;
- Verify the identity and location of the patient and be prepared to inform the patient of the licensee’s name, location, and professional credentials;
- Establish a diagnosis through the use of accepted medical practices, which may include patient history, mental status evaluation, physical examination, and appropriate diagnostic and laboratory testing in conformity with the applicable standard of care;
- Ensure availability of follow-up care and maintain a complete medical record that is available to the patient and other treating health care practitioners, to be distributed to other treating health care practitioners only with patient consent and in accordance with applicable law and regulation;
- Prescribe within a practice setting fully in compliance with the law and during an encounter in which threshold information necessary to make an accurate diagnosis has been obtained in a medical history interview conducted by the prescribing licensee. See Code for specific information on controlled substances.”
- “Maintain a complete record of the patient’s care according to prevailing medical record standards that reflects an appropriate evaluation of the patient's presenting symptoms; provided that relevant components of the telemedicine interaction be documented as with any other encounter;
- Maintain the patient’s records’ confidentiality and disclose the records to the patient consistent with state and federal law; provided, that licensees practicing telemedicine shall be held to the same standards of professionalism concerning medical records transfer and communication with the primary care provider and medical home as licensees practicing via traditional means; further, provided, that if a patient has a primary care provider and a telemedicine provider for the same ailment, then the primary care provider's medical record and the telemedicine provider's record constitute one complete medical record;
- Be licensed to practice in South Carolina provided, however, a licensee need not reside in South Carolina so long as he or she has a valid, current South Carolina medical license; further, provided, that a licensee residing in South Carolina who intends to practice medicine via telemedicine to treat or diagnose patients outside of South Carolina shall comply with other state licensing boards; and
- Discuss with the patient the value of having a primary care medical home and, if the patient requests, provide assistance in identifying available options for a primary care medical home.”
“A licensee, practitioner, or any other person involved in a telemedicine encounter must be trained in the use of the telemedicine equipment and competent in its operation.”
“Schedule II and III prescriptions are not permitted except as specifically authorized by the board.”
Source:
SC Code Annotated Sec. 40-47-37. (Accessed Feb. 2020).
Refer to the source provided for all requirements and limitations.
Medicaid Telehealth Parity Law
Source: SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 29
Refer to the source provided for all requirements and limitations.
Originating Site Reimbursement: There is no reference of the member's home as an approved originating site.
Source: SC Health and Human Svcs. Dept., Physicians Provider Manual, p. 28-29 (July. 2019)
Private Pay Telehealth Parity Law
We are not aware of any parity law.
Payment Parity
We are not aware of any explicit payment parity.
*Clinicians who have had an experience with telehealth reimbursement in this state are invited to share their experiences in the comments section below: a) type of service provided; b) insurance provider; c) payment parity, payment issues, or insurance requirements.
Permission for the Temporary Practice of Clinicians Licensed Outside the State
Source: SC Code ann 40-55-110
"A person or firm of consultants not licensed in this State and nonresidents of this State who wishes to perform practices under the provisions of this chapter for a period not to exceed sixty days within a calendar year must petition the board for a temporary permit to perform such practices. If the petitioner is licensed or certified in another state deemed by the board to have standards equivalent to those set forth in this chapter, a permit will be issued for a fee to be fixed by the board."
Refer to the source provided for all requirements and limitations.
Social Workers
We are not aware of any specific rules and regulations of the practice of telemental health services for Social Workers.