Amended in Senate June 16, 2015

Amended in Assembly May 11, 2015

Amended in Assembly March 26, 2015

California Legislature—2015–16 Regular Session

Assembly Bill No. 250

Introduced by Assembly Member Obernolte

February 9, 2015

An act to amend begin delete Section end delete begin insert Sections 2290.5 and end insert 4980.43 of the Business and Professions Code, relating to healing arts.

LEGISLATIVE COUNSEL’S DIGEST

AB 250, as amended, Obernolte. Telehealth: marriage and family therapist interns and trainees.

Under existing law, “telehealth” is defined as the mode of delivering health care services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant begin delete site. end delete begin insert site, and “health care provider” is defined as a person who is licensed under specified provisions of law relating to healing arts end insert begin insert . end insert Existing law requires a health care provider prior to the delivery of health care services via telehealth to inform the patient about the use of telehealth and obtain verbal or written consent from the patient for the use of telehealth. begin delete For these purposes, existing law defines a health care provider as a healing arts licensee. end delete Existing law, the Licensed Marriage and Family Therapist Act, provides for the registration of marriage and family therapist interns and regulates marriage and family therapist trainees. Existing law requires applicants for a marriage and family therapist license to complete specified experience subject to certain limitations, including no more than a certain number of hours providing counseling services via telehealth. Existing law requires all marriage and family therapist trainees and registrants to be supervised at all times by a supervisor, as defined, responsible for ensuring that the extent, kind, and quality of counseling performed is consistent with the training and experience of the person being supervised. Existing law requires the supervisor to be responsible to the board for compliance with all laws, rules, and regulations governing the practice of marriage and family therapy.

This bill would begin delete , notwithstanding a specified section of law, end delete begin insert expand the definition of health care provider to include a marriage and family therapist intern or trainee, as specified. The bill would also end insert authorize a marriage and family therapist intern and trainee to provide services via telehealth if he or she is supervised as required by the act, and is acting within the scope authorized by the act and in accordance with any regulations governing the use of telehealth promulgated by the Board of Behavioral Sciences.

Vote: majority. Appropriation: no. Fiscal committee: no. State-mandated local program: no.

The people of the State of California do enact as follows:

begin insert

begin insert SECTION 1. end insert   

end insert

begin insert Section 2290.5 of the end insert begin insert Business and Professions
Code end insert begin insert is amended to read: end insert

2290.5.  

(a) For purposes of this division, the following
definitions shall apply:

(1) “Asynchronous store and forward” means the transmission
of a patient’s medical information from an originating site to the
health care provider at a distant site without the presence of the
patient.

(2) “Distant site” means a site where a health care provider who
provides health care services is located while providing these
services via a telecommunications system.

(3) “Health care provider” means begin delete a person who is licensed under
this division. end delete begin insert either of the following: end insert

begin insert

(A) A person who is licensed under this division.

end insert begin insert

(B) A marriage and family therapist intern or trainee functioning
pursuant to Section 4980.43.

end insert

(4) “Originating site” means a site where a patient is located at
the time health care services are provided via a telecommunications
system or where the asynchronous store and forward service
originates.

(5) “Synchronous interaction” means a real-time interaction
between a patient and a health care provider located at a distant
site.

(6) “Telehealth” means the mode of delivering health care
services and public health via information and communication
technologies to facilitate the diagnosis, consultation, treatment,
education, care management, and self-management of a patient’s
health care while the patient is at the originating site and the health
care provider is at a distant site. Telehealth facilitates patient
self-management and caregiver support for patients and includes
synchronous interactions and asynchronous store and forward
transfers.

(b) Prior to the delivery of health care via telehealth, the health
care provider initiating the use of telehealth shall inform the patient
about the use of telehealth and obtain verbal or written consent
from the patient for the use of telehealth as an acceptable mode of
delivering health care services and public health. The consent shall
be documented.

(c) Nothing in this section shall preclude a patient from receiving
in-person health care delivery services during a specified course
of health care and treatment after agreeing to receive services via
telehealth.

(d) The failure of a health care provider to comply with this
section shall constitute unprofessional conduct. Section 2314 shall
not apply to this section.

(e) This section shall not be construed to alter the scope of
practice of any health care provider or authorize the delivery of
health care services in a setting, or in a manner, not otherwise
authorized by law.

(f) All laws regarding the confidentiality of health care
information and a patient’s rights to his or her medical information
shall apply to telehealth interactions.

(g) This section shall not apply to a patient under the jurisdiction
of the Department of Corrections and Rehabilitation or any other
correctional facility.

(h) (1) Notwithstanding any other provision of law and for
purposes of this section, the governing body of the hospital whose
patients are receiving the telehealth services may grant privileges
to, and verify and approve credentials for, providers of telehealth
services based on its medical staff recommendations that rely on
information provided by the distant-site hospital or telehealth
entity, as described in Sections 482.12, 482.22, and 485.616 of
Title 42 of the Code of Federal Regulations.

(2) By enacting this subdivision, it is the intent of the Legislature
to authorize a hospital to grant privileges to, and verify and approve
credentials for, providers of telehealth services as described in
paragraph (1).

(3) For the purposes of this subdivision, “telehealth” shall
include “telemedicine” as the term is referenced in Sections 482.12,
482.22, and 485.616 of Title 42 of the Code of Federal Regulations.

begin delete SECTION 1. end delete
begin insert SEC. 2. end insert   

Section 4980.43 of the Business and Professions Code
is amended to read:

4980.43.  

(a) Prior to applying for licensure examinations, each
applicant shall complete experience that shall comply with the
following:

(1) A minimum of 3,000 hours completed during a period of at
least 104 weeks.

(2) Not more than 40 hours in any seven consecutive days.

(3) Not less than 1,700 hours of supervised experience
completed subsequent to the granting of the qualifying master’s
or doctoral degree.

(4) Not more than 1,300 hours of supervised experience obtained
prior to completing a master’s or doctoral degree.

The applicant shall not be credited with more than 750 hours of
counseling and direct supervisor contact prior to completing the
master’s or doctoral degree.

(5) No hours of experience may be gained prior to completing
either 12 semester units or 18 quarter units of graduate instruction
and becoming a trainee except for personal psychotherapy.

(6) No hours of experience may be gained more than six years
prior to the date the application for examination eligibility was
filed, except that up to 500 hours of clinical experience gained in
the supervised practicum required by subdivision (c) of Section
4980.37 and subparagraph (B) of paragraph (1) of subdivision (d)
of Section 4980.36 shall be exempt from this six-year requirement.

(7) Not more than a combined total of 1,000 hours of experience
in the following:

(A) Direct supervisor contact.

(B) Professional enrichment activities. For purposes of this
chapter, “professional enrichment activities” include the following:

(i) Workshops, seminars, training sessions, or conferences
directly related to marriage and family therapy attended by the
applicant that are approved by the applicant’s supervisor. An
applicant shall have no more than 250 hours of verified attendance
at these workshops, seminars, training sessions, or conferences.

(ii) Participation by the applicant in personal psychotherapy,
which includes group, marital or conjoint, family, or individual
psychotherapy by an appropriately licensed professional. An
applicant shall have no more than 100 hours of participation in
personal psychotherapy. The applicant shall be credited with three
hours of experience for each hour of personal psychotherapy.

(8) Not more than 500 hours of experience providing group
therapy or group counseling.

(9) For all hours gained on or after January 1, 2012, not more
than 500 hours of experience in the following:

(A) Experience administering and evaluating psychological
tests, writing clinical reports, writing progress notes, or writing
process notes.

(B) Client centered advocacy.

(10) Not less than 500 total hours of experience in diagnosing
and treating couples, families, and children. For up to 150 hours
of treating couples and families in conjoint therapy, the applicant
shall be credited with two hours of experience for each hour of
therapy provided.

(11) Not more than 375 hours of experience providing personal
psychotherapy, crisis counseling, or other counseling services via
telehealth in accordance with Section 2290.5.

(12) It is anticipated and encouraged that hours of experience
will include working with elders and dependent adults who have
physical or mental limitations that restrict their ability to carry out
normal activities or protect their rights.

This subdivision shall only apply to hours gained on and after
January 1, 2010.

(b) All applicants, trainees, and registrants shall be at all times
under the supervision of a supervisor who shall be responsible for
ensuring that the extent, kind, and quality of counseling performed
is consistent with the training and experience of the person being
supervised, and who shall be responsible to the board for
compliance with all laws, rules, and regulations governing the
practice of marriage and family therapy. Supervised experience
shall be gained by interns and trainees only as an employee or as
a volunteer. The requirements of this chapter regarding gaining
hours of experience and supervision are applicable equally to
employees and volunteers. Experience shall not be gained by
interns or trainees as an independent contractor.

(1) If employed, an intern shall provide the board with copies
of the corresponding W-2 tax forms for each year of experience
claimed upon application for licensure.

(2) If volunteering, an intern shall provide the board with a letter
from his or her employer verifying the intern’s employment as a
volunteer upon application for licensure.

(c) Except for experience gained pursuant to subparagraph (B)
of paragraph (7) of subdivision (a), supervision shall include at
least one hour of direct supervisor contact in each week for which
experience is credited in each work setting, as specified:

(1) A trainee shall receive an average of at least one hour of
direct supervisor contact for every five hours of client contact in
each setting. No more than six hours of supervision, whether
individual or group, shall be credited during any single week.

(2) An individual supervised after being granted a qualifying
degree shall receive at least one additional hour of direct supervisor
contact for every week in which more than 10 hours of client
contact is gained in each setting. No more than six hours of
supervision, whether individual or group, shall be credited during
any single week.

(3) For purposes of this section, “one hour of direct supervisor
contact” means one hour per week of face-to-face contact on an
individual basis or two hours per week of face-to-face contact in
a group.

(4) Direct supervisor contact shall occur within the same week
as the hours claimed.

(5) Direct supervisor contact provided in a group shall be
provided in a group of not more than eight supervisees and in
segments lasting no less than one continuous hour.

(6) Notwithstanding paragraph (3), an intern working in a
governmental entity, a school, a college, or a university, or an
institution that is both nonprofit and charitable may obtain the
required weekly direct supervisor contact via two-way, real-time
videoconferencing. The supervisor shall be responsible for ensuring
that client confidentiality is upheld.

(7) All experience gained by a trainee shall be monitored by the
supervisor as specified by regulation.

(8) The six hours of supervision that may be credited during
any single week pursuant to paragraphs (1) and (2) shall apply to
supervision hours gained on or after January 1, 2009.

(d) (1) A trainee may be credited with supervised experience
completed in any setting that meets all of the following:

(A) Lawfully and regularly provides mental health counseling
or psychotherapy.

(B) Provides oversight to ensure that the trainee’s work at the
setting meets the experience and supervision requirements set forth
in this chapter and is within the scope of practice for the profession
as defined in Section 4980.02.

(C) Is not a private practice owned by a licensed marriage and
family therapist, a licensed professional clinical counselor, a
licensed psychologist, a licensed clinical social worker, a licensed
physician and surgeon, or a professional corporation of any of
those licensed professions.

(2) Experience may be gained by the trainee solely as part of
the position for which the trainee volunteers or is employed.

(e) (1) An intern may be credited with supervised experience
completed in any setting that meets both of the following:

(A) Lawfully and regularly provides mental health counseling
or psychotherapy.

(B) Provides oversight to ensure that the intern’s work at the
setting meets the experience and supervision requirements set forth
in this chapter and is within the scope of practice for the profession
as defined in Section 4980.02.

(2) An applicant shall not be employed or volunteer in a private
practice, as defined in subparagraph (C) of paragraph (1) of
subdivision (d), until registered as an intern.

(3) While an intern may be either a paid employee or a
volunteer, employers are encouraged to provide fair remuneration
to interns.

(4) Except for periods of time during a supervisor’s vacation or
sick leave, an intern who is employed or volunteering in private
practice shall be under the direct supervision of a licensee that has
satisfied the requirements of subdivision (g) of Section 4980.03.
The supervising licensee shall either be employed by and practice
at the same site as the intern’s employer, or shall be an owner or
shareholder of the private practice. Alternative supervision may
be arranged during a supervisor’s vacation or sick leave if the
supervision meets the requirements of this section.

(5) Experience may be gained by the intern solely as part of the
position for which the intern volunteers or is employed.

(f) Except as provided in subdivision (g), all persons shall
register with the board as an intern in order to be credited for
postdegree hours of supervised experience gained toward licensure.

(g) Except when employed in a private practice setting, all
postdegree hours of experience shall be credited toward licensure
so long as the applicant applies for the intern registration within
90 days of the granting of the qualifying master’s or doctoral
degree and is thereafter granted the intern registration by the board.

(h) Trainees, interns, and applicants shall not receive any
remuneration from patients or clients, and shall only be paid by
their employers.

(i) Trainees, interns, and applicants shall only perform services
at the place where their employers regularly conduct business,
which may include performing services at other locations, so long
as the services are performed under the direction and control of
their employer and supervisor, and in compliance with the laws
and regulations pertaining to supervision. begin delete Notwithstanding end delete begin insert For
purposes of paragraph (3) of subdivision (a) of end insert Section 2290.5,
interns and trainees working under licensed supervision, consistent
with subdivision (b), may provide services via telehealth within
the scope authorized by this chapter and in accordance with any
regulations governing the use of telehealth promulgated by the
board. Trainees and interns shall have no proprietary interest in
their employers’ businesses and shall not lease or rent space, pay
for furnishings, equipment, or supplies, or in any other way pay
for the obligations of their employers.

(j) Trainees, interns, or applicants who provide volunteered
services or other services, and who receive no more than a total,
from all work settings, of five hundred dollars ($500) per month
as reimbursement for expenses actually incurred by those trainees,
interns, or applicants for services rendered in any lawful work
setting other than a private practice shall be considered an
employee and not an independent contractor. The board may audit
applicants who receive reimbursement for expenses, and the
applicants shall have the burden of demonstrating that the payments
received were for reimbursement of expenses actually incurred.

(k) Each educational institution preparing applicants for
licensure pursuant to this chapter shall consider requiring, and
shall encourage, its students to undergo individual, marital or
conjoint, family, or group counseling or psychotherapy, as
appropriate. Each supervisor shall consider, advise, and encourage
his or her interns and trainees regarding the advisability of
undertaking individual, marital or conjoint, family, or group
counseling or psychotherapy, as appropriate. Insofar as it is deemed
appropriate and is desired by the applicant, the educational
institution and supervisors are encouraged to assist the applicant
in locating that counseling or psychotherapy at a reasonable cost.