OC Lawyers provided answers:
Q: Legally, can a clinician conduct psychotherapy while being physically in another state with a client who is in CO? For example - a clinician goes on vacation to CA for one month and continues to see their client via teletherapy while in CA?
A: Yes. A therapist is free to move between state lines for vacation and continue seeing clients who reside in states where they (the clinician) are actively licensed. The burden of geographical location falls on the client, as they are required to be physically in the state where the therapist is licensed (note the circumstances below).
What does this mean for OC employees? - You may see clients when YOU are not physically in CO.
Q: Legally, can a clinician conduct a therapy session with a client who is temporarily out of state? For example - the clinician is in CO and the client goes on vacation to FL and they conduct one teletherapy session while the client is in FL on vacation.
A: This one is a little murkier. The regulation reads that the client does need to be physically in the state where they are receiving care from the therapist who is licensed in said state. That said, there are circumstances where we can, (AND HAVE SUCCESSFULLY!) argued that services rendered on a known temporary basis for clients traveling outside of their home state are permitted. Rationales can include but are not limited to: safety reasons, ensuring care is not disrupted and interfering with client outcomes, supporting a client through a traumatic event (think of clients who travel for the death of a loved one), etc.
What does this mean for OC employees? - Only conduct a session with a client outside of CO if it is therapeutically necessary. If there is no genuine therapeutic reason to conduct the session, cancel the session and wait until the client returns to CO to have the next session.
Q: Legally, can a clinician continue treatment with a client who is moving from CO for 30 days after they leave CO to continue care while the client finds a new therapist and establishes care with a new provider in their new home state? Then terminate care once the 30 days is up or the client finds a new provider - whichever comes first?
A: This answer is similar to above - Use the same language to reflect the importance of continuity of care and demonstrate steps taken to connect them to the new provider (documenting referrals, conversations about transition, etc.), and you will remain in good standing.
What does this mean for OC clinicians? It is best practice to terminate clients who are moving out of state when they leave CO.
Q: We currently have a father who is deployed (out of the country) and he wants to participate in family teletherapy. Can he join?
A: There is no blanket military exception for service members living abroad to receive psychotherapy services from providers licensed in Colorado (unless of course, said providers are licensed in the respective country where the military personnel is actively serving). The father cannot participate in family therapy unless he is 1) physically in CO or 2) your therapist is licensed in the country where the father is stationed. Here is the nuance and where an exception may apply: the father's status as a "client" in therapy. Specifically, we recognize that some family therapy is conducted with a singular identified client (who, in this case, must be the individual located in CO). In this case, and where family therapy may be accessible to the father, is if he were to be considered a 'third—party participant' or 'collateral' to the identified client's care. In practice, this looks like the father joining sessions to support the clinically indicated treatment outcomes OF THE IDENTIFIED CLIENT, and not the family system as a whole. Should this exception be met, it is critical that the therapist secure documentation that delineates and distinguishes the father as a collateral and NOT a client in psychotherapy receiving treatment.
Additionally, a Colorado therapist can treat someone stationed abroad if they are licensed there or given express permission to practice there. The Tricare website indicates that telehealth can be secured on different bases for military personnel by contacting the appropriate authorities in the respective jurisdiction and getting that approval. The same applies for non-Interstate Compact states - if (FL is historically one of these states) you simply get the proper approval from the state, a Colorado licensed therapist can practice telehealth there. In short, conditional approval is also possible among the exceptions to the general rule that telehealth must be conducted by someone who is licensed to practice in the jurisdiction where the client is physically located.