The purpose of my submitting this petition is to remove the phrase "directly bill for services rendered” in the LPC and LMFT regulations so a Resident in their own private practice under supervision can directly bill clients and directly receive client payments without their income passing through their Supervisor. Although the regulations do not specifically say that a Resident cannot "collect" payment, this phrase has been interpreted that Residents are not allowed to take payments from clients (as verified by the Board of Counseling).

This is the third attempt to submit this petition. This same regulation change request was previously submitted in 2005 and 2019 by two other individuals and was denied both times.  My hope is that it will be reconsidered by the Board of Counseling and this time, accepted.

The 2019 petition “Ability for residents in counseling to directly bill for services” resulted in 70 comments with more in favor than not. Regardless of that, the Board of Counseling “after consideration” stated: “The Board decided to take no action based on its concern that [1.] direct billing by residents is contrary to the reimbursement policy of DMAS and other third party payors, and [2.] that it might incentivize residents to engage in independent practice without appropriate supervision.”

It’s unclear how #1 applies because the Board of Counseling has said they have no purview over insurance reimbursement for services (insurance companies make their own decisions regarding which providers they accept) and it seems this would include DMAS as Residents are not allowed to bill insurance (including Medicaid).

Now, regarding #2. Residents are required, per the regulations to inform their clients “in writing that the resident does not have authority for independent practice and is under supervision” so clients are already aware their counselor is not an independently practicing provider. Residents who follow the regulations should not be penalized when acting ethically by the possibility another individual may act unethically and practice independently.  If that does happen, they can be reported to DHP and sanctioned.

It’s sometimes difficult for a master’s level graduate to find a job in the field because of a variety of reasons. In Virginia a resident is allowed to have a private practice if they are under Board approved supervision, identify themselves as a Resident in Counseling under supervision and by whom, and inform clients they cannot practice independently.  The problem is that not taking payment directly from clients presents an additional significant hardship for a Resident who wishes to have a private practice because of the difficulty in finding a supervisor willing to take them on because of the lack of clarity on how to manage the process of the “pass through” of client payments.  Supervisors are concerned their Residents' incomes will be considered their own and the financial machinations needed to prove the income is not theirs is burdensome.  Potential supervisors are thinking: “what if I’m audited by the IRS?…why take the risk?   

Actually, payment is more of a mechanical issue especially since the client’s payment in its entirety must go right back to the Resident (as there are to be no “split payments”; for example, a supervisor is not to keep any portion of the funds as payment for supervision).  Cash and paper checks (signed back over to the Resident) are a thing of the past now with instantaneous payments, credit card billing, and cash transfers. The gyrations of having the payment go through the supervisor is unnecessary and puts a tremendous strain on both Residents and Supervisors, specifically those Residents in private practice.  And why shouldn't the payment go directly to the Resident who is the one who provided the service?  It’s more likely confusing to clients to be told they must pay a supervisor and not the counselor, the one with whom they have made a therapeutic connection and received the service. 

For those who may suggest that Residents should not be encouraged to have their own practice because of a lack of experience and who would like to keep this regulation unchanged, please take into consideration the following example. In exempt settings, graduates are practicing as counselors in many cases without Board approved supervision, may have a supervisor who isn’t even licensed, and who are required to see the next client on the waiting list regardless of whether or not they have the skills to work with those clients who are often in very intense and difficult situations and may be diagnosed as seriously mentally ill, because it’s the job.  There’s no reason then, for an individual coming out of graduate school to not be able to see clients in their own private practice when they are as qualified as those going into exempt settings but must have the required Board approved supervision. Also, this doesn’t necessarily apply only to someone new in the field. There are many Residents who, with experience, may want to leave their current employment and build their own practice but have the same challenges in finding a Supervisor because of the client billing issue.

In fact, this requirement serves to penalize Residents who do not work in exempt locations or who are employees or contractors in a private practice where client payments are billed to the client or the client’s insurance and are collected by the employer.

An additional support for this petition is that there are some states who either don't require that client payments be collected by the supervisor or don't even discuss the issue of client payments in their regulations (and therefore the supervisee can directly bill and receive payment from their clients).  With the upcoming implementation of the Counseling Compact and the agreement that each participating state accepts the regulations required for licensure of other states in the Compact, this is an opportunity for the Virginia Board of Counseling to be in the forefront of making this change in the regulations to be more in line with our increasingly technologically based world and with the opportunities this brings for Residents. 

Dictating that a resident not take direct client payment does not make our licensure process better, it just keeps us from adapting to the present and keeps some graduates entering the field without employment and income if they are unable to find a job and also unable to have their own practice, as well as for those Residents needing or wanting to move from employment to private practice, if they can’t find a Supervisor willing to take them on.