94 comments
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.
I strongly support this petition.
For the reason other's have stated we should allow this, I believe we should not.
I fully support this petition for all the reasons that were stated in detail by Sharon Watson. It will in no way adversely affect the fact that residents are required and must be supervised.
I fully support this
I support this
They are residents for a reason. There is no substitute for experience and knowledge - we need to stop rushing the PROCESS and lowering standards to meet what may or may not be a need. The risk is much greater than the reward. Think of the damage that has been propagated by those that are licensed.
This petition will help therapists to provide more needed services without insurance burdens.
I absolutely support this. As it stands, many residents in private practices pay outside clinical supervisors separately upwards of $100 to $180 a week for outside supervision. Then, within the confines of the practice, the residents are expected to pay anywhere from $600 to $1000 plus a month, cover the costs (time and expenses) of my own electronic health record system, marketing, trainings, etc, and then pay a percentage of their profits (usually 20 to 40 percent of collections).
Essentially, the laws and codes as written allow many LPC private practice owners to choose to serve only as money launderers for residents. I understand this was not likely the intent of the code, but this is how it is being manipulated as of now and it is unfair and predatory to residents at the expense of clients.
As it stands clients keep a card on file with an EHR, the fee gets deposited to an LPC practice owner account, and then filtered back to the resident. That is the only service required by practice owners. Clients are still paying full fee and largely or entirely ignorant (thankfully) to the ways their clinicians are being raked over, taken advantage of and burned out.
We as a field should be better than this. We should expect that those serving as LPC practice owners taking on residents are their to mentor and mold and shape the next generation, helping to multiply impact on the mental health outcomes for many more than just 1:1 client work would allow. But oh how quickly greed and easy money can get in the way… and boy is it easy to create essentially a multi-level marketing approach to having interns and residents make quick money with minimal work on the part of a practice owner whose main job becomes simply filtering hard-earned Resident money through their LPC account because residents are prohibited from direct billing.
I feel that residents have a supervisor and should be allowed to take clients and bill directly
Yes. Let’s get rid of this. Nothing more than codified theft of client fees under the false flag of what exactly? Continue to require the stringent requirements of clinical supervision but let’s call a spade a spade and not enrich LPC practice owners at the expense of resident mental health and draining client wallets.
If this is passed, it essentially renders the independent licensure unnecessary or said differently, it makes the supervision process impossible.. Consumers cannot be expected to understand the difference in nomenclature, so residents can easily operate their own practices.. Additionally it seems incongruous with wage/hour laws — if a supervisor is still being held responsible for services provided by residents, they need to be able to exercise a certain amount of control over their work. If residents can accept payment independently, they are essentially acting as 1099 independent contractors. To be in compliance with the IRS definition of a 1099, the supervisor cannot exert control over the work of their resident. This puts supervisors in an impossible position. If the Board thinks residents can operate independently, it needs to eliminate the supervision requirement altogether and award independent licensure to graduates of Masters programs. Moreover if residents are able to accept payment, the workforce available to serve in community mental health and agencies will be even farther reduced.
I understand the push for this likely revolves around inadequate pay for residents. Let’s get to the root of that problem - insurance rates are too low and have not increased with inflation and cost of living. Rather than reducing the quality of the profession by reducing the supervision and oversight of new clinicians, let’s focus on raising the quality of services provided and demonstrate the ways in which counselors promote the health of the community thus reducing the overall cost of untreated mental health issues.
This petition runs against the requirements that supervisors are responsible for Residents. It impacts only those in Private practice and could send a mixed message to clients.
The journey to become a counselor is long are arduous and the current policy adds to the challenges to support oneself with livable means. Allowing residents to bill directly will help residents to fully dedicate themselves to the hours needed to obtain full licensure without the added stressor of worrying how to making ends meet.
I strongly do not support this
I strongly support this petition which will create more equity and access for Residents, which in turn creates better access for patients in a field that desperately needs more practitioners who take insurance. Residents would still be required to be under supervision for the entirety of their residency, but this would allow for insurance payments to go directly to the provider and not through a third-party (supervisor). Allowing residents to successfully begin their own solo or group private practice prior to full licensure creates a necessary pipeline to allow for more professionals to earn a living wage, which will remove unnecessary barriers currently keeping potential practitioners from joining the field.
Residents in Counseling need to receive supervision before the Commonwealth certifies that they are eligible to practice independently. Allowing Residents to collect payment directly for services, and to operate their own independent counseling practices, does not contribute to the safety and welfare of citizens in the Commonwealth who rely on Residents for professional services.
I support this petition as it addresses an important aspect of professional development for Residents in Counseling. Allowing Residents to directly bill and receive payments for their services under supervision will not only align Virginia with practices in several other states, but it also reduces unnecessary administrative burdens on both Residents and Supervisors. Importantly, this change does not alter the required supervision hours or the standards for supervision itself. Instead, it creates an environment where Residents can establish their practices under clear guidance and oversight during their formative years. By streamlining the billing process, Supervisors can focus more on providing quality guidance, which enhances the overall supervision experience.
Additionally, Residents in Counseling often face low wages in the Commonwealth, making it difficult to sustain themselves while gaining necessary experience. This adjustment would provide an opportunity for Residents to improve their financial stability, making the profession more accessible and sustainable for emerging counselors. This adjustment fosters a clearer and more professional relationship between counselor and client while ensuring that the integrity and rigor of the supervisory process remain intact. It also provides a vital pathway for Residents to establish and grow their own practices, ultimately benefiting both the counseling profession and the clients served.
I strongly support the petition to amend 18VAC115-20-52(B)(10) and 18VAC115-50-60(B)(8) to allow residents in counseling to directly bill for services and receive payments from clients. This change is crucial for promoting professional development and financial stability for new practitioners in the field.
The current regulation creates unnecessary hurdles for residents who are already under strict supervision requirements. By allowing residents to directly bill clients, we empower them to take ownership of their practice while still under the mentorship and guidance of experienced supervisors. This fosters a learning environment where residents can develop their business acumen alongside their clinical skills, better preparing them for independent practice.
Moreover, this amendment would reduce the administrative burden on supervisors, who currently have to manage the complex process of passing through client payments. The existing system not only complicates the financial aspects of supervision but also potentially dissuades qualified professionals from taking on supervisory roles due to the perceived risks and inconveniences.
It is also important to recognize that the cost of living continues to rise, and residents in counseling often face low wages and limited employment opportunities in the Commonwealth. Allowing residents to directly bill clients could alleviate some of the financial stress they experience, making the profession more sustainable and attractive to future practitioners. This change would not incentivize unethical practice but rather support residents in adhering to ethical guidelines while gaining the experience they need to become licensed professionals.
In exempt settings, graduates practice without the same level of oversight, often dealing with complex cases without adequate support. By contrast, allowing residents in private practice to bill directly while still under supervision ensures they receive the guidance they need to develop into competent, ethical practitioners.
In conclusion, this amendment is not only a step toward modernizing our regulatory framework to match current technology and payment systems but also a move to support the next generation of counselors. It acknowledges the reality of the field and offers a practical solution that benefits both residents and their supervisors, ultimately leading to better outcomes for clients. I urge the Board to reconsider this petition and allow residents to directly bill for their services.
I support the petition to amend 18VAC115-20-52(B)(10) and 18VAC115-50-60(B)(8) to allow residents in counseling to directly bill for services and receive payments from clients. It’s important to emphasize that this proposed change is not about reducing or altering the supervision requirements for residents. Instead, it’s about providing clarity and modernizing the process to better reflect the current professional landscape.
The current regulation’s wording has led to confusion and unnecessary complications around the billing process for residents in counseling. This amendment seeks to address that confusion without altering the essential requirements for supervision or the pathway to licensure. Residents will still be under the same rigorous supervision and will still be required to complete all necessary hours and meet all other criteria set by the Board.
This amendment is not about changing the certification of licensure; it’s about clarifying an administrative aspect that impacts the day-to-day functioning of residents in counseling. The ability to directly bill clients simplifies the process for all parties involved. It allows residents to manage their practice more effectively while under supervision, ensuring that their focus remains on providing quality care to clients rather than navigating cumbersome billing procedures.
This clarification also aligns with practices in other states and reflects the shift towards a more streamlined and efficient healthcare environment. By removing the unnecessary complexity of billing through a supervisor, we are not compromising the integrity of the supervision process. Instead, we are allowing residents to operate more independently within the boundaries of their training, supervision, and ethical obligations.
In summary, this change is about clarity and practicality, not about altering the foundational requirements for becoming a licensed counselor. It is a necessary step to ensure that residents can focus on their professional growth and client care without unnecessary administrative burdens.
I absolutely support this
I am in full support of the petition to amend the regulations to allow residents in counseling to directly bill for services and receive payments from clients. This change is essential for aligning the profession with modern practices and the realities of today’s technology-driven world.
The current regulations were established in a time when payment methods were more manual and required greater oversight. However, in today’s world, we have access to digital payment systems that offer transparency, efficiency, and security. The requirement for payments to pass through supervisors is outdated and no longer necessary given these advancements.
Direct billing by residents does not undermine the supervision process; instead, it modernizes it. Supervisors will still provide essential oversight to ensure that residents are practicing ethically and within the bounds of their competence. What changes is the administrative burden on supervisors and the financial clarity for residents, who will now have the ability to manage their own income without unnecessary complications.
Furthermore, this amendment would benefit clients by simplifying the payment process. Clients often prefer to handle payments directly with the counselor they are working with, as this maintains the integrity of the therapeutic relationship. By allowing residents to bill directly, we respect the client-counselor relationship and make the process more straightforward for everyone involved.
Finally, the current regulation places Virginia out of step with many other states that allow direct billing by residents. As we move toward greater interstate cooperation in counseling licensure through initiatives like the Counseling Compact, it is important that Virginia aligns its regulations with those of other states to ensure consistency and mobility for professionals.
This amendment is not about reducing oversight or compromising ethical standards; it is about bringing our profession in line with current practices and technology. I urge the Board to approve this petition and take a necessary step forward in modernizing our regulations.
I do not support this measure. Why should LPC's be the only profession allowed to do this? No!
I do not support this.
I fully support this proposal for a multitude of reasons. First, it's time that we all understand what "operate independently" really means. "Operating independently" means practicing without supervision, not that "Residents can't own and operate their own practice." There's a clear difference between "operating independently" and being self-employed (with supervision) and many other states recognize this and allow their supervisees to have their own private practices - as does Virginia! Fact: Virginia Residents CAN legally (and DO) own and operate private practices. This provision alone, has no bearing on the issue at hand (Residents not being able to bill clients directly).
Second, others' have commented that if this bill is passed, then the "experience" that Residents are supposed to be receiving will be compromised. Billing clients directly should not equate to professional "experience." Such claims completely demean and disparage the the work and dedication that Residents give in order to maximize all of the benefits surrounding said experience. If a Resident is able to bill their clients directly, the quality of their experience won't change - because they'll still be under supervision. It's supervision that perpetuates the quality of the Residents "experience," not the money.
Some people who are opposed to this proposal think that if LPC's aren't monitoring (aka controlling) the money, then Residents can do whatever they want. I find this this frame of thought to be extremely concerning for multiple reasons. One is because it conveys that Residents are ONLY being monitored in one way. If this is the case, then supervisors need to be held accountable for their lack of supervision. Perhaps Supervisors also need be monitored more closely - and maybe revoking their ability to bill Residents directly will achieve this?
Furthermore, Residents being in charge of their own billing/money should not be threatening to LPCS/Supervisors. The simple fact that many people in higher positions than Residents are threatened by this should be of great concern to those in charge of regulating the profession. It's no secret that there are numerous "puppy mill" style practices in Virginia wherein LPCs/Supervisors hire Residents (some of them ONLY hiring Residents) because they can make more of a profit this way. I personal know of at least one practice in Virginia that has made over $1 million per year because of this "business model." So, if this proposal goes through, these places fear losing their "golden goose" (i.e., Residents). Personally, I think that this is the real reason why many people oppose this proposal. Other states (such as Texas, Oregon, Colorado, and Ohio) allow their counseling supervisees to bill clients directly. This proposal is not an unprecedented concept in our profession. It is happening in other states and it's happening successfully. These supervisees are still getting the experience they need and they aren't operating independently - because they're still being supervised. Furthermore, the fully-licensed counselors in these states are not of lesser quality or have less competence because their supervision experience is different than ours. So, it's clear that the problem many people have with this proposal just comes down to money.
Lastly, many people opposing this proposal also state that prohibiting Residents from billing their clients directly actually helps clients because it shows that Residents are not LPCs and are under supervision. They still seem to say this despite the multiple regulations in place that require Residents to show/explain/document/discuss/brandish (to the point of extreme overkill) that they are not licensed professional counselors and are indeed under supervision. Changing how the client is billed does not change this requirement. As a matter of fact, I have personally witnessed clients being even more confused and essentially turned off from starting therapy due to the Resident not being able to bill them directly. We're constantly being told that there is a severe therapist shortage in Virginia; so, why are we refusing to make changes that could actually make the process easier for Virginians to get help?
At the end of the day, Residents in Counseling should be supported, encouraged, and nurtured - not held back by archaic ideals that only benefit those wishing to profit off of Residents. Rules and regulations should evolve along with an evolving profession, as ours does. Other states recognize the importance of what is being proposed here and have updated their rules and regulations. Virginia should too!
Approving this change will strengthen the mental health services the State of Virginia can provide to its citizens and bring Virginia to the forefront of tackling the challenges of the mental health crisis in America in this generation. The burnout rate of counselors is unsustainable and one preventable cause of that loss is addressed here, fair and equitable compensation for services provided. Allowing residents to bill directly if they choose does not weaken the requirements for supervision and professional development. Instead, it will likely strengthen the resident/supervisor relationship. The resident who chooses to have their own practice will feel less taken advantage of and more autonomous, which is in line with the code of ethics and the supervisor can focus more on their responsibility to provide oversight and mentoring.
As a resident, it is disheartening under the current regulations to see the workload I have to take on in order to make ends meet and provide for my family, when all that separates me from being more fairly compensated is an outdated, unnecessarily oppressive regulation.
I support the petition to amend the regulations to allow residents in counseling to directly bill clients. The current system, which requires payments to go through supervisors, disrupts the natural client-counselor relationship and creates unnecessary confusion for clients.
When clients seek therapy, they establish a trusting relationship with their counselor. This trust is the foundation of effective therapy, and clients naturally expect to handle all aspects of their service, including payment, directly with the person providing their care. The current regulation, which requires clients to pay the supervisor rather than the resident counselor, can erode this trust and create unnecessary administrative hurdles.
Allowing residents to bill clients directly also reflects the modern landscape of payment systems. With digital payments becoming the norm, the process of transferring payments through supervisors is outdated and cumbersome. It is far more efficient and transparent for clients to pay their counselor directly, ensuring a smoother process for all involved.
Furthermore, this change would alleviate the administrative burden on supervisors, allowing them to focus more on providing quality supervision rather than managing financial transactions. Supervisors should be there to guide and mentor, not act as intermediaries for payments.
This amendment would not compromise the quality of supervision or the ethical standards of the profession. Residents would still be under the oversight of their supervisors, ensuring they adhere to all regulations and continue their professional development. I urge the Board to support this change for the benefit of residents, supervisors, and clients alike.
I am writing to express my strong support for the petition to amend 18VAC115-20-52(B)(10) and 18VAC115-50-60(B)(8) to allow residents in counseling to directly bill for services and receive payments from clients. This change is necessary to alleviate the financial strain on residents and to modernize the regulations in line with current payment practices.
Residents in counseling are often recent graduates who are still building their professional foundation. The financial burden of entering the field can be significant, especially given the low wages that many residents receive in their early years. The current requirement that residents must pass their earnings through their supervisors adds an unnecessary layer of complexity and financial strain. Supervisors, understandably, may be hesitant to take on residents due to concerns about the implications for their own tax liabilities and the administrative burden of managing these payments.
Allowing residents to directly bill clients simplifies this process and provides a clearer financial path for both residents and supervisors. Residents can more easily manage their own income, which is essential for their financial stability and professional growth. Supervisors, in turn, can focus on what they do best—providing guidance and support to the next generation of counselors—without the added stress of handling payments.
The argument that direct billing could incentivize unsupervised practice does not hold when we consider the robust supervision requirements already in place. Residents are required to inform clients in writing that they are under supervision, ensuring transparency and adherence to ethical standards. This amendment would not change the rigorous supervision requirements; it would merely streamline the financial aspect of the supervisory relationship.
Furthermore, in many other states, residents are permitted to bill clients directly, and these states have not reported issues with residents practicing independently without appropriate oversight. This demonstrates that direct billing can be implemented without compromising the integrity of the supervision process.
The current regulation also creates an artificial barrier for residents who wish to start their own private practice under supervision. In a time when employment opportunities may be limited, especially in certain geographic areas, being able to establish a private practice under supervision can be a critical opportunity for residents to gain experience and build their client base. By allowing residents to bill clients directly, we support their entrepreneurial efforts and help ensure that they can sustain themselves financially while continuing their professional development.
In conclusion, the proposed amendment to allow residents in counseling to directly bill clients is a necessary and logical step forward. It supports the financial well-being of residents, reduces administrative burdens on supervisors, and aligns Virginia’s regulations with modern payment practices and the standards of other states. I strongly urge the Board to approve this petition for the benefit of all involved in the counseling profession.
I fully support the petition to amend the current regulations and allow residents in counseling to directly bill clients and receive payments for their services. The existing rules create an unfair disadvantage for residents, limiting their ability to build a successful practice and placing unnecessary financial and administrative burdens on both residents and supervisors.
The current system, which requires payments to be routed through supervisors, is both cumbersome and outdated. In an era where digital payments are the norm, requiring a middleman for financial transactions only serves to complicate what should be a straightforward process. This outdated requirement places Virginia’s residents at a disadvantage compared to their peers in other states where direct billing is allowed.
Residents are often in the early stages of their careers, working hard to establish themselves in the field. They face the dual challenge of gaining clinical experience while managing the financial realities of life after graduate school. The inability to directly bill clients adds an unnecessary layer of financial stress. It forces residents to rely on supervisors to manage their income, which can be problematic if the supervisor is not well-versed in these financial processes or is simply unwilling to take on the extra administrative load.
Moreover, the requirement for payments to go through supervisors can deter qualified professionals from becoming supervisors. The administrative burden and potential tax implications are significant deterrents, which ultimately limits the availability of quality supervision for residents. By allowing residents to handle their own billing, we can remove this barrier and potentially increase the pool of willing and qualified supervisors.
Additionally, clients who choose to work with a resident counselor should not be burdened with a complicated payment process. Clients prefer transparency and simplicity, and being required to pay someone other than the person providing the service can create confusion and disrupt the therapeutic relationship. Direct billing respects the client’s choice and maintains the integrity of the counselor-client relationship
I think this is an excellent idea! The supervision requirements will remain the same and it cuts out the middle man when it comes to billing. It also helps residents have a better understanding of the operational/administrative side of working with clients. School teaches us how to provide care but we aren't given many opportunities to learn the side related to running a business. This move will set clinicians up for success.
This change is crucial for the economic viability of residents in counseling and for fostering a more equitable entry into the profession.
Currently, residents are often caught in a difficult financial situation. They are required to undergo extensive training and supervision, which is essential for ensuring quality care. However, the inability to directly bill clients creates a financial bottleneck that can discourage talented individuals from continuing in the profession. Many residents face low wages and struggle to meet their basic living expenses, let alone pay for the supervision required to advance in their careers.
By allowing residents to bill clients directly, we are acknowledging their role as professionals who are capable of managing their own practices under supervision. This change does not reduce the amount or quality of supervision required; instead, it allows residents to focus on providing excellent care without the additional stress of financial uncertainty.
This amendment would also bring Virginia in line with other states that have modernized their regulations to reflect the realities of today’s healthcare environment. In a world where digital payments are standard and the administrative burden on professionals is increasing, streamlining the billing process is not just a convenience—it's a necessity. This change would simplify the payment process for clients, reduce administrative burdens on supervisors, and make it more feasible for residents to establish their own practices.
Moreover, the current regulations may inadvertently penalize those who choose to work in private practice settings under supervision, as opposed to exempt settings where billing and payment practices are less restricted. This creates an uneven playing field that limits opportunities for many qualified professionals.
In summary, allowing residents to bill clients directly is a common-sense change that supports the financial and professional growth of new counselors while maintaining the necessary safeguards of supervision. It’s a step towards a more sustainable and equitable path into the counseling profession.
I strongly support the petition. This amendment is essential not only for promoting ethical practice but also for ensuring the financial independence of residents.
The current regulations place residents in a difficult position by requiring their income to be funneled through their supervisors. This setup creates unnecessary complications and opens the door to potential ethical concerns. For example, there could be misunderstandings about the division of payments or delays in residents receiving their rightful earnings. These issues can strain the supervisory relationship and create unnecessary tension between supervisors and residents.
Allowing residents to bill clients directly removes these potential conflicts and promotes transparency. Residents can clearly document the services they provide and the payments they receive, fostering an ethical practice where all parties have a clear understanding of the financial arrangements. This clarity is essential for maintaining the trust and integrity of the supervisory relationship.
Moreover, the current system can discourage talented individuals from pursuing supervision roles. The added responsibility of managing another professional’s income, with all its associated administrative and tax complexities, is a deterrent for many would-be supervisors. By allowing residents to handle their own billing, we remove this barrier, potentially expanding the pool of qualified supervisors and improving the overall quality of supervision available to residents.
Financial independence is a critical component of professional development. Residents are emerging professionals who are working to establish their careers and build their reputations in the field. Allowing them to manage their own income is an important step in this process. It teaches them how to handle the business side of private practice, an essential skill for any successful practitioner.
Additionally, the current regulation is out of step with modern payment practices. In today’s world, digital payments are standard, and the requirement for payments to go through a third party is outdated and unnecessary. Clients expect a streamlined process where they can pay the individual providing the service directly. This not only makes the payment process more efficient but also reinforces the therapeutic relationship between the counselor and the client.
Finally, the concern that allowing residents to bill directly might incentivize unsupervised practice is unfounded. The regulations already require residents to inform clients in writing that they are under supervision and not practicing independently. This amendment would not change the supervision requirements; it would simply make the financial aspect of their practice more transparent and manageable.
In conclusion, the proposed amendment to allow residents to bill clients directly is a necessary step forward for the counseling profession in Virginia. It promotes ethical practice, financial independence, and aligns our regulations with modern payment systems. By supporting this change, the Board will be fostering a healthier, more sustainable environment for residents, supervisors, and clients alike. I urge the Board to approve this petition.
I don’t believe this will cause harm or damage the learning process to become fully licensed. I fully support this.
Strongly support for all the reasons state in Sharon Watson’s original posting. With the Counseling Compact coming into effect, it is more timely than ever.
Ethically, it is essential to allow Virginia Residents in Counseling to bill directly for services rendered as the exchange of money (and open dialogue about the same) between client and counselor is an integral aspect of healthy, effective psychotherapy. Residents should be given the opportunity to engage in all aspects of professional counseling practice while under supervision, working with their supervisor to resolve any problematic aspects of client care. Singling out the exchange of money as the only integral part of psychotherapy that Residents cannot take the lead on inhibits their professional growth as Residents and is at worst detrimental to clients (creating confusion regarding payment) and at best completely irrelevant to client welfare (having a supervisor accept a client’s money does not improve client wellbeing). This limit on Residents is arbitrary and does not enhance their professional development nor safeguard clients. As Virginia supervision and other Residency requirements (e.g. clearly indicating their status as Resident in Counseling to clients and on all written documentation) are still in place for Residents regardless of whether they accept direct payment, client wellbeing is still at the forefront of the spirit of Residency guidelines; this proposed update to Residency guidelines will afford Residents the right to practice as the ethical and competent masters level clinicians they are.
As the mental health crisis intensifies across our state, it is increasingly crucial that all professionals in the healthcare sector operate at the highest level of their licensure capabilities. Currently, Virginia residents are facing extensive waitlists for essential services, which impedes their access to timely mental health care. This situation also places an undue burden on Licensed Professional Counselors (LPCs), who are responsible for managing a broad array of services and associated billing.
The delay in advancing the proposed legislation exacerbates the challenges faced by an already overwhelmed behavioral health services system. Without this critical reform, the constraints on LPCs will persist, further impeding the delivery of necessary services to those in need.
We propose that immediate action be taken to push this law through, as it will alleviate the current pressures on LPCs and enhance the efficiency of mental health service delivery. By doing so, we can ensure that Virginia residents receive timely and effective care, and that LPCs are better supported in their vital roles.
I support this petition.
I am in full support of this. My time was taken advantage of as a free intern in grad school, but I was willing to overlook this, as the experience was necessary for my growth and education. My supervisor even boasted about pocketing more than 100k for my services back then. The cycle of reliance for payment should be broken at the resident level. If providers can see patients alone and at a different site from their supervisors, they should be allowed to directly bill for their services. Other states have provided a great example of this. This would be the best ethical thing to do!
I support this petition as a step towards financial independence of residents.
I support this, and believe it is fair and necessary.
Residents in counseling should be allowed to directly bill for services and directly receive payments from clients because, after rigorous training, internship, and supervision, they are capable professionals and deserve to have access to directly bill clients so they don't get paid a portion of what they work for and through a third party. After years of rigorous counselor training, practicum, and internships, the residents are resilient and need encouragement to boost their morale. What better way than receiving direct payment for what they have worked hard for?
I support Residents in Counseling having the ability to directly bill for counseling services. I recently moved from out of state, where Residents had this right. In VA, residents can currently bill indirectly under their supervisors. This results in drastic pay differences between provisionally licensed clinicians in VA vs other states, as companies take advantage of the fact that residents need them to bill. The only benefit offered is illusion of added client care. Residents will be consulting with supervisors about clients whether or not they can bill directly, and this supervision includes session documentation. With supervision of client care occurring in either scenario (and in greater amounts when compared to others states), limiting Residents ability to directly bill for client services serves only to gatekeep Residents and encourage licensure/business development in outside states. With the counseling compact nearing completion, it would be easy, and financially, it would make more sense to be licensed and running a business in an outside state where Residents can bill directly (I know people already doing this)! This only hurts the many clients needing services in VA. Help prospective clients in VA maintain access to skilled clinicians who want to receive deserved reimbursement and personal freedom in their practice.
It is time to practice the social justice our profession preaches, by adequately compensating counseling residents. There is no downside to changing this law, as it will attract more people into the profession, in VA (other states do not have this barrier). Our graduate internships are unpaid (which is in itself a big issue), so the extra 2+ years of residency should be an opportunity to serve our clients/patients without continuing the financial burden. This will increase the quality of VA counselors.
Allowing Residents to take their payments directly would not necessarily require Supervisors to allow that in their practice.
But for Supervisors who do prefer to allow Residents to directly bill and take payments, this could take a real headache off their plate.
If there is a legal reason to not let Residents deal with billing and money, explain the concern. Otherwise, letting Residents learn to deal with money is a serious aspect of training! The emotional issues around billing and getting paid are significant, and it ought to be Supervisors who decide when a Resident is ready to start learning how to do that, not just an arbitrary law that says they may not until they are fully licensed.
Let Residents learn all aspects of being a Counselor, including the money part.