Notice of Emergency Rule

DEPARTMENT OF HEALTH

Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling

RULE NO.: RULE TITLE:

64B4ER20-24 Revised Definition of “Face-to-Face psychotherapy”

SPECIFIC REASONS FOR FINDING AN IMMEDIATE DANGER TO THE PUBLIC HEALTH, SAFETY OR WELFARE: The Board Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling (hereinafter the “Board”) is statutorily mandated to adopt rules to implement and enforce the provisions of Chapter 491, Florida Statutes. Pursuant to this authority, the Board has promulgated rules setting forth the guidelines and requirements for clinical social work, marriage and family therapy, and mental health counseling interns while completing internship hours.

Rule 64B4-2.002, Florida Administrative Code, requires interns to complete clinical internship hours by face-to-face psychotherapy with client. It distinguishes between face-to-face psychotherapy and face-to-face by electronic methods for sessions with the intern’s Qualified Supervisor. The rule currently does not allow face-to-face psychotherapy by electronic methods with clients. Additionally, the Rule also limits the number of face-to-face supervision sessions between registered interns and their Qualified Supervisors to 50% of the total number of supervision sessions by electronic methods. The present rule also supersedes emergency rule 64B4ER20-20, F.A.C., which limits face-to-face psychotherapy by electronic methods to clients who had an existing psychotherapeutic relationship established with a registered intern prior to the effective date of the rule and did not clarify that clinical hours obtained by electronic methods would count toward an interns experience requirements.

On March 1, 2020, Florida Governor Ron DeSantis issued Executive Order Number 20-51 which directed the State Health Officer and Surgeon General, Dr. Scott Rivkees, to declare a public health emergency pursuant to the spread of the Coronavirus Disease 2019 (COVID-19). On March 9, 2020, Governor DeSantis issued Executive Order Number 20-52 (Emergency Management - COVID-19 Public Health Emergency) and officially declared that a state of emergency exists in the State of Florida. COVID-19 is a severe acute respiratory illness that can spread among humans through respiratory transmission and presents with symptoms similar to those of influenza. As of April 1, 2020, there are 6,955 cases of COVID-19 in the State of Florida, with the number rising exponentially. The Center for Disease Control (“CDC”) recommends mitigation measures to combat the spread of COVID-19 such as staying home when sick, keeping away from others who are sick, staying home when a household member is sick with respiratory disease symptoms, and for those who are at higher risk, including older adults and those who have serious chronic medical conditions, to avoid non-essential air travel and to avoid crowds as much as possible. Many communities have enacted stay at home orders requiring individuals to work form home whenever possible, to closer non-essential business, and to limit travel outside the home to essential needs only.

Since the issuance of the Executive Order and the declaration of a public health emergency by the State Health Officer and Surgeon General Dr. Rivkees, the Board office has received numerous calls and emails from registered interns and qualified supervisors concerned about the dangers of individual therapy and supervision sessions related to COVID-19. Furthermore, since emergency rule 64B4ER20-20, F.A.C., was enacted, the Board office has received numerous calls and emails from registered interns, domestic violence shelters, and rape treatment centers stating that they are seeing an increase in new clients and cannot provide services to these new patients under social distancing guidelines without registered interns being able to conduct psychotherapy sessions via electronic means. Inquiries have been made as to whether there are alternative methods by which clients can receive a continuation of therapy and allowing the expansion of supervision by electronic means thereby eliminating the possibility of contracting or spreading COVID-19. Many registered interns, Qualified Supervisors, and clients of registered interns are included as part of the particularly vulnerable population impacted by COVID-19 as identified by the CDC. As the current rule requires that all psychotherapy sessions between a registered intern and their existing and new clients take place face-to-face at the same location and since qualified supervisor sessions are limited to only 50% of meeting via electronic means, this emergency change will ensure that Florida’s citizens continue to have access to mental health care professionals and are not denied services or placed in unnecessary risk. This revision will ensure that a particularly vulnerable population, e.g. victims of domestic violence and sexual battery, are able to receive services regardless of when they were victimized. This revision is essential during this healthcare emergency.

Accordingly, the Board, by emergency rule, allows for the continuation of services to clients of registered interns so that necessary and helpful psychotherapeutic services may be established and are not interrupted. The Board finds that these actions are a measured regulatory approach that helps to mitigate the threat of exposure to COVID-19 and to protect the registered interns and their clients from exposure to COVID-19

REASON FOR CONCLUDING THAT THE PROCEDURE IS FAIR UNDER THE CIRCUMSTANCES: Given the recently declared emergency in the State of Florida, the recent guidance from the CDC, the Federal Social distancing guidelines which will be in effect through at least April 30, and the risk of denying mental health care services to citizens of Florida during the current declared emergency, the Board finds that an immediate danger to the public health, safety, or welfare necessitates immediate action. Notice of this emergency meeting was published in the Florida Administrative Register on April 1, 2020. In addition, notice of the Board’s emergency meeting was posted on the Board’s official website.

SUMMARY: The proposed emergency rule allows for a continuation of services to Florida’s mental health care recipients of registered interns which will likely be interrupted due to risk of transmittal of COVID-19 during the present health care emergency as registered interns are not currently able to provide services via remote electronic methods.

THE PERSON TO BE CONTACTED REGARDING THE EMERGENCY RULE IS: Janet Hartman Executive Director, Board of Clinical Social Work, Marriage and Family Therapy and Mental Health Counseling, 4052 Bald Cypress Way, Bin # C-06 Tallahassee, Florida 32399-3256.

THE FULL TEXT OF THE EMERGENCY RULE IS:

64B4ER20-24 Revised Definition of “Face-to-Face psychotherapy”

(1) “Face-to-face psychotherapy” for clinical social workers, marriage and family therapists, and mental health counselors registered pursuant to Section 491.0045, F.S., includes face-to-face by electronic methods so long as the registered intern establishes and adheres to the following:

(a) The registered intern has a qualified supervisor and maintains a qualified supervisor for the duration of the application of this rule; and

(b) The registered intern has a written telehealth protocol and safety plan in place with their current qualified supervisor which includes the provision that the qualified supervisor must be readily available during the electronic therapy session.

(2) Notwithstanding 64B4-2.002(3) and (4), F.A.C., a qualified supervisor may utilize face-to-face electronic methods, including telephone only communication, to conduct all supervisory sessions for internship hours. Any clinical hours obtained via face-to-face psychotherapy by electronic means shall be considered clinical hours for the purpose of meeting internship requirements.

(3) Emergency rule 64B4ER20-20, F.A.C., is hereby superseded by the present rule.

Rulemaking Authority 491.004(5), 491.005(1)(c), (3)(c), (4)(c) FS. Law Implemented 491.005(1)(c), (3)(c), (4)(c) FS. History–New, .

THIS RULE TAKES EFFECT UPON BEING FILED WITH THE DEPARTMENT OF STATE UNLESS A LATER TIME AND DATE IS SPECIFIED IN THE RULE.

EFFECTIVE DATE: April 3, 2020

Link For Rule: https://www.flrules.org/gateway/View_Notice.asp?id=23115311

Copied and pasted from the HHS.gov website (US Dept of Health & Human Services):

FOR IMMEDIATE RELEASE
March 17, 2020
Contact: HHS Press Office
202-690-6343
media@hhs.gov

OCR Announces Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency

Today, the Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) announced, effective immediately, that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communications technologies during the COVID-19 nationwide public health emergency.
This exercise of discretion applies to widely available communications apps, such as FaceTime or Skype, when used in good faith for any telehealth treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19.

In support of this action, OCR will be providing further guidance explaining how covered health care providers can use remote video communication products and offer telehealth to patients responsibly.

"We are empowering medical providers to serve patients wherever they are during this national public health emergency," said Roger Severino, OCR Director. "We are especially concerned about reaching those most at risk, including older persons and persons with disabilities," Severino added.

The Notification of Enforcement Discretion on telehealth remote communications may be found at: https://www.hhs.gov/…/notification-enforcement-d…/index.html.

For more information on HIPAA and COVID-19, see OCR's February 2020 Bulletin: https://www.hhs.gov/…/february-2020-hipaa-and-novel-coronav…

Note: All HHS press releases, fact sheets and other news materials are available at https://www.hhs.gov/news.
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Last revised: March 17, 2020

Resting Heart Rate May Predict Future Mental Ills

By NICHOLAS BAKALAR    OCT. 26, 2016

Extremely high or low resting heart rates in young men may predict psychiatric illness later in life, a large new study has found.

Researchers used heart rate and blood pressure data gathered at Swedish military inductions from 1969 to 2010, and linked them with information from the country’s detailed health records through the end of 2013. The study, in JAMA Psychiatry, included 1,794,361 men whose average age was 18 at induction.

The highest heart rates — above 82 beats a minute — were associated with increased risks of obsessive-compulsive disorder, anxiety disorder and schizophrenia. The lowest, below 62 beats, were associated with an increased risk of substance abuse and violent criminality. Extremes in blood pressure followed similar patterns, but the associations were not as strong.

The lead author, Antti Latvala, a researcher at the University of Helsinki, said that the reasons for the association remain unknown. But, he added, “These measures are indicators of slightly different reactivity to stimuli. These people might have elevated heart rates because of an elevated stress level that is then predictive of these disorders.”

Still, Dr. Latvala said, a high or low heart rate does not mean future psychiatric disease. “These are very complex illnesses,” he said. “People with high or low heart rate have nothing to worry about because of these findings. This is just a tiny piece of the puzzle.”

A version of this article appears in print on November 1, 2016, on Page D4 of the New York edition with the headline: Mind: Heart Rate and Mental Illness.