Last week, a decision was made in favor of Texas counselors, who had gone toe-to-toe with the Texas Board of Examiners of Professional Counselors over a proposed ruling that would have imposed unwanted restrictions on distance counseling. The Board had modeled its proposal after a similar ruling adopted by the Texas Medical Board last year. More than 130 counselors signed a petition to weigh in heavily against the proposed ruling. Their efforts were supported by the American Telemedicine Association (ATA) and the Center for Connected Health Policy, a federally-funded group developed to support telehealth policy change.

ATA Addressed Texas Board of Examiners of Professional Counselors

In a February 11 letter to the Texas Board of Examiners of Professional Counselors’ (“the Board”) Proposed Rules on clinical practice, the ATA addressed the Board’s proposed ruling that would have restricted online therapists and distance counselors. The ATA letter first established the strong need for behavioral health services to be more easily accessed in Texas, by citing data related to the state’s current mental health crisis:

Of the state’s 254 counties, roughly 200 are designated as Mental Health Professional Shortage Areas.1 In 2014, The Texas Department of State Health Services concluded in a report to the state legislature regarding the state’s mental health workforce shortage that the “expansion of tele-mental health services may prove beneficial in increasing the geographic reach of the mental health workforce.”2

The ATA letter then addressed the first suggested amendment to the Texas Board of Examiners’ proposed ruling, which involved Texas’ suggested residency requirements for licensure. If accepted, the proposal would have required counselors and online therapists to be located in the state when delivering services to clients in Texas. The ATA‘s position read:

While all applicants must meet the state’s requirements for licensure and ethical clinical practice, enforcing an in-state residency precondition solely for “distance counseling” is an unreasonable burden that will further limit mental health service delivery across Texas. We recommend that the Texas Board of Examiners remove requirements for in-state residency as it pertains to “distance counseling”.

The second issue addressed by the ATA‘s letter was that of requiring in-person assessment prior to the delivery of distance care. In other words, counselors would have required all clients to travel to their brick-and-mortar office for at least one in-person meeting prior to establishing a telehealth-mediated relationship. In part, the ATA‘s report read:

All telemental or behavioral health encounters, whether conducted in-person or remotely, should be based on the provider’s clinical competence and professional decision making using sufficient, appropriate clinical and non-clinical information to provide the health service. Yet, the Texas Board of Examiner’s proposal would enforce clinically unnecessary and ethically questionable standards and severely limit client access to mental health and behavioral health care.

Adding support to the ATA stance, two studies were  cited in the ATA letter to give credence to the efficacy and safety of videoconferencing to conduct intakes and assessments. 3, 4 

Subsequent Ruling by Texas Board of Examiners of Professional Counselors

Success came to the dissenters in Texas. The Texas Board of Examiners was quite responsive to the requests made by the Texas counselors and their many supporters. As reported in the Austin American Statesman, the Texas Board of Examiners voted to back away from the unpopular proposal. We can expect similar battles in different states as telemental health needs continue to be identified and addressed by various stakeholders. Regulatory boards in several other states are debating legislation that could mandate the in-person meeting in certain circumstances. Such states include Alaska, Alabama, Arkansas, and Mississippi, which is a hotbed for ideas, with almost 80 telemedicine-related bills filed this year alone. Counselors and other professionals facing similar battles in other states or provinces can now take heart that their voices can be heard when they rally to support the use of telemental health with consumer need.  The assistance of the ATA certainly had to help.

ATA Annual Meeting, May 14-17, 2016

If you are tempted to go to the ATA‘s annual meeting, let me encourage you to do so. It is the largest meeting for telehealth-interested professionals in the United States and Canada, and the best telehealth networking meeting of the year. With more than 600 telemental health professionals belonging to their Special Interest Group (SIG), their annual meeting is always both informative and inspirational. The meeting this year will be in Minneapolis, Minnesota, from May 14-17.

I’ll be there as well. Join me for the E-Prescribing Short Course, where I’ll be addressing the Medical Psychology and the Ryan Haight Act, on May 14, 2016 from 2:00 PM – 5:00 PM CST. If you enjoy social networking events, you might also want to consider attending one of our TMHI MEETUPS! We’ll be sharing an evening of fine dining on Monday evening, the 16th of May at one of the convention hotel restaurants.


Make your reservation now by clicking here



1 Texas Department of State Health Services. “The Mental Health Workforce Shortage in Texas”. September 2014.

2 Ibid.

3 Copeland, J and Martin, G. (2004) Web-based interventions for substance use disorders: A qualitative review. Journal of Substance Abuse Treatment, 26(2), 109-116.

4 Frueh, B., Henderson, S., and Myri, H. (2005). Telehealth service delivery for persons with alcoholism. Journal of Telemedicine and Telecare, 11, 372-375.