Can LPC Diagnose in GA > 2016 Law

Senate Bill 319: The Amended 2016 GA Composite Board Law

As a former composite board president, for 7 years I enforced the Georgia law that regulates the practice of professional counselors, social workers and marriage and family therapists. Also known as SB 319, the 2016 amendment is the most sweeping change to our practice law since the law creating these licenses was passed in 1984. Therefore, it is important to have a thorough understanding of how this 'diagnosis and psychological testing law' impacts licensees. Also, my ethics workshops provide opportunities for colleagues to ask questions about my experience enforcing this law.  You should also sign up for updates as the board begins to enforce new rules:

“I have heard that it was illegal for LPC’s in GA to diagnose–is this true?” False. Georgia composite board has always enforced that LPC’s MFT and Social workers can legally diagnose. Whereas programs for example Medicare may choose which credentials they will reimburse for mental health services. Legality is determined by states. However, inclusion of "diagnose" could be helpful with legal/civil matters not related to your license.

The language of this amendment is complex and convoluted. The driving force behind the amendments to the recent law was the professional association the Licensed Professional Counselors Association of Georgia (LPCA). Their efforts resulted in a small but important change for professional counselors: the word 'diagnose' has been inserted into LPC scope of practice. The law contains many other elements and changes that impact everyone licensed by the Composite Board- GA Social Workers, Marriage and Family Therapists and Professional Counselors. The primary issues in addition to diagnosing are related to education requirements and the various instruments used for psychological testing. However, now that GA law contains the word "diagnose" for LPC SW and MFT, they now also must prove they're qualified to do it. The new rules were passed and became effective September 21 2017. What will actually happen with these rules? How will they be enforced? How will I know if I am in compliance? All of these questions are answered below.

9/21/17: Rule Chapter 135-12 Testing and Assessment Now in Effect. What Should I Be Doing to Satisfy the Rules?

Board Acceptable Educational Requirements

What has changed is there are now educational requirements that must be met in order to be in compliance with the new rules. If you have been fully licensed ( not associate level) for 10 years, you are exempt from any additional requirements. If you have been licensed for less than 10 years you will need to document that you completed a 3 semester or 5 quarter credit hour graduate course that had diagnosing in the course content or a curriculum in diagnosing workshops. If you have not satisfied these requirements, here is where things get a little complicated primarily because the board has yet to determine the best way to enforce the educational requirements. The board could exercise discretion in the following areas: 

1) Accept a combination of graduate coursework, continuing education, and organized programs in diagnosing.

2) Accept courses that are completed after the 12/31/17 deadline as stated in board rules but prior to 9/30/18 license renewal.  

Did you know you can get rules updates from composite board directly to your inbox? http://sos.ga.gov/plb/subscribe.htm

Click to Tweet

4 Key Points: compliance with SB 319 diagnose and testing.

The following recommendations also are based upon personal experience with many of Georgia's other healthcare boards e.g. psychology, nursing, dental and their board processes.

Diagnosing Mental Disorders

Limit your diagnosing to mood and adjustment disorders if possible. Usually it is not necessary for LPC SW and MFT to render highly specific diagnoses in order to carry out our work. For example, it is not inaccurate to render a simple diagnosis of recurrent major depression for a patient who a psychiatrist or psychologist may concurrently diagnose as bipolar type I or borderline personality disorder since with all of these disorders patients may suffer from major depressive episodes. Psychiatrists and psychologists sometimes need to render more specific diagnoses because some entity has requested it. Personality disorders are usually diagnosed by differential diagnosis through a battery of psychological testing. You are protecting yourself on several fronts if whenever possible you allow a psychiatrist to be the diagnosing clinician of record.

Social Workers, LPC and MFT and Psychological Testing

From reading the previous paragraph it is easier to determine which type of testing you are able to perform. Even prior to the new law, Composite Board licensees could legally administer many tests including the MMPI--clearly a psychological test. The fundamental change in this new law is that it further strengthens - through statute-the psychology board's sole right to perform psychology testing. The result is that it could be easier for the psychology board to issue cease and desist orders to non-psychologists for unlicensed practice of psychology. Cease and desist orders are a very serious and public disciplinary action. 

Guidelines for Psychological Testing

1) The new board rules state you can administer tests that you have been properly trained to administer and interpret, but even though you have been trained in administering for example the Rorschach, it is clearly a psychological test that is studied only in a psychology PhD program. If you are administering this test, consider eliminating it. 

2) "The board does not a have list of tests masters prepared psychotherapists can administer. How can I determine which I can get in trouble for administering?" In order to protect your license, follow these guidelines.  

Avoid

Psychological tests that can potentially cause psychological harm to a patient if misinterpreted. For example, some IQ testing.

Tests that are primarily used in psychological research. For example, the lexical decision task (LDT).

Many of the common instruments used in a formal neuropsychological battery for example those used by the Social Security Administration for making determinations about psychological disability. Avoid making a determination of malingering. You can query this in your progress notes but also document either a referral or reference to a psychologist or psychiatrist needing to assess it. Avoid tests which are used to diagnose degenerative brain disorders. In fact, this potentially places you in the realm of practicing medicine.

Safe But Proceed with Caution

Questionnaires completed by the patient that render results that are a simple sum total of the items which you then interpret. Examples include the Beck Depression Inventory and the Hamilton Anxiety Rating Scale.

A good example of a test you can administer and interpret by virtue of training is the dissociative experience scale. Many masters level therapists are trained in trained and skilled in treating dissociative disorders and the DES renders information useful for assessment and informing treatment planning.

Career and vocational tests are acceptable.

Some psychological tests, but only if under supervision of a psychologist. Document in your record that the psychologist both interpreted the results and directed you to administer the test. If you are not sure you can defend in a court of law that you have adequate training in these psychological tests, consult an attorney experienced in this area.


Advertising Your Testing Services

Avoid the use of any and all terms with variants of the word, "psychology" in your advertising. Examples of what to avoid are psychological assessment, career psychology assessment services and psychological and counseling testing services. 

"Career and vocational testing" won't be challenged by either the Composite or the Psychology Board. Be clear about your testing services. As a rule, don't attempt to push the boundaries of any of your advertising.

Information for New Licensing applicants

It is important you learn how to submit an application that is clean, concise and clear.


States That Include “diagnose” in their counselors licensing law.

It's important to understand the history of diagnosing for professional counselors, social workers, marriage and family therapists and other master's level mental health providers. Many states have only added 'diagnose' to masters level therapists scope of practice laws. However, many boards including Georgia's composite board have enforced masters level therapists diagnosing is legal even though the word 'diagnose' was not in the law. All of the following states now have diagnose in their board or practice law. 

georgia counselor social work diagnose rules law

Alabama

“…diagnose and develop treatment plans but shall not attempt to diagnose, prescribe for, treat, or advise a client with reference to problems or complaints falling outside the boundaries of counseling services.”

Alaska

“..may diagnose or treat, other than through the use of projective testing or individually administered intelligence tests…”

Arizona

” diagnosis and treatment of individuals, couples, families and groups.”

Arkansas

‘Diagnose’ is in the Social Workers law, however it is not in the Marriage and Family Therapists and Counselors laws.

California

“…the application of counseling interventions and psychotherapeutic techniques to identify and remediate cognitive, mental, and emotional issues…”

Colorado

Will provide information as it becomes available.

“I have heard that it was illegal for LPC’s in GA to diagnose–is this true?” False. Whereas programs–for example Medicare and Tricare–may choose which credentials are acceptable to them, determining their legality is generally outside of their jurisdiction…the Georgia composite board has always determined that under the law, LPC’s MFT and Social workers may engage in the activity of diagnosing.

Connecticut

“…evaluation, assessment, analysis, diagnosis and treatment of emotional, behavioral or interpersonal dysfunction or difficulties that interfere with mental health and human development.”

Delaware

“… methods or procedures and the diagnosis and treatment of mental and emotional disorders to assist individuals in achieving more effective personal and social adjustment.”

Florida

“…practice of mental health counseling includes methods of a psychological nature used to evaluate, assess, diagnose, and treat emotional and mental dysfunctions or disorders…”

Georgia

“…utilizes counseling and psychotherapy to evaluate, diagnose, treat, and recommend a course of treatment for emotional and mental problems and conditions…”

Hawaii

“…The assessment, diagnosis, and treatment of, and counseling for, mental and emotional disorders;…”

Idaho

“…prevent, assess, and treat mental, emotional or behavioral disorders.”

Illinois

“…diagnosing for the purpose of establishing treatment goals and objectives…”

Indiana

“… to evaluate and treat emotional and mental problems and conditions in a variety of settings…”

Iowa

“…“Mental health setting” means a behavioral health setting where an applicant is providing mental health services including the diagnosis, treatment, and assessment of emotional and mental health disorders and issues…”

Kansas

“…may engage in the independent practice of professional counseling and is authorized to diagnose and treat mental disorders…”

Kentucky

“…methods, and procedures, including assessment, evaluation, treatment planning, amelioration, and remediation of adjustment problems and emotional disorders,…”

Louisiana

“…means rendering offering prevention, assessment, diagnosis and treatment…”

Maine

“…means assisting individuals, families or groups through the counseling relationship to develop understanding of intrapersonal and interpersonal problems, to define goals, to make decisions,…”

Maryland

“… methods in the diagnosis, prevention, treatment, and amelioration of psychological problems and emotional or mental conditions…”

Massachusetts

“… includes, but is not limited to, assessment, diagnosis and treatment, counseling and psychotherapy, of a nonmedical nature of mental and emotional disorders,…”

Michigan

“…a service involving the application of clinical counseling principles, methods, or procedures for the purpose of achieving social, personal, career, and emotional development…”

Minnesota

“…the implementation of professional counseling treatment interventions including evaluation, treatment planning, assessment, and referral;…”

Mississippi

“…Counseling/Psychotherapy involves diagnosis, assessment and treatment by use of the following:…”

All 50 states LPC laws and Diagnose will be posted soon.

Can LPC diagnose in GA ? Prior to passing the 2016 SB 319 Law, I have heard it was only legal for LPC’s to make diagnostic impressions, but diagnosing mental conditions was illegal–is this true?

This is false. The term “diagnostic impression” is used in many different ways, but it did not form the basis for legality of diagnosing in Georgia. It is important to understand this since it sheds light on how the law might be enforced in the future. Whereas programs–for example Medicare –may choose which credentials are acceptable to them for reimbursement, determining their legality is outside of their jurisdiction. Healthcare licenses are issued by states therefore states determine which practice activities are legal. Despite the absence of the word diagnose in the law, the composite board has always determined that under the law, LPC’s MFT and Social workers may engage in the activity of diagnosing. Still, the inclusion of the word diagnose is critical: courts and other entities sometimes question mental health licensees opinion on clients’ mental conditions by attempting to challenge whether they are qualified to diagnose.

A chronology of the new 2016 GA diagnose law and rules

11/10/16- Proposed Rules to Be Presented at the December 2016 Board Meeting

At present the board is proceeding with posting new rules for public input. The proposed rule change appends a new section 135-12-.01 at the end of our current rules.

11/21/16- The 2016 Law and Pending Composite Board Rules

If you are licensed by the Composite Board, avoid the use of any form or derivative of the word “psychology” in your practice or any information you publish or advertise through print and the internet or social media unless you are also licensed by the GA State Examining Board of Psychologists. This is regardless of whether the proposed rules are passed. 

2/8/17: Rule changes focusing on psychological testing

First and foremost, the board enforces our practice law–no one else. There is no way of knowing what is legal under this new law until new rules are passed. The board has significant discretion in the interpretation of this law. Your main concern at present is to be certain you are not representing yourself as a psychologist.

  • Any new diagnose course requirements which could be passed for LAPC/LPC will become partially moot when an existing rule becomes effective after 9/30/2018 requiring a course in diagnose as part of an acceptable graduate degree. In essence, you will automatically be in compliance if you have completed that course and that course is required by most CACREP and other board approved degrees.
  • There may be CEU requirements, but the law allows the board to accept experience in lieu of educational requirements. It is not known whether the board will write the rules to allow that.
  • In essence how the new law will be enforced is unknown at this time. It is possible that the Board of Examiners of Psychologists will attempt cease and desist orders with individuals who are engaging in certain activities. However, most of psychology board’s cease and desist orders on Composite Board licensees are related to advertising.
  • The Composite Board has it’s February 2017 meeting on 2/9/2017 to further discuss SB 319 and rules drafts.
  • Don’t panic. As usual, adhere to GA composite board code of ethics 135-7. Avoid the use of any form or derivative of the word “psychology” in your practice or any information you publish or advertise through print and the internet or social media unless you are also licensed by the GA State Examining Board of Psychologists. This is regardless of how the proposed rules are passed. Beside that, there is no way of knowing what you will need to do to be in compliance with this law until the Composite Board begins to enforce it and new rules are passed.

2/15/2017: Rule Changes Still in Discussion and on the March 2017 Board Meeting Agenda

The outcome of the meeting will be reflected in the minutes which should be posted within a few weeks on the Secretary of State licensing board website. I will try to post here any other updates asap.

4/10/17: Composite Board Public Rules Hearing: May 5 2017, 2:20 pm, Macon Georgia

The most recent version of the diagnose and testing rules has been confirmed by the Attorney General’s office and has been posted on the Secretary of State Professional Licensing board website.  The May 5th hearing is open to any member of the public. There have been several versions of rules drafts that the board has considered. They could be changed again.

It is important to note that the board has enforcement power over our practice law and they then write rules to interpret that law. Sometimes the board will exercise discretion and enforce a rule differently than written. It is a complex and fluid process and partly why it is difficult to predict how the board will enforce any aspect of regulating our practice.

The previous rules draft was scheduled for a possible vote on 3/10/17. The vote was again tabled. This partly owed to administrative and other work on the rule having not been completed. In effect, we are therefore still regulated under the old/current rules. Until rules are passed, there is nothing factual that can be stated regarding any additional licensee requirements or legality of practice activity under the new law.  All of the recent rules drafts have contained diagnose course curriculum, completion of a graduate level course which includes DSM V diagnosis content or exemptions for those licensed 10 years or more, and revised language addressing psychological testing, but the rules could still undergo further revisions. For now, obtain a copy of your graduate transcript, descriptions directly from the school bulletin of any courses that include diagnosing, and course syllabus. Retain these in the event the board requires you to produce them. When passed, it is not possible to know precisely how the board will enforce the new rules. The logistics of enforcement of new rules can be a challenge for board members as well as staff.

5/5/17: Board Votes Unanimously to Accept 135-12 Proposed Rules

Have the new diagnose and testing rules officially passed? Not quite–the rules will be sent to the governor who has 90 days to approve, change or veto them. They will then be sent back the the Board Executive Director and once received after 21 days will become effective. It could be August 2017 or later when the rules are official. Stay tuned for developments on how the board begins to enforce this new rule.

8/18/17: Governor Signs “Certificate of Active Supervision”

The new diagnose and testing rules have been approved by the governor. They will be in effect 21 days from 8/18/17. This document is entitled “Certificate of Active Supervision” and is a reference to that section of the Georgia Law–not our Georgia therapist practice law– that grants the governor duties to actively supervise all of the professional licensing boards. So don’t confuse this with supervision as it applies to our licensing. You can view Nathan Deal’s signed document.