Can Georgia APCs and LPCs Legally Diagnose?
Table of Contents
On 8/8/2017 Georgia governor Nathan deal signed into law bill SB 319 that explicitly added “diagnose” into state law for LPCs.
However, a frequently asked question is whether this law change also allows APCs (provisionally licensed) to diagnose.
In Georgia, LPCs and APCs are treated similarly. For example, APCs must respond to board complaints even though they are under supervision, continuing education requirements are identical.
Both share the same scope of practice. The exception is that APCs must be practicing in a work setting acceptable to the board and under supervision simultaneously.
APCs diagnosing usually only becomes a problem with the Georgia Composite Board in the same manner it would for an LPC. So in that respect there is no difference.
An example is a board complaint by a peer that either an APC or LPC was diagnosing disorders in an area they are not trained.
The confusion and misinformation about this is likely related to managed care issues, but these are generally matters that managed care insurers might consider a violation of the contract agreement you have with them.
So in short, the board has enforced it is legal for APCs to diagnose.
“I have heard that prior to SB 319 it was illegal for LPC’s in GA to diagnose”.
This is false.
The Georgia composite board has always enforced it is legal for LPC’s to diagnose. The driving force behind the new law was the Licensed Professional Counselors Association of Georgia.
It further establishes the professional identity of masters level therapists. Now the word, “diagnose” is in the LAW and allows LPC, SW and MFT to inform a judge they can legally diagnose.
Amending the law to include “diagnose” was important especially for civil suits.
In practical terms, SB 319 addressed reimbursement issues and compliance with other state laws. For example Medicaid chooses which credentials they will reimburse for mental health services.
If you bill Medicaid without that credential they can seek remedy including reporting this to federal authorities as fraud, but legality of “diagnosing” is determined by the state licensing board.
What is GA SB 319?
First, SB 319, is the most sweeping change to our practice law since the law creating these licenses was passed in 1984. My ethics workshops provide opportunities for you to ask questions about my experience enforcing this law.
Senate Bill 319 includes an amendment to GA Code § 43-10A-3. This section of our law states what PC, SW and MFT can perform, what we can not perform, and what is an infringement especially on other licensed healthcare professions. Do I need to understand this law?
The language of this amendment is complex and convoluted.
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 other issues in the new law 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.
You should read that law, but it is not possible to interpret because the board enforces it in a manner that suits the current climate of the profession. What is important is that you read and understand Board rule Chapter 135-12.
Corresponding Rule Chapter 135-12, Testing and Assessment
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) The composite board does not accept diagnose continuing education as meeting the diagnose rule requirements. At least not yet. As of 5/13/2019, the board is waiting for a decision from the Georgia attorney general’s office. This will officially establish if the board can begin to accept continuing education courses as a substitute for diagnose courses and the 45 hour curriculum offered by LPCAGA, GA NASW, GSCSW and GAMFT.
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.
PRO Tip: Would you like a personalized evaluation of diagnosing in your practice?
If you are interested in structuring your practice in an ethical manner including diagnosing, I can answer questions at any of my workshops. If you would like a comprehensive evaluation, call me and we can schedule a license consultation appointment.
4 Key Points: Rules Compliance With Diagnose and Testing
The following recommendations are based upon personal experience with many of Georgia’s other Georgia licensing boards scopes of practice violations e.g. psychology, nursing, and dental boards.
Diagnosing Mental Disorders
There is no list of mental disorders that LPCs can’t diagnose, however limit your diagnosing 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 more general diagnosis of recurrent major depression for a patient who a psychiatrist or psychologist has diagnosed 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. You are protecting yourself on several fronts if whenever possible you allow a psychiatrist to be the primary 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 clarifies the psychology board’s rights to perform psychology testing in an exclusive manner. 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 usually studied in a psychology PhD program.
2) The board does not a have list of tests masters prepared psychotherapists can administer. In order to protect your license, err on the side of caution:
Suggestions To 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.
An example of a test you can administer and interpret by virtue of training is the Dissociative Experiences 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 generally 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.
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 likely 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 LPC application that is clean, concise and clear.
All 50 States Diagnose
An alphabetical listing of counselor diagnosing by state scope of practice law and regulations. I have quoted this language directly from each state’s law or regulations.
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 recently added ‘diagnose’ to masters level therapists scope of practice laws.
Some state boards including Georgia’s composite board have enforced masters level therapists diagnosing is legal even though the word ‘diagnose’ may not be in the state law.
In some states, counselors have vast authority primarily due to their licensing boards lack of resources or the shortage of psychologists and psychiatrists.
“…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.”
“..may diagnose or treat, other than through the use of projective testing or individually administered intelligence tests…”
” diagnosis and treatment of individuals, couples, families and groups.”
‘Diagnose’ is in the Social Workers law, however it is not in the Marriage and Family Therapists and Counselors laws.
“…the application of counseling interventions and psychotherapeutic techniques to identify and remediate cognitive, mental, and emotional issues…”
(Will provide information as it becomes available.)
“…evaluation, assessment, analysis, diagnosis and treatment of emotional, behavioral or interpersonal dysfunction or difficulties that interfere with mental health and human development.”
“… methods or procedures and the diagnosis and treatment of mental and emotional disorders to assist individuals in achieving more effective personal and social adjustment.”
“…practice of mental health counseling includes methods of a psychological nature used to evaluate, assess, diagnose, and treat emotional and mental dysfunctions or disorders…”
“…utilizes counseling and psychotherapy to evaluate, diagnose, treat, and recommend a course of treatment for emotional and mental problems and conditions…”
“…The assessment, diagnosis, and treatment of, and counseling for, mental and emotional disorders;…”
“…prevent, assess, and treat mental, emotional or behavioral disorders.”
“…diagnosing for the purpose of establishing treatment goals and objectives…”
“… to evaluate and treat emotional and mental problems and conditions in a variety of settings…”
“…“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…”
“…may engage in the independent practice of professional counseling and is authorized to diagnose and treat mental disorders…”
“…methods, and procedures, including assessment, evaluation, treatment planning, amelioration, and remediation of adjustment problems and emotional disorders,…”
“…means rendering offering prevention, assessment, diagnosis and treatment…”
“…means assisting individuals, families or groups through the counseling relationship to develop understanding of intrapersonal and interpersonal problems, to define goals, to make decisions,…”
“… methods in the diagnosis, prevention, treatment, and amelioration of psychological problems and emotional or mental conditions…”
“… includes, but is not limited to, assessment, diagnosis and treatment, counseling and psychotherapy, of a nonmedical nature of mental and emotional disorders,…”
“…a service involving the application of clinical counseling principles, methods, or procedures for the purpose of achieving social, personal, career, and emotional development…”
“…the implementation of professional counseling treatment interventions including evaluation, treatment planning, assessment, and referral;…”
“…Counseling/Psychotherapy involves diagnosis, assessment and treatment by use of the following:…”
“…techniques, methods, or procedures based on principles for assessing, understanding, or influencing behavior…”
“…conducting assessments and diagnoses for the purpose of establishing treatment goals…”
“Diagnosing major mental illness or disorder except in consultation with a qualified physician, a psychologist licensed to engage in the practice of psychology…”
“…counseling interventions to prevent, diagnose and treat mental, emotional or behavioral disorders and associated distresses…”
Can LPC’s only give diagnostic impressions?
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.
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 for LPC SW and MFT 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 and signed by the governor. They will be in effect 21 days from 8/18/17. Nathan Deal’s signed document can be viewed here.