The Illinois Telehealth Act and What It Means for Psychotherapy
The past year and a half have brought significant shifts to the field of psychotherapy. In March of 2020 Illinois Governor JB Pritzker signed Executive Order 2020-09, enabling therapists to quickly shift their clinic work to a virtual format, with minimal disruption to their client’s care and insurance coverage. Insurance companies were required to reimburse health care providers for telehealth with the same payment rates as in-person care, and some waived the client’s usual copayment responsibilities, making therapy more financially accessible than ever.
While virtual therapy (or telehealth) is hardly a new concept, prior to 2020 many therapists had a steady in-person caseload and felt little need to venture into the world of phone and video sessions. There were few secure platforms available and the understanding of the state and federal laws and therapeutic guidelines for conducting virtual sessions was still quite vague and unresolved. And most graduate programs hardly taught how to navigate virtual interactions with clients beyond standard emails and phone calls for scheduling, billing, and emergency purposes. That all changed when virtual sessions became a vital format for continuing care through a global pandemic. This was true for therapists who have practiced for many years and graduate students alike, the latter of which ushered a new cohort of therapists who are more familiar with virtual than in-person therapy.
As we begin to move towards in-person interactions, many therapists are considering a hybrid model for offering services: some in-person sessions and some virtual sessions. Others are shifting their caseload entirely back to in-person and a new wave of therapists are making their practice completely virtual. Of course, as essential workers, some therapists never stopped offering in-person sessions throughout the pandemic for various reasons.
Given the coronavirus (COVID-19) safety concerns that led to the large-scale shift to virtual sessions in the first place, safety is at the forefront of these decisions. Both client and therapist will be choosing how to meet based on a series of delicate, informed, and consent based conversations. Since consent is an ongoing process, what is decided on at one point in the therapy may be changed later on. This means starting therapy virtually or in-person does not guarantee that the format will be the same throughout treatment. Should clients prefer a different option than what their therapist can offer, alternative options, such as making a referral to another clinician, may be discussed.
The option for continued access to phone and video sessions in Illinois, beyond the initial Executive Order, has been made possible for therapists and clients alike by Illinois House Bill 3308/Senate Committee Amendment 1. This Bill, signed into law by Governor JB Pritzker on July 22nd 2021, was achieved after a hard fight by therapists, other health professionals, politicians, and organizations during the prior month. The Bill, referred to as the Telehealth Act, ensures several protections to clients and providers, including the following:
Bars insurers from requiring patients to prove a hardship or access barrier in order to receive healthcare services through telehealth.
Prohibits geographic or facility restrictions on telehealth services, allowing patients to be treated via telehealth in their home.
Protects patient preference by establishing that a patient cannot be required to use telehealth services.
Ensures patients will not be required to use a separate panel of providers or professionals to receive telehealth services.
Aligns telehealth practice with privacy laws for in-person practice, while giving healthcare professionals the latitude to determine the appropriateness of specific sites and technology platforms for telehealth services.
Aligns telehealth coverage and payment with in-person care, making appropriate patient access to care the priority and removing harmful barriers that shift costs to the patient and healthcare professional.
As Governor JB Pritzker proudly stated during the public signing, "The legislation I'll sign today will solidify Illinois as a leader in telehealth access and expansion in the nation… Illinois is now one of the first states in the nation to turn our emergency pandemic response into a permanent reality….We are taking great strides to make sure that where you live no longer impacts how long you live. Thanks to this new law, we are one step closer to that reality today."
The continuation of phone and video sessions still comes with a number of risks and benefits. A client signs-off on these items when they begin meeting with their therapist virtually: they understand that virtual therapy helps with accessibility and consistency of care, but can cause issues with building a connection with their therapist due to technological glitches and being in separate physical locations. For some, virtual therapy is the ideal way to attend therapy, for others it’s a temporary or as-needed format, and there are those who find it prohibitive of progress. All of these experiences are valid, and ideally a conversation to be held collaboratively with one’s therapist when deciding to begin or continue sessions with them in-person or virtually.
Along with health safety considerations, such as mask and social distancing guidelines and COVID-19 vaccination status, below are some additional considerations to include when making a decision:
Consider how you will implement before and after therapy rituals.
Will you have time before and after your session (even just 5-10 minutes) to shift your focus from whatever you were doing prior to therapy or from therapy to the tasks you will need to focus on afterwards?
Much like a walk to your car or the bus after an in-person session, virtual sessions benefit from a brief pause before and after.
Are there certain activities that you have found or might find useful to make time for before or after sessions?
Examples of this are journaling, taking a walk, having a bite to eat or drink of water, etc.
If needed, are there ways you can advocate at work for a specific time of the day to schedule your session?
For those who use shared or team scheduling applications at work, make sure to block-off your session time so that others cannot double book your schedule. It's also worth considering adding in a few minute buffer that will help you make the transition in and out of therapy. Therapy is different from work meetings and requires particular intention on how you want to be present for that time.
If you schedule a session during your lunch break, will you still have time in the day to nourish your body?
Consider choosing another time of the day, such as the time before or after taking your lunch or the start or end of your work day, and adjusting your work hours as needed. You and your therapist may be comfortable with a small snack, but large meals can interfere with communication.
Consider where the therapy will occur.
Are you able to find a spot that is non-work related to minimize distractions?
If you’re at an office space, consider scheduling available conference rooms or (safety and weather permitting) attending from your car.
Will this location be consistent each week?
Will this spot offer adequate internet or phone connection?
Consider how to prepare for the sessions.
Have you identified how to turn-off notifications on your phone or computer?
Similar to being in the therapy room, phones ringing and text dinging can disengage you from your thought or emotional process.
If you’re at home or at your office, are there ways to remove distractions around you that might interfere with the content you want to focus on in the session?
Are there things you might need to prepare for the session, such as a particular journal, art supplies, pillow, or glass of water?
If privacy is an issue, are you comfortable using the chat feature on the video software to communicate sensitive information to your therapist?
If the client is younger or needs support with technology, is there someone available to assist them before, during, and after the session?
Considerations for couple and family sessions.
Are you able to arrange the room so that everyone can view each other?
Don't worry too much about looking at the computer (and your therapist) throughout your session, what’s most important is connecting with those in the room with you. This means you can arrange your chairs with each other versus the computer in mind. Just make sure your therapist can see and hear everyone in the room.
Are you open to considering a hybrid option for therapy, such as some sessions in-person and some sessions virtual?
Some research (for example by Erbe, Eichert, Riper, Ebert, 2017 and Wentzel, van der Vaart, Bohlmeijer, & van Gemert-Pijnen, 2016) points to this hybrid model improving the efficacy of therapy.
Conversations about the experience of virtual therapy are ongoing, even after you decide you can change your mind. What is the structure that you and your therapist can agree on for continuing to check-in on how the chosen format is working?
An example would be at the end of each month starting the session by discussing how the virtual, in-person, or hybrid therapy experience has helped or inhibited progress in your goals and relationship building with your therapist.
For more clarification on the myths versus facts of telehealth see the resource located here. Please note that the state location of both the client and therapist must be considered. Your therapist must be licensed in the state you permanently reside. If you are temporarily visiting another state while meeting with your therapist virtually, be sure you review their current telehealth laws (here is one resource to find that information). Clients cannot be required to meet with therapists virtually, however your current or intended therapist may not be offering in-person sessions at this time and a referral would be necessary. Verify coverage and benefits with your specific insurance plan before beginning telehealth treatment with your therapist.
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