Due to the debilitating nature of some mental health-related symptoms, it is not uncommon for clients to request documentation for leave of absence requests, including Family and Medical Leave Act (FMLA) or short-term/long-term disability (STD/LTD) certification. Given this, it is important to be familiar with the evolving legislative landscape that impacts these requests.
By understanding your scope of practice, adhering to state-specific requirements, and following best practices, you can effectively assist clients to navigate the process of applying for disability and/or medical leave. This article will outline scope of practice and compliance considerations to guide a therapist’s involvement in creating documentation for leave of absence requests from clients.
Scope of Practice: Key Considerations
If a client is considering a leave of absence related to their mental health, it is likely an extremely challenging time in their life. They are now faced with the daunting prospect of filing for disability, which will require both advocating for themselves and your support.
Your very first step is to determine whether your client has Kaiser Permanente regional market insurance. If so, proceed to the section below for Responding to FMLA Requests: Kaiser Permanente Regional Markets.
After reviewing your client’s insurance, the next step is to discuss your client’s needs, and be clear about how your scope of practice informs how you can best assist them. In many states (including but not limited to California, Texas, Florida, and New York), mental health therapists’ documentation is not sufficient for a client to be approved for STD/LTD. FMLA certification varies on a state-by-state basis.
In order to ensure a positive and streamlined client experience, Rula strongly recommends all providers consult with their licensing board and malpractice insurance to verify whether they are eligible to complete FMLA, disability, or other leave of absence certifications and explore the risks and benefits (for both patient and provider) of doing so.
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In states where a therapist’s license type is not allowed to complete FMLA or disability certification:
- The client should be referred to a provider whose licensure allows them to complete documentation for both disability and FMLA purposes, such as MDs/DOs and NPs.
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In states where a therapist’s license type is allowed to complete FMLA and/or disability certification:
- Rula providers should use clinical judgment to make decisions regarding paperwork completion on a case-by-case basis.
- This covers best practice in most states, however, there are some state-specific nuances, so we recommend consultation with the state licensure board for the most updated information.
Understanding Leave Types: Intermittent vs. Block Leave
When a client wants to request FMLA leave, you should first determine which type of leave matches their clinical needs. Choosing the correct type ensures that the client receives the right level of support while maintaining compliance with Rula partner requirements.
Intermittent Leave (Occasional or Part-Time)
Intermittent leave is used when a client is mostly able to work but requires separate, non-consecutive blocks of time off for a single qualifying condition.
- Common Clinical Uses: Attending weekly outpatient therapy, 2x/week sessions, or Intensive Outpatient Programs (IOP).
Block Leave (Continuous Leave)
Block leave (also known as continuous leave) is an uninterrupted period of absence, typically defined by partners as any duration greater than two weeks.
- Common Clinical Uses: Stabilization during a severe mental health crisis, recovery from a major depressive episode with significant functional impairment, or transition from an inpatient/residential setting.
Responding to FMLA Requests: Kaiser Permanente Regional Markets
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Rula providers are permitted to complete Intermittent Leave of Absence paperwork for KP members, as long as:
- The request aligns with the client’s clinical need.
- The time off is used to attend mental health treatment.
- The documentation supports the need for an intermittent leave of absence.
- Rula providers are typically not permitted to complete requests for Block/Continuous Leaves of Absence, particularly for durations of greater than 2 weeks.
- These requests must be evaluated by a provider at the client’s local Kaiser Permanente mental health clinic, where a KP physician will determine whether there is a clinical justification for processing disability paperwork.
Responding to FMLA Requests: Non-Kaiser CA Pathways
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Providers that do not complete disability paperwork or FMLA certification due to license restrictions or other reasons should direct patients to one of the following resources:
- Their established psychiatrist (if applicable).
- Their PCP.
- A Rula medication management provider for a mental health evaluation using this form
- Please note that a relationship with Rula’s medication management provider is required before any determination of disability can be made. It often takes multiple visits before enough information is gathered to make an appropriate determination regarding disability status and form completion is not guaranteed.
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Providers that are eligible to complete FMLA paperwork:
- Make a determination on the case based on clinical judgment and guidelines from their licensing board.
- Ensure that your clinical documentation supports a need for FMLA. This may look like a documentation of increased symptoms and impairment, for example.
- Before completing any paperwork on behalf of a client, secure written consent from the client to release information.
Additional Ways to Support a Client’s LOA Request
While therapists may be ineligible to or may choose not to complete disability paperwork or FMLA certification, therapists of any license type are able to contribute to the leave of absence process by providing a Treatment Summary to the client. Clients should be advised that this is not sufficient on its own, but can be used as a tool to advocate for their leave of absence request.
Your role in this process is to provide accurate, concise, and legally compliant documentation based on your professional expertise that discloses the minimum information necessary in order to protect your client’s privacy. Before drafting a formal treatment summary, secure written consent from the client to release information.
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