Supervised Private Practice

MUST BE APPROVED.
Practice may not commence until receiving board approval.
 
Pursuant to A.A.C. R4-6-211a master’s level, non-independent licensee may provide behavioral health services in a practice that they own or manage under Board-approved clinical supervision. 
 
REQUIREMENTS
 
CLINICAL SUPERVISION:
The Board-approved clinical supervisor is responsible to provide direct, clinical supervision AND monitor the practice as a whole.
 
This requires:
  • Thorough and regular reviews of client records and practice documents, such as billing records.
  • Supervisee and supervisor:
    • Must meet individually for 1 hour for every 20 hours of direct client contact.
    • Must meet onsite every 60 days. There are no exemptions, and the meeting must be physically in-person at the practice location, even if the practice is a home-based telehealth practice.
NOTE: Only one supervisor shall be approved for each practice at any given time. The supervisor and supervisee must not be family members.
 
Supervision Agreement:
A copy of the supervision agreement must be provided to the Board pursuant to A.A.C. R4-6-211(B)(2).  see Sample supervision agreement
 
NOTE: the template is provided as a sample only and contains the information required in Board rule, however additional stipulations may be included as the parties deem appropriate.
 
Upon approval, due to the Board every six months, no later than 2 weeks after due date.
NOTE: After two non-compliant reports, the supervisor and supervisee will be brought before the Board for possible disciplinary action that may also include revoking the ability to participate in supervised private practice.
 
Termination of Supervision:
  • Must provide 30-day notice prior to either party terminating the agreement.
  • Must provide notice to the Board within 10 days of the termination date.
  • Must cease practicing within 60 days of the termination date until such time as a subsequent agreement is provided to the board and approved.
  • Must submit a final report.
NOTE: To request a change in supervisor, complete the application process (see below).   
 
SUPERVISOR:
  • Must be independently licensed for a minimum of 2 years.
  • Must be independently licensed in the same discipline of the supervisee.
  • Must be in compliance with supervisor educational requirements pursuant to A.A.C. R4-6-214.
  • Must be physically located in Arizona while providing supervision.
  • Must not be prohibited from providing clinical supervision by a Board consent agreement and will provide notice to supervisee should prohibited in the future.
NOTE: Clinical supervisors shall not be approved for more than five supervised practices at any given time.
 
SUPERVISEE/OWNER:
  • Must be the sole owner.
  • Must be physically located in Arizona while providing services.
  • Must not hire others to work in practice.
  • Must not be a temporary licensee who has been approved to test, but hasn’t taken and passed the exam, pursuant to A.A.C. R4-6-306(F).
NOTE: If the supervisee seeks to use the supervised work experience and clinical supervision hours toward independent licensure in the future, the supervision must meet the clinical supervision requirements in A.A.C. R4-6-212, in addition to the requirements in A.A.C. R4-6-211.  At the time supervisee applies for independent licensure, verification of work experience and clinical supervision forms must be completed and submitted that are different from the reports submitted regularly for Supervised Private Practice. 
 
PRACTICE:
  • Must be located in Arizona.
  • All advertising, marketing, and practice materials must contain the supervised private practice notice below:
This is a supervised private practice. It is owned and/or managed by a master’s level, non-independent licensee under Board-approved clinical supervision pursuant to A.A.C. R4-6-211. The Board-approved clinical supervisor of this practice is:
Name:
Phone Number:
Email: 
 
NOTE: If your supervised private practice has not been approved, all public-facing materials (including website) must clearly indicate that clients are not being accepted until Board approval.
 
APPLICATION PROCESS
Prior to submitting your application, you must review all applicable Supervised Private Practice rules and requirements.
 
Submit the application including:
  • Signed supervision agreement
  • If applicable, evidence that the clinical supervisor is compliant with the educational requirements in A.A.C. R4-6-214. Additional documentation is not required if the supervisor is on the Board’s registry.
Submit the application for approval to:
Both parties will be notified upon approval and notified of due dates for the required reporting. 
 
NOTE: To request a change in supervisor, complete the application process, indicating “change of supervisor’ on the form.