TITLE 18. PROFESSIONAL AND OCCUPATIONAL LICENSING

BOARD OF SOCIAL WORK

Proposed Regulation

Title of Regulation: 18VAC140-30. Regulations Governing the Practice of Music Therapy (adding 18VAC140-30-10 through 18VAC140-30-110).

Statutory Authority: §§ 54.1-2400 and 54.1-3709.2 of the Code of Virginia.

Public Hearing Information:

December 20, 2024 - 10:05 a.m. - Department of Health Professions, 9960 Mayland Drive, Board Room 3, Second Floor Conference Center, Henrico, VA 23233.

Public Comment Deadline: February 14, 2025.

Agency Contact: Jaime Hoyle, Executive Director, Board of Social Work, 9960 Mayland Drive, Suite 300, Henrico, VA 23233, telephone (804) 367-4441, FAX (804) 977-9915, or email jaime.hoyle@dhp.virginia.gov.

Basis: The Board of Social Work promulgates regulations under the general authority of § 54.1-2400 of the Code of Virginia, which authorizes the board to promulgate regulations to administer the regulatory system. Section 54.1-3709.2 of the Code of Virginia provides the board the authority to adopt regulations governing the practice of music therapy, upon consultation with the Advisory Board on Music Therapy.

Purpose: The regulation establishes qualifications for education, examination, and experience that will ensure minimal competency for issuance or renewal of licensure as music therapists to protect the health and safety of clients or patients who receive music therapy services. The proposed amendments ensure there are standards for confidentiality, patient records, dual relationships, and informed consent to protect public health and safety.

Substance: The proposed amendments are similar to other licensed professions in regard to fee structure, renewal or reinstatement, continuing competency, supervision of persons in training, and standards of practice. The proposed amendments (i) set forth the educational, clinical training, and examination requirements for licensure to practice music therapy; (ii) provide for appropriate application and renewal fees; and (iii) include requirements for licensure renewal and continuing education.

Issues: The primary advantage to the public is that the proposed amendments ensure competency and accountability by having persons who use the title of music therapist licensed by the board. Additionally, as a licensed mental health professional, a music therapist may be reimbursed by third-party payors for services provided. Other licensed mental health practitioners who are trained in the therapeutic use of music may use the modality, provided they do not call themselves music therapists or claim to be practicing music therapy. There are no disadvantages to the public. There are no advantages or disadvantages to the Commonwealth.

Department of Planning and Budget Economic Impact Analysis:

The Department of Planning and Budget (DPB) has analyzed the economic impact of this proposed regulation in accordance with § 2.2-4007.04 of the Code of Virginia and Executive Order 19. The analysis presented represents DPB's best estimate of the potential economic impacts as of the date of this analysis.¹

As required by Chapters 103 and 233 of the 2020 Acts of Assembly,² which are identical, the Board of Social Work (board) proposes to promulgate a new regulation governing the practice of music therapy.

Background. Chapter 680 of the 2019 Acts of Assembly³ directed the Board of Health Professions to "evaluate whether music therapists and the practice of music therapy should be regulated and the degree of regulation to be imposed," and further required that the evaluation be submitted to the relevant General Assembly committees by November 1, 2019. The Board of Health Professions assembled a regulatory research committee that conducted the study titled "Study into the Need to Regulate Music Therapists in the Commonwealth of Virginia."⁴ The major findings of the study are:

1. Music therapy is the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.

2. Not all music in a health care setting is music therapy. Clinical music therapy is the only professional, research-based discipline that actively supplies supportive science to the creative, emotional, and energizing experiences of music for treatment and educational goals.

3. Music therapists work with vulnerable populations, individuals with intellectual or emotional disabilities, or persons coping with physical, mental, or terminal health diagnoses. Potential for harm exists when nonqualified individuals provide inappropriate applications of music therapy interventions that could cause emotional harm.

4. Music therapists practice autonomously as well as under supervision.

5. Music therapists are bachelor's degree level trained and must sit for a national board certification exam to obtain the Music Therapist-Board Certified (MT-BC) credential, which is necessary for professional practice.

6. Five states license music therapists, one state provides title certification, and two states require registration.

7. There are approximately 227 music therapists who hold the MT-BC credential in Virginia.

8. There is a need for music therapists in Virginia.

Subsequently, Chapters 103 and 233 of the 2020 Acts of Assembly were enacted and became the legislative mandate for this action. Chapters 103 and 233 also established an advisory board on Music Therapy (advisory board) to assist the board in formulating regulations related to the practice of music therapy. The board now proposes to establish the requirements for licensure as a music therapist, continuing education requirements, standards of practice, disciplinary actions for violations of the standards of practice, and a fee structure to cover the program's operating expenses at the Department of Health Professions (DHP).

Estimated Benefits and Costs. Music therapy was practiced in Virginia before the legislative mandate became effective. However, the legislation created title protection for "music therapists" and prohibits a person from engaging "in the practice of music therapy unless he is licensed by the board." The legislation and the regulation would affect individuals who previously practiced music therapy differently depending on the credentials they possess and whether they qualify for one of the exceptions in the legislation. Generally speaking, music therapy specific jobs would not be as abundant or pay as well without a required license. Thus, individuals who would meet the proposed standards, because they already possess a certification and education in music therapy, are the ones that stand to gain the most from the proposed regulation as they would likely have an easier time finding jobs in Virginia; they may also be able to increase their compensation due to the new license. A second group that would appear to be affected consists of those who were already practicing music therapy and would be able to continue practicing based on the exceptions in the legislation. These exceptions include (i) the practice of music therapy by a student pursuing a course of study in music therapy if such practice constitutes part of the student's course of study and is adequately supervised or (ii) a licensed health care provider, other professional registered, certified, or licensed in the Commonwealth, or any person whose training and national certification attests to his preparation and ability to practice his certified profession or occupation from engaging in the full scope of his practice, including the use of music incidental to his practice, provided that he does not represent himself as a music therapist. The impact on such individuals appears to be limited to the impact of not being able to use the title of "music therapist." If they wish to use the title of "music therapist," they would have to obtain the new license. The last group consists of those individuals who lack the credentials for a Virginia music therapy license and who do not fall under the listed exceptions. These individuals would have to not only cease any practice of music therapy, but also cease using the title "music therapist." If they wish, they can obtain a music therapy license by fulfilling the proposed credentials. The cost of meeting the proposed standards for these individuals would likely be proportional to the extent of education and experience they would need to qualify for a Virginia license. The legislation mandated that "the board shall consider requirements for board certification offered by the Certification Board for Music Therapists or any successor organization." While not mandated to do so, the advisory board concurred that the credential cited in the legislation is the best measure of minimal competency for the profession because it requires a national board certification examination. The advisory board also concurred that graduation from a music therapy program accredited by the American Music Therapy Association (AMTA) should be a requirement for licensure because it includes 1,200 hours of clinical training, including a supervised internship. Consequently, the proposed regulation would require Music Therapist-Board Certification (MT-BC), a credential issued by the Certification Board for Music Therapists (CBMT) after completing the academic and clinical training requirements of the AMTA and passing a national examination.

The proposal heavily relies on the MT-BC credential from CBMT and on the academic and clinical training requirements of the AMTA. CBMT and AMTA are independent entities and as such are free to establish or modify from time to time their own standards for their own credentials and their fees for exams, periodic renewals, or registration. This would produce some risk for the Commonwealth as decisions made by these independent entities would effectively become Virginia administrative law without any oversight or approval from the Commonwealth. The proposed regulation also requires a minimum of 20 hours of continuing education for each annual licensure renewal. Similarly, maintaining the CBMT credential also requires 100 hours of continuing education over its five-year renewal cycle independently from this regulation.⁵ The regulation recognizes continuing education credits earned for maintaining CBMT credentials. Thus, continuing education required by this regulation and CBMT are allowed to overlap. In addition to costs associated with education, experience, and continuing competency, the licensure applicants would be required to pay fees to DHP. These fees would be used to pay administrative costs associated with the proposed program. The administrative costs would include staff time for application processing, issuance of licenses, disciplinary hearings and actions, postal costs, office supplies, etc. The proposed fee structure is as follows: initial application processing and licensure as a music therapist ($100); active annual license renewal ($55); inactive annual license renewal ($30); late renewal ($20); duplicate license ($15); verification of licensure to another jurisdiction ($25); reinstatement of a lapsed license ($120); replacement of or additional wall certificate ($25); returned check or dishonored credit card or debit card ($50); reinstatement following revocation or suspension ($500). DHP estimates that the number of persons seeking licensure in this program would initially be fewer than 300, which would translate to less than $16,500 in total collected from annual renewal fees. To the extent that educational institutions respond to the new license, this regulation may encourage educational institutions to start new degree programs or increase the number of courses offered specific to music therapy. The study notes that there are two universities in Virginia, Radford University and Shenandoah University, that offer bachelor's level and master's level music therapy training. Both are accredited and approved by the AMTA. At one end of the spectrum, for someone who is just starting and who has no background in music therapy, the proposed education and experience requirements for a license in music therapy would undoubtedly impose significant compliance costs. At the other end of the spectrum, there may be individuals who meet all the proposed requirements and who only need to apply and pay the associated fees. Regardless of the magnitude of compliance costs, the individual choosing to obtain a license in music therapy thereby indicates that the expected benefits exceed the expected costs. The "Study into the Need to Regulate Music Therapists in the Commonwealth of Virginia" includes the statement that "Music therapists do not utilize dangerous equipment while performing within their practice guidelines. They do, however, work with vulnerable populations, individuals with intellectual or emotional disabilities, and persons coping with physical, mental or terminal health diagnosis. The potential for harm exists if a nonqualified individual provides inappropriate applications of music therapy interventions that could cause emotional harm." It is notable that the study asserts the potential for emotional harm, but it does not provide any additional information on how these harms may occur. Also notable is the absence of any assertion that physical harm may occur, perhaps because music therapists do not utilize dangerous equipment. The lack of evidence of harm to patients in this case is unusual compared to most other regulations from health boards, but as noted, the regulation of music therapy results from the legislative mandate.

Businesses and Other Entities Affected. The legislation and this regulation affect individuals who would be practicing music therapy in the future and those who were practicing music therapy prior to 2020. According to DHP, when the Board of Health Professions conducted its study of the need for licensure of music therapists, the CBMT reported 227 professional members located in Virginia. DHP estimates that the number of persons seeking licensure will initially be fewer than 300. The number of those who were practicing music therapy prior to 2020 and who would not seek licensure is unknown.

The Code of Virginia requires DPB to assess whether an adverse impact may result from the proposed regulation.⁶ An adverse impact is indicated if there is any increase in net cost or reduction in net revenue for any entity, even if the benefits exceed the costs for all entities combined. As discussed, individuals who were practicing music therapy prior to 2020 would have to cease their practice unless they obtain a license or fall under one of the exceptions. For some individuals, particularly for those who have relatively lower costs in obtaining licensure, the costs may be outweighed by the increased possibility that their services would be reimbursed by health insurance. For others, particularly those who have relatively higher costs in obtaining licensure, the costs would likely outweigh the benefits. Because there is the potential for an increase in net cost or reduction in net revenue for some entities an adverse impact is indicated.

Small Businesses⁷ Affected.⁸ No data are available to determine if any of the individuals who were practicing music therapy prior to 2020 were associated with a small business.

Localities⁹ Affected¹⁰. The proposed regulation neither disproportionately affects particular localities nor introduces costs for local governments.

Projected Impact on Employment. The proposed licensure of music therapists may allow those who meet the licensure criteria to secure better jobs. However, some individuals who had been practicing music therapy without a license may not be able to maintain their employment in that capacity. Thus, the net impact on employment is uncertain.

Effects on the Use and Value of Private Property. The proposed regulation does not appear to directly affect the use and value of private property or real estate development costs.

_____________________________

¹ Section 2.2-4007.04 of the Code of Virginia requires that such economic impact analyses determine the public benefits and costs of the proposed amendments. Further the analysis should include but not be limited to: (1) the projected number of businesses or other entities to whom the proposed regulatory action would apply, (2) the identity of any localities and types of businesses or other entities particularly affected, (3) the projected number of persons and employment positions to be affected, (4) the projected costs to affected businesses or entities to implement or comply with the regulation, and (5) the impact on the use and value of private property.

² https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+CHAP0103. https://lis.virginia.gov/cgi-bin/legp604.exe?201+ful+CHAP0233.

³ https://lis.virginia.gov/cgi-bin/legp604.exe?191+ful+CHAP0680.

⁴ https://www.dhp.virginia.gov/media/dhpweb/docs/studies/Music_Therapy.pdf.

⁵ https://www.cbmt.org/certificants/recertification/.

⁶ Pursuant to § 2.2-4007.04 D: In the event this economic impact analysis reveals that the proposed regulation would have an adverse economic impact on businesses or would impose a significant adverse economic impact on a locality, business, or entity particularly affected, the Department of Planning and Budget shall advise the Joint Commission on Administrative Rules, the House Committee on Appropriations, and the Senate Committee on Finance. Statute does not define "adverse impact," state whether only Virginia entities should be considered, nor indicate whether an adverse impact results from regulatory requirements mandated by legislation.

⁷ Pursuant to § 2.2-4007.04 of the Code of Virginia, small business is defined as "a business entity, including its affiliates, that (i) is independently owned and operated and (ii) employs fewer than 500 full-time employees or has gross annual sales of less than $6 million."

⁸ If the proposed regulatory action may have an adverse effect on small businesses, § 2.2-4007.04 requires that such economic impact analyses include: (1) an identification and estimate of the number of small businesses subject to the proposed regulation, (2) the projected reporting, recordkeeping, and other administrative costs required for small businesses to comply with the proposed regulation, including the type of professional skills necessary for preparing required reports and other documents, (3) a statement of the probable effect of the proposed regulation on affected small businesses, and (4) a description of any less intrusive or less costly alternative methods of achieving the purpose of the proposed regulation. Additionally, pursuant to § 2.2-4007.1 of the Code of Virginia, if there is a finding that a proposed regulation may have an adverse impact on small business, the Joint Commission on Administrative Rules shall be notified.

⁹ "Locality" can refer to either local governments or the locations in the Commonwealth where the activities relevant to the regulatory change are most likely to occur.

¹⁰ Section 2.2-4007.04 defines "particularly affected" as bearing disproportionate material impact.

Agency Response to Economic Impact Analysis: The Board of Social Work concurs with the economic impact analysis prepared by the Department of Planning and Budget.

Summary:

The proposed action establishes regulations governing the practice of music pursuant to Chapters 103 and 233 of the 2020 Acts of Assembly, which require the board to adopt regulations establishing a regulatory structure to license music therapists in the Commonwealth and establish an advisory board to assist the board in this process. The proposed regulations provide for (i) licensure requirements, (ii) a fee structure, (iii) renewal or reinstatement of a license, (iv) continuing competency, (v) supervision of persons in training, and (vi) standards of practice.

Chapter 30

Regulations Governing the Practice of Music Therapy

18VAC140-30-10. Definitions.

A. The following words and terms when used in this chapter shall have the meaning ascribed to them in §§ 54.1-3700 and 54.1-3709.1 of the Code of Virginia:

"Board"

"Music therapist"

"Music therapy"

B. The following words and terms when used in this chapter shall have the following meanings, unless the context clearly indicates otherwise:

"Applicant" means any individual who has submitted an official application and paid the application fee for licensure as a music therapist.

"CBMT" means the Certification Board for Music Therapists.

"MT-BC" means a Music Therapist-Board Certified, a credential issued by the CBMT after completing the academic and clinical training requirements of the American Music Therapy Association and passing a national examination.

18VAC140-30-20. Fees required by the board.

A. The board has established the following fees applicable to licensure as a music therapist:

Initial licensure: Application processing and initial licensure	$100
Active annual license renewal	$55
Inactive annual license renewal	$30
Late renewal	$20
Duplicate license	$15
Verification of licensure to another jurisdiction	$25
Reinstatement of a lapsed license	$120
Replacement of or additional wall certificate	$25
Returned check or dishonored credit card or debit card	$50
Reinstatement following revocation or suspension	$500

B. All fees are nonrefundable.

18VAC140-30-30. Prerequisites for licensure as a music therapist.

A. Every applicant for licensure shall submit to the board:

1. A completed application;

2. The application processing fee and initial licensure fee as prescribed in 18VAC140-30-20;

3. Verification of any other mental health or health professional license, registration, or certificate ever held in Virginia or another jurisdiction; and

4. A current report from the U.S. Department of Health and Human Services National Practitioner Data Bank.

B. An applicant shall have no unresolved disciplinary action against a mental health or health professional license, certificate, or registration held in Virginia or in another United States jurisdiction. The board will consider history of disciplinary action on a case-by-case basis.

18VAC140-30-40. Requirements for licensure.

In addition to prerequisites as set forth in 18VAC140-30-30, every applicant for licensure shall submit to the board:

1. Evidence of the current certification as an MT-BC granted by the CBMT or its successor organization, as approved by the board; and

2. An attestation of having read and understood the regulations and laws governing the practice of music therapy in Virginia.

18VAC140-30-50. Annual renewal of licensure.

A. Every licensed music therapist who intends to continue active practice shall submit to the board on or before June 30 of each year:

1. A completed form for renewal of the license on which the licensee attests to compliance with the continuing education requirements prescribed in this chapter; and

2. The renewal fee prescribed in 18VAC140-30-20.

B. A licensed music therapist who wishes to place a license in an inactive status may do so upon payment of the inactive renewal fee as established in 18VAC140-30-20. No person shall practice music therapy in Virginia unless the person holds a current active license. A licensee who has selected an inactive status may become active by fulfilling the reactivation requirements set forth in subsection C of 18VAC140-30-80.

C. Licensees shall notify the board of a change in the address of record or the public address if different from the address of record within 60 days. Failure to receive a renewal notice from the board shall not relieve the license holder from the renewal requirement.

D. Practicing with an expired license is prohibited and may constitute grounds for disciplinary action.

18VAC140-30-60. Continuing education requirements for renewal of a license.

A. For annual licensure renewal, a music therapist shall either hold a current credential as an MT-BC or be required to have completed a minimum of 20 hours of continuing education within the past 12 months. A minimum of three of these hours every five years shall be in courses that emphasize the ethics, standards of practice, or laws governing behavioral science professions in Virginia.

B. Hours of continuing education activity for a music therapist shall be approved if the hours meet the continued education requirements for recertification as an MT-BC.

C. The board may grant an extension for good cause of up to one year for the completion of continuing education requirements upon written request from the licensee prior to the renewal date. Such extension shall not relieve the licensee of the continuing education requirement.

D. The board may grant an exemption for all or part of the continuing education requirements due to circumstances beyond the control of the licensee, such as temporary disability, mandatory military service, or officially declared disasters.

E. A music therapist who holds another license, certification, or registration issued by a Virginia health regulatory board may use up to 10 continuing education hours earned to satisfy the renewal requirements of that profession to satisfy the 20 total continuing education hours required to renew a music therapy license.

F. Up to two hours of the 20 hours required for annual renewal may be satisfied through delivery of music therapy services, without compensation, to low-income individuals receiving health services through a local health department or a free clinic organized in whole or primarily for the delivery of those services. One hour of continuing education may be credited for three hours of providing such volunteer services, as documented by the health department or free clinic.

G. A licensed music therapist is exempt from meeting continuing education requirements for the first renewal following initial licensure in Virginia.

18VAC140-30-70. Documenting compliance with continuing education requirements.

A. All licensees are required to maintain original documentation for a period of two years following renewal.

B. After the end of each renewal period, the board may conduct a random audit of licensees to verify compliance with the requirement for that renewal period.

C. Upon request, a licensee shall provide documentation as follows:

1. Official transcripts showing credit hours earned; or

2. Certificates of participation.

D. Continuing education hours required by a disciplinary order shall not be used to satisfy renewal requirements.

18VAC140-30-80. Late renewal; reactivation or reinstatement.

A. A person whose license has expired may renew the license within one year after its expiration date by paying the late fee prescribed in 18VAC140-30-20 as well as the license renewal fee prescribed for the year the license was not renewed and providing evidence of having met all applicable continuing education requirements.

B. A person who fails to renew a license after one year or more and wishes to resume practice shall apply for reinstatement, pay the reinstatement fee for a lapsed license, submit verification of any mental health or health professional license the person holds or has held in another jurisdiction, if applicable, and provide evidence of having met all applicable continuing education requirements to satisfy the hours necessary for the number of years the license has been lapsed, not to exceed a maximum of 80 hours, or evidence of current certification as an MT-BC. The board may require the applicant for reinstatement to submit evidence regarding the continued ability to perform the functions within the scope of practice of the license.

C. A person wishing to reactivate an inactive license shall submit (i) the renewal fee for active licensure minus any fee already paid for inactive licensure renewal; (ii) documentation of continued education hours to satisfy the hours necessary for the number of years the license has been inactive, not to exceed a maximum of 80 hours, or evidence of current certification as an MT-BC; and (iii) verification of any mental health or health professional license the person holds or has held in another jurisdiction, if applicable. The board may require the applicant for reactivation to submit evidence regarding the continued ability to perform the functions within the scope of practice of the license.

18VAC140-30-90. Standards of practice.

A. The protection of the public health, safety, and welfare and the best interest of the public shall be the primary guide in determining the appropriate professional conduct of all persons whose activities are regulated by the board. Regardless of the delivery method, whether in person, by telephone or electronically, these standards shall apply to the practice of music therapy.

B. Each person licensed as music therapists shall:

1. Be able to justify all services rendered to or on behalf of clients as necessary for therapeutic purposes.

2. Provide for continuation of care when services must be interrupted or terminated.

3. Practice only within the competency areas for which the licensee is qualified by education and experience.

4. Report to the board known or suspected violations of the laws and regulations governing the practice of music therapy.

5. Neither accept nor give commissions, rebates, or other forms of remuneration for referral of clients for professional services.

6. Ensure that clients are aware of fees and billing arrangements before rendering services.

7. Inform clients of potential risks and benefits of services and the limitations on confidentiality and ensure that clients have provided informed written consent to treatment.

8. Keep confidential therapeutic relationships with clients and disclose client records to others only with written consent of the client, with the following exceptions: (i) when the client is a danger to self or others; or (ii) as required by law.

9. When advertising services to the public, ensure that such advertising is neither fraudulent nor misleading.

10. As treatment requires and with the written consent of the client, collaborate with other health or mental health providers concurrently providing services to the client.

11. Refrain from undertaking any activity in which a licensee's personal problems are likely to lead to inadequate or harmful services.

12. Recognize conflicts of interest and inform all parties of the nature and directions of loyalties and responsibilities involved.

13. Not engage in conversion therapy with any person younger than 18 years of age.

C. In regard to client records, music therapists shall comply with provisions of § 32.1-127.1:03 of the Code of Virginia on health records privacy and shall:

1. Maintain written or electronic clinical records for each client to include identifying information and assessment that substantiates treatment plans. Each record shall include a treatment plan, progress notes for each case activity, information received from all collaborative contacts and the treatment implications of that information, and the termination process and summary.

2. Maintain client records securely, inform all employees of the requirements of confidentiality, and provide for the destruction of records that are no longer useful in a manner that ensures client confidentiality.

3. Disclose or release records to others only with clients' expressed written consent or that of the client's legally authorized representative or as mandated or permitted by law.

4. Ensure confidentiality in the usage of client records and clinical materials by obtaining written consent from a client or a client's legally authorized representative before (i) video-recording, (ii) audio recording, (iii) permitting third-party observation, or (iv) using identifiable client records and clinical materials in teaching, writing or public presentations.

5. For a music therapist practicing in an institution or school setting, follow the recordkeeping policies of the institution or school. For a music therapist practicing in a noninstitutional setting, maintain records for a minimum of six years or as otherwise required by law from the date of termination of the therapeutic relationship with the following exceptions:

a. At minimum, records of a minor child shall be maintained for six years after attaining the age of majority or 10 years following termination, whichever comes later.

b. Records that are required by contractual obligation or federal law to be maintained for a longer period of time.

c. Records that have been transferred to another mental health professional or have been given to the client or his legally authorized representative.

D. In regard to dual relationships, music therapists shall:

1. Not engage in a dual relationship with a client or a supervisee that could impair professional judgment or increase the risk of exploitation or harm to the client or supervisee. (Examples of such a relationship include familial, social, financial, business, bartering, or a close personal relationship with a client or supervisee.) Music therapists shall take appropriate professional precautions when a dual relationship cannot be avoided, such as informed consent, consultation, supervision, and documentation to ensure that judgment is not impaired and no exploitation occurs.

2. Not have any type of romantic relationship or sexual intimacies with a client or those included in collateral therapeutic services, and not provide services to those persons with whom they have had a romantic or sexual relationship. Music therapists shall not engage in romantic relationship or sexual intimacies with a former client within a minimum of five years after terminating the professional relationship. Music therapists who engage in such a relationship after five years following termination shall have the responsibility to examine and document thoroughly that such a relationship did not have an exploitative nature, based on factors such as duration of therapy, amount of time since therapy, termination circumstances, client's personal history and mental status, or an adverse impact on the client. A client's consent to, initiation of, or participation in sexual behavior or involvement with a music therapist neither changes the nature of the conduct nor lifts the regulatory prohibition.

3. Not engage in any romantic or sexual relationship or establish a therapeutic relationship with a current supervisee or student. Music therapists shall avoid any nonsexual dual relationship with a supervisee or student in which there is a risk of exploitation or potential harm to the supervisee or student, or the potential for interference with the supervisor's professional judgment.

4. Not engage in a personal relationship with a former client in which there is a risk of exploitation or potential harm or if the former client continues to relate to the music therapist in the music therapist's professional capacity.

E. Upon learning of evidence that indicates a reasonable probability that another mental health provider is or may be guilty of a violation of standards of conduct as defined in statute or regulation, a person licensed by the board shall advise the licensee's clients of the licensee's right to report such misconduct to the Department of Health Professions in accordance with § 54.1-2400.4 of the Code of Virginia.

18VAC140-30-100. Grounds for disciplinary action or denial of issuance of a license.

The board may refuse to issue a license to an applicant or reprimand, impose a monetary penalty, place on probation, impose such terms as the board may designate, suspend for a stated period of time or indefinitely, or revoke a license for one or more of the following grounds:

1. Conviction of a felony or of a misdemeanor involving moral turpitude;

2. Procuring, attempting to procure, or maintaining a license by fraud or misrepresentation;

3. Conducting a practice in such a manner so as to make the practice a danger to the health and welfare of the person's clients or to the public. In the event a question arises concerning the continued competence of a licensee, the board will consider evidence of continuing education.

4. Being unable to practice music therapy with reasonable skill and safety to clients by reason of illness; excessive use of alcohol, drugs, narcotics, chemicals, or any other type of material; or as a result of any mental or physical condition;

5. Conducting a practice in a manner contrary to the standards of ethics of music therapy or in violation of 18VAC140-30-90;

6. Performing functions outside the board-licensed area of competency;

7. Failure to comply with the continued education requirements set forth in 18VAC140-30-60 or maintaining documentation as set forth in 18VAC140-30-70; or

8. Violating or aiding and abetting another to violate any statute applicable to the practice of music therapy or any provision of this chapter.

18VAC140-30-110. Reinstatement following disciplinary action.

Any person whose license has been suspended, revoked, or denied renewal by the board under the provisions of 18VAC140-30-100 shall, in order to be eligible for reinstatement, (i) submit a new application to the board for a license, (ii) pay the appropriate reinstatement fee, and (iii) submit any other credentials as prescribed by the board. After a hearing, the board may, at the board's discretion, grant the reinstatement.