An Arizona mental health provider is warning that new supervision requirements announced by insurance giant Blue Cross Blue Shield of Arizona could cut access to counseling services for insured patients, particularly in rural communities like Maricopa where providers are already in short supply.

Brianna Reinhold, a licensed professional counselor and founder of Northern Lights Therapy, said the insurer recently communicated policy changes affecting associate-level clinicians, including Licensed Associate Counselors and Licensed Master Social Workers.

The changes, set to take effect on Jan. 1, impose supervision rules that Reinhold says could disrupt care for thousands of patients statewide.

Under the new requirements, associate clinicians would only be permitted to provide services if their supervising clinician is physically present in the same building during sessions, even when appointments are conducted virtually, Reinhold said. Supervisors would also be required to be immediately available during those sessions, preventing them from seeing their own clients at the same time. In addition, she said supervisors must personally complete a client’s initial assessment before an associate clinician can assume care.

Reinhold said the policy would affect five associate clinicians at her practice because she is unable to be physically present during all office hours. Once the new rules take effect, she said, patient schedules and continuity of care would be disrupted almost immediately.

Blue Cross Blue Shield is also accused by a nearby clinic of cutting off access to OB/GYN in Maricopa through poor reimbursement.

Reinhold said the policies do not explicitly ban evening or weekend appointments, but make them dependent on a supervisor’s physical presence during those hours, effectively limiting availability based on staffing logistics rather than patient need.

“When supervision availability is limited, access to care is limited,” Reinhold said.

Northern Lights Therapy operates multiple locations in Chandler, Maricopa and Casa Grande and serves a large number of clients across rural Pinal County. Reinhold said the practice is one of the few private providers in Maricopa that accepts private insurance and offers ongoing mental health care.

A significant portion of the practice’s workforce consists of associate-level clinicians, who practice under supervision while working toward independent licensure. It is a process that typically takes several years. Reinhold said many of those clinicians live in the communities they serve and provide the bulk of day-to-day care.

She said the new insurer requirements conflict with standards set by the Arizona Board of Behavioral Health Examiners, which allows licensed associates to own and operate supervised private practices. By contrast, she said, the insurer’s policy would prevent associates from seeing clients independently within the same building, even when state regulations permit it.

Reinhold also raised concerns about the lack of a transition period, saying practices were given little time to restructure staffing and supervision models before the changes take effect.

“Providers are being forced to choose between immediately altering care or continuing under unclear guidance,” she said. “That creates a real risk of disruption or client abandonment.”

The changes come amid a broader mental health workforce shortage in Arizona and nationwide, with providers reporting increased demand, staffing challenges and low reimbursement rates. Reinhold said additional administrative barriers could further reduce capacity, particularly in rural areas.

As a single mother and business owner overseeing more than 20 clinicians across multiple sites, Reinhold said the requirement for constant on-site supervisory presence is unsustainable and removes the flexibility that allows practices to offer care outside traditional business hours.

“These decisions are being driven by supervision logistics rather than clinical necessity or community need,” she said.

Reinhold questions why insurer policies impose requirements that exceed state licensure rules and how those changes improve access to care for insured members.

Reinhold plans to lobby state lawmakers to protect mental health services. She posted a template on her Facebook for patients to use.