Office Space for Therapy and Behavioral Health Practices

Many therapy and counseling practices do not need the plumbing, equipment and heavy mechanical work behind a typical medical build-out. That widens your choices and can reduce build-out. An ordinary office suite, a converted house or an upper floor in a retail building may work, subject to zoning and the landlord's approval.

Behavioral health is a broad category, though, so start by listing what you actually do. Art or play therapy may want a sink, durable floors and storage. Group therapy needs a larger room and more chairs. Psychiatric practices that administer medication or treatments may have clinical needs closer to a medical office. Testing rooms need quiet for long periods. Substance use programs may bring additional rules on records and consent. Your use list decides which spaces qualify.

A client who can hear the session next door will not feel safe talking. Sound deserves your own testing, because ordinary office walls are not necessarily planned for confidential speech.

The federal rule itself is less strict than many people assume. An HHS FAQ says the HIPAA Privacy Rule requires appropriate safeguards and reasonable efforts to prevent impermissible disclosures, and that the Department does not consider facility restructuring to be a requirement under that standard. The Privacy Rule does not demand that all risk be eliminated. Covered entities assess the risks and consider the effects on care and the burden of each safeguard. So soundproofing is not a federal mandate, but confidentiality is central to your clinical work, and your state licensing board and professional ethics may also matter.

• ✓Do the walls between rooms run all the way to the structural deck, or stop at the ceiling tile?
• ✓Can we test by speaking at normal volume in one room and listening from the next and from the corridor?
• ✓Do doors have solid cores and seals, and is there an undercut carrying sound into the hall?
• ✓Do HVAC ducts connect adjoining rooms, carrying voices through the vents?
• ✓What neighbors share our walls, and do they make noise that would intrude on sessions?
• ✓Can the landlord allow added insulation, sound masking or sealing at our cost or as part of the allowance?

If the suite needs improvement, ask an acoustical consultant or an experienced contractor which fixes matter most. It is usually cheaper to deal with during a build-out than after you move in.

For many clients, the walk from the car to the therapist's door is the most exposed part of the visit. Think through who might see whom. A private entrance, an unmarked suite door and a waiting area out of the corridor's view can all make a difference.

• Waiting area. A smaller or partly screened area can feel more discreet than an open one. Consider seating for family members and children, and how noise carries into session rooms.
• Shared waiting rooms. In a shared suite, ask who else uses the room and what clients may overhear. HHS lists speaking quietly in a waiting room and avoiding patients' names in public hallways as examples of reasonable safeguards.
• A second way out. Some practices like a separate exit so clients do not walk back through the waiting room. It is a preference, and many suites cannot offer it, so check that any such route works for fire exits and for accessibility.
• Signage. Think about what you want on the directory and door, and check what the lease allows.
• Records. Secure storage matters too. HHS gives isolating or locking file cabinets or records rooms as another example of a safeguard.

Accessibility still applies. The professional office of a health care provider is listed as a place of public accommodation under ADA rules, and the regulation's definition covers providers of services related to mental as well as physical health. The landlord and tenant are both subject to these rules, and the lease may divide responsibility. Have a qualified consultant review any older building or converted house.

Most of a therapy lease reads like any small office lease, but a few clauses touch on your work directly. Raise them early, while the landlord is still competing for you.

• Permitted use. Make sure the wording covers all your services, including groups, children, testing and any added clinicians.
• Hours and HVAC. Many clients come in evenings and on weekends. Ask whether heating and cooling run at those hours and what they cost.
• Landlord entry. Real estate attorneys note that privacy rules may call for changing a clause that gives a landlord open access. Ask for notice and for an escort.
• Right to share or sublease. See below.
• Term and exit. A solo practitioner may want a shorter term or a right to end the lease on death or disability, which one law firm author suggests solo owners consider.
• Personal guarantee. Landlords often ask for one. Limits on amount and time can be negotiated.

As that practice found, a price check on the build-out belongs before you commit, even for therapy space. TAG represents tenants, and for therapy and behavioral health practices we compare suites and negotiate these terms on the practice's behalf.

Renting rooms by the day or half-day to other clinicians is common, and it can make a suite affordable. Before you count on that income, check three things.

1. Read the lease. Subleasing and space sharing often need landlord consent, and you should get the right you need in writing before you sign.
2. Think about referrals. If you and the other clinician refer clients to each other, and federal program patients are involved, a room arrangement can raise Anti-Kickback or Stark questions. The space rental safe harbor expects a part-time lease to specify the schedule, length and exact rent for each interval. Ask healthcare counsel whether it applies.
3. Plan for privacy. Decide how records, voicemail, keys and shared computers will be separated, since each clinician has separate confidentiality duties.

Substance use treatment programs should also ask counsel about 42 CFR Part 2, the federal rules limiting use and disclosure of certain program records. Those rules apply to certain federally assisted programs and may affect how sharing works.