ESA Accommodation Letter Request Policies and Procedures

Requests for letters confirming the need for emotional support animals (ESA) will be decided on an individual basis and will be determined based on therapeutic history and current state of mind. They will not be provided without a thorough evaluation. 

If Stacy has not been seeing you for therapy for at least three months, she will not consider writing an ESA letter for you. 

What You Need to Know

ESAs and Housing

• Unlike service animals, the only situation in which federal law requires others to allow you to have your ESA with you is for housing. Note that an ESA does not have public access rights. In other words, having an ESA letter does not entitle you to bring your ESA to public places with you. The accommodation letter applies to housing situations only. Note that housing refers to your dwelling. Depending on your state laws, public access for the animal may include common areas within the housing property. However, public access for the ESA does not include common areas outside that property. 

ESAs and Airplane Travel

• ESAs are no longer covered under the ACAA (Air Carrier and Access Act).

ESA Animal Training

• It is beyond the scope of Stacy's practice to assess the animal's training, but it is within her purview as a mental health professional to request documentation of that training when evaluating clients for ESA letters if such training has occurred. Training includes both owner training of the animal and professional training of the animal.  

• Assessment of the animal for suitability as an emotional support animal is a required component of the ESA evaluation and must be conducted by a veterinarian, qualified animal behaviorist, or qualified animal trainer along with documentation from that professional regarding the animal’s fitness as an ESA. Stacy will supply you with a letter to the animal care professional to explain what is needed. The cost of that evaluation is between you and the animal care professional and is independent of the cost of this evaluation.

Time Frame

• The ESA evaluation time is separate from your initial treatment evaluation. An ESA evaluation may take two to four hours of session time, plus the administration of psychological assessments, which may take another two hours. Additional time is needed for collection and review of records (e.g., medical records, school records, public records, work-related records, etc.), along with collateral interviews of persons who may have helpful information about your difficulties with functioning and your ability to care for an animal (i.e. landlord, family members, partners, employers, therapists/counselors, teachers, third parties in the setting in which you and the animal have been or will be living and interacting, etc.). 

• Please anticipate anywhere from one to three weeks for the evaluation to be completed and a letter issued if appropriate.

• Should Stacy provide an ESA letter, there may be time restrictions or other limitations as dictated by your case. Please note that ESA letters are valid for one year. If clinically appropriate, updated ESA letters are provided only for current clients who have attended therapy for a minimum of once a month. In all other cases, a new evaluation will need to be conducted.

The Therapeutic Relationship and ESA Evaluation

• Stacy does not write ESA letters for clients she is seeing for the first time. Your first therapy appointment is the start of treatment and consists of an initial evaluation for therapy. An ESA evaluation is a different kind of evaluation and will include a session specifically for that purpose. If there is no prior therapeutic relationship with you, it is not ethical to provide you with ESA documentation. This is because the ESA accommodation is connected to your diagnosis/diagnoses. It may take longer than one appointment for your diagnosis/diagnoses to be clear. Assessment measures will be required to determine need, and this takes time. 

• Please note that the initiation of an ESA evaluation does not guarantee that you will receive an accommodation letter. The decision to write an ESA accommodation letter will be based on the results of a thorough evaluation, and that evaluation will include information from multiple sources. 

Disability Requirement

• A determination of disability will need to be conducted before an ESA letter can be considered. If you have a prior diagnosis of disability, you may ask your previous clinician to provide you with documentation of your diagnosis and symptoms. It will be necessary to assess the current presence of those symptoms as a component of the ESA evaluation.

• To obtain an ESA accommodation, you must have a mental or emotional disability that matches the disability criteria established by the Americans with Disabilities Act. Having a mental or emotional disability may be different from having a mental health diagnosis. Mental health disorders and disabilities are not necessarily synonymous. 

  • What is a disability?

    • The Americans with Disabilities Act defines a person with a disability as “a person who:

• Has a physical or mental impairment that substantially limits one or more major life activities;

• Has a record of such an impairment; or

• Is regarded as having such an impairment.”

• • What is a major life activity?

    • The Americans with Disabilities Amendments Act of 2008 provides the following “non-exhaustive list of examples of major life activities: caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, sitting, reaching, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, interacting with others, and working.”

Disability-Related Costs

• If you do not have a prior diagnosis of disability, please be aware that a disability assessment requires additional psychological tests and associated costs. If a disability assessment is needed and Stacy is qualified to do it, you will be provided with an oral and written good faith estimate of the cost of such tests before proceeding. Depending on your disability, it may be necessary to refer you to a professional who specializes in assessing that disability. Note that whether it is conducted by Stacy or another healthcare provider, a disability assessment will add additional time and cost to the process of obtaining an ESA letter. 

Implications and Risks

• Because you must meet the criteria for a disability to receive ESA  accommodations, Stacy is required to document in your chart and on the accommodation letter that your disability has been verified. This information becomes a part of your permanent health record. Recall that, as defined by the ADA, disability identifies “physical or mental impairment that substantially limits one or more major life activities.” If you did not have a documented disability prior to requesting an ESA evaluation, it is important for you to understand that the documentation of impairment in your health record could limit your employment opportunities, military enlistment or advancement, cost and procurement of health and life insurance policies, firearm ownership, custody disputes, and security clearance.  Please take these risks into consideration when requesting an ESA evaluation, and feel free to bring up these concerns in session. 

Need versus Want

• Need must be established (as opposed to want). It must be clear how the ESA contributes to managing your disability-related impairment. Your reasons for requesting an ESA letter must be related to the animal’s role in managing your disability. If you are requesting the letter simply because you want to circumvent a landlord or housing complex’s no pet policy, or because it is inconvenient or expensive to board your pet when you travel and you want to take your pet with you, it is not ethical to provide the requested documentation.  

Renewal

• By law, the letter is valid for one year. If you remain an active client, a new ESA evaluation will not be necessary for a letter renewal. If there is a gap in services, a new ESA evaluation will be required at the cost listed in the above paragraph. Gaps in services vary from client to client and are based on diagnosis, mental state, support environment, and other resources. Therefore, whether you are defined as an active client will be determined by a combination of your informed consent agreement, the frequency with which you participate in therapy sessions, and the clinical presentation of your case. In other words, it will be based on clinical and ethical standards of care and will be at clinical discretion. 

Additional Animals

• The Fair Housing Act permits ESA accommodations for multiple animals within the same household, but each animal must meet the criteria described in this policy. The animals do not each have to alleviate different symptoms of a disability, but they do each have to alleviate one or more symptoms of a disability. A separate letter is required for each animal. The cost of your evaluation and letter(s) (if clinically appropriate) will cover as many animals as you have at the time of that evaluation and for a period of one month following that evaluation, provided that you remain an active client during that month. Should you acquire additional ESAs later than one month after the evaluation was completed, an additional evaluation may be required at the same cost as the first service. Therefore, if you need an ESA accommodation letter for more than one animal, it is most cost-effective to complete the evaluation process for all animals at the same time. 

Cost

Fees

• The cost of the ESA accommodation service is the base hourly rate times the number of hours it takes to complete the evaluation. You should expect the process to involve approximately three to six hours of billable time, not to exceed six hours. 

• This service includes the following:

  • The clinical interview, which will take 1-2 sessions.

  • Administration and interpretation of relevant psychological tests.

  • Collateral interviews.

  • Review of relevant records.

  • Writing a letter documenting the need for the ESA if deemed clinically appropriate. 

• Note that payment must be received before the ESA evaluation process begins. 

• You will be provided with a written good faith estimate of the cost as part of the informed consent process for the ESA service. Since the service can take three to six hours, the fees on your good faith estimate will be based on that range and the factors unique to your case. If the service takes less time than anticipated, the difference in cost will be credited back to your original payment method.

Refund Policy

• There will be no refund for the ESA accommodation service if Stacy concludes that the legal, clinical, and ethical requirements for writing an ESA letter have not been met; you are paying for the assessment process. Please keep this in mind when initiating your request for an ESA evaluation and letter. 

Additional Costs

• As stated above, this service does not include a disability assessment; a disability assessment is a specialized assessment with its own process and costs (see previous section on disability requirement). Additionally, you are responsible for acquiring and compensating the animal care professional who evaluates your ESA for suitability as an emotional support animal.

Consent and Understanding

If you decide to request an ESA letter evaluation, you will be asked to sign: 

• An informed consent agreement specific to the ESA letter and evaluation.

• A financial responsibility contract (aka fee agreement). 

Both must be signed before starting the evaluation process. If a third party is paying for this service, they need to sign these agreements as well. 

Legal Concerns

No Guarantees

• If Stacy supplies an ESA letter as a result of the evaluation, she cannot guarantee that your landlord will accept the letter and provide an accommodation for you and your ESA to live in their dwelling. 

Confidentiality

• If your landlord declines, and you choose to pursue legal action against them, please be advised that Stacy will be permitted to disclose protected health information in legal proceedings. By involving her in legal actions against your landlord, you will be effectively waiving your right to privacy under HIPAA law. 

Criminal Activity

• Please note that forging an ESA letter on behalf of a healthcare provider may be a criminal offense. If you are found misrepresenting a healthcare provider with an unauthorized or altered ESA letter, this constitutes a waiver of confidentiality, and you may be reported to law enforcement.