Worker classification — Rhode Island & Massachusetts behavioral health

Is My Therapy Practice's VA a 1099 Contractor or an Employee?

Q: Does it matter if my VA works for other therapy practices too?

It helps, but it isn't decisive by itself. Serving other practices supports Prong C (an independently established trade), but if she's still handling scheduling, intake, or billing — work that's core to how a practice runs — Prong B remains the harder obstacle regardless of her other clients.

Short answer: if your VA handles scheduling, intake, insurance verification, or billing, she's very likely a Rhode Island or Massachusetts employee for state wage and unemployment purposes — even if your accountant says she passes the federal IRS test. Those tasks are the operational core of a therapy practice, not incidental to it, and that's exactly what trips up Prong B of the state ABC test.

The Question Behind the Question

This comes up constantly in r/therapists, r/PrivatePractice, and r/socialwork threads: "My VA does 1099 work for me, I got advice that it's fine, so why does this keep coming up?" The honest answer is that most of the advice floating around — including a lot of what a general accountant will tell you — only checks the federal test. Rhode Island and Massachusetts layer a second, stricter test on top, and it's built specifically around whether the work is core to your business. For a solo or small therapy practice, front-office work almost always is.

The Tasks That Actually Trigger the Problem

It's rarely the clinical work that's in question — it's the administrative layer around it. If your VA is doing any of the following, that's the part of the arrangement worth a closer look:

Scheduling

Booking, rescheduling, and confirming client appointments in your EHR or practice management system.

Intake

Sending and collecting intake paperwork, consent forms, and new-client onboarding.

Insurance verification

Checking eligibility, benefits, and authorization before a client's first session.

Billing

Submitting claims, following up on denials, and posting payments.

These are the exact functions a front-desk employee or office manager has traditionally handled — which is precisely why the state test treats them as central to how a practice operates, not peripheral to it.

Why Prong B Is the Real Obstacle

Rhode Island and Massachusetts both use a three-part ABC test, and every worker is presumed an employee until the employer proves all three parts. Prong A (control) and Prong C (independent trade) are worth checking, but for a solo therapy practice, Prong B — is the work outside your usual course of business? — is usually where the arrangement actually fails, regardless of how independently the VA otherwise operates.

Prong B, in plain terms

Ask yourself: would my practice function without this role being filled by someone, in some form? If scheduling, intake, and billing stopped happening, would the practice still run? For most therapy practices, the answer is no — which means the work is part of the operational engine of patient care, not a side project.

A common version of this: "I run a solo therapy practice in Providence. My VA handles scheduling, insurance verification, and intake forms, about 15 hours a week. She's 1099 and invoices me monthly. My accountant says the IRS test looks fine. Are we actually okay?" Running it through Rhode Island's ABC test: Prong A possibly passes if she truly sets her own hours. Prong B very likely fails — scheduling and intake are core to how a therapy practice runs day to day. Prong C likely fails too — 15 hours a week for one practice, with no indication of other clients. Two of three prongs failing means employee status by default under state law, regardless of what the federal test says.

What Actually Helps — and What Doesn't

Documentation strengthens a genuinely independent arrangement, but it doesn't change the nature of the work itself. What helps: evidence the VA actively serves other therapy practices, not just references; a registered business name and her own liability insurance; billing at a project or deliverable rate rather than an hourly rate that resembles a wage; no practice-branded email address or mandatory use of your internal systems where avoidable. What doesn't help: a written agreement alone, if the actual day-to-day work is still scheduling and billing for your practice exclusively. Paperwork supports a real independent-business relationship — it can't manufacture one.

What This Actually Costs in Massachusetts and Rhode Island

Massachusetts treats willful misclassification as a criminal offense, with civil liability that can reach treble damages on unpaid wages and benefits. Rhode Island puts the full burden of proof on the employer from the start, with civil penalties and criminal referral available once a complaint is investigated. In both states, unemployment insurance and workers' compensation exposure are assessed independently of any federal resolution — fixing your IRS position doesn't touch either one.

This material is for general education and does not constitute tax or legal advice. Consult a qualified professional licensed in Massachusetts or Rhode Island for guidance specific to your practice.

Frequently Asked Questions

Is my virtual assistant a 1099 contractor or an employee if she does scheduling for my therapy practice in Massachusetts?

Very likely an employee under Massachusetts law, even if she passes the federal IRS test. Scheduling is a core operational task in a therapy practice, which usually fails Prong B of the state's ABC test.

My accountant says my VA passes the IRS test — does that mean I'm covered in Rhode Island?

No. The federal test and the Rhode Island ABC test are two separate analyses. A worker can pass one and fail the other, for the same role, at the same time.

Does it matter if my VA works for other therapy practices too?

It helps, but it isn't decisive by itself. It supports Prong C, but if she's still handling scheduling or billing that's core to how a practice runs, Prong B remains the harder obstacle.