PSYPACT: interjurisdictional psychology practice on the horizon

Janet Orwig, MBA, CAE, is the Associate Executive Officer for Member Services and Executive Director of PSYPACT for the Association of State and Provincial Psychology Boards (ASPPB). Janet plays an integral part in the development of new services and programs, securing and managing large government grants and furthering member relations. 

Laura Myhr, PhD, is a clinical psychologist licensed in Washington, DC, and Virginia. She provides therapy and assessment across the lifespan. As Vice President of Organizational Affairs and a member of the Government Relations and Social Justice & Diversity teams for the District of Columbia Psychological Association, she advocates for psychology in the public sphere, focusing on improving access to mental health services for a variety of populations.

Hannah Calkins: The Psychology Interjurisdictional Compact is an interstate compact facilitated by the Association of State and Provincial Psychology Boards, or ASPPB. Called PSYPACT for short, it’s designed to reduce barriers to practice for psychologists, and to expand access to care for patients.

On this episode of Progress Notes, we’ll learn how PSYPACT works, and what needs to happen for the compact to become operational. I’ll be speaking with Janet Orwig, who holds two roles at ASPPB: associate executive officer for member services, and executive director of PSYPACT. I’ll also talk to Dr. Laura Myhr, a psychologist who’s working to bring PSYPACT to the District of Columbia.

First, here’s Janet Orwig.

Janet Orwig: PSYPACT is an interstate compact that will allow licensed, doctoral-level psychologists to practice telepsychology across state lines without having to get a license in all of those compact states. They do have to be licensed in their home state, but they won’t have to get licensed in any of the other compact states. It also allows for 30 days of temporary, face-to-face, in-person practice in a compact state.

Hannah Calkins: PSYPACT will become operational once seven states pass legislation enacting the compact. Arizona led the charge in 2016, followed by Nevada, Utah, Colorado, Nebraska, Missouri and, most recently, Illinois. If you counted seven states in that list, you’re right—but, unfortunately, Illinois’ legislation won’t go into effect until 2020, so for now, PSYPACT is still waiting on that last state before it can kick into gear.

Janet Orwig: We are hoping that we could possibly have another jurisdiction introduced before the end of the year; we’re keeping our fingers crossed on that—but, if not, we have heard from several states that they intend to introduce legislation next year. Whichever one of those comes in and gets it enacted, they will be number seven and we will be able to get started based on that one. And hopefully that will happen before Illinois in January of 2020. We are excited about seeing what’s going to happen in ’19.

Hannah Calkins: One of the contenders for the seventh state differs from the current compact states in significant ways. For one, it’s a geographically small, densely populated jurisdiction on the East Coast. And for another, it’s not actually a state at all.

Laura Myhr: My name is Laura Myhr. I’m a licensed clinical psychologist in DC and Virginia.

Hannah Calkins: Dr. Myhr is passionate about advocacy, especially when it comes to expanding access to mental health care. She’s channeling that passion into propelling PSYPACT forward in her role at the District of Columbia Psychological Association.

Laura Myhr: It’s been me and one of my partners on the government relations team, Dr. Erin Gelzer, who have been working together most of this year to actually get the PSYPACT legislation going—to take the next step from consideration to action.

Hannah Calkins: The current compact states form a sort of chain across the far and mid-west of the country. They are all geographically large states, and they all share at least one border. It’s easy to imagine how both PSYPACT’s telepsychology and temporary practice provisions would benefit both patients and providers who live or work in the remote rural areas of these states. But then why consider PSYPACT in DC—or in any of the other small but densely populated states in the mid-Atlantic and Northeast?

Laura Myhr: PSYPACT really is relevant in a place like DC and in the wider DC-Maryland-Virginia area. There are a few main ways that we think PSYPACT would improve care here. The first is, despite the fact that this is a relatively dense city and metro area, there are still areas that are really underserved in terms of mental health care. I think there can be just a wide range of reasons why the traditional model of in-person, once-weekly therapy sessions might not work for people. And that could be because people don’t have a car and there isn’t a good place accessible on the Metro; it could have to do with lack of child care; people with work schedules that involve a lot of travel; and also people with mobility issues or physical health needs that make it difficult or impossible for them to easily access an office.

Hannah Calkins: Furthermore, just like in other places, it can also be very difficult to find a provider who is affordable or takes your insurance. Widening the pool of possibilities to include telepsychology with a provider across a nearby state line could be really helpful for many people.

Laura Myhr: And the other piece here is that a large portion of the DC population is transient.

Hannah Calkins: Lots of people come to DC—and lots of people leave. Via telepsychology, PSYPACT would allow for continuity of care as patients and providers move in and out of the District.

But this transience also happens on a day-to-day level in DC, which blends into Virginia and Maryland on all sides. Here, PSYPACT’s temporary practice elements could be a game-changer.

Laura Myhr: You have people who are going across state lines sometimes daily. Examples of how PSYPACT would work in this dense area where there are several state lines, is I could have a patient that I see in DC, because they work here, but lives in Maryland. And that’s totally fine practice. The issue could come up if, say, that client was at home and began to have some suicidal thoughts. I might want to provide care to them in their home and that raises a concern about the legality, because I would be practicing outside of where I hold a license. And similar issues come up all the time with kids. So, if a child is being seen in DC but maybe goes to school in another state, say the school wants the psychologist to come in to do a school observation. That’s really not possible under the current system. So PSYPACT would allow for people to easily cross state borders in a fashion that is both regulated and ethical, and also provides the best care.

Hannah Calkins: Of course, these benefits depend on DC’s closest neighbors, Maryland and Virginia, joining the compact.

Laura Myhr: We’ve been in touch with Maryland and Virginia, and of course because they’re our neighbors, we are excited for them to join PSYPACT as well. The last we’ve heard, there is some movement in that direction. So, specifically for the DC area, that’s one thing that’s going make PSYPACT great here is to have those states involved as well.

Hannah Calkins: While the benefits of PSYPACT that Dr. Myhr discussed are specific to DC, it’s easy to apply this same thinking to other states. In fact, even advocates in current compact states made pretty similar arguments when persuading their legislators to support the compact. But there’s one more way that DC stands alone – Dr. Myhr has to propel the legislation through a unique process.

Laura Myhr: DC is not a traditional state, and so the government is much more like a city government. So, the PSYPACT legislation will need to be passed by the city Council and signed off on by the mayor. And so the really unusual thing about the DC legislative process is that also all our legislation is reviewed by Congress. So we go through a period of time where Congress is able to review that legislation; if there are any concerns, they could try to address those. We don’t expect that to happen, but that will be the process—it will go through the Council, to the mayor, to Congress, and then it would finally be enacted.

Hannah Calkins: Dr. Myhr expects the legislation to be introduced in the DC Council’s next legislative session at the beginning of 2019.

At this point, you may be wondering what will happen once that seventh jurisdiction formally joins the compact. At that time, the licensing board in each jurisdiction will appoint a delegate a governing body called the PSYPACT Commission. ASPPB will then convene a meeting of the commission to begin drafting bylaws and regulations.

Janet Orwig: As soon as those are done, PSYPACT will become operational. During that process, the commission will also finalize all the requirements for the E-Passport, which is the certificate that psychologists have to get in order to be able to practice telepsychology. So once the criteria has been finalized by the commission, the application process for that will be open, and also the psychologist, if they want to practice temporarily need an IPC, and that is actually already a current certificate and psychologists can go ahead and apply for that in anticipation of getting PSYPACT up and going.

Hannah Calkins: Ms. Orwig is referring to the Interjurisdictional Practice Certificate, which will allow psychologists taking advantage of PSYPACT to participate in temporary practice in compact states. You can find more information about this certificate, as well as the E-Passport, on ASPPB’s website.

In the meantime, Ms. Orwig has some useful information to share with potential PSYPACT advocates.

Janet Orwig: One of the things I’d like to point out, and it’s been confusing to some states, is that the main thing about a compact is that the language can’t be modified. They’re all enacting the same language. Some of the states have had some components and things they’ve needed to add extra to reference another section and that can be fine but they can’t change the four corners of the compact document. So that’s just something that kind of needs to be said because sometimes I think they think they can just go in and changes pieces and parts and that changes the whole purpose of the compact by not making everybody function under the same document. Another important thing that may need be known, is how the telepsychology component works. The psychologists will be practicing under the authority of their home license, in their home state, but they’re going to be practicing under the scope of practice into the receiving state. So that is kind of the agreement to allow the two states to work together, and so that’s an important component going forward that everyone needs to know. And that also helps improve the public protection component that PYSPACT has in there.

Hannah Calkins: Another thing that advocates should know is that compact states will pay an annual fee to ASPPB to participate in PSYPACT.

Janet Orwig: The cost that we’re anticipating for states to participate in PSYPACT is going to be somewhere between three thousand and six thousand dollars.

Hannah Calkins: Ms. Orwig says that the final figure will be determined by the PSYPACT Commission once they meet. Depending on the state, those fees may come from the licensing board’s budget or from the state’s general fund, and the money will support the administrative function of the compact. It’s important to note that this cost burden falls on the state, rather than on individual practitioners.

Janet Orwig: Part of PSYPACT is to reduce the barriers to practice. And we know that telepsychology is a growing mode of delivery and that the cost of getting licensed in every single state that you think they might want to provide services is extremely expensive and very challenging. So, we knew that in order for telepsychology to grow and advance, and be able to do the things it’s able to do, those financial burdens had to be reduced. And that’s kind of how PSYPACT got where it got, was allowing the states to work together, but only to require the one license.

Hannah Calkins: While some states have tried and failed to get PSYPACT legislation passed, the reasons for the failure are usually political and unrelated to the content of the compact. Many of the states who have been successful have reported little to no opposition.

Laura Myhr: You know, I keep expecting there to be some type of opposition, but from what I’ve heard across states and so far in DC, I think people are just generally really supportive of this. The way that PSYPACT works, it’s going to have the maximum impact and be most beneficial for people if states across the country are involved with this. So I think anyone who supports PSYPACT sort of has the responsibility to make sure people are as educated as possible because that’s the way we’re going to reach the most people, and that’s the goal of the legislation.

Hannah Calkins: ASPPB’s website, ASPPB.net, has a wealth of resources on PSYPACT, including information on its history and background, legislative updates, and some really helpful FAQs. You can also read the model legislation there and sign up for coordinated advocacy efforts to get PSYPACT passed in your state.

That’s it for this episode of Progress Notes. It was produced by me, Hannah Calkins, with help from Jewel Edwards-Ashman. If you’re enjoying these episodes, please Tweet about them, share them with your friends and colleagues, and importantly, subscribe to Progress Notes on iTunes or Google Play. Follow us on Twitter @APAPractice for more news and resources for practicing psychologists. Thanks for listening!