COVID-19: Is it legal to treat clients in another state?

To minimize the spread of COVID-19, many employers are continuing to allow their staff to telework, and many schools have shifted to remote learning. Some people are using the flexibility that remote work and schooling allow to relocate temporarily. Some college students who went away for college are also returning home to complete their coursework online. As a result, psychologists are encountering situations where they are asked to provide telehealth to patients who may be living temporarily in another state.

But can psychologists legally provide virtual services regardless of where their patients may be? It depends on each state’s licensing law and whether the state has made exceptions for services provided during the pandemic.

Health-care care provider licensing is strictly state-based, so your psychology license only allows you to practice psychology in the state or territory that issued your license. When a patient comes into your office, you can provide psychological services even if the patient lives elsewhere. But if you provide telehealth services to a patient living in a state where you aren’t licensed to practice, you could be considered practicing without a license. This is also true if you provide in-person services in a state where you aren’t licensed or practice telehealth from a location where you aren’t licensed.

If you or your patient are planning to relocate temporarily, here are some factors to consider when practicing across state lines:

In response to physical distancing measures, many states have issued emergency orders temporarily easing licensing requirements for out-of-state providers to allow for ongoing continued care to patients and to ensure access to much needed health-care providers. Some states have instituted a temporary emergency license process (e.g., Louisiana, New Hampshire, Oregon, and Utah) while other states require a basic registry enrollment for out-of-state psychologists (e.g., Arizona and Montana). Some states require no advance notification to the licensing board (e.g., D.C., Illinois, and Nebraska). Likewise, some states issued waivers for a specific time duration, while most states have linked waivers to the COVID-19 public health emergency declaration. It is important to comply with state waiver requirements.

APA’s resource on states’ COVID-19 emergency orders provides information about these temporary state waivers. The Association of State and Provincial Psychology Boards (ASPPB) also developed a resource based on information from member psychology licensing boards about temporary interstate practice policies in response to the COVID-19 pandemic.

Prior to COVID-19, some states already had temporary practice provisions as part of the psychology licensing laws. Some provisions appear in the licensing exemption statute or a standalone temporary practice law. Typically, a state temporary practice provision includes a limitation on the number of days in a calendar year that an out-of-state psychologist may practice without having to obtain licensure. It will also specify whether the psychologist must notify the psychology board in advance and the process for getting board approval. However, not all states have such a law.

For example, Florida’s temporary licensing waiver under COVID-19 has expired, but the state has a permanent registration process allowing out-of-state licensed providers to provide telehealth services to patients in Florida.

The Psychology Interjurisdictional Compact (PSYPACT) is a multistate compact allowing eligible psychologists licensed in a PSYPACT state to provide telepsychological services or temporary, in-person services to patients in other PSYPACT states. Currently, 15 states have enacted legislation to formally join PSYPACT and another 13 states have legislation pending this year with more indicating plans to pursue legislation in 2021.

PSYPACT is intended to meet two goals:

• ensure consumer protections are in place when patients are in different jurisdictions from their psychologists
• provide a clear, legal means for psychologists to practice across state lines with guidelines for which state’s laws apply

APA has endorsed PSYPACT because it facilitates a process whereby psychologists can practice lawfully and ethically across state lines to meet their patients where they are.

ASPPB is accepting applications to practice from psychologists in PSYPACT states. Application fees are currently waived through the end of 2020. More information can be found on PSYPACT’s website.