PSYPACT: 26 states have now passed laws allowing interstate practice

So far this year, 11 jurisdictions—Alabama, Arkansas, Kansas, Kentucky, Maine, Maryland, Minnesota, Ohio, Tennessee, Washington, D.C., and West Virginia—have joined the Psychology Interjurisdictional Compact (Psypact). Psypact is an agreement allowing psychologists in participating jurisdictions to practice across state lines, whether via telepsychology or temporary in-person practice.

Of the 26 states participating in the compact, 18 states have enacted Psypact legislation that has been formally adopted by the Psypact Commission, the compact’s governing body. Alabama, Kentucky, and Minnesota have enacted Psypact legislation, but, due to modifications made to the legislation, that legislation has not yet been formally adopted by the Psypact Commission. (The Commission is slated to meet in August 2021 to review legislation in these states.) New laws take effect later this summer for Arkansas, Ohio, and West Virginia. Maine’s law goes into effect in September. And Kansas’s law goes into effect in January, 2022.

“Psypact may get a few more states by the end of the legislative session,” said Psypact Executive Director Janet Orwig. Five other states—Iowa, New Jersey, Rhode Island, South Carolina, and Vermont—introduced Psypact legislation this year. “And we’re hoping to continue this same kind of growth next year.”

A combination of factors has helped drive this growth in the number of participating states, said Orwig. For one, the COVID-19 pandemic caused many patients to relocate beyond the reach of their psychologists’ licenses at a time when mental health needs—whether new or ongoing—were soaring. Many college students returned to their hometowns to take classes virtually, for example, and some families retreated to second homes with more space in rural areas. Plus, said Orwig, legislators have become increasingly familiar not just with telehealth but with the idea of interjurisdictional compacts as other professions have started introducing legislation of their own. Occupational therapists, audiologists and speech therapists, counselors, and teachers are working on compacts, too.

Psypact’s growth is good news for psychologists and patients alike, said Paul Berman, PhD, professional affairs officer for the Maryland Psychological Association.

Maryland, he pointed out, is a small state bordering Virginia, Pennsylvania, Delaware, West Virginia, and Washington, D.C. “Many psychologists in our state treat patients who may live in another jurisdiction and see a therapist after work or during lunch before going home in the evening,” said Berman.

Many jurisdictions issued emergency rules or executive orders temporarily waiving certain licensing requirements for out-of-state providers during the pandemic, said Deborah C. Baker, JD, director of legal and regulatory policy at APA. But of the 39 jurisdictions that issued such waivers, she said, 19 have already seen their waivers expire.

That’s what happened in Maryland, said Berman. “People were seeing ongoing patients via telehealth under these exceptions, and then the exceptions terminated and they couldn’t see those patients anymore,” he said. Plus, he said, the exceptions only covered treatment of ongoing patients, meaning that patients seeking help for the first time couldn’t access services across state lines.

By the time the waivers started lapsing, however, legislators had greater first-hand experience with using telehealth for all types of health care. “The pandemic convinced legislators that telehealth services were an effective way to receive treatment,” said Berman. “Legislators realized that there’s no reason to prohibit services just because someone lives in another state.”

But Psypact won’t just help psychologists continue to serve patients in bordering states, said Eric Russ, PhD, executive director of the Kentucky Psychological Association. It also helps ensure that patients can have access to the services they need, whether it’s specialty services or simply a psychologist who shares their language or racial or ethnic background.

“The real advantage of interstate practice is that specialist care will be much more accessible,” said Russ. “With Psypact, all of our specialists in the state can now access patients in lots of other states and, hopefully, eventually the whole country.” An individual in a state with a shortage of psychologists might seek care from a Kentucky psychologist who specializes in eating disorders or obsessive compulsive disorder, for example. “And people in Kentucky will be able to access services we don’t have here,” he added.

Psypact also helps psychologists and their patients by clarifying legal and regulatory issues that have complicated interjurisdictional practice in the past, said Baker. States have different laws regarding recordkeeping, mandatory reporting, and confidentiality, for example, and it has sometimes been unclear which jurisdiction’s laws a psychologist should follow.

“The beauty of Psypact is that it addresses those issues and provides more protection, both for the patient in understanding what laws apply and the psychologist in understanding how to practice lawfully and ethically,” said Baker. “With Psypact, providers know which laws are to be followed and how to inform their patients at the outset.”

If your state has joined Psypact, submit an application to practice via telepsychology or temporary face-to-face practice. Psychologists licensed in Psypact states must apply to the Psypact Commission for an authority to practice interjurisdictional telepsychology or a temporary authorization to practice in person. For telepsychology, psychologists must obtain an E.Passport from the Association of State and Provincial Psychology Boards (ASPPB). For temporary in-person practice, they must obtain an interjurisdictional practice certificate from ASPPB.

If your state is not yet a Psypact member, contact your state psychological association and state licensing board and let them know you support Psypact. State psychological associations typically lead advocacy efforts for enacting Psypact legislation, explained Baker, while state licensing boards will send a representative to the Psypact Commission if a Psypact law is enacted.

If you want to speak with legislators directly, Psypact offers a legislative toolkit (PDF, 976KB), fact sheet (PDF, 129KB), and other resources to help you prepare. “It will take some time to move legislation forward, find a bill sponsor, and do the nuts and bolts to get it passed,” said Russ. “Start having those conversations now.”