What to know about doing telehealth in a different state

The COVID-19 outbreak has dramatically increased the use of telehealth services as patients look for ways to continue their treatment while following physical distancing guidelines. Stay-at-home orders and displacement of patients and providers have likely amplified practice across state lines.

When engaging in interstate practice, psychologists should comply with all relevant laws and regulations—both in the psychologist’s own state and where the patient is located. APA Services, Inc., in collaboration with the California Psychological Association, provides answers to the most commonly asked questions about how to do this.

You should be licensed or legally permitted to practice in the states where you and your patient are physically located when services are provided. If your patient is temporarily in another state, you may be legally permitted to practice there under temporary practice laws. Temporary practice laws allow psychologists licensed in one state to practice for a limited amount of time in another state (e.g., 20 days per year) and may specify additional requirements such as obtaining a temporary permit or license. However, not all states allow for temporary practice. For information about another state’s temporary practice laws, please contact the state’s board of psychology.

In addition, you may be able to engage in interstate practice through the Psychology Interjurisdictional Compact (PSYPACT) (see questions nine and 10).

The interstate practice rules that we discuss in this FAQ apply whether your patient is out of state temporarily or permanently. The clinical issues, however, may be different. If a patient is moving permanently out of state, they may benefit from transitioning their care to a psychologist in their new state of residence.

You should be licensed or legally permitted to practice both where you and where your patient are located, including internationally. It can be challenging, however, to determine the licensing laws (if any) in some foreign countries. Checking with the relevant national psychology association is a good place to start. Clinical issues and patient welfare should also be considered. For example, will the time difference make treatment inconvenient? Will cultural issues be an important factor? Are there skilled therapists in the country where the patient is living? What are the local resources available if the patient were to be in crisis and need emergency services?  In addition, there may be specific patient data privacy requirements that must be followed in that country.

Most states do not have a specific requirement that care must be initiated in person or must be initiated in the same state where their psychologist is located. Your expertise may be an important clinical reason for initiating treatment with a patient in another state. However, practitioners should consider the patient’s best interests. If appropriate services are available, a patient may benefit from working with a local psychologist who would be able to provide in-person care.

You should be licensed or legally permitted to practice both where you and where your patient are physically located when services are provided because you are arguably practicing psychology in both of those places. Most states clearly consider you to be practicing psychology where the patient is located. Some states also consider you to be practicing psychology where you are located. Please check with the relevant state’s board of psychology to find out its rules in this situation.

As mentioned in question number 5, you could be considered to be practicing psychology in the place where you are located, even if your patients are in a different state. If you are permanently living in a new state, it will likely be worthwhile to get licensed in that state. Licensure in your new state gives you clear authority to practice there. It also allows you to treat patients who live in your new state.

Typically, no. Temporary practice laws generally require you to have a license to practice psychology in another state.

Some states have temporarily relaxed their rules about interstate practice during the pandemic. Like the temporary practice laws mentioned in the answer to the first question, temporary waivers vary by state. For information, please check our telehealth guidance by state during COVID-19 and confirm current rules with the relevant board of psychology.

The Psychology Interjurisdictional Compact (PSYPACT) is a multi-state licensing compact allowing a psychologist licensed in a state that has joined PSYPACT to provide telepsychological services or temporary in-person services to patients in other PSYPACT states. A licensed psychologist in a PSYPACT state would need to obtain authority to practice through the compact by either applying for an E.Passport for telepsychology practice or an Interjurisdictional Practice Certification (IPC) for temporary, in-person practice. The psychologist would also need to abide by the regulations set by the PSYPACT Commission. Information about how to apply for authority to practice under PSYPACT and PSYPACT Commission rules for practice are available on the PSYPACT “About Us” website.

PSYPACT facilitates interstate practice among those states that have joined the compact. Therefore, both the psychologist and the patient have to be in PSYPACT states for the psychologist to be able to provide services through PSYPACT.  Otherwise, the psychologist will need to comply with the other state’s temporary practice law, if any.

If a patient contacts you with a clinical emergency, your professional and ethical duties to protect the patient from harm are paramount. Prompt action to address the emergency comes first. Reasonable steps to comply with jurisdictional rules should then be taken as appropriate.

The risks of engaging in temporary interstate practice may be low, especially when such services are brief and are clinically indicated such as when an ongoing patient who is temporarily located out of state requests a telehealth session. However, if there is a complaint and you have not complied with the relevant interstate practice rules, you could be accused of practicing psychology without a license. It is recommended that you consult with your professional liability company about risk management guidance.