TBHI Q&A #20: My State Licensing Board advises that I can practice over state lines as long as I am licensed where my patient/clients resides.
This may be where the devil is in the details. For most states, interjurisdictional issues used to be a matter of knowing where the client “resides.” Many state boards have gotten more precise lately. Licensure is now typically considered to be a matter of where the client/patient is at the time of the session, and not just where they reside. Typically, healthcare follows the patient, in line with the concept identified by the term “patient-centered healthcare.”
For example, a client/patient can reside in your state but if they travel to Florida for a vacation, the Florida boards may consider you as practicing illegally, and your state board might object, too. In that particular state, they will likely ask you to sit for their jurisprudence exam to be compliant with their state law. Now it may seem ridiculous, but this is true even if you only deliver one session. Furthermore, if you practice illegally, your malpractice carrier may not pay any benefits for your malpractice insurance. For that reason, when you decide to step into another state to render services, it is always wise to let your insurer know.
Personally, many licensing boards are working to straighten this out, but right now, things are in a jumble. Getting a license in multiple states is possible, but expensive, time-consuming, and requires a fair amount of organization to keep it all available to you when needed. Different states have different laws related to a wide variety of issues, from informed consent to regulations related to intakes, the content of session notes, termination, fees, and myriad other issues. The truth is, they have many challenges to overcome.
I’m not sure how the exchange took place with the board you contacted, but speaking with someone over the telephone can, unfortunately, lead to misunderstandings on both sides. Sending them an email is usually better than a paper letter too because response time for email is typically much shorter. Most boards respond within a week or two by email. Keep your letter short and to the point. Send the same to your malpractice carrier.
The best thing to do is to write to all involved boards, tell them what you want to do, and ask each one of them how to proceed. Ask them for any webpages of relevance, documentation (forms), needed continuing education, supervision, and whatever interests you over state lines. Be the pebble in their shoe if they haven’t gotten clear enough about their regulations to put your mind at ease about practicing over state lines.
For specific information about legally practicing over state lines, register for the Telebehavioral Health Institute’s webinar, How to Legally Practice Over State Lines with Telebehavioral Health and Telemental Health. This quick, 1-hour, on-demand recording will give you the information you need to practice both legally and ethically over state lines. Moreover, it will point you to the appropriate resources to give you the peace of mind to grow your practice online and sleep comfortably at night.