Practicing Over State Lines: Licensure Portability Update

LicensureIn response to a question about licensing as posed by a new member of our  LinkedIn group, called “TeleMental Health Institute,” I wrote this recent recap of my views:

Kudos for seeking clarification of current licensing issues. If you want to work with clients who have moved out of state, you might consider contacting the licensing board in their new state of residence. Simply ask for their permission to work in their state with the client in question, and explain why (client isolation and specific need, continuity of care, unavailability of local specialists, etc.). In most cases (not all), foreign licensing bodies will grant you permission if you register with them ahead of time as I am suggesting. In all cases, seek ~written~ authorization to go over your state line with your license.

Also you probably want to write to your own board and let them know of the permission you’re seeking in these foreign states, and ask for their authorization to proceed. That’s the “best and suspenders” approach to licensing, and will give you the most reliable responses.

I strongly suggest you do not rely on professional associations or simply read their “guidelines” to give you assurances about licensure. Associations are not decision-makers when it comes to licensing.  Some professional association representatives I’ve spoken with just in the last couple months are woefully under-informed. Get your licensing information straight from all directly involved licensing boards.

The other base to cover is with your malpractice company. CC them all the permissions you get and ask them to give you written assurance that they will honor your policy if you get in trouble for practicing over state lines under your specific circumstances, as detailed in your permission requests (outlined above). I hope you can read between the lines here…it might not be enough to ask if they will cover you for “online counseling”  or  “online therapy.” Describe the specific technology you plan to use (email, video, telephone, chat, texting), as well as your rationale for each client. ~Put it all in writing.~

Remember how insurance companies maintain their high profit margins…. Make sure you get their response in writing — all of it. (A phone discussion of your benefits won’t help you a year from now.)  Read their written response from the perspective of an attorney using their written statement to deny your benefits. If you are unsure of the meaning of their response, run it by your own attorney.

For example, I’ve consulted with professionals who get written responses that say, “We’ll cover you for everything you do that is comparable to face-to-face practice.” In a courtroom, it would be easy for their counsel to take the position that your email or chat-room interventions are a far cry from in-person care, largely because the literature supporting such treatment is sparse and often poorly designed.

Finally, you may want to be even more cautious if they say they will cover you for licensing board infractions — but not for civil suits. Licensing board infractions are relatively inexpensive to defend, so sure, a malpractice company may cover the cost of those complaints for you… but those are not your biggest liability. Civil suits can be the most expensive, especially when they involve a patient or client who has suicided or homicided. In consumer protection states, such as California, those civil suits can be quite expensive to not only defend, but losing them can actually cost you a fortune.

If you need better malpractice coverage, petition your professional association to arrange that for you and your colleagues as a group. They have the power to make these pivotal changes happen. We don’t have much power with malpractice companies as individuals. (Having collective power is why most of us join professional associations….)

In sum, I’d suggest you get permission in writing from all foreign states you wish to serve, your own state, and your malpractice carrier. You might also want to consider involving your professional association when necessary to collectively find malpractice coverage for us to manage our risk when using evidence-based, proven effective telehealth strategies and protocols.

Search this blog site for other posts about licensing — and please let me know what you think by commenting below. 🙂

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