If you see a U.S. citizen and your communication channel is crossing state lines, say, New York to New Jersey through Pennsylvania to Ohio, none of the intermediate states count. You are not practicing in New Jersey or Pennsylvania. Ohio is where the patient resides, and the licensing board in the patient’s state of residence is the one to consider.
Along with your own state, the location of the client/patient at the time of the contact is most often the regulatory board that may prosecute if something is amiss. Thus, you can most often choose to move to Timbuktu for all that anyone cares as long as you are licensed in Ohio to work with Ohioans. Then again, some states run contrary to this general principle, so checking with your licensing board and that of the state.
As for getting into trouble, first, you have to get caught (or a patient or someone has to complain or sue, which certainly can happen). Second, the state or provincial board that deals with licensure for your discipline has to do something about it.
To date, in the United States, many various regulatory boards for behavioral health disciplines have already begun looking at their state laws related to interjurisdictional issues related to telebehavioral health. Some are very active in this regard and have made remarkable progress, including requiring professional training for all licensees who deliver any form of telehealth, including telephone work.
Many states have not yet made their efforts visible to the public or to their licensees. Funds, staff, and time are often too limited, and if they have to choose between the cost of a hearing for a practitioner who committed a heinous crime vs. practicing over state lines. Well, the perpetrator of the heinous crime usually gets the attention.
If you treat an existing patient who is temporarily in another state, the state board will probably never know, unless your legal infraction surfaced in another way, such as someone bringing a complaint against you for billing. However, most of us do not go into practice to evade the law in any way, so being in full compliance with all state and federal laws is the best route. Also, your malpractice insurance is likely to not cover the cost of your legal defense in the case of a lawsuit if it is determined that you were practicing illegally over state lines.
What if the client/patient is in a foreign state/country when they contact you?
If a patient moves to another state and takes up a residency in that state, the best policy in this regard is to ask for a formal opinion. Almost invariably, the state board will respond saying it’s “OK” in any specific case, at least temporarily. A letter to that effect markedly reduces any risk stemming from the licensure issue. You may also want to check with your lawyer and your malpractice company if you are uncertain about any particular situation.
Secondly, opening every session with a question about the client’s/patient’s geographic location is “de rigeur” and therefore expected in all aspects of telehealth. Much more information about such “opening protocols” is available to you here at TBHI through the telemental health and telehebehavioral health professional training courses offered.
What if I want to travel and be licensed over state lines?
If you are the one traveling, you must, according to all state laws in all disciplines, be licensed appropriately. That means that if you go to Florida, for example, you have contacted the Florida licensing board for your discipline and gotten their permission, or taken their jurisprudence exam to demonstrate your competence in understanding their state-specific laws for your discipline.
And lastly, always contacting your own board to ask for their opinion about you seeing your clients/patients when they travel is the responsible way to go.
For more information about other telebehavioral health and telemental health legal and ethical issues, see the Telebehavioral Health Institute’s professional training and consultation. Need specific information about legally practicing over state lines and licensure portability? Join TBHI’s “How to Legally Practice Over State Lines with Telebehavioral Health and Telemental Health” online training that will outline the scope of distance therapy and detail telemental health licensure portability.