Online psychotherapy within US

April 28, 2019 9:06 AM

My understanding is that it is illegal for online therapists in the US to have a patient in another state unless they are credentialed in both states. Is this the case? Does it matter if their patient has residency in the state they are credentialed in but is often out of state when they are treated?
posted by rednikki to Law & Government (4 answers total)

Best answer: The concern is that without credentialing, the therapist is essentially practicing in a state they are not licensed in. The residency requirement would definitely be necessary for any billing, but I'm not sure if the patient simply having a permanent address in Licensed State would be enough for telemedicine. It may depend on both states' laws re telemedicine.
posted by cobaltnine at 10:16 AM on April 28, 2019

Best answer: It's a very complicated question because every state has different rules, there are five or six different credentials under which professionals can practice psychotherapy and some licensure boards may have differing rules too, and there's the further question of whether a telehealth encounter might not be banned, but still wouldn't be reimbursable by insurance. For psychiatrists, there's the additional question of whether they're allowed to place prescriptions based on a telehealth encounter, particularly for controlled drugs.

Here's an overview that looks decent. Here's a detailed report with a state-by-state breakdown of reimbursement and regulatory policy for telemedicine in general (including but not limited to behavioral health services like therapy), but fair warning, it's more than 400 pages long.
posted by strangely stunted trees at 10:18 AM on April 28, 2019 [2 favorites]

Best answer: It is state by state licensing board dependent. Some states are OK with a therapist being licensed and certified in the state they practice in, while others won’t let a therapist see someone in another state unless they are licensed by that state. Telemedicine has additional rules because it involves prescribing meds, which can definitely get weird crossing state lines. The clinician is bound to follow the rules of the state they are in as well as the state/country their client is in (we had to look into the laws in Italy one time due to a client going overseas for a study abroad semester. Teletherapy wasn’t an option due to Italy laws.
posted by MultiFaceted at 5:30 PM on April 28, 2019

Best answer: Does it matter if their patient has residency in the state they are credentialed in but is often out of state when they are treated?

For California, the guidance from the professional organization is that if the client is only very temporarily out of state and is definitely expected to return, that's probably ok. Or if the client has recently moved and there's a transition plan to get the client a local therapist quickly, that's probably ok. I don't know if that translates to therapists licensed in other states.

It's partly a patients' rights issue, too. If you're a client in Tennessee and I'm a therapist licensed in California and I do something egregiously awful to you, it's hard for you to sue me in California if you're a TN resident and the service occurred in TN. If TN comes after me, they don't necessarily have the authority to suspend my CA license.
posted by lazuli at 8:24 PM on April 28, 2019