Can I Provide Teletherapy Across State Lines During the Pandemic?

As of March 2, 2021, there are no federal provisions that allow mental health professionals to practice teletherapy over state lines; you must register or become licensed in your client’s state to provide teletherapy.

However, there have been federal recommendations for states to relax licensure requirements. In March 2020, the federal Center for Medicare and Medicaid Services (CMS) began implementing policies expanding telehealth access and delivery across states. As a result, some states have ordered waivers on certain licensure requirements for the duration of the crisis or beyond.

See below for updates on teletherapy status by state.

Notable examples

• Rhode Island's expedited 90-day license program has expired. Behavioral health providers must apply for full Rhode Island licenses to continue providing telehealth services to patients in Rhode Island. An executive order from March 2020 which served to increase health insurance coverage for behavioral health services to meet COVID-19 demands was made permanent by the Rhode Island Senate in June. The bill requires health insurance companies to comprehensively cover telemedicine visits, including audio-only phone calls.
• Washington DC has temporarily waived licensure requirements for out-of-district providers who are providing a continuation of care for an individual who has returned to DC and who was previously in their care, or providing services at a licensed healthcare facility in DC. However, no other out-of-district telehealth services are allowed at this time. This waiver is scheduled to expire March 31, 2021.
• New Jersey allowed out-of-state practitioners to apply for an expedited NJ license. All such temporary licenses previously issued, as well as those issued hereafter, are set to expire on June 30, 2021. The NJ Division of Consumer Affairs recommends out-of-state providers who need to continue services to apply for a plenary NJ license through the usual process, or to prepare ahead for patients’ transfer of care.
• Connecticut suspended licensure/certification requirements for being an approved telehealth provider in CT to increase patient access to out-of-state telehealth providers. The Department of Public Health issued an order stating that the requirements for licensure, certification, and registration are all suspended for 60 days in CT. In January, the suspension of these requirements, as part of the state of emergency declaration, was extended to April 20, 2021.
• Illinois' Department of Financial and Professional Regulation interprets Governor Pritzker's Executive Order 2020-9 to mean that out-of-state providers may practice via telehealth to maintain a continuation of care with clients previously in their care: "The Department interprets Executive Order 2020-9 to permit an out-of-state health care provider not licensed in Illinois to continue to provide health care services to an Illinois patient via telehealth where there is a previously established provider/patient relationship. The Department deems such a provider to be 'authorized to practice in the State of Illinois' pursuant to Section 5 of the Executive Order without further need to obtain licensure in Illinois." This order is active until March 7th, 2021.
• Massachusetts issued an order from the Commissioner of Public Health allowing out-of-state providers who "present to the corresponding Massachusetts licensing authority verification that such license is in good standing in that other State where it was issued shall forthwith be issued a corresponding Massachusetts license that shall remain valid during the state of emergency. All health care providers licensed under this provision may provide services within the scope of practice authorized by the license in such profession, both in-person in Massachusetts and across State lines into Massachusetts using telemedicine where appropriate."  The application for out-of-state emergency temporary licenses closed in July, but privileges will remain active until 30 days after the state of emergency is terminated.
• California temporarily suspended licensing requirements for healthcare practitioners in March 2020, allowing professionals to provide services in the state of emergency to help mitigate the effects of COVID-19. To perform services, providers must be affiliated with a facility that has approval from EMS to work with out-of-state licensees.
• New York issued an order allowing mental health professionals licensed and in good standing in other states but without a NYS license to practice without penalty in the State of New York (extended and superseded by EO202.44). This order was recently extended through March 24, 2021 as part of EO 202.95. The state also allows psychologists licensed in non-New York states to provide teletherapy to NYS residents through a one-time-only 90-day exemption.
• Colorado allows mental health professionals with out-of-state or expired licenses to provide services in Colorado for a cumulative total of 20 days per calendar year.
• Washington allows out-of-state psychologists to provide services to Washington clients if they have a temporary practice permit, which allows for 90 cumulative calendar days of practice, including teletherapy. During the COVID-19 state of emergency, other out-of-state mental health providers can register as volunteer health practitioners in Washington, and must be affiliated with a host entity operating in Washington to provide telehealth services.
• PSYPACT states: Psychologists who have applied and been approved to practice teletherapy can do so under the authority of PSYPACT in the following states: Arizona, Colorado, Delaware, Georgia, Illinois, Missouri, Nebraska, Nevada, New Hampshire, Oklahoma, Pennsylvania, Texas, and Utah.

Note: Although these changes have been announced, there may be some lag or discrepancy during implementation. Not all states consider mental health providers "healthcare providers" so make sure that your state, or the state you hope to practice in, includes your profession in their definition.

It may also be the case that a client will be required to connect with a local provider after a certain amount of time.

It's always best to stay up-to-date and contact your licensing board if you have any doubts! Some states may relax licensure rules for providers who will go in person to assist in the COVID-19 treatment effort, but these new rules may not apply to telehealth.

Coronavirus changes to licensure requirements for out-of-state providers

Many thanks to The Shrink Space for this helpful table!