Out of State Temporary Telehealth in the age of PSYPACT

[ImAFreudNot]

I've searched the forum but couldn't find an answer to this question. I also reached out to the appropriate state board but haven't heard back yet.

I'm a psychologist licensed in one state (A); a client is moving to another state (B). The client has requested "bridge" sessions - i.e., short-term telehealth sessions to continue treatment - until they can find a new therapist in their new state. Both states are in PSYPACT, but I am not. According to the regulations of State B, a psychologist can see clients on a temporary basis without a license if they hold an IPC and submit information in advance to the Board. However, according to the website below, IPC is really only for temporary in-person sessions. Membership in PSYPACT is required for telehealth sessions; no separate option for those wishing to provide telehealth on a temporary basis.

So the way I understand this, I would have to apply for and join PSYPACT in order to provide telehealth sessions on a temporary basis. Does anyone have experience with getting authorization for temporary telehealth sessions out-of-state?

https://www.asppb.net/page/PSYPACT

TYIA! I really value this community and the wealth of experience offered (for free!) by its members.

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[smalltownpsych]

I've searched the forum but couldn't find an answer to this question. I also reached out to the appropriate state board but haven't heard back yet.

I'm a psychologist licensed in one state (A); a client is moving to another state (B). The client has requested "bridge" sessions - i.e., short-term telehealth sessions to continue treatment - until they can find a new therapist in their new state. Both states are in PSYPACT, but I am not. According to the regulations of State B, a psychologist can see clients on a temporary basis without a license if they hold an IPC and submit information in advance to the Board. However, according to the website below, IPC is really only for temporary in-person sessions. Membership in PSYPACT is required for telehealth sessions; no separate option for those wishing to provide telehealth on a temporary basis.

So the way I understand this, I would have to apply for and join PSYPACT in order to provide telehealth sessions on a temporary basis. Does anyone have experience with getting authorization for temporary telehealth sessions out-of-state?

https://www.asppb.net/page/PSYPACT

TYIA! I really value this community and the wealth of experience offered (for free!) by its members.

I typically tell the patient I can’t do it. Telling patients no is difficult especially when it seems like it makes sense and that some of our regulations are arbitrary. State boards are not very responsive so by the time you got an answer it would be time for them to get someone else. Also, boards don’t make exceptions typically as their job is to ensure compliance moreso than anything else. If I make the ethical decision that the patient is so fragile or the situation is so concerning that they need my support, then I would have to weigh my own ethics with what the laws or state rules are.

 

[foreverbull]

I consulted directly with ethics experts in my state and my malpractice insurance company a few years ago (I’m not in a PSYPACT state, by the way) who told me that the bigger risk was client abandonment over not following that state’s temporary practice guidelines (and no, I wasn’t seeing someone in crisis). They said temporary practice for someone who is in another state temporarily or relocates was justifiable because of this ethics principle.

Make of that what you will, but definitely check with your ethics consultant in your malpractice insurance carrier, regardless of whether PSYPACT exists or not in the state and document everything to show that you made a good faith effort to do the “right” thing. I wouldn’t leave it up to opinions on here.

 

[AbnormalPsych]

I consulted directly with ethics experts in my state and my malpractice insurance company a few years ago (I’m not in a PSYPACT state, by the way) who told me that the bigger risk was client abandonment over not following that state’s temporary practice guidelines (and no, I wasn’t seeing someone in crisis). They said temporary practice for someone who is in another state temporarily or relocates was justifiable because of this ethics principle.

Make of that what you will, but definitely check with your ethics consultant in your malpractice insurance carrier, regardless of whether PSYPACT exists or not in the state and document everything to show that you made a good faith effort to do the “right” thing. I wouldn’t leave it up to opinions on here.

It seems like they are valuing ethics and care over strict interpretation of some other states laws. I wonder if there are board investigations/actions or legal cases about this yet, given telehealth has been around for quite some time now.

I am surprised to hear they are saying temporary visitation to another state is viewed similarly to relocation. What did was "temporary" practice defined as when they were giving you this feedback?

 

[foreverbull]

It seems like they are valuing ethics and care over strict interpretation of some other states laws. I wonder if there are board investigations/actions or legal cases about this yet, given telehealth has been around for quite some time now.

I am surprised to hear they are saying temporary visitation to another state is viewed similarly to relocation. What did was "temporary" practice defined as when they were giving you this feedback?

This was in either 2020 or 2019, I think.

They left “temporary” vague and I estimated with my situation that a few months would be likely the most the client would be out of state caring for an ailing family member. They seemed to indicate that was justifiable because there isn’t the time to get temporary licensure in other states or find them another therapist immediately when a client suddenly up and leaves for an emergency. I didn’t mean to imply permanent relocation is the same—in that case they said to do a few sessions and help the client adjust before transitioning to a new therapist. I know some folks who even did this internationally.

But it is possible that things have changed in the last 3-4 years around this issue, certainly. I wonder if anyone has consulted more recently on this topic?

 

[PikminOC]

It all depends on if there's a bad outcome, what the plaintiff attorney and expert witness and the jury decide.

 

[WisNeuro]

It all depends on if there's a bad outcome, what the plaintiff attorney and expert witness and the jury decide.

I wouldn't worry about opposing experts or plaintiff attorneys. I'm pretty sure I can find an opposing expert who will say whatever I want them to. I can also find attorneys who will take on the thinnest of cases. That shouldn't be the dissuading factor. In this case I'd be more worried about what my liability carrier and my board say.

 

[PikminOC]

I wouldn't worry about opposing experts or plaintiff attorneys. I'm pretty sure I can find an opposing expert who will say whatever I want them to. I can also find attorneys who will take on the thinnest of cases. That shouldn't be the dissuading factor. In this case I'd be more worried about what my liability carrier and my board say.

Jury makes the final decision. I guess I worry about that more than you guys

 

[WisNeuro]

Jury makes the final decision. I guess I worry about that more than you guys

Well, the vast majority just get settled, way before trial. But, if it goes that far, yes, a judge or jury will make a decision.

 

[PikminOC]

I have a patient with a psypact psychologist. I couldn't find their license in my state. They are licensed in one nearby state. Wouldn't they have a license in each state?

 

[WisNeuro]

I have a patient with a psypact psychologist. I couldn't find their license in my state. They are licensed in one nearby state. Wouldn't they have a license in each state?

No. Not if both states have passed PSYPACT. Even if not, some states have idiosyncratic laws for telehealth.

 

[PikminOC]

No. Not if both states have passed PSYPACT. Even if not, some states have idiosyncratic laws for telehealth.

Now that COVID is over how does that affect these licenses?

 

[WisNeuro]

Now that COVID is over how does that affect these licenses?

Depends on if the statutes are temporary during PHEs or a permanent statute. If they're both PSYPACT states, that part is irrelevant.

 

[AcronymAllergy]

Now that COVID is over how does that affect these licenses?

Doesn't affect PSYPACT, which allows inter-jurisdictional practice (in-person and telehealth, via different certifications and with different restrictions) between participating states, of which there are 40 (although only 37 technically effective at the moment). You just need to be licensed in your identified "home" state, which is basically where you're physically located most of the time.

This is the list of current participating states: https://psypact.org/mpage/psypactmap

 

[AbnormalPsych]

How does PSYPACT work with billing insurance?

 

[WisNeuro]

How does PSYPACT work with billing insurance?

Same rules, you're either in or OON.

 

[ImAFreudNot]

Thanks everyone for the thoughtful discussion! I appreciate the suggestions to consult my malpractice insurance and ethics specialists in my state. I thought I'd provide an update, in case anyone is in my situation in the near future.

I received a response from the board of the state to which my client was moving (State B). They informed me that their rules around temporary in-person practice apply to temporary telehealth sessions. So, for state B, that means they require notification to the board 5 days in advance about the services that I would be rendering and either a) confirmation from State A's board that have not been subject to any disciplinary matters or b) an IPC certificate from ASPPB, which is basically enrollment in PSYPACT but for a temporary license, and thus cheaper.

According to ASPPB, temporary is limited to 30 days (not consecutive, but 30 days of sessions). In my judgement, I would limit a client to 6 weekly sessions, with the explicit agreement that they start reaching out to new clinicians within 2 weeks of moving and that our sessions would stop before their first appointment with their new therapist. In my area, waiting lists are very long - 2-3 months at least for outpatient therapy, up to 10 months - so I did not want to abandon this family and leave them languishing without a therapist for several months if I could help it.

The client that I initially wrote about, the one who was moving to State B, was able to set up an appointment with a new clinician within a week of moving, so I closed the client's case without having to provide any bridge services. This is my preferred outcome in these circumstances - moving is stressful, and I would always prefer to know that the client has connected with a new therapist than drag out our relationship any longer. Coincidentally, 2 other clients are traveling to PSYPACT states (State B and Stace C) this summer for several weeks and were interested in telehealth sessions while away. I decided to give the IPC/TAP route a try, since I would only need to provide 2 telehealth sessions this summer to recoup the cost of the certificate and (thanks to COVID) I have lots of experience providing telehealth sessions and felt I could provide services ethically and effectively. I am not interested in doing PSYPACT long-term for a number of professional reasons, but being able to offer some flexibility in scheduling with families while they are on vacation was appealing.

I applied for IPC in mid June and was approved for TAP (Temporary Authorization to Practice) in just over 3 weeks. It cost $240 to ASPPB, and an additional $5 to my graduate school to email a transcript to ASPPB. I am now able to provide telehealth sessions in at least two states whose rules specify that telehealth sessions are allowed in place of face-to-face sessions on a temporary basis (up to 30 working days). If I wanted to provide telehealth sessions for more than 30 days or sessions, or in PSYPACT states that do not allow telehealth sessions in place of face-to-face sessions, I would need to apply for an e.passport and be approved for APIT (Authority to Practice Interjurisdictional Telepsychology), which costs $440. I'll be billing insurance per usual, specifying the session is via telehealth (and confirming I know where they are physically located at the start of each session, for safety reasons).

Thank you again for this discussion! I appreciate hearing everyone's input regarding this scenario.