Can a Therapist Do Telehealth Across State Lines?

Modern society is incredibly mobile. Our therapy clients may cross state lines to travel for work, visit family, go away to college, or hit the road simply to have an adventure. 

The ability for therapists to provide telehealth across state lines via video therapy has increased accessibility of therapy and mental health services to those in some areas who need it.

But, given the state licensure barriers to providing secure HIPAA-compliant telehealth video therapy to clients in different states, how do we provide consistent mental health care when our clients travel?

Can a therapist do telehealth across state lines?

Can we legally provide therapy and mental health telehealth across state lines?

5 keys to providing therapy by telehealth across state lines

It might be easier than you think use mental health telehealth across state lines to continue working with an established client who temporarily travels out of state for work, the holidays, or any other reason. 

Here’s a useful, stepwise approach to maintaining contact while your client is outside of your state of licensure.

A couple of caveats, of course. 

First, I’m not a lawyer. So this shouldn’t be taken as legal advice, or as a substitute for consulting with your state board or a qualified attorney. 

Second, the rules on this topic are in flux and can significantly vary by location. 

For the most current information on the rules where you are, check your board’s web site.

To get things started, let’s assume that you are licensed in a single state, and have been working in-person with a client who tells you they are going to be in a different state for three months for their job. 

Can they continue to see you via telehealth during their trip?

Step 1: Know the laws of your own state

Generally speaking, state licensing boards take the view that therapy happens where the client is physically located at the time of service. 

In other words, if you do a telehealth video session while you are in California and the client is in Illinois, the therapy is considered to be happening in Illinois. 

But since your license is in your home state, your first step should be to check the rules where you are–both for practicing with clients out of state, and for telehealth more generally. 

Of course, make sure that you have met all your state’s requirements for telehealth practice.

This also is a good time to check in with your professional liability insurer, to make sure that you have the right coverage in case you move forward with telehealth video treatment but something goes wrong along the way.

Step 2: Know the laws of the state where the client will be physically located

Will the other state allow you to meet with the client while the client is visiting that location? 

A growing number of states have put carve-outs into their licensure laws, allowing temporary care from out-of-state licensees when a person travels to their state on a short-term basis. 

It’s important to check the laws of the state where the client will be located during the teletherapy session, so that you can learn whether such a carve-out exists, and if so, what its limitations and requirements are. 

Some states allow up to 90 days of temporary practice, just enough for you to maintain contact throughout the client’s trip. 

States may have rules surrounding specific disclosures to the client, or notifying the state board.

For what it’s worth, the same principles apply here even if the client is traveling outside of the U.S. 

At this stage, you want to check the laws of the place where the client will be physically located at the time of service. 

If that place has no regulatory structure for psychotherapists, then you can practice there. 

If the place does have a regulatory structure for psychotherapists, then you need to know what those rules are. That way, you can determine whether those rules allow you to continue meeting with the client.

For our purposes here, let’s say the client is traveling within the U.S, and that the place where they will be visiting does not have a carve-out in their licensure law allowing for temporary care from an out-of-state licensee.

Step 3: Ask the other state’s board for permission

If the state where the client will be doesn’t have a specific rule allowing temporary care from an out-of-state provider, the board may still be able to issue a temporary permit or some other kind of limited permission. 

Anecdotally, I’ve heard from several clinicians who were successful at obtaining such clearance. 

If you ask that state’s board, and they give their blessing, you can stop here. 

You’re set to keep meeting with the client while they’re away, assuming, of course, that you follow all standards and requirements for telehealth care. 

For our purposes, though, let’s say that you reach out to the other state’s board, and they either say no, or you don’t hear back in time. 

What do you do then?

Step 4: Differentiate therapy from check-ins

Just because you can’t treat someone in another state doesn’t mean you’re prohibited from all contact with them. 

You could ask your client to call or email you on a regular basis, just to make sure that any symptoms are under control and that any crisis needs can be promptly addressed. 

If the client does appear to develop an urgent need for care, these regular check-ins will give you the opportunity to connect them with a local provider in their current location.

Of course, if you don’t have the credentials or permission necessary to treat someone based on where they are physically located, you typically shouldn’t treat them. 

In this case, it’s safest to avoid interactions that appear to be assessing, diagnosing, or treating mental illness. 

And make sure that any billing generated from these check-ins is not coded as billing for treatment. Yes, that means insurance would not cover such services, and clients who use insurance to pay should be informed of this in advance.

Some clients find that just a couple of check-ins while they are gone allows them to jump back into therapy easily once they return to their home state where you typically practice and see them.

Step 5: Differentiate therapy from crisis care

If you aren’t qualified to treat the client in the place where they are visiting, what happens if the client calls you and says they’re thinking of harming themselves or others? 

In this instance, it makes sense to prioritize the immediate safety of the client and those around them.

There’s an easy case to make for providing care in such an emergency. 

Obviously, your intervention at this time could save a life.

Furthermore, simply guiding the client to safety and connecting them with local crisis resources arguably isn’t therapy and doesn’t require a license. (If it did, then every 911 dispatcher and crisis line volunteer would need a mental health license to do their valuable work.) 

And even if those arguments failed for some reason, I land in a moral place: Would that other state really prosecute you for trying to help an out-of-state client in a crisis?

It becomes a much more gray area if you intend to keep meeting with the out-of-state client simply because you perceive them as being at risk of falling into crisis. 

If there’s no immediate crisis need, but you’re worried that one may develop, then a better, safer course of action might be to connect the client with a provider local to where they will be staying, and proactively develop a safety plan and a list of crisis resources.

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