Behavioral Health Newsletter

April 2024

Questions to Ask Yourself Before Practicing Telehealth Over State Lines

In the ever-evolving landscape of behavioral health care, the advent of telebehavioral health has revolutionized how professionals connect with their patients. The ability to reach individuals beyond geographical boundaries holds immense promise for expanding access to care in one of the most needed areas. However, with this promise comes a myriad of legal and regulatory considerations, particularly when practicing across state lines. Below are a few specific areas to consider and questions to ask before beginning to provide services across state lines.


At the forefront of these challenges is the issue of licensure. Each state maintains its own set of licensing requirements for mental health professionals, encompassing educational qualifications, clinical experience, and ongoing professional development. Practicing across state lines often necessitates compliance with multiple sets of regulations, as well as awareness of interstate licensure compacts – agreements among states that facilitate the practice of certain professions across borders. Having an understanding of these compacts is essential for telebehavioral health professionals, as they define the specific boundaries within which practitioners can lawfully operate across different jurisdictions.

  1. Are my current credentials and licensure recognized in the state(s) where I intend to practice?
  2. If I need to obtain a separate license, how long will the application process take and is there an “interim” license available I can use to see patients in the meantime?
  3. Are there any interstate licensure compacts or agreements that facilitate practice across state lines, and am I eligible to participate in them?
  4. Can I provide services to the patient even when they are temporarily located in another state?

Scope of Practice

Furthermore, variations in scope of practice across states add another layer of complexity to interstate telebehavioral health practice. While some states may permit certain interventions or modalities, others may impose restrictions or require additional certifications. Negotiating these differences requires a more in-depth understanding of each state’s regulations to ensure that practitioners operate within the legal boundaries of each jurisdiction.

  1. Are there any restrictions or limitations on the types of modalities I can use in telebehavioral health practice?
  2. Do I need to obtain additional certifications or training to provide certain services? For example, does my scope of practice allow group psychotherapy?
  3. Does my licensure type allow me to provide both mental health and substance abuse services or is additional training required?

Consent and Duty to Warn

Consent and duty to warn laws further complicate the landscape of interstate telebehavioral health practice. Professionals must navigate differing requirements for obtaining informed consent from clients, as well as obligations regarding disclosure of potential harm to third parties. Failure to comply with these laws can have legal (and ethical) ramifications, underscoring the importance of comprehensive knowledge and adherence to state-specific regulations.

  1. What are the requirements for obtaining informed consent from clients in each state where I practice telebehavioral health?
  2. Am I required to warn under state law, or does state law allow a “permissive” duty to warn?
  3. What documentation should I have in place to ensure that I am meeting my legal obligations regarding informed consent and duty to warn when practicing across state lines?

Despite these challenges, there are strategies that telebehavioral health professionals can employ to mitigate risks and ensure compliance with relevant laws and regulations. Staying informed about licensure compacts, maintaining clear communication with clients regarding the scope of services provided, and seeking legal counsel when necessary are essential steps in staying compliant
with the ever-changing landscape.

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