Telehealth Across State Lines: Legal Guide

Your long-term client texts you: "I'm visiting my parents in Florida for three weeks. Can we still do our sessions?" Your stomach drops. You're licensed in New York. What are the rules? Can you legally see them?

This question lands in therapists' inboxes every single day. And the stakes are high. Get it wrong, and you could face disciplinary action from licensing boards, malpractice liability, or insurance claim denials. Get it right, and you can maintain continuity of care while staying completely within legal boundaries.

The telehealth landscape has shifted dramatically since 2020, with new interstate compacts, temporary practice exceptions, and evolving regulations. This guide cuts through the confusion and gives you exactly what you need to know.

The Fundamental Rule: Location Determines Jurisdiction

Here is the principle that governs all of telehealth: you are practicing in the state where your client is physically located at the time of the session, not where you are sitting.

Read that again. It does not matter that you are licensed in California and your office is in San Diego. If your client opens their laptop in Texas, you are practicing in Texas at that moment. This is not a technicality - it is the foundation of how telehealth licensure works.

This rule exists because each state has the authority to regulate healthcare delivered to people within its borders. The rationale is consumer protection: if something goes wrong, the client should have recourse through their local licensing board.

Interstate Compacts: The Game-Changers

The good news? The mental health field has been working on solutions. Interstate compacts allow licensed professionals to practice across state lines without obtaining individual licenses in each state. Two major compacts are transforming telehealth practice.

PSYPACT for Psychologists

The Psychology Interjurisdictional Compact, known as PSYPACT, allows licensed psychologists to practice telepsychology and conduct temporary in-person practice across member states. As of 2024, 42 states plus the District of Columbia have joined.

To participate, you must hold a current license in a PSYPACT member state, have no disciplinary actions on your record, and obtain an E.Passport (for telepsychology) or IPC (for temporary in-person practice) through the PSYPACT Commission. The process typically takes a few weeks and involves a fee.

Counseling Compact for LPCs and LMHCs

Licensed Professional Counselors have their own interstate compact. The Counseling Compact currently includes 36 member states, with more legislation pending. Similar to PSYPACT, it allows counselors to practice across member states through a privilege system rather than obtaining multiple licenses.

Temporary Practice Exceptions

What if your client is traveling to a non-compact state, or you are not eligible for compact privileges? Many states offer temporary practice exceptions that can help.

These exceptions vary significantly by state, but common scenarios include:

30-Day Client Travel Rules: Some states allow out-of-state therapists to continue seeing established clients who are temporarily visiting for up to 30 days per calendar year. The client must have an established relationship with you before traveling.

Emergency or Crisis Exceptions: Most states allow unlicensed practitioners to provide services in genuine emergencies. This is narrow and should not be relied upon for routine care.

Established Relationship Provisions: A handful of states have provisions allowing continuation of care for clients with whom you have a pre-existing therapeutic relationship, even without compact membership.

Supervision Arrangements: In some cases, practicing under the supervision of a locally-licensed clinician may be an option, though this adds complexity and documentation requirements.

Understanding Different License Types

The patchwork of mental health licensure creates additional complexity. Different license types have different compact options and reciprocity arrangements.

Licensed Clinical Psychologists (PhD, PsyD): PSYPACT is the primary solution. With 42 member states, most psychologists can serve clients across the majority of the country through a single E.Passport credential.

Licensed Professional Counselors (LPC, LMHC, LCPC): The Counseling Compact is growing rapidly. Check counselingcompact.org for current member states and pending legislation in your state.

Licensed Clinical Social Workers (LCSW): Social workers currently lack a widespread interstate compact, though efforts are underway. Most LCSWs must pursue individual state licenses or rely on temporary practice exceptions.

Licensed Marriage and Family Therapists (LMFT): Similar to social workers, LMFTs do not have a national compact yet. Some states have reciprocity agreements or endorsement pathways that simplify the multi-state licensing process.

Psychiatrists and Prescribers: The Interstate Medical Licensure Compact covers physicians, including psychiatrists. This allows expedited licensing rather than true practice mobility, but significantly reduces barriers.

Documentation and Compliance Best Practices

Proper documentation protects you and demonstrates good faith compliance efforts. Here is what you should be recording for every interstate telehealth session.

Session Documentation Requirements

At the start of each telehealth session, verify and document your client's physical location. This is not just a city - you need to know the state. Some practitioners ask clients to confirm their location verbally and note it in the session record.

Your progress notes should include the client's location, your license number and the state it is issued in, confirmation that you have authority to practice in the client's state, and the platform used for the session.

Informed Consent Updates

Your telehealth informed consent should address interstate practice explicitly. Include information about which states you are licensed or authorized to practice in, what happens if the client travels outside those states, emergency protocols for the client's current location, and limitations on care if licensure issues arise.

Insurance and Billing Considerations

Interstate telehealth adds complexity to insurance verification and billing. Before seeing any out-of-state client, consider these factors.

Malpractice Coverage: Contact your malpractice carrier to confirm your policy covers telehealth across state lines. Some policies have geographic limitations or require endorsements for multi-state practice. Do not assume coverage extends automatically.

Health Insurance Verification: The client's health insurance may have different benefits or network status depending on where services are delivered. An in-network provider in California might be out-of-network for the same insurance plan when the client receives services in Texas.

Billing Address Considerations: Some payers require the service location on claims. Understand your payer's requirements for documenting where telehealth services were rendered.

State-Specific Rules: Some states have telehealth parity laws requiring insurers to cover telehealth the same as in-person services. Others have more restrictive policies. Research both your state and the client's state.

When You Cannot See the Client

Sometimes the answer is no. If your client is traveling to or relocating to a state where you have no authorization to practice, and no exceptions apply, you must decline to provide services while they are in that state.

This is hard. It disrupts treatment. It frustrates clients. But the alternative - practicing without authorization - puts your license, your livelihood, and ultimately your client at risk.

Handling Care Transitions

When you cannot continue care, help your client prepare. Provide referrals to licensed providers in their new location. Offer to share records with the new provider if the client consents. Schedule a termination session before they leave if possible. Discuss whether services can resume when they return to a state where you can practice.

Document your reasoning for discontinuing services and the steps you took to facilitate a smooth transition. This protects both you and the client.

Frequently Asked Questions

Quick Reference Resources

Bookmark these resources for checking interstate telehealth regulations: