Once one establishes the general laws and regulations that guide their practice, one of the biggest questions among videoconferencing providers is the notion of cross-state work. Can one legally practice across states? The short answer is yes, but there are many caveats to this answer. For those providers only seeking brief, short-term services (< 30 days) for a patient outside of the provider’s state of license, most states within the United States have adopted a temporary cross-state practice protocol, with such information found by either calling the licensing board, or finding the information on their respective websites (Campbell & Norcross, 2018). Alternatively, for those providers who will be conducting services with patients on an ongoing basis (i.e., >30 days), with the exception of specific governmental organizations that are subject to their own cross-state regulations (e.g., Veteran’s Affairs, Indian Health Services, Department of Defense; Luxton et al., 2016, chap. 3), best practice suggests one of two primary options: multiple licenses or joining an interjurisdictional compact.
The first primary option for legal cross-state practice involves the provider becoming licensed in all states in which they provide services. This means that if they are physically living in Illinois, but are providing services to patients in Illinois, Ohio, Texas, and Florida, the safest means of ensuring cross-state practice is securing licenses to practice in Illinois, Ohio, Texas, and Florida. In becoming licensed, the provider learns about the laws and regulations of each specific state. This becomes especially important when one considers that each of the states may have different regulations related to mandated reporting, emergency situations (e.g., involuntarily hospitalization), and red flag laws (i.e., a court can temporarily remove firearms from an individual). While becoming licensed in each state of practice may be a safe strategy, this approach could become costly both financially and in terms of time.
The second primary option for legal cross-state practice involves the provider becoming enrolled in a compact. To put it simply, a compact is a legal agreement between states that sign the compact into law. Any provider who is accepted as a member of the compact is under the compact’s rules. Thus, a provider of the compact can practice across all states that are legally part of the compact without having to get individual licenses for each of the states. While some mental health organizations have introduced legislation (e.g., АСА Interstate Compact created by the National Center for Interstate Compacts and the Council of State Governments; Meyers, 2020), to date, one of the only fully implemented mental health-focused compacts uniquely applies to psychologists. The Psychological Interjurisdictional Compact, or PSYPACT (www.psypact.org/), was spearheaded by the Association of State and Provincial Psychology Boards (ASPPB), and formally introduced in February 2015. PS YPACT required seven states to enter the pact into law before it could be considered operational. As of its launch in July 2020, 15 states have enacted PSYPACT (i.e., Arizona, Colorado, Delaware, Georgia, Illinois, Missouri, Nebraska, New Hampshire, Nevada, Oklahoma, Texas Utah, Pennsylvania, Virginia, North Carolina), with 13 more locations having introduced legislation (i.e., Alabama, District of Columbia, Hawaii, Iowa, Kentucky, Michigan, Minnesota, New Jersey, Ohio, Rhode Island, Tennessee, Washington, West Virginia). Updates of legislative changes can be found at the PSYPACT website (https://psypact.org/page/psypactmap). PSYPACT created a means of cross-state practice through an Authority to Practice Interjurisdictional Telepsychology (APIT), which requires an active ASPPB E.Passport (ASPPB, 2016). To facilitate provider mobility, the PSYPACT states communicate and exchange information related to verification of licenses, necessary demographic information, and details of any disciplinary actions taken against the provider.
Per related ASPPB and PSYPACT documentation (ASPPB, 2020), to be eligible for an E.Passport, a provider must have an active license based on a doctoral degree in at least one PSYPACT state, with no disciplinary action listed against their license. Their degree must be from an APA or Canadian Psychological Association (CPA) accredited program, designated as a psychology program by the ASPPB/National Register Joint Designation Committee at the time of conferral, or deemed to be equivalent. The provider must have also successfully passed the Examination for Professional Practice in Psychology (EPPP). Finally, the program will require annual renewal with at least three hours of CE relevant to the use of technology in psychological practice. Assuming maintenance of qualification, the E. Passport is considered unlimited in time. Of important note, the provider will be subject to the scope of practice of the receiving state (i.e., originating site), which is the PSYPACT participating state where the patient is physically located when the services are delivered.
The Identification of Minimal Contact
Whether securing multiple licenses or joining a compact, knowledge of state regulations for cross-state work is important for two primary reasons. First, and most obvious, if a provider does not follow the regulations (e.g., licensing), they may be practicing illegally. Second, and equally as important, regardless of the license type, a provider may still be held liable in both the state that they are physically in (i.e., distant site), and the state of the patient (i.e., originating site) should an issue occur. For example, some have documented that attorney generals for many states have claimed jurisdiction even if the provider is from outside of the state (Koocher & Morray, 2000). Jurisdiction claims can be based on what some have termed “minimal contact.” More specifically, a court may apply jurisdiction over a defendant who has no physical presence in a state as long as the defendant has engaged in purposeful actions in the state (Gupta & Sao, 2011; Kramer et al., 2013). Some have argued that videoconferencing providers who remotely diagnose and/or treat patients from another state are in fact establishing a minimal contact for the purposes of jurisdiction (Gupta & Sao, 2011).