As the world of telehealth continues to evolve and respond to client's needs, the legislative landscape around practicing across state lines continues to evolve, too. Currently, out-of-state care is one place where the realities of practice and licensure diverge from what therapists may consider to be in the best interest of their clients.
Rula celebrates the fact that many therapists in our network care passionately about the continuity of their clients’ mental healthcare and want to support them as they engage in travel and/or temporary/permanent moves. Rula continues to monitor legislation that impacts out-of-state care, and we encourage providers to stay up-to-date on any changes that could affect their professional licenses.
Therapist residency requirements for Blue Cross in GA, NC, and CA
- In California therapists must physically be in the state they’re practicing in
- In North Carolina and Florida all providers (including psychiatric practitioners) must be located in the state they’re practicing in
- In Georgia, providers no longer need to physically be in the state they’re practicing in.
Therapist traveling out of state
It’s generally not a problem for you to continue to see clients through Rula when you are out of state. Your license covers you practicing in a particular state even if you are not located there.
Therapist traveling internationally
AdvancedMD states that its platform works internationally. However, we cannot guarantee it will work in all situations and it could cause confusion, especially considering appointment time zone challenges. It is allowable, especially in countries that have no governing body over the counseling profession.
If you or your client are going to be out of the country, please tread cautiously in these situations and be sure to test out the platform and your connection before an actual appointment.
Client traveling out of state
We recommend this process if you and your client are interested in continuing care across state lines. As this process can take some time,
We encourage you to engage in this process weeks before the anticipated travel dates:
- Consult with your board of licensure about practicing across state lines.
- Consult with the destination state’s board of licensure about practicing in their state.
- Consult with your malpractice/liability insurance about practicing across state lines.
- Document this research in a blank note in the patient chart.
- Based on these discussions, share your findings with the client to determine the plan of care moving forward.
If you choose to proceed with practice across state lines, please note that this is currently considered to be a risk, given potential liability concerns should an adverse event occur. We would highly recommend that you consider developing a safety plan with the client and including relevant resources in the state, should a crisis or other adverse event occur, as well as documenting other ways you have worked to mitigate risk for the client. It is also recommended to document why continuing care with you across state lines is more advantageous than transitioning to in-state care with a new care team.
If the patient moves to a state where Rula has a contract for services, we can arrange for the patient to be rematched with an approved therapist in the Rula network.
Finally, it’s important for both you and the patient to know that when a patient moves to a new state, they will need a new health plan for that state. Our contracts with commercial payors do not cover claims for out-of-state residents, so we do not allow this practice beyond a 30-day window. In addition, our EHR is programmed to be state-specific. For example, a provider in CA only sees the record elements required in CA.
Client traveling internationally
As stated above, it is advised to check with the licensing board of your profession and your malpractice carrier before conducting sessions with a client who is traveling for a short time period. Clinical issues and patient welfare should also be considered.
For example, will the time difference make treatment inconvenient? Will cultural issues be an important factor? Are there skilled therapists in the country where the client is living? What are the local resources available if the client were in crisis and needed emergency services? In addition, there may be specific patient data privacy requirements that must be followed in that country.
We have to toe the line between legal, ethical, and clinical decision-making here:
- Legally, check with the licensing boards.
- Ethically, it may be the right thing to do for the patient who needs care despite being out of town (especially in a crisis situation).
- Clinically, it may be the right thing to do to maintain continuity of care (esp. since some folks have high stress/increased symptoms when out of town/family visits, etc. that absolutely warrant a session)
Client has permanently moved out of state or country
For a permanent move, the client should get connected with a new therapist in their state or the new country.