Out-of-state care

Practicing across state lines has a lot of variation and lack of clarity for a one size fits all response.  There are often not clear yes or no answers, as you can see from this APA article on the topic.  Answers also vary quite a bit depending on where you are licensed and the state where the client is physically located. 
Although rare, some payors require the patient to be physically present in the state where they are insured to receive mental health coverage. This is something the client may want to check with their carrier. Ultimately, the decision needs to be made by the practitioner who is taking on the risk in regard to their license.  If a complaint arises, a licensing board could find that you are practicing without a license in the state (or country) where the client is located. 

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 psych clinicians) 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 to practice 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

If the client is traveling within the United States for a short period, under 30 days, it is typically fine to continue to see the client as usual. Rula's legal team has advised that the risk is considered very low when it is less than 30 days. However, you should always check with the licensing board for your profession in your state and the state where the patient will be to see what is allowable.

It is also advised to check with your malpractice carrier as well to be sure you are covered for providing services in a state outside where you are licensed.  If it would be in the best interest of your client to remain under your care during the transition or temporary gap, you have the option to continue treatment, however, this decision is at your discretion.

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 to be in crisis and need 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:  

  1. Legally, check with the licensing boards.
  2. Legally, risk is very low because your client would have to report you to the licensing board (they have zero incentive to do that)
  3. Ethically, it is the right thing to do for the patient who needs care despite being out of town (especially in a crisis situation).
  4. Clinically, it is the right thing to do to maintain continuity of care (esp. since some folks have high stress/increase symptoms when out of town/family visits, etc. that absolutely warrant a session)


Client has permanently moved out of state or country

Generally speaking, if a client moves and you would like to continue to see them for 30 days for continuity of care until they can transition to a local therapist, that's a very low-risk situation. It is usually fine and would be considered ethical practice in the best interest of the client.  However, for a permanent move, the client should get connected with a new therapist in their state or the new country.  


It's important 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 the 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. Thus, there is a risk that documentation requirements are not being met.  


Our legal team has advised that the initial 30 days after a move or for a trip is fine and low risk to the therapist or to Rula's claims, but beyond that, it is not allowed with Rula due to the insurance coverage change.  


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. There are Rula contracted licensed therapists in CA, TX, OH, IL, VA, NC, GA, HI, FL and NY.  


There may be times when you make an arrangement to continue to see the patient privately after an out-of-state move. There are licensing boards that may allow practicing across state lines (you would have to contact each state to inquire and would be required to follow state laws in your own state as well as the state where the patient is residing). Therapists are also advised to check with their malpractice coverage to see if out-of-state practice is covered. 


Client relocates for college

If your client relocates for college, but keeps their home address as their primary residence commercial payors recognize the client’s “home” address as their permanent address.  Thus, in most cases an individual who is out of state for college is fine to continue to see as their coverage plan and address remains the same. 

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