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.
Providers should comply with all relevant laws and regulations in their and their client's location(s). This article shouldn’t be taken as legal advice or as a substitute for consulting with your state board or a qualified attorney.
Please note that at this time therapists cannot live outside of the US or in a US territory while practicing with Rula.
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.
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. Rula has providers in all 50 states and 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.
Client traveling internationally
While we understand the desire to provide continuity of care, Rula strongly discourages conducting sessions with clients who are physically located outside of the United States. Providing international teletherapy introduces significant risks that often outweigh the clinical benefits:
Non-Reimbursement: Most insurance payers will not reimburse for services rendered to a client located outside of the U.S. Sessions conducted internationally may result in denied claims and loss of payment.
Legal & Licensure Risks: A U.S. license does not grant the right to practice in a foreign country. You are responsible for navigating the local laws of the client’s current location; practicing without authorization in a foreign jurisdiction can result in legal action or board disciplinary measures.
Malpractice Coverage: Most professional liability policies explicitly exclude coverage for services provided to clients outside of the U.S. and its territories.
Crisis & Safety Limitations: In the event of a clinical emergency (e.g., suicidal ideation), you will likely be unable to coordinate with local emergency services or utilize U.S.-based involuntary hospitalization protocols, leaving both you and the client at high risk.
If a client is traveling internationally, it is best practice to pause care for the duration of their trip. If the client experiences a high-stress situation or crisis while abroad, you should provide them with global crisis resources, such as those offered by the International Association for Suicide Prevention.
Therapist traveling internationally
Rula prohibits providers from rendering services while physically located outside of the United States or its territories, even temporarily. Insurance companies will not pay claims in which services are rendered by a therapist who is outside of the United States.
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.
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