Providing telehealth therapy services over the Internet can expand your business and be rewarding, too. Telehealth can fit into your clients’ busy schedules so that they can obtain care that they might not otherwise have access to. Since the COVID-19 pandemic, people have become accustomed to remote meetings and appointments, and new programs have emerged to increase access to care, including Medicare mental telehealth coverage and authorization for telehealth prescribing of many controlled substances. Numerous states have also made it easier to practice psychiatry, psychology, and nursing across state lines, by way of interstate license compacts, which we will explore in this article. For providers who live in compact license states, telehealth may present a new opportunity to expand their reach.

Understanding Compact License States

Interstate or multistate licensure compacts are agreements between states to allow practitioners to practice in other states that are members of the compact. Compacts are organized by discipline, such as nursing or psychology. Most compacts require application fees and standardized criteria, and some confer automatic reciprocity with all member states, whereas others simplify and streamline the process to apply for licensure from individual states. It is important to know the rules for your field of practice and state of residence, and to keep up with new developments in interstate compacts, as the field is rapidly expanding.

Most compacts require you to have a home state of licensure where you also reside, and you may be required to be physically located in that state while practicing (e.g., for PSYPACT). Your clients must be located in a compact member state during each appointment, and you must be licensed in the client’s state if the compact does not confer automatic reciprocity (e.g., IMLC).

Currently, interstate compacts are operational for physicians (including psychiatrists), psychologists, and nurses (RNs and LPNs only). In late 2024 and beyond, compacts for counselors, social workers, APRNs, and audiologists and speech-language pathologists are expected to come into force. We will explore the operational and emerging compacts in the next section.

Navigating the Interstate Compact Landscape

In this section, we will discuss the details of several key interstate compacts with relevance to behavioral health, and mention applicability to the most populous states. As the details are frequently changing, please check the compact websites and the website of your home state’s licensing board to learn the latest developments.

Interstate Medical Licensure Compact (IMLC):

The IMLC is for physicians, which includes psychiatrists, and covers 40 compact license states and 2 territories (D.C. and Guam), including Florida (implementation in process) and Texas. The IMLC simplifies and streamlines licensure applications to individual member states and requires a $700 fee plus licensure fees in each state, so most physicians select only a small number of states to practice in.

Physicians must have an unrestricted medical license in their home state (“State of Principal License,” or SPL), and once they are issued licenses in other states, renewals are handled through each state’s board of medicine—not the IMLC. About 80% of U.S. physicians are eligible. Notably, California does not participate.

Nurse Licensure Compact (NLC):

The NLC is for registered nurses (RNs) and licensed practical nurses (LPNs), and covers 41 jurisdictions, including Florida and Texas. Expansion legislation is also pending in California, New York, and several other states. The NLC is reciprocal and usually automatic, which means that if you are a licensed RN or LPN in your home state (“Primary State of Residence,” or PSOR), you can automatically practice in other member states with no additional applications or fees (but, verify with your state’s board of nursing and Nursys.com). The NLC likens it to a driver’s license. Although RNs and LPNs are included, advanced practice registered nurses (APRNs) are not. An APRN Compact is in the works but has only been passed by Utah and the Dakotas as of May 2024.

Psychology Interjurisdictional Compact (PSYPACT):

This compact is for psychologists with full, unrestricted licenses based off doctoral-level degrees in a member state. PSYPACT is effective in 38 states and 2 territories (D.C. and Northern Mariana Islands), including Florida and Texas. Legislation has also been introduced in California and New York. The PSYPACT Commission offers a telehealth practice pathway and a temporary face-to-face pathway, each with different requirements. A separate application is required to the Association of State and Provincial Psychology Boards (ASPPB), for either an “E.Passport” (telehealth option) or certificate (temporary/face-to-face option). The E.Passport must be renewed annually and has continuing education requirements. Once licensed, the psychologist can provide telehealth services to clients in any member state, but the psychologist must be physically present in their home state during all telehealth services.

Compact License States: Other Upcoming Interstate Compacts:

Interstate compacts offer exciting opportunities for practitioners and patients, and there are many more under development. These include the Counseling Compact, which is authorized in 35 compact license states and expects to start taking applications in late 2024; the Social Work Licensure Compact, which is authorized in 17 states and expects to start issuing multistate licenses in 2025 or 2026; the Audiology & Speech-Language Pathology Interstate Compact (ASLP-IC), which is authorized in 31 states and expects to start taking applications by early 2025; and the ARPN Compact, which is authorized in 3 states.

How to Check if Your State Participates

Make sure to carefully examine the compact license states’ websites from the previous section. Pay particular attention to the frequently asked questions (FAQs) pages to ensure your compliance with compact requirements. Also, be sure to review your home state’s rules for participating in compacts, which can be found on your state’s licensing board website, and don’t be afraid to reach out to the compact organization and state licensing board with specific questions

To see if your state participates, review the maps and details on the compact’s website, as well as state websites and news articles. Sometimes, implementation of legislation in your state may be delayed, which should be noted on maps or webpages. Also, seek out information on which laws, regulations, and jurisdictions you will be accountable to when practicing telehealth for clients in your chosen states.

Conclusion

States’ needs for licensed practitioners along with the emerging sophistication and flexibility offered by remote telehealth services has resulted in an explosion of interstate compacts, as we have detailed above. This could help you increase your client base and expand access to behavioral health services in states that don’t have enough providers. Along with the opportunities presented by interstate compacts, using a robust and accessible telehealth software platform can help you serve new clients in an effective, secure, and convenient manner.