I’m Operating a Multi-State Psychology Practice Under PSYPACT. Which State’s Laws Do I Need to Follow?

PSYPACT opens up opportunities for psychologists who want to practice across state lines. But what happens when the laws between states conflict? We discuss some rules of thumb.

If you’re a psychologist in a member state, PSYPACT authorization provides an excellent opportunity to have a multi-state practice. But seeing clients located in several different states demands a new understanding of the laws that guide your practice. For instance, say you have PSYPACT authorization and run a virtual practice from your home in Texas. You accept clients from a multitude of states. Does Texas law apply to your treatment? What about the law where the client lives?

What is PSYPACT?

Before understanding how PSYPACT affects state law, it is helpful to understand what PSYPACT is. PSYPACT is a cooperative agreement that allows licensed psychologists to practice across different states. However, it only applies to licensed psychologists. If you’re another type of mental health professional, it doesn’t apply to you.

States must enact legislation to become a member state of PSYPACT. The rules apply only to states that enact PSYPACT legislation. They also supersede any state laws that cover the inter-jurisdictional practice of telepsychology and temporary in-person practice. To regulate psychologists’ activity across member states, PSYPACT states share information on licensure verification and professional disciplinary sanctions.

How PSYPACT Works

If you’re a licensed psychologist in a member state, PSYPACT can help you expand your business. But how does it work?

Essentially, psychologists in member states can obtain authorization from the PSYPACT organization to practice in limited circumstances without obtaining separate licenses in each of those states. “Limited circumstances” means that you can only provide services across state lines via telepsychology or temporary face-to-face practice. PSYPACT does not replace licensure if you’re planning to practice using an indefinite cross-border, face-to-face model.

Once you have PSYPACT authorization, the applicable laws depend on your “home state” — the state where you, the psychologist, have a license to practice. Under PSYPACT legislation, regulatory authority rests with the home state for each psychologist. 

Moreover, only the psychologist’s home state may take disciplinary actions against a license. Usually, states may not have the authority to impose discipline on their licensed psychologists for practice outside state boundaries. However, PSYPACT allows the home state to impose discipline regarding the practice in other states.  

While the disciplinary authority rests with the home state, other states you practice in also have the power to take adverse action against you. PSYPACT allows non-home states to take action against your authority to practice under PSYPACT in that state, potentially limiting your participation.

What Happens if You’re Licensed in More Than One State?

Say that a psychologist has licenses in more than one PSYPACT state and is doing telepsychotherapy. In this case, the PSYPACT state where the psychologist is physically present during the telepsychotherapy session serves as the “Home State” for purposes of regulation. However, suppose the psychologist is licensed in more than one PSYPACT state and is practicing temporary in-person psychotherapy. In that case, the home state can be any PSYPACT state where the psychologist has a license.

In short, determining which state’s laws to follow can get complicated and will depend on the method of practice.

But understanding which laws apply is crucial, especially when state laws conflict. For example, Illinois and Nevada are both members of PSYPACT. Illinois has a duty to warn requirement for psychologists whose patients communicate a serious threat of physical violence against a reasonably identifiable victim or set of victims. Meanwhile, Nevada doesn’t have this requirement. So, if you’re a psychologist in Illinois treating Nevada patients via telehealth, which law must you follow?

The answer: It depends. According to PSYPACT, a psychologist providing therapy via telehealth should follow the laws and rules of their home state. Thus, if you’re licensed in Illinois and provide telepsychology out of your house in Illinois, Illinois laws and rules apply. This goes against the custom that the patient’s location controls the guidelines for practice. However, it sets one standard home location for multi-state practice. It also means that in the example above, the patient in Nevada might be unfamiliar with the laws, such as a duty to warn, that apply to the relationship.

In contrast, a psychologist providing temporary in-person care must adhere to the laws of the “distant state” where they are temporarily practicing — that is, the physical location of the session. For example, if you have a license in Wisconsin but travel across the border to temporarily see a patient in Illinois, Illinois law applies.

Still, PSYPACT applicants must acknowledge that they “will practice within the specified legal requirements of [their] Home State and all other Receiving States, including but not limited to any requirement to have liability insurance in the state into which the services are being provided.” Additionally, PSYPACT applicants agree that when laws might conflict, they will inform the client of all significant conflicts that could adversely impact the professional services that they will provide, with emphasis on any limits to confidentiality, privilege, and duties to report.

Practical Steps For Treating Patients Under PSYPACT

You’re probably wondering, “How do I handle these guidelines?” Multi-state practice can be confusing. The bottom line is that regulations vary for psychologists throughout the state. To best treat your clients:

• Know your licensing state’s laws and regulations.
• Become familiar with the laws of all the states in which you practice. You may have conflicting duties to clients and thus need to be aware of where potential conflicts or gray areas exist.
• Communicate your obligations, potential state law conflicts, and applicable state laws to clients at the start of the psychologist-client relationship, such as through intake forms and informed consent conversations.
• If you want to practice beyond either temporary, in-person practice or telepsychology, PSYPACT won’t apply. Instead, you will need to obtain a license in the patient’s state.

PSYPACT can be a beneficial tool for helping build a multi-state psychology practice. But those who participate must pay close attention to the obligations that arise. If you’re setting up a multi-state practice and want to understand how to meet your obligations, a healthcare attorney can help. If you operate in one of the states where we have licensed attorneys, reach out to us for a free consultation.

This blog is made for educational purposes and is not intended to be specific legal advice to any particular person. It does not create an attorney-client relationship between our firm and the reader. It should not be used as a substitute for competent legal advice from a licensed attorney in your jurisdiction.