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.

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(Originally published July 2022, updated September 2023)

If you’re a psychologist in a member state, PSYPACT authorization provides an excellent opportunity to have a multi-state practice. However, 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, and they 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.

It is important to understand that the rules of PSYPACT only override state laws pertaining to the inter-jurisdictional practice of telepsychology and temporary in-person, face-to-face practice. Psychologists work within the scope of practice defined by the State Psychology Regulatory Authority of the “receiving state,” the state where a telepsychology patient is located, or the “distant state,” the state where a psychologist is providing temporary in-person services. 

Additionally, a psychologist must follow a receiving or distant state’s state law to protect the health and safety of its citizens. These laws may include laws governing abuse reporting, informed consent, disclosure of risk, and standards for involuntary commitment. 

With that said, only the psychologist’s home state may take disciplinary action against a license. Typically, states don’t 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, PSYPACT allows a receiving or distant state to take action against your ability 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 multiple PSYPACT states and is practicing temporary in-person psychotherapy. In that case, the home state can be any PSYPACT state where the psychologist has a license.

Understanding which laws apply is crucial, especially when state laws conflict. For example, Nevada and Illinois 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 Nevada treating Illinois patients via telehealth, which law must you follow?

The short answer: Illinois. According to PSYPACT, a psychologist providing therapy via telehealth has the authority to provide psychology services under their home state license. However, even if you are licensed in Nevada and provide telepsychology out of your house in Nevada, you would practice under the scope of practice of the State Psychology Regulatory Authority for Illinois. Additionally, you would need to comply with Illinois’ State Law to Protect the Health and Safety of its Citizens. Notably, this means that you would need to familiarize yourself with Illinois law, including, for example, the duty to warn requirement mentioned above. 

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.

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