Licensure for behavioral health
To increase access to care, states are creating new pathways for out-of-state providers to practice, including for behavioral health and prescribing of medications online.
Overview of behavioral health licensure
Telehealth has played a major role in meeting the need for behavioral health services. According to the National Institutes of Health (NIH) National Institute of Mental Health, telebehavioral health can be effective for many people, including, but not limited to those with attention-deficit/hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), depression, anxiety, as well as substance use disorders (SUD), such as opioid addiction.
Licensure requirements
Telehealth registration and other flexible cross-state licensure requirements may vary. These include:
- Definitions of telehealth, telemedicine, and what types of telehealth services can be provided.
- Requirements for in-person visits, including an initial in-person visit to establish a provider-patient relationship, and ongoing in-person visit requirements.
- Online prescribing of medications, including controlled substances and noncontrolled substances.
Did you know?
Specialty organizations have outlined guidelines and best practices regarding licensure, including for telehealth services.
Check with the national association for your specialty area to find out more information.
Emergency situations
All providers, regardless of their clinical specialty, should establish and maintain an emergency plan that outlines how to respond to emergency situations or complications following a telehealth appointment. The emergency plan is especially essential for out-of-state providers practicing telehealth. Licensing boards and associations across practice areas provide guidance for emergency plans to ensure there is a referral process for the patient to obtain appropriate care, such as a referral to the emergency department or another provider. Each patient situation should be evaluated on an individual basis.
An emergency plan also supports continuity of care for patients treated through telehealth by an out-of-state provider. If an out-of-state provider is unable to continue providing medical care to a patient, then adequate notice to the patient and arrangements for continued care should be established. Abruptly ending care, even if delivered through telehealth from a different state than where the patient is located, may be considered neglect of a patient if reasonable steps are not taken to ensure continuity of care.
How do state licensure boards regulate health professionals after issuing a license?
State licensure boards can suspend or revoke licenses, including for telehealth services and registration, in order to protect the public and ensure patient safety.
Disciplinary action against one’s license varies by practice areas. For example: physicians and psychologists (PDF) have different approaches.
State licensure requirements for behavioral health professionals
A range of providers deliver behavioral health care, including telebehavioral health. This care may be provided by physicians (especially, psychiatrists), psychologists, nurses, social workers, counselors, and therapists. There are different state licensing boards based on their profession.
Resources for telebehavioral health licensure requirements
The Telebehavioral Health Center of Excellence tracks the telebehavioral health laws and regulations in all 50 states and Washington D.C. The telebehavioral health database provides detailed information on licensure and regulations by state for each clinical specialty.
The Best Practice Guide on Telehealth for Behavioral Health Care covers legal considerations, billing, operational strategies, and other issues for providers to consider when delivering telebehavioral health services.
The general rule regarding licensure requirements for telehealth services, including telebehavioral health, is for providers to meet the licensure requirements of the state where they are licensed and any licensure requirements of the state where the patient is physically located at the time of the telehealth appointment. Before providing telebehavioral health services, providers should check:
- State licensing board where the provider is located;
- State licensing board where the patient is located;
- Malpractice/professional liability insurance; and
- Reimbursement from payor, including private insurance, Medicare, and Medicaid.
Resources for telebehavioral health and substance use disorders
The Substance Abuse and Mental Health Services Administration offers educational and technical assistance content, including a guide on telehealth for the treatment of serious mental illness and substance use disorders.
The NIH National Institute on Alcohol Abuse and Alcoholism, has developed a navigator for providers and patients to identify telehealth and online options for alcohol treatment.
Licensure and online prescribing
In most states, a patient-provider relationship must be established in order to write a prescription. There is variation across states in how a patient-provider relationship is established.
Some states recognize a telehealth visit can establish a patient-provider relationship. States may require additional steps or outline restrictions for prescribing medications online.
Federal law limits the prescribing of controlled substances via telehealth. The prescribing of controlled substances is overseen by the U.S. Drug Enforcement Agency, which has issued guidance on this topic. Providers must comply with federal law, state laws where they are licensed, and the state where the provider is prescribing medications online. The federal law called the Ryan Haight Online Pharmacy Consumer Protect Act of 2008 (PDF) requires at least one in-person medical evaluation prior to issuing a controlled substance in a telehealth appointment, with limited exceptions.
Resource
See the Center for Connected Health Policy (CCHP) interactive map on online prescribing for all 50 states, Washington D.C., and territories.