VT bill targets mental healthcare in interstate counseling compact

In mid-March, Vermont’s House of Representatives passed a bill that would make practicing across state lines a lot easier for licensed mental health professionals. The bill outlines allowances for licensed professionals in Vermont to practice in other states and out-of-state licensed professionals to practice in Vermont.

Should the legislation pass, Vermont would join New Hampshire and Maine along with 15 other states in the Interstate Counseling Compact. Compact licenses would then be available by late 2023 or early 2024.

The need for mental healthcare has skyrocketed over the past few years.

During the pandemic with lockdowns, social distancing and high illness rates, telehealth became a necessity.

Patients continue to have a difficult time getting appointments. Often, scheduling an appointment can take six or more months. Additionally, a nationwide shortage in mental healthcare professionals exists, compounding the problem.

According to Lauren Layman, the bill was prompted by the increase in need for mental healthcare during the pandemic as well as the shortage of professionals. She emphasized those factors make it necessary for Vermont to find ways to fill in the gaps.

Layman is general counsel for the Vermont Secretary of State’s Office of Professional Regulation (OPR). She said, “The pandemic certainly amplified the need for all compacts for the continuity of care. During the pandemic, people were moving around. Patients wanted to stay with their provider which meant providers had to practice across state lines.”

Layman has been closely involved in trying to get Vermont on board with the counseling compact. A compact is a voluntary agreement between states and Vermont already has one for medical professionals such as nurses. The counseling compact would only cover licensed doctorate-level psychologists. A compact for other mental healthcare professionals like social workers is currently being drafted.

Some critics, in particular the state’s Joint Fiscal Office, have said the state will take a financial hit if not enough mental health professionals pay licensing and application fees.

According to a statement from that office, “… Entering the compact would result in an estimated revenue reduction of approximately $50,800 from the loss of licensing fees and $4,000 from the loss of application fees from out-of-state applicants from compact states in Fiscal Year 2025.”

Since the license renewal with a fee of $200 takes place every other year in January, any fiscal reduction wouldn’t take place until 2025. Vermont’s nursing compact was up for renewal at the end of March and it is still being worked out how much of a financial hit the state will incur.

Estimates indicate it could be 25 to 30 percent. As Lauren Hibbert, former OPR director and currently the deputy secretary of state, explained in the House Committee on Healthcare meeting in January, joining a compact has a monetary impact.

“Every profession has an application fee and a renewal fee,” she explained. “The OPR budget is a special fund so that means we do not receive any general fund money. Before there’s a compact, that professional needs to get a license in Vermont and that means a fee in Vermont and a fee that’s paid to OPR. So, it does have a revenue impact on Vermont to join a compact.”

Layman, who presented to the House Committee on Healthcare with Hibbert, noted, “We don’t want to sacrifice policy for money, but by the same token, we need to be aware of the costs,” she said. “We’ve seen other compacts in which the only people who get state licenses are the ones who live and work here.”

One of the benefits of interstate compacts is alleviating any interruption in healthcare for patients. In some cases, particularly in chilly Vermont, you have “snowbirds” who head down to Florida until the ice melts.

With telehealth, those patients can still be connected with their doctor despite being in a different state for a lengthy period of time. It also has the potential to quell the worker shortage. With out-of-state professionals able to practice in Vermont as part of the compact, they can fill a void left by a shortage in the workforce. Layman, however, was a little skeptical.

“It remains to be seen if there’s a long-term impact,” she said. “It could fill a gap in providers, but we’re not going to get more psychologists simply because we have a compact. It’s limited in what it allows. We will need special studies to see if access improves.”

This bill is currently under review in the state Senate. If approved in the current session, it most likely would be implemented next summer.