License mobility allows greater public access

Several NE states participate in PsyPact

As a psychologist in New England, I recently learned that I have the option of applying for an EPassport and Authority to Practice Interjurisdictional Telepsychology (APIT), authorizations accepted in PsyPact participating states.

PsyPact is an interstate compact that allows psychologists to practice telepsychology with clients living in PsyPact participating states. Maine, New Hampshire, and Connecticut have enacted legislation and Rhode Island has recently joined, with laws that become effective in January 2023.

Massachusetts has active legislation but has not enacted PsyPact.  Vermont has introduced PsyPact but the bill was not taken up by the legislature in 2022.  In total, 32 states have enacted PsyPact legislation.

The idea of being able to practice telepsychology without fear of violating state laws appeals to me!  New England is a relatively small region, a bit more than 70,000 square miles. Clients in border states often seek care from providers across state lines.  The proliferation of tele-mental health has given rise to increasing numbers of clients such as college and university students, who need continuity of care from a psychologist in a different state.

There are numerous benefits of telepsychology. Clients who might have otherwise not sought care because of perceived stigma, severe anxiety, or scheduling difficulties are more easily able to access mental health treatment.

It is not uniformly optimal. Technical problems crop up and some patients are clearly more distracted in a remote setting.  A few commercial insurance carriers have set copayments at higher rates for in person visits, compared to telehealth, making it more than a little challenging for practitioners in independent practice.

I prefer a mix of face-to-face and telepsychology clients, but it is hard to argue with the reduced overhead cost of an exclusively telehealth practice.

If living in one of the four New England states that participate in PsycPact, should you apply for the two credentials, an EPassport and APIT?  There is also the option to apply for authorization to temporarily practice face-to-face psychology in a different PsyPact participating state.

The idea of decamping to a vacation home in Maine is so appealing and if I had this option, the temporary face-to-face practice credential would be helpful! But alas, this is not the case and so I applied only for the telepsychology authorization.

I began the process of completing the electronic application in October. The initial application was straightforward, though not inexpensive. The initial EPassport fee is $400 with an annual renewal of $100 and the onetime APIT fee is $40. To complete the application, I requested my transcripts be sent.

Two months later, my transcripts had still not arrived. I made a second request and received an apologetic note from the registrar’s office letting me know that the request had been delayed because my file was “still in the paper archives.” Ouch. Such are perils of graduating before the dawn of the internet, let alone cloud-based data storage.

National license mobility allows for greater access to mental health for the public. Addiction, autism, pain, and psycho-oncology are examples of subspeciality psychological treatments that are inaccessible to many people.

Importantly, the Center for Medicare and Medicaid (CMS) recognizes authorization under the Psychology Interstate Compact. Commercial insurance carriers and other third-party payers should be contacted ahead, to determine coverage.

Psychologists are required to be aware of and abide by the laws of the recipient state as well as their home state, including but not limited to, the requirement to maintain liability coverage in the state into which the services are provided. The degree to which this will impact on the cost of malpractice insurance is unclear.

National license mobility will certainly change the job outlook for psychologists.  Job advertisements have begun to note the requirement of licensure in a PsyPact state. Though PsyPact would seem to be beneficial to the public health, it also undoubtedly could be exploited. On a whim, I ran a quick internet search on “concierge psychology” and sure enough, found multiple pricey psychology group practices noting that they offer telehealth therapy in PsyPact participating states.

As of this writing, I await the completion of the formal review process of my EPassport and APIC applications.  Do you have experience with PsyPact?  Share your thoughts with other New England psychologists in the comments section that follows the online version of this article.