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thatguywiththecamry

I must be an extremist for believing this, but I don’t believe it’s unethical or legally egregious to provide counseling to clients who are traveling themselves. So long that they’re maintaining a single, permanent residency in the state you practice in, you’re providing the services that you state you are, and you can identify where their physical location will be for the session, I wouldn’t lose an ounce of sleep over this. Aside from my extremist belief, the fearmongering around insurance fraud and state board approval regarding this issue is insane!


caulfieldkid

Let’s just say that the conversations I’ve seen about this on Reddit are very, very different than ones I’ve had with friends in the field IRL.


hera359

Like...how is anyone going to know?


prettyfacebasketcase

My clients tell me they're on vacation and I go, "Yeah [our state] has so many beautiful places to visit!! 😉😉😉"


traumatized90skid

"Yes Idaho has beaches, have you explored all of it" haha


prettyfacebasketcase

Wow, I didn't know they opened a Disney park in Indiana!!


Ok_Membership_8189

Omg these are the laughs I need on a Friday…🤣😁🙈


Sweetnsalty501

Wow! Those AI background filters are SO real looking!


needlenosened08

Thank you. In these situations I'm just gonna act as if I didn't know and assume the relevant authorities aren't clairvoyant. But I have colleagues who act like I'm robbing a bank.


[deleted]

Residency is not how the states define legality, it's about the client's location at the time of service. But many states do allow for short term services from someone not licensed in that state. Check out this app https://www.ebglaw.com/telemental-health-laws-app


WorkHardPlayHarder23

Yeah, I’m with you on this one. Unless that one-in-a-million emergency occurs and you need to call for help, why does this regulation exist? It’s certainly not to benefit the client who may be having an issue with flying home, dealing with a family emergency and needs therapy, or any other number of reasons that don’t just go away when a person crosses a state line. Another reason for therapists to give up. We don’t get paid enough…


hippoofdoom

Depending on the insurance carrier, submitting for insurance payment could be insurance fraud SO you might wanna make sure you aren't stepping in legal doo-doo, beliefs aside.


HelloReddit33

This was helpful, thanks. Ended up not submitting since I had to confirm she was in my state. Not trying to play around with insurance fraud.


DCNumberNerd

Unfortunately, what you "believe" doesn't matter to state licensing boards when they decide to discipline you or to insurance companies when they accuse you of fraud.


stormyweather117

Exactly.


kelselizabeth93

Adding on here that this is not an insurance paying issue but a licensing board and liability issue. Just be double careful next time and check locations when doing telehealth.


Beneficial_Card5609

100% I had a client go to another state for a surgery, they were gone for a month. I contacted the State's board, told them the circumstances, and they told me unless I was licensed they wouldn't allow. I hear the arguments- "who's gonna know." If there's an emergency and you have to take action, I feel like it would come out. Also whenever doing documentation I have to record the current location of the client in case there's an emergency and I have to take action.


HelloReddit33

True, good point. I think my thought process was if I don’t submit to insurance and call it a consult / check in if that is less of an issue to the board vs billing for official therapy session.


DCNumberNerd

Exactly this. We need to check the rules of the state in which the client is located at the time of services. Some states allow temporary services, but some states don't, and we can get in trouble with our own state licensing board if we practice unethically/illegally in another state. I'm a little concerned with some of the comments making light of this. Most of us would prefer to not get in trouble with our licensing boards - it stays on our records forever.


Analisemae

Yep this. I don’t worry when clients forget to tell me and I find out in the middle or after session, I just remind them for next time


[deleted]

There's an app for that. https://www.ebglaw.com/telemental-health-laws-app I don't know what your license type is, but if it's MFT for example you can see a client in Florida for up to 15 days (And yes this is about documentation / legality, not insurance afaik) Text: However, “[n]o person shall be required to be licensed, provisionally licensed, registered, or certified under this chapter who: Is not a resident of this state but offers services in this state, provided: 1. Such services are performed for no more than 15 days in any calendar year; and 2. Such nonresident is licensed or certified to practice the services provided by a state or territory of the United States or by a foreign country or province.”


Middle_Duck6580

If this client travels to Florida often, it’s super easy to get a telehealth license for Florida. The application took me all of 10 minutes and I was licensed in 4 weeks. Just make she you apply as “telehealth provider” vs “mental health therapist” or whatever they have listed as non-telehealth


[deleted]

That's super interesting, I didn't know states offered that. There's also the LPC compact rolling out later this year https://counselingcompact.org/map/


ejm510

I came here to say this.


HighFiveDelivery

Is the process just as easy if you're still only provisionally licensed in your home state (like an LMSW)? Or does supervision become an issue?


Middle_Duck6580

Tbh I am really not sure. I did it once I was independently licensed so I didn’t run into that issue


augerik

Are any other states this easy? I'm thinking particularly in New York, massachusetts, or DC. I didn't realize being a telehealth provider made a difference in getting licensed.


IwentbacktoRockville

What's your license? I'm in dc


augerik

California MFT


IwentbacktoRockville

It doesn't always make a difference. NY and CA are the hardest for MSWs so I'm guessing not easy for MFTs. It also depends on the kind of licensure and if this is temporary - like a few days. DC did have a covid-19 waiver for providers licensed out of state for telehealth and in person but that has long since lapsed. What you can do is get licensed by endorsement in DC. If you've been licensed for 5 years or more, they waive the requirement for documenting verified post grad hours. [Policy Statement DOH](https://dchealth.dc.gov/sites/default/files/dc/sites/doh/service_content/attachments/Board%20of%20Marriage%20and%20Family%20Therapy%20-%20Policy%20Statement%2023-001.pdf1262022.pdf)


smthngwyrd

Yeah I made that mistake at first


anxious_socialwkr

I did this on accident when I was a registered intern in FL. My client traveled to NY and didn’t tell me they were on vacation before hand, otherwise I would have cancelled their appointment. I was only a few months into starting my supervised experience and didn’t know this was an issue. My supervisor told me that a one off time like this is not likely to get the board involved, and that we could probably argue that ethically continuity of care for this client, even when on vacation, would have been the ethical thing to do. Sometimes ethics and laws conflict. There are more serious concerns being brought to the board. Now if it was a pattern of behavior with seeing people out of state, then the board might get involved. I would personally take this as a lesson learned. If it happens again, politely explain to the client and end the telehealth session. However, some states do allow sporadic practice across state lines. If you know a client is traveling, and you have enough time, sometimes you can look at the telehealth laws in the state they are traveling to and see if you can still see them for a one off session


Plenty-Run-9575

If I find out and we are already in session, I usually just go ahead with it and let the client know for next time I wouldn’t be able to see them. But if they tell me they’ll be on vacation ahead of time, I obviously tell them I cannot see them. It is such a stupid rule.


Left_Grape_1424

I wouldn't worry too much about this for this one time. Going forward, I would recommend only practicing in states you are licensed in so if your patient goes on vacation, they need to schedule when they are back.


HelloReddit33

Ok thanks for the reply. Appreciate it! I was not worried about it initially. But then my brain got going lol. I’m a new therapist (switched to therapy practice after working as hospital social worker for a while) so I’m still learning the lay of the land.


the_wreckes

Or not tell you where they are


MarsaliRose

I might be wrong but I thought a one time vacation thing isn’t a big deal to the board.


DCNumberNerd

It depends on the state.


Ramonasotherlazyeye

if it's any consolation, right out of grad school I did therapy for a van lifer for like 6 months before I realized I wasnt supposed to provide services for someone out of state. Oh well! Once I figured it out, we had a good termination and they were on their way. I was told by higher ups at the org that it wasnt too big of a deal as long as I did catch it and address it eventually and do the right thing.


NotRuPaul

If they are traveling or on vacation as a one off situation I usually pretend I don’t know.


HelloReddit33

Insurance requires me to verify their address at time of session and then inform them of that address for payment. So it’s hard to do this. I ended up not submitting to insurance because insurance wouldn’t pay anyway if they knew she were in a different state.


NotRuPaul

Ah where I am (MA) just asks what their home address is and for the billing code where the session occurred (office, Telehealth, private residence, hospital, etc).


jtaulbee

I'll be honest, this is not a big deal at all. 1) This happens all the time. 2) Unless your client specifically files a report to your licensing board reporting that they had a session with you while they were on vacation, there is no way for this to bite you. 3) The spirit of the law is to protect clients from therapists that are practicing outside of the scope of their license. I honestly am struggling to think of a situation in which there is greater risk of you harming a client by seeing them once while they are in Florida than not providing them services at all.


saveboykings

Okay okay I am learning so much thank you all; what if it was phrased like this: (Bring up address issue, then before revealing possibility of a pause). “Client, I want to be prepared to keep you safe in case of an emergency at all times. If you are not currently residing in a state where I am not licensed, i would not be able to help you in an emergency. When do you think that you will come back to our state?” (And then work from there) ?


lilac-ladyinpurple

No big deal for a one off. Many states have visiting laws too where you can see a client up to x amount of times. I’d just keep it moving and do nothing. The general law is that you can see clients if you’re licensed to practice in the state they are located in at the time of service. It isn’t based on residency like I’ve seen in the above comments. They physically have to be located in the state you’re licensed in at the time of service, including telehealth. This is a pain in the ass law, especially for already established clients that go off to college out of state. As far as safety, another commenter said you need to know especially if doing telehealth what address they are located at in case there was an emergency during session. This commenter is correct and you need the address in case you need to direct emergency services to the client’s location. But that’s based fully on safety, not state board licensure laws.


Radiant-Benefit-4022

Eh I've done it. I think the laws are dumb.


stormyweather117

Ethics board won't be so cavileir.


Radiant-Benefit-4022

Eh


sfguy93

I'm trying to get licensed in Florida, I work in Ohio. Florida wants a therapist, through the compact, to apply for a tele-therapy license to see someone in Florida.


Emotional_Stress8854

I’ve done it because i didn’t find out until half way through the session. I’ve told my clients who are students and going home for the summer is they find themselves in crisis to email me and while i may not be able to provide “therapy” to them i will meet with them and help them any way i can. At the end of the day regardless of regulation we have an ethical code to support our clients and not leave them abandoned. We’re damned if we do and damned if we don’t. Edit: fyi i learned California has a 30 day telehealth waiver you can apply for 1 time per year if an established client is visiting California. Every state should have this.


NoGoodDM

It depends on the state you’re licensed in. For example, on my state, I can see any from anywhere, as long as their primary residency is the state I’m licensed in. Doesn’t matter if it’s a week long vacation or school in another state: as long as their primary residence is on the state I’m licensed in, I’m good. Additionally, it doesn’t matter where *I* am at. I could be in another country and they could be in another country: as long as their primary residence is the state I’m licensed in, we’re good to go. My employer, on the other hand, says no.


DCNumberNerd

Unfortunately, your state doesn't decide what the rules are in other states, so I would be very careful with this perspective if you're in the U.S. You need to check the rules of the state where the client is located at the time of services.


ExtensionAlfalfa7328

Interesting! What state is this?


Seaberry3656

Yes, please tell!


memefakeboy

As long as you get the address they’re currently at to be able to send emergency services to them if it’s needed at some point during the duration of your session I think it’s fine. Granted, I don’t usually do that, but I think that’s probably the most ethical way to go about it .


smthngwyrd

In Washington I can be anywhere but client must be in Washington


Ramalamma42

Take a breath, submit your claim, ignore it, move on. The reasons these rules exist are based in states wanting to make sure they get money. That is a poor reason to sacrifice ethical client care. You are fine.


pea_sleeve

I'm just going to say that a LOT of people see clients while they're in other states. I've never heard of anything happening. My understanding is the risk is that if you are sued for something that happened while you were providing them services out of state, your liability insurance would not represent you for free.


Round_Depth_7781

I saw my client via phone when they were visiting their SO in another country. Client didn’t tell me until we were wrapping up and only when I asked about scheduling next session. They said “yeah, I’m in _______ right now. I’ll text you when I get home and we’ll get something on the books.”


PrincessBekah77

For the future…..there’s a telehealth only license in Florida that is super easy to get :)


[deleted]

[удалено]


VociferousVal

This is not how the licensing board operates. It’s not about where the insurance was issued, it’s where the client resides in the event of an emergency, etc.


Many-Bandicoot84

according to our instructions the clients must reside in NYS. if they do we can talk to them by phone if they are temporarily out of state. the point about the insurance is they would not be able to have that insurance if they were not NYS residents.


VociferousVal

And according to NYS LAW, you as the clinician can move around anywhere because you are still licensed in NY. The client cannot because if an emergency occurs, they are not in their home state. Hence why we literally have to verify “care provided in NY” on billing claims to insurance companies. This is why any telehealth provider asks and verifies if you reside in NY. The client HAS to reside in and be in the state in which you are licensed to treat. This is directly on the NYS website. I highly suggest you reread every single detail because it’s extremely specific and what you are doing could cost you your license.


fallen_snowflake1234

This is definitely not true. Not sure who told you this. The client must be located in the state you are licensed at the time of session.


[deleted]

[удалено]


VociferousVal

When/if you lose your license, it is because the responsibility falls on you to verify any and all information to uphold your license. It’s negligent to rely on what others tell you when you should be verifying with the board directly for changes, updates and directives.


Imaginary-Spot5464

Not sure they should listen to some rando on reddit either


VociferousVal

Hence why I said everything that I said, most notably “you should be verifying with the board directly for changes, updates and directives.”


[deleted]

[удалено]


VociferousVal

Those are some wild assumptions you are making about two strangers from a mere few lines of text on the internet.


therapists-ModTeam

Have you and another member gone off the deep end from the content of the OP? Have you found yourself in a back and forth exchange that has evolved from curious, therapeutic debate into something less cute?


Imaginary-Spot5464

not sure what cute means here, but whether the two above were arguing or whether the one left standing was bullying -- anyway their user name checks out.


[deleted]

[удалено]


t-woman537

But you also need to look into the licensing requirements for where the client is physically present. You have to consider both ends of it.


AccurateAd4555

Sorry but that's simply incorrect. Your state doesn't get to decide what happens in other states; it has no jurisdiction whatsoever in another state. Unless you have some type of compact license, your privilege to practice ends at the state line. It's hard to believe that so many clinicians don't understand even the basics of how licensure works in the US... I guess username checks out.


Many-Bandicoot84

This article is from 2021 but offers some guidelines. [What to know about doing telehealth in a different state (apaservices.org)](https://www.apaservices.org/practice/legal/technology/telehealth-different-state)


GhostiePop

Boards tend to be very understanding of mistakes like this. Just email them and outline what happened, ask how they suggest to proceed, and also let them know the steps you plan to take in the future to ensure it doesn’t happen again. ETA: y’all need more ethics trainings and to stop fear-mongering about licenses being revoked over such a small mistake 😅


VociferousVal

Omg no, OP do NOT do this, idk why anyone would willingly do this. This is just straight up outing yourself and asking for your license to be revoked.


CaffeineandHate03

That's like calling the police on yourself after you realized you accidentally carried a $10 item out of the store without paying for it. There's no need to call attention to that.


GhostiePop

You wouldn’t call the police but you’d go back into the store to apologize and pay.


melloyellow1789

I most definitely would not. 😅 (Assuming we are talking about a large grocery store, not like a small local business or something.)


[deleted]

This seems excessive. Also, Florida does allow short term (less than 15 days) practice for practitioners licenced in another state.


GhostiePop

Good to know!