Navigating Mental Health Compacts: Expanding Practice Across State Lines
Before the pandemic, telehealth services were available and utilized to some extent, but their widespread adoption was limited. However, the COVID-19 pandemic acted as a catalyst for the expansion and acceptance of telehealth, including in the field of mental health care. Recognizing the potential of telehealth to bridge gaps in access to care, professional organizations and policymakers have worked to address regulatory barriers through the development of compacts.
The top 3 questions that people ask regarding compacts are
What is a compact?
How do states/jurisdictions participate in a compact?
How do I participate in multistate practice through a compact?
So, let’s start there.
What is a compact?
A compact is a legal agreement between two or more jurisdictions. When people reference a compact when talking about mental health practice, they are talking about an agreement that states can opt into to allow clinicians to practice in other compact states. In simpler terms, states opting into a compact are agreeing to allow clinicians to provide services to clients located in other compact member states without having to go through each member state’s licensure process.
How does a state/jurisdiction participate in a compact?
The state (or territory) must meet compact requirements, pass state legislation enacting the compact language, and the Governor must sign it into law.
How do I participate in multistate practice through a compact?
This depends on your license type and state of residence.
Psychologists have an active compact called PSYPACT.
Counselors are expected to start the registration process for the Counseling Compact mid- 2024.
Social workers have finalized language for the Social Work Licensure Compact and are advocating for legislation in states throughout the US.
It seems that Marriage and Family Therapists will likely not see a compact in the near future as the American Association for Marriage and Family Therapy (AAMFT) has focused on advocating for a license portability model law instead of developing a compact.
PSYPACT
PSYPACT is the compact for psychologists. Development on PSYPACT began in 2014. It currently has 37 jurisdictions that have enacted legislation to participate in the compact. The goal of PSYPACT is to enable licensed psychologists to practice across state lines without having to go through each state's individual licensure process.
To provide telehealth services under PSYPACT the following eligibility requirements must be met:
Full, unrestricted license to practice psychology in at least one PSYPACT State with no disciplinary action
APA/CAP accredited doctoral degree in psychology*
Possess an active ASPPB E. Passport
Successful completion of the Examination for Professional Practice (EPPP)*
*Exceptions apply
The PSYPACT requires psychologists practicing under the authority of PSYPACT to be physically located in their PSYPACT home state at the time services are provided.
Counseling Compact
A majority of US states have legislation pending or have enacted the Counseling Compact. Registration by counselors for the compact is expected to begin mid-2024.
To be eligible for the Counseling Compact counselors must
Reside in a state participating in the compact
Hold an unencumbered, independent license
Have taken a national exam
Have completed a supervised professional experience
Have earned a 60 semester-hour master’s degree
The Counseling Compact website indicates that registration will be available at that website when registration opens. They recommend that interested parties maintain a license in good standing in their home state and prepare for any jurisprudence exams that might be required in the state(s) in which they plan to apply for compact privilege.
If your state has enacted the compact that does not automatically mean that you will be able to practice in compact states. You will need to apply in each state that you want to practice. You will apply through the compact as opposed to going through the licensing process of the board. The cost of compact privilege is set by each state. More information will be provided when states are ready to grant privilege. Counselors can register to get updates about the Counseling Compact here.
Social Work Licensure Compact
Social Workers have finalized the language for their compact, so states can now enact the legislation.
The compact covers licensure levels at the bachelor, master, and clinical levels. The compact allows eligible social workers residing in a compact state to apply for a multistate license, which will allow them to practice in all other compact states.
To be eligible for the multistate license offered by the compact social workers must
Hold an active, unencumbered license
Reside in a compact state
Hold an accredited degree base on the license level (BSW, MSW)
Pass a National Qualifying Exam
Clinical eligibility requires 3,000 hours or 2-years post graduate supervised clinical practice
Benefits of Compacts
The establishment of these compacts brings forth several benefits for mental health professionals, clients, and the overall mental health care system:
Increased Access to Mental Health Care
By enabling professionals to practice across state lines, compacts expand access to mental health services, particularly in underserved areas and regions with a shortage of mental health professionals. This increased access promotes early intervention, improved treatment outcomes, and reduced disparities in mental health care.
Continuity of Care
For individuals who relocate or travel frequently, maintaining continuity of mental health care can be challenging. Compacts address this issue by allowing licensed professionals to continue providing care to existing clients, even across jurisdictional borders. This ensures that clients can maintain therapeutic relationships and receive uninterrupted care, enhancing treatment effectiveness.
Streamlined Licensing Process
Compacts streamline the licensing process by providing pathways for licensed professionals to practice in multiple jurisdictions without undergoing separate licensure procedures for each state. This reduces administrative burdens and allows professionals to focus on providing care rather than navigating complex licensing requirements.
Compact Considerations
While compacts facilitate interjurisdictional practice, it's important to note a few considerations:
Varying State Laws
Professionals are still required to comply with the laws and regulations of the state(s) they practice in. It is important to review state laws regarding
Scope of practice
Disclosure/Informed Consent
Record Retention
Mandatory Reporting
Telehealth Regulations
Advertising
Insurance Mandates
Insurance policies may have specific requirements regarding the delivery of mental health services, including the preference for, and in some cases mandated, face-to-face sessions.
Conclusion
Compacts for mental health professionals open up a world of possibilities for clinicians to practice across state lines and for clients to have greater access to mental health care and have more continuity of care. The compacts represent significant steps forward in breaking down barriers. With states continuing to regulate mental health practice within their jurisdictions, it is important for clinicians to also understand their responsibilities in providing ethical and compliant care.