Cross-State Telehealth: Can I See This Client?
Most therapists who provide telehealth eventually encounter some version of the same question:
"My client is in another state. Can I still see them?"
Sometimes the client is traveling for a few days. Sometimes they have relocated. Sometimes they attend college in another state or divide their time between multiple residences throughout the year. In many cases, the therapeutic relationship is already established, the client is engaged in treatment, and the session itself may look no different than any other telehealth appointment.
The challenge is that telehealth can make geographic boundaries feel less obvious while professional practice remains tied to jurisdiction. A client may be familiar, treatment may already be underway, and clinical needs may be unchanged. The legal questions can look very different depending on where the client is physically located when services occur.
What I want to do here is walk through the questions therapists often need to answer when determining whether they can legally provide telehealth services across state lines and how to think through those decisions before scheduling the session.
Determining Whether You Can See a Client Often Depends on Where They Are Located
If you're trying to determine whether you can legally see a client across state lines, the next step often depends on where the client is located and what authority you have to practice there:
• If the client is physically located in your licensing state → review state-specific telehealth requirements.
• If the client is physically located in a different state → determine whether you hold authority to practice in that jurisdiction.
• If the client is temporarily traveling → review the destination state's laws regarding temporary practice.
• If the client recently moved → determine whether your authority to practice still applies.
• If you're unsure which state's laws control the session → start by identifying where the client will be physically located when services occur.
Why Cross-State Telehealth Creates So Much Confusion
Telehealth has expanded access to care and increased flexibility for both therapists and clients. At the same time, it has introduced situations that were less common when services were delivered primarily in person. Clients travel for work, attend college away from home, relocate for family reasons, spend part of the year in another state, or work remotely from different locations throughout the year.
When these situations arise, therapists often focus first on their own license. While licensure is certainly part of the analysis, it is often only one piece of the picture. Questions about jurisdiction, temporary practice authority, telehealth regulations, and professional board requirements may also need to be considered.
This is one reason cross-state telehealth can feel confusing. The answer is not always determined by a single rule, and the circumstances surrounding the client's location can affect which questions need to be reviewed.
The First Question: Where Is the Client Physically Located During the Session?
When therapists begin evaluating a cross-state telehealth situation, one of the first questions is often where the client will be physically located during the session itself. This question can seem straightforward, but it is not always as simple as it appears.
A client's permanent residence, mailing address, or state of record may differ from where they are physically located when services are provided. A client who normally resides in one state may be attending school elsewhere, visiting family, traveling for work, or temporarily living in another jurisdiction.
For this reason, many telehealth providers verify client location at the beginning of each session. Location can change from week to week, and those changes may affect the legal and regulatory considerations that apply to the appointment.
Before assuming that services can continue as usual, it can be helpful to confirm where the client will be physically located when treatment occurs and then determine what requirements may apply in that jurisdiction.
Common Situations That Often Raise Cross-State Telehealth Questions
Many interstate telehealth questions arise from situations that are relatively common in clinical practice.
Clients may travel for vacations that last several days or several weeks. College students may live in one state during the academic year and another during school breaks. Some clients relocate permanently while hoping to continue working with their existing therapist. Seasonal residents may divide their time between multiple states throughout the year. Military families and individuals who travel extensively for work may also move across jurisdictions more frequently than other clients.
While these situations may appear similar on the surface, the legal analysis may differ depending on the states involved, the profession involved, the duration of the client's stay, and any temporary practice provisions that may apply.
Because regulations can vary considerably across jurisdictions, many therapists find it helpful to approach each situation as a separate review rather than assuming the same answer applies to every cross-state telehealth scenario.
Why Licensure Is Only Part of the Decision
Licensure is often the first issue therapists think about when evaluating interstate telehealth, but additional considerations frequently arise during the review process.
Depending on the situation, therapists may need to consider telehealth regulations, temporary practice provisions, emergency management procedures, documentation requirements, informed consent practices, and local emergency resources available to the client. Some jurisdictions have specific telehealth requirements that extend beyond basic licensure questions.
These considerations become particularly relevant when services will continue for an extended period of time or when clients are regularly receiving treatment while located outside the therapist's home state.
Determining whether services can legally be provided is often the first step. Once that question has been answered, attention typically shifts toward ensuring that telehealth procedures, documentation practices, and informed consent processes are appropriate for the situation.
At this point, many therapists know they need to verify jurisdictional requirements but are not always sure which questions need to be asked or where to begin. The Cross-State Telehealth Jurisprudence Checklist was developed to provide a structured way to review jurisdictional authority, licensing considerations, temporary practice questions, and other legal factors that commonly arise when providing telehealth services across state lines.
→ Cross-State Telehealth Jurisprudence Checklist
Once You've Determined You Can Legally Provide Services
After establishing that services can be provided, many therapists turn their attention to implementation. Questions about location verification, emergency contacts, local emergency resources, documentation practices, technology procedures, and informed consent often become the next area of focus.
These discussions help establish clear expectations and provide clients with information about how telehealth services will be delivered. They can also help therapists prepare for situations involving technology failures, emergencies, crisis response, and changes in client location.
Many therapists already cover some of these topics in their standard informed consent process. Cross-state telehealth situations often provide an opportunity to review those procedures and ensure they reflect the realities of providing services remotely.
The free Telehealth Informed Consent Checklist provides a structured way to review informed consent considerations, documentation practices, emergency planning, technology issues, and other topics that commonly arise when delivering telehealth services.
→ Telehealth Informed Consent Checklist
Building a Broader Framework for Telehealth Compliance
Telehealth continues to evolve, and the questions therapists encounter often extend beyond interstate practice. Privacy considerations, documentation standards, informed consent procedures, technology platforms, artificial intelligence tools, jurisdictional requirements, and professional regulations continue to develop over time.
Many therapists find that these decisions become easier to navigate once they have a broader framework for evaluating telehealth-related issues. Rather than searching for a new rule every time a question arises, they develop a process for evaluating legal, ethical, and clinical considerations before implementing a new service, technology, or practice procedure.
The Telehealth: Efficacy, Laws & Ethics CE course was developed for clinicians who want a more comprehensive understanding of telehealth practice, informed consent, documentation, privacy considerations, interstate service delivery, and ethical decision-making. The course is self-paced and eligible for continuing education credit, allowing you to complete the training on your own schedule while building practical skills that can be applied immediately in clinical practice.
→ Telehealth: Efficacy, Laws & Ethics CE
Conclusion
Cross-state telehealth questions often become easier to navigate once the relevant jurisdiction has been identified and the appropriate authority to practice has been verified. A structured review process can help organize the questions that need to be answered and reduce uncertainty when client circumstances change.
As telehealth becomes increasingly common, therapists are likely to encounter situations involving travel, relocation, temporary residence, and interstate service delivery on a regular basis. Having a consistent approach to evaluating these situations can support thoughtful decision-making and help therapists respond more confidently when questions about jurisdiction and authority to practice arise.
Research References
American Psychological Association. (2024). Guidelines for the Practice of Telepsychology. American
Psychologist, 79(1), 54-67. https://doi.org/10.1037/amp0001234
Centers for Medicare & Medicaid Services. (2025b, April). Telehealth & remote patient monitoring
(MLN901705). U.S. Department of Health & Human Services.
https://www.cms.gov/files/document/mln901705-telehealth-remote-patient-monitoring.pdf
Code of Federal Regulations. (2025). 42 C.F.R. § 410.78 – Telehealth services. U.S. Government Publishing
Office. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-410/subpart-B/section-410.78
U.S. Department of Health & Human Services. (2025). Telehealth policy updates. Telehealth.HHS.gov.
https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates
