Laws Governing Telepsychology and Interstate Licensing Requirements
Practicing across state lines has become one of the biggest challenges for psychologists offering telehealth. Questions about state licensing regulations, PSYPACT participation, HIPAA compliance, and Medicare rules often leave clinicians uncertain about what they can and cannot do. Many assume that federal rules override state laws, but the truth is that states hold the power to regulate professional licensure and practice. This means that even when federal guidance is issued, psychologists must still adhere to the requirements of each state in which their clients are located.
During the COVID-19 pandemic, this issue became especially confusing. Temporary federal telehealth waivers allowed psychologists to expand care across state borders for Medicare patients and in certain federally governed contexts. However, those waivers did not override state licensing laws. Each state continued to control whether — and under what conditions — an out-of-state psychologist could legally provide services to its residents. Some clinicians misunderstood this distinction, believing that federal waivers gave them free rein to practice across state lines, when in reality, state licensing boards remained the ultimate authority.
As those temporary waivers expired, the regulatory landscape became even more complex. Some states reverted back to stricter pre-pandemic rules, while others adopted more flexible telehealth provisions or joined PSYPACT, the interstate compact that allows eligible psychologists to practice across participating state lines. The result is a patchwork system that demands ongoing attention and vigilance from clinicians.
Staying informed about these changes is no longer optional — it is a critical component of clinical competence and ethical practice. By grounding our work in up-to-date knowledge of state regulations and compact agreements, and by pursuing ethics CEUs from an APA-Approved Sponsor, we can navigate this landscape responsibly. With clear guidance and ongoing education, psychologists can continue expanding access to care while honoring the legal and ethical frameworks that protect both clients and clinicians.
Interstate Practice and PSYPACT
The Psychology Interjurisdictional Compact (PSYPACT) has transformed interstate practice by making it possible for licensed psychologists to deliver telepsychology across participating states without obtaining multiple full licenses. However, a key feature of PSYPACT is often misunderstood: to participate, a psychologist must designate a “home state” where they hold an unrestricted license and from which they are physically present when providing telehealth services.
Some clinicians have mistakenly assumed they could bypass this requirement by obtaining a license in a state where they do not reside or practice, believing that would qualify them as “home state” providers under PSYPACT. In reality, the compact requires your home state to be the jurisdiction in which you practice psychology — not simply a state where you’ve acquired paperwork. Misinterpreting this rule can lead to noncompliance and significant legal or ethical risks.
While PSYPACT adoption is expanding, it is not universal. As of 2025, more than 40 states have joined, creating wide access for many psychologists and clients. Yet several large jurisdictions — including California and New York — remain outside the compact. This means you might be able to provide telehealth services to a client living in Arizona or Georgia, but you would still need separate licensure to legally see someone in non-participating states.
This variability underscores the importance of staying current with PSYPACT updates and maintaining transparent, proactive communication with clients. For example, informed consent documents should clearly state the limits of your ability to practice across jurisdictions, especially for clients who travel frequently, relocate, or split time between states. Grounding practice in up-to-date compact rules — and reinforcing knowledge through ethics CEUs from an APA-Approved Sponsor — ensures psychologists can expand access responsibly while safeguarding both client care and professional integrity.
CE Course: Telehealth - Efficacy, Laws & EthicsTelehealth Informed Consent Laws
Informed consent in telehealth isn’t just a formality — it’s a cornerstone of ethical practice. A strong consent process ensures that clients understand their rights, the unique risks of virtual care, and the boundaries of the therapeutic relationship before sessions begin. Psychologists are ethically obligated to review:
Client rights and limits of confidentiality.
Risks of telecommunication technologies.
Emergency protocols and local resources.
What complicates this is that informed consent requirements are often updated as telehealth standards evolve. For example, guidelines may shift from accepting verbal acknowledgment to requiring a signed form stored in the client record. Some boards now expect consent to be renewed annually as part of risk management best practice. Embedding these changes into your workflow not only ensures compliance but also models transparency for clients.
Beyond meeting professional requirements, a thorough informed consent process strengthens the therapeutic alliance itself. When clients see that you are clear, proactive, and collaborative about risks and boundaries, it fosters trust and positions them as active partners in their care. This collaborative stance can be especially important in telehealth, where the technology itself may already feel unfamiliar or uncertain to clients.
Embedding these elements into consent forms demonstrates both ethical integrity and legal compliance, reinforcing the role of APA-Approved Sponsor ethics CEUs in everyday practice.
Ethical Issues in Telehealth Practice and Licensing
Ethical issues in licensing often arise when psychologists unintentionally practice across jurisdictional lines. Even a single telehealth session with a client who moves or travels can create legal exposure. Staying current with laws governing telepsychology and maintaining clear policies with clients helps avoid misunderstandings.
Another common challenge is when clients maintain dual residencies — for example, living part of the year in Florida and part in another state. Without clear agreements, psychologists may find themselves practicing unlawfully without realizing it. Using a thorough intake process to establish where clients live, documenting travel schedules, and clarifying the limits of your license are practical steps that align with both ethical guidelines and state law.
That’s why self-paced online CEUs from an APA-Approved Sponsor matter — they give psychologists the flexibility to stay current as regulations and best practices continue to evolve.
Enroll in our ethics CE course online
Bringing it all together
Navigating telepsychology laws and interstate licensing is complex, but not impossible. By understanding PSYPACT, informed consent laws, and ethical principles, psychologists can provide accessible, legally compliant, and ethically sound care. Pairing your practice with CE courses from an APA-Approved Sponsor ensures you not only meet continuing education requirements, but also safeguard your clients, your license, and your professional integrity.
Ultimately, legal knowledge and ethical reflection go hand in hand. Laws determine where we can practice, but ethics guide us in how we should practice. When we integrate both, we strengthen public trust and expand access to psychological care in ways that are safe, competent, and sustainable.
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Enroll in our ethics CE course onlineRead next in the series: Ethics in Telehealth: Competence and Care
References
American Psychological Association. (2024). Proposed revision of guidelines for the practice of telepsychology. APA Task Force on Telepsychology. https://www.apa.org/practice/guidelines/telepsychology-revisions.pdf
Code of Federal Regulations. (2025). 42 C.F.R. § 410.78 – Telehealth services. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-410/subpart-B/section-410.78
Psychology Interjurisdictional Compact (PSYPACT). (n.d.). About us. PSYPACT. https://psypact.org/page/About
U.S. Department of Health and Human Services. (2024, September 18). Obtaining informed consent for telebehavioral health. Telehealth.HHS.gov. https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-for-behavioral-health/preparing-patients-for-telebehavioral-health/informed-consent-for-telebehavioral-health
