Practicing across state lines is one of BHEC's most frequently queried topics from licensees. Counselors want to know what they can or cannot do if their client is not a TX citizen and both parties aren't in TX at the time services are delivered.

This can be a very confusing topic because once you take into account citizen or non-citizen, in-state or out of state or out of country, who has jurisdiction, what licensing is needed, and the whole, "where must a complaint be filed" thing, there are about 287 different possible scenarios to consider. Well, not that many but the exponential math does get ridiculous.

Practicing Across State Lines

We actually have a diagram/chart that encompasses about 64 of those scenarios. In an effort to try and keep things simple we've taken that chart and boiled it down to the "10 Precepts" that form the guidelines used to create the chart. When you get done absorbing The Top 10 I'm going to make it even simpler for you. Here they are.

The JURISDICTION Precepts

1. A "jurisdiction" is defined as another state, province, territory, commonwealth, protectorate, or another country.

2.  The State of TX does have an obligation to protect anyone within its' jurisdiction, regardless of citizenship or residenc, BUT our authority to provide that protection extends only to those services delivered to individuals in TX and to providers in TX, regardless of where the recipient is located.

In other words, if the patient or client is located in TX, then TX can exercise authority over a provider who delivers services from abroad, and BHEC can exercise authority over a provider in TX who is delivering services to someone outside of the state.

The LICENSING Precepts

3. There are no reciprocal mental health license agreements in place between Texas and other jurisdictions. (A TX license does NOT authorize a provider to practice in another "jurisdiction".)

(*This does not take PsyPact into account which will be the subject of a future blog post.)

4. A provider SHALL be licensed in each state in which he plans to deliver services to one or more citizens OF THAT STATE. (You are legally allowed to practice only in the state(s) in which you are licensed.)

5. A TX licensee may provide services to non-TX clients that have travelled TO TX and are PHYSICALLY PRESENT IN TX at the time services are delivered.

6. A TX licensee may provide services to clients IN TX regardless of the counselor's physical location at the time those services are delivered. (The counselor may be out-of-state at the time services are delivered.)

7. A provider MAY need to be licensed in each non-US country in which he plans to deliver services to one or more resident citizens of that country. BUT,....BUT,...this statement is not without its caveats!

The ability to deliver services to someone in TX from abroad also depends upon the state where the licensee is practicing from.  In short, the jurisdiction where the licensee is located may have regulatory authority over the licensee despite the fact that the recipient of services is located in TX.

While some states consider the location of the patient or client to be where the services are delivered - and thus that jurisdiction's laws would govern the licensing requirements - others are like TX in that they consider an individual to be practicing within their jurisdiction if either the provider or the patient is located in their jurisdiction. Bottom-line here is you better know the laws in the state from which you will be delivering services before you do anything.

The COMPLAINT/LAWSUIT Precepts

8. Complaints should be filed in the state in which the client is a legal citizen. They may also be filed in the jurisdiction where the provider is located if that jurisdiction requires licensure to deliver services, regardless of where the patient is located. (This may require you to do a little travelling!)

9. The ability to file a complaint in TX is equally available to anyone, regardless of citizenship.

10. No matter where you practice or your clients live they always have civil lawsuit legal recourse. Knowing that, if you're sure this will never happen to you, then carry on. Just keep a very large pile of cash on hand because chances are your malpractice insurance won't be covering that either!

That's it. These precepts apply to any possible scenario you can come up with under the umbrella of, "practicing across state lines".

Tell Me This Gets Easier....

For 98% of us who will never encounter a situation that involves needing to be licensed in another state, or treating a citizen of another state from that in which we are licensed, here's all you have to remember:

If you're licensed in (TX), you should only see/treat (TX) citizens,
and do it IN TX.

Do so and you'll be fine. If you find yourself in any other situation involving practicing across state lines, refer to the 10 Precepts above. Failing that, you're gonna need a chart and an attorney familiar with BHEC and your Board's rules.

Plan Smart. Be Safe. Serve Others.

Kathleen Mills, LPC-S, CEAP