2. Marlene M. Maheu, PhD
Founder and CEO of Telehealth.org
Published five peer-reviewed telehealth textbooks,
50+ book chapters and journal articles, and 1000+
blog posts found at blog.telehealth.org.
Developed 70+ hours of evidence-based and
competency-based telehealth training at
Telehealth.org, trained more than 66k professionals
in telehealth since 1994.
• Founder and CEO of the Coalition for
Technology in Behavioral Science (CTiBS) &
Founder of the Journal for Technology in
Behavioral Science
• Chair of the first Committee for Telebehavioral
Health Competencies
4. Learning Objectives
1. Explain what’s happening with the US Public Health Emergency
and how that can impact your ability to work over state lines.
2. List at least one way your malpractice coverage can
automatically be nullified, despite your carrier’s claims that you
are “covered” for online practice.
3. Outline the 2-step process for legally and ethically practicing over
state lines and international borders.
5. Audio-Only Mode
• Please hold your questions for the
Q&A period at the end of today’s
training. I will stay as long as it takes
after the end of the hour to get all your
questions answered.
• Telehealth.org assistants are here to
help you with administrative issues,
such as not hearing me. TIP: Use a
landline.
6. Maximize Your Learning
By
• Turning on your camera
• Joining the conversation
throughout this activity
• Muting your phone
• Asking family and friends to stay
away
12. End of Public Health
Emergency Is Predicted for
April, 2023
• Thereafter, practicing over state lines
will be enforced by the states.
• To date, licensed professionals have
been obligated to complete and
affidavit, registration or licensure in
every state.
• Contact each state to determine how
you can meet their criteria. Contact
your board, too.
13. Medicare In-Person Visit
Requirement Starting January
1, 2025
• For behavioral health only
• One in-person visit is
required within the first six
months of an initial
telehealth visit and every 12
months thereafter, with
certain exceptions.
• Two years is a long time.
Medicare is working on this
and other requirements.
62. 5 Steps to Practicing
Legally in Foreign
States & Countries
63. 1. Verify your licensure in your own state (enter your license
number into your state website).
64. 2. Comply with all foreign state laws re:
• Intake/progress notes
• Termination notes
• Informed consent
• Mandated reporting (suicide, Tarasoff, etc.)
• Continuity of care
• TBH training/supervision
• Additional security and/or privacy laws/other
65. 3. Contact the local licensing boards of all states you wish to serve to review
their requirements. Ask about any telehealth-specific documents that you
can review. Ask if they are in, or are considering joining, a profession-specific
model act of some type to facilitate practicing across state lines.
66. 4. Check the destination state’s licensing board website for their requirements in
your profession. Compare and contrast to see what’s different. Consider: abuse
reporting, duty to warn, crisis intervention and planning, state policy guidelines for
involuntary hospitalization, continuing education requirements and reporting,
license renewal. Decide if your practice can develop a policy to encompass each
state’s rules and regulations or if your practice will need separate policies for each
state of practice.
Determine if you are up for the challenge in each foreign state (or country) being
considered.
67. 5. Contact your malpractice carrier and get a written explanation of your
coverage. Have an attorney interpret their response.
68. Questions for Your Malpractice
Carrier about Practicing Over
State Lines
1. Will you cover me for practicing over state
lines?
2. What if I am not licensed in the foreign state or
country, will you still cover me?
3. If you do cover me, will I be covered for
regulatory or civil actions?
4. What are the limits of each of those types of
coverage?
5. What if I do something illegal to meet the
requirements of my online employer, will you
cover me?
71. Cultural Sensitivity
Over State Lines
• Essential aspect of telehealth
• Screening procedures must be well
developed
• Referral options must be responsibly
offered
• Knowing how to handle emergencies,
including at first visit, must be error-
proof
73. Diversity Sensitivity or
Training for Practicing
Over State Lines &
Internationally
Telehealth poses unique challenges
to respecting diversity:
• People can present from “neck up”
• Many speak a different form of
English
• If “impossible,” telehealth & diversity
training are warranted.
74. Disparities
Telehealth providers must
educate themselves about
telehealth and disparities,
especially in rural areas.
• Literacy
• Local idioms
• Local religious and political
beliefs