Practicing Across State Boundaries

Last week, we provided the “state licensing scoop,” sharing the difference between licensing and certification as health practitioners in your respective states. The Center for Nutrition Advocacy provides an illustrative look at who may practice nutrition counseling in your state.

Taking this a step further, we’re exploring what state licensure or certification means when it comes to practicing across state boundaries. If I’m certified in Washington, can I provide telehealth counseling in Texas, for example?

If you’re not sure of the answer, you’re not alone. Findings from a 2015 survey conducted by the Academy of Nutrition and Dietetics, “Telehealth Practice Survey: Executive Summary,” showed that 69 percent of respondents were not sure whether it was legal to provide telehealth services to those who reside in states other than the one in which the provider is licensed.

According to “Practice Tips: Telehealth Challenges and Opportunities,” (available via free download for AND members), states have the authority to regulate activities that affect the health and welfare of their citizens within their borders. Most importantly, this document states that the practitioner must receive a certificate of licensure, if available, in the state in which they work as well as a license (again, if available) in the state where the patient is. Additional considerations from the document:  

  • If you interact electronically with clients in other states, you must be licensed or certified (check your state-specific regulations) in each state in which you electronically practice.

  • Some states’ laws provide for reciprocity. Note that this may qualify one already holding a license to obtain licensure in an additional state, but the second state may still require submission of paperwork and a fee. The ability to practice in a state prior to obtaining a license varies in each state.

  • Some laws may require you, as a telehealth provider, to obtain informed consent from patients prior to providing telehealth services. Visit the Center for Connected Health Policy website for detailed information: State Laws and Reimbursement Policies.

When it comes down to it, knowing your state’s legislation is key. We hope this helps to clear up some of the complicated and sometimes confusing scopes of practice when it comes to practicing across state lines. If you have questions or are unsure, contact us!