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Your trusted source for ehealth, telehealth, home health and telemedicine information and networking. | ||
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Telehealth: REGULATION OF INTERSTATE PSYCHOLOGYby: George J. Alexander, J.D., J.S.D., The interstate practice of psychology is growing quickly as technology advances. Regulation of the field, beyond professional regulation of licensed psychologists, is very sparse. How regulation applies to cyberpsych (telEhealth) is still less clear even as it concerns licensed psychologists with clients out of the state of their license. It seems that they are governed by the laws of the states of their clients which generally prohibits anyone not licensed in that state from practicing there. A few states have expressly dealt with cyberpsych but they have not added clarity to the practice. All states prohibit therapist from calling themselves psychologists unless they are licensed in that state (or allowed to practice on the basis of another state's license). This provision is called the reservation of title provision. All states other than New York and Washington have a similar prohibition against practicing as a psychologist even without calling oneself a psychologist. It is extremely difficult to define the practice of psychology because it overlaps many practices no one would call professional psychology. This makes it difficult to write legislation barring the practice of psychology. Some states follow the California example and broadly prohibit a large range of acts, which many other professions use, as the practice of psychology. For example: methods relating to learning, perception, motivation, emotions and interpersonal relationships are expressly covered. California then allows non-psychologists to use those methods if they are licensed in another field. Most of these exemptions are equally broadly drawn. The federal government, which has a great interest in cyberpsych as a means of providing entitlements as cheaply as possible, serving remote places for which it bears responsibility and, especially, the military, has been in the forefront of attempting to develop a national delivery system. While there has been some movement toward multi-state admission of psychologists by the states, there has been more activity to clarify the need for a license in each state of practice. There is general agreement that (with the possible exception of an occasional contact with a present client who is briefly in another state) the practitioner must be licensed in the state in which the client is being treated. For many forms of cyberpsych, this requirement presents an insuperable barrier as the location of the client cannot be definitively established. California even expressly bars its licensed psychologists from transmitting treatment into other states which have not given their permission. It is also, however, studying a provision which would allow out of state psychologists to obtain a special license for interstate practice into California. There is, in any event, almost no enforcement of the practice rules upon those unlicensed. In fact, a recent study of attorneys-general demonstrates total ignorance of majority of them that their state even has regulatory provisions for unlicensed practice of psychology. Few states have expressly regulated cyberpsych in their own state. California passed what may become a model act. Its principal requirements are: obtaining informed consent, non-discrimination against those who do not consent to its use, and preserving confidentiality. To obtain informed consent, the practitioner must explain the risks and benefits of telemedicine. The literature makes clear that there is insufficient research to know risk and benefits. By amendment, the statute now does not cover telephone and electronic messages which seem more professionally problematic than interactive video conferences which are covered. Since the non-included practice is apparently not outlawed, this seems to be an advantage to using it. On the other hand, the statute also requires the state and some insurers to compensate covered practices thus providing an incentive to supply services by interactive video. Of course, none of these comments have asked what the rationale of regulation is. That question should be answered. When it is, much of the law should be repaired to meet the agreed on objective.
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