Telehealth legislation aimed at removing barriers to care is abounding in the current landscape of state law. Emergency out-of-state practice allowances have been ending, bringing legislators to look towards meeting the telehealth and healthcare needs of their constituents for the long term.
We’ve seen examples of progressive telehealth legislation being passed in Arizona, Illinois, West Virginia, and Connecticut, to name a few. However, in the instance of Connecticut, there has been conflicting information — both for clients and providers — about whether or not an out-of-state provider has permission to practice with a client located in Connecticut under the newly enacted legislation.
State of Confusion in the State of Connecticut
If you’re a healthcare provider that is not licensed by the board of your profession in Connecticut but is licensed in another state, are you currently able to work with a client that’s physically located in Connecticut?
If you’ve looked to authoritative sources, you may have reasonably determined the answer to that question is ‘yes.’ If you then followed the Person Centered Tech recommended process of performing and documenting due diligence with regards to legality and permissibility to practice in another jurisdiction, and you contacted the board of your profession in Connecticut for confirmation, you’ve been told that there is no such permission to practice for out-of-state providers in place. That permission ended on July 20th, and to legally be permitted to work with a client located in Connecticut you must obtain a license in Connecticut.
Who, then, is right? And, why is there conflicting information?
We’ll answer the question as to whether or not out-of-state providers are currently permitted to practice in Connecticut, but first let’s look at the context of how we’ve arrived at this point of confusion.
Context of Confusion from Authoritative Sources
On May 10th, 2021, Governor Lamont of Connecticut signed HB 5596, enacting Public Act No 21-9, An Act Concerning Telehealth. In the celebratory press release it was stated that it would “Permit licensed healthcare providers in other states to provide telehealth services to Connecticut residents providing they carry the minimum professional liability insurance coverage” through June of 2023.
screencap of the press release from CT.gov
On May 11th, 2021, CT.gov — Connecticut’s official state website — posted “Can I receive telehealth services from a practitioner who is based out of state?” under the tags “Healthcare. Official Guidelines.” The post declares that use of telehealth services is extended through June 2023, and that “the two year extension will: … Permit licensed healthcare providers in other states to provide telehealth services to Connecticut residents providing they carry the minimum professional liability insurance coverage.”
screencap of CT.gov
The Center for Connected Health Policy (CCHPPH) updated their Connecticut information under Cross-State Licensing to include “HB 5596: extends Telehealth emergency orders until June 30, 2023.” mHealth Intelligence declared that “Lamont’s signature on HB 5596 extends until June 30, 2023, an emergency provision he’d signed in March 2020 to help providers address COVID-19. Among other things, the law allows a variety of providers, including dentists, therapists, physician assistant and behavioral healthcare providers, to use telehealth, permits audio-only telehealth services and allows licensed providers from other states to treat Connecticut residents via telehealth.”
screencap of the CCHP website
The Federation of State Medical Boards (FSMBD) updated their Connecticut entry in their States Waiving Licensure Requirements in Response to COVID-19 tool, stating “ [5/14/21 Update] re: two-year waiver extension – On May 10, 2021, Gov. Lamont signed CT HB 5596, which, among other things, allows for physicians licensed out-of-state to provide services via telemedicine to Connecticut residents for two years.”
screencap of the FSMB update RE CT HB5596
At Person Centered Tech, we updated the Connecticut entry in our Teletherapy Practice Rules by State tool from having a ‘no’ for temporary practice provision under non-emergency rules for each of the 4 professions to having a ‘yes,’ with special requirements, outcome for all 4 professions. We stated that the “Order allowing out of state practitioners to render temporary assistance in Connecticut. “Section 2 of Governor Lamont’s Executive Order 9S authorizes the DPH Commissioner to issue an order suspending the license requirement for the professions listed for an out-of-state licensee whose license is in good standing. Paragraph 4 of Executive Order 12B extends the suspension of the license requirement through midnight on July 20, 2021. PLEASE NOTE THAT THE ORDER WILL NOT BE EXTENDED BEYOND JULY 20, 2021. There is no application or other notification to the Department required in order for an out-of-state licensee to provide care to patients in Connecticut.” And, in keeping with the governor’s statement, the CT.gov statement, CCPH, FSMB, and mHealth Intelligence, declared “in preparation for the Emergency Order expiring, HB 5596 — “An Act Concerning Telehealth” — was approved on 5/10/21, which creates temporary practice provision through 6/30/23.”
Then, a professional colleague who had a client moving to Connecticut who wished to continue working with the provider contacted the board in the course of performing their due diligence. She was told that the new legislation did not, in fact, give permission to practice for out-of-state providers.
Upon receiving this report, PCT contacted the board ourselves to seek clarification on the conflicting information. The board responded, “The Executive Order (EO) allowing out of state practitioners to provide care via telehealth to patients/clients in Connecticut expired on July 20, 2021. Please see the language from House Bill number 5596 below. The highlighted portion is referring to the EO that was in place until July 20, 2021. The EO has not been extended. Therefore, if out of state practitioners, who are not licensed in Connecticut, wish to continue providing care to their Connecticut patients/clients, they must hold a current Connecticut license.”
Sure enough, there are 11 crucial words within the 20 page Act: “under any relevant order issued by the Commissioner of Public Health” in the section that defines a telehealth provider to whom the provisions of the Act apply as including “an appropriately licensed, certified or registered… psychologist, marital and family therapist, clinical social worker, master social worker, alcohol and drug counselor, professional counselor…in another state or territory of the United States or the District of Columbia.”
Dun-Dun-Dun…
The Verdict and What’s Next
Where, then, does this leave us? The Act contains a provision and process to permit practice by out-of-state providers, but does not itself provide that permission to practice.
Permission to practice for out-of-state providers in Connecticut is predicated on an order from the Commissioner of Public Health — an order that does not exist at this time. As a result, there is not permission to practice for out-of-state providers — under current emergency or regular rules.
Why would the governor and state government website declare to their constituents that out-of-state providers could work with Connecticut residents through June of 2023 when that is not, in fact, the case?
Our best guess is that the desire and intent for such permission to practice be in place is present, because that permission to practice is important in order to meet continuity of care needs. Needs whose importance has been highlighted throughout the pandemic.
However, there is clearly an incongruence between the desire and perhaps intent of what the legislation provides for, and what it actually does provide. We imagine there will be pushback from constituents, clients, providers, and legislators alike as a result of both the incongruency and the state of confusion. It would be a wonderful outcome if the response to that anticipated pushback includes the Commissioner of Public Health making an order or declaration that would create permission to practice for out-of-state providers, but time will tell what the outcome will be.
In the meantime, check out our podcast Episode 212: [Teletherapy] Cross-State Practice Confusion, May Be a Sign of the Times for guidance on what to do in light of this state of confusion both in terms of if you conducted a session with a client located in Connecticut as an out-of-state provider after July 20th, 2021, on the basis of incorrect information, and how this illustrative example highlights the importance of following a process for performing and documenting due diligence with regards to permissibility to practice in other jurisdictions.
Who is Providing Clarification?
Person Centered Tech has updated the Connecticut entry in our Teletherapy Practice Rules by State tool to reflect that there is no current permission to practice for out-of-state providers. The FSMB put a strikethrough in the text about the out-of-state-provider permission to practice under HB 5596 in their Connecticut entry and added an update: “ re: status of waivers – The executive order that allowed a physician or PA licensed in another state to practice in Connecticut without a Connecticut license expired on July 20,2021. The order did not distinguish between in-person and telehealth. Public Act 21-9 (HB 5596) authorizes the Commissioner of Public Health to issue an order allowing an out of state licensed physician or PA to provide services via telehealth without obtaining a Connecticut license through June 30, 2023. However, there is no such order in place at this time.” CCHP removed the portion of their Connecticut Cross-State Licensing section that declared HB 5596 extended Telehealth emergency orders through June 2023. (Interestingly, though, this change was done quietly without reference to what was previously present in the entry and that the previous information was incorrect.)
As of the time of publishing, the CT.gov “Healthcare. Official Guidelines” tagged page “Can I receive telehealth services from a practitioner who is based out of state?“ still has not been updated or corrected, nor has there been a clarification statement or amended press release from Governor Lamont’s Office. Hopefully those official sources will provide corrective and clarifying statements soon.
While the current rapidly changing landscape of rules and regulations may well lead to unfortunate circumstances of confusion and conflicting information for providers and clients alike, rest assured that Person Centered Tech will do our best to keep you apprised of developments that impact your legality and permissibility to practice across jurisdictions and to clarify points of confusion that arise.
Further Resources:
- Free Worksheet: Legality and Permissibility to Practice Across Jurisdictions in the United States for Mental Health Clinicians — designed to help you figure out (and document!) if you can and should practice across state lines
- Legal-Ethical CE Training: Cross-Border Practice in the Age of Telehealth: Interstate and International Mental Health Practice, 2021 Edition
- Teletherapy Practice Rules by State For Counselors, MFTs, Psychologists, and Clinical Social Workers