Introduction to Telepsychiatry
Telepsychiatry is a dynamic and rapidly expanding branch of telehealth services that leverages technology to deliver mental health care remotely. By connecting patients and providers—including healthcare professionals authorized to deliver telepsychiatry—through secure video conferencing and digital communication tools, telepsychiatry makes it possible to access psychiatric evaluations, therapy, and consultation services from virtually anywhere. This approach is especially valuable for individuals in rural or underserved communities, where access to in-person mental health care may be limited. As telepsychiatry becomes more prevalent, it is essential for providers to navigate a complex landscape of state laws, state licensing, and regulations to ensure that health care and medical care services are delivered safely, ethically, and in compliance with all legal requirements. Physician licensure regulations, which are controlled by each state, remain the main barrier to broader interstate telehealth access. The growth of telepsychiatry reflects a broader shift in health care, prioritizing convenience, accessibility, and patient-centered care through innovative telehealth technologies.
Understanding State-by-State Licensure Challenges
Before interstate licensing compacts, healthcare professionals in the U.S. faced significant barriers to practicing across state lines. Each state required a separate professional license, and providers handling controlled substances needed individual Drug Enforcement Administration (DEA) registrations. However, some states allow exceptions for an out of state physician to practice under the following circumstances, such as on an irregular or infrequent basis or when providing episodic consultation services, provided the physician is in good standing with their home licensing board or medical licensure commission. In many cases, the relevant certification board also determines eligibility for such exceptions. Out-of-state practice still requires a valid license issued by the appropriate state authority.
This process was time-consuming, costly, and involved navigating varied state requirements, often taking months to complete. Despite the effort, additional licensing did not improve care quality, as education and training standards are already consistent nationwide.
How Interstate Compacts Transform Healthcare
Interstate licensing compacts have revolutionized healthcare by allowing professionals to practice in multiple states with a single license or privilege, streamlining licensure and DEA registration processes. These agreements tackle workforce shortages, particularly in psychiatry and psychology, where over 60% of U.S. counties lack a psychiatrist and nearly half of adults with mental health needs cannot access care. The Interstate Medical Licensure Compact (IMLC) has been enacted in 40 states, the District of Columbia, and the territory of Guam, further expanding its reach and impact on healthcare accessibility.
By enabling cross-state practice, compacts enhance access to telehealth services and allow providers to remotely provide health care services, especially in underserved and rural areas, reducing treatment delays and addressing critical mental health provider shortages. Compacts also improve patient care across state lines by supporting continuity and quality of care for individuals regardless of their location. Additionally, compacts help oversee compliance with legal and regulatory requirements, ensuring that telehealth providers maintain high standards and adhere to state and federal laws. However, any telehealth provider practicing across state lines must still comply with state regulations and meet specific registration requirements to ensure legal and safe delivery of care.
Revolutionizing Telemedicine and Mental Health Access
Compacts have transformed telemedicine, enabling providers to deliver virtual mental health careacross state lines without redundant licensing barriers. Telemedicine services allow a licensed physician to treat patients located in other states; however, legal requirements for providing services are determined by where the patient is physically located at the time of the telehealth encounter, and providers must comply with the laws of the state where the patient is located. When treating patients via telemedicine, it is essential that providers are authorized to practice telemedicine legally in the patient’s jurisdiction. This is vital for telepsychiatry, where a national shortage of psychiatrists—approximately 28,000 for a population exceeding 330 million—leaves facilities understaffed. Most temporary licensure flexibilities allowing practice across state lines during the public health emergency have expired. Compacts like the Interstate Medical Licensure Compact (IMLC) and Counseling Compact provide expedited licensing pathways, ensuring timely access to psychiatric evaluationsmedication managementtherapy in areas with limited providers.
Nurse Licensure Compact (NLC)
Origin (1996-2000)
The Nurse Licensure Compact (NLC), launched in 1996 by the National Council of State Boards of Nursing (NCSBN), aimed to simplify cross-state nursing practice by allowing nurses to practice nursing across state lines under a multistate license. It was enacted in 2000, with Utah, Texas, Wisconsin, and North Carolina as the first participating states.
Development
The original NLC allowed registered nurses (RNs) and licensed practical/vocational nurses (LPNs/VNs) to practice in member states using a multistate license. In 2015, the Enhanced NLC (eNLC) introduced stricter standards, including federal background checks, and by 2018, states fully transitioned to the eNLC
Growth and Advocacy
As of 2025, over 40 states and territories participate in the eNLC, driven by demand for telenursing and nurse mobility, especially post-COVID-19. The compact supports psychiatric nurse practitioners in addressing mental health shortages, reducing wait times for virtual mental health care, with streamlined DEA registration for prescribing. Lobbying by groups like the American Nurses Association and state hospital associations has spurred expansion, with Michigan advancing legislation in 2025 and New York proposing bills despite nursing union opposition. This growth enhances telemedicine for mental health, enabling nurses to provide cross-state virtual care.
Interstate Medical Licensure Compact (IMLC)
Origin (2013-2017)
Proposed in 2013 by the Federation of State Medical Boards (FSMB), the Interstate Medical Licensure Compact (IMLC) aimed to streamline physician licensure for telemedicine and cross-state practice. Drafted in 2014, it launched in 2017 after 11 states passed enabling legislation.
Development
The IMLC offers an expedited licensure process, allowing physicians to apply through their principal state license to practice in other member states, often simplifying DEA registration. It upholds strict standards, such as a clean disciplinary record.
Growth and Advocacy
By 2025, 39 states, the District of Columbia, and Guam participate, fueled by the rise of during the pandemic. The IMLC alleviates psychiatrist shortages by enabling providers to deliver virtual psychiatric care, including medication management and evaluations, without delays. Advocacy from organizations like Weill Cornell Medicine supports New York’s proposed legislation, while Michigan’s bills aim to make the IMLC permanent, ensuring ongoing access for telemedicine physicians. The IMLC has driven investments in telehealth platforms and interstate health data exchange, normalizing virtual mental health care.
Counseling Compact
Origin (2018-2022)
The Counseling Compact, conceptualized in 2018 by the American Counseling Association (ACA), sought to remove barriers for licensed professional counselors, particularly in telehealth. Model legislation was finalized in 2020.
Development
Georgia enacted the compact in 2021, and it became operational in 2022 after reaching the 10-state threshold, allowing counselors to apply for cross-state practice privileges.
Growth and Advocacy
By 2025, over 20 states have joined, driven by demand for mental health services amid a shortage of psychology providers, with only about 100,000 licensed counselors nationwide. The compact enhances access to teletherapy, addressing behavioral health shortages worsened by resource strains. With 39 states passing legislation and privileges set to be granted by fall 2025, ACA’s advocacy investment has accelerated adoption, with Texas’ legislation authorizing implementation fees to support cross-state telebehavioral health. This expansion boosts telemedicine, enabling counselors to conduct virtual therapy sessions across states for timely mental health support.
Types of Licenses in Telepsychiatry
To provide telehealth services across state lines, telepsychiatrists must secure the appropriate licenses and certifications. The most common pathway is obtaining a full and active license to practice medicine or psychology in the state where the patient is located, as state licensure is typically required for all health care services provided. Providers are often required to annually register with the relevant state boards to maintain compliance and ensure ongoing licensure. Some states, recognizing the unique nature of telehealth, offer special telehealth registrations or limited licenses that allow out-of-state physicians to provide telehealth medical services without undergoing the full licensure process. Eligibility for licensure compacts or special registrations generally requires that the provider holds an unrestricted license in their home state. Additionally, licensure compacts—such as the Interstate Medical Licensure Compact—offer a streamlined process for obtaining licenses in multiple states, making it easier for providers to deliver care to patients in different jurisdictions. Key requirements for telemedicine licensing often include having a current, unrestricted license, board certification, passing background checks, and maintaining professional liability insurance. Understanding the specific requirements for each state, whether through traditional licensure, telehealth registrations, or participation in licensure compacts, is crucial for any provider looking to expand their telepsychiatry practice and provide services to a broader patient population.
Professional Standards in Telepsychiatry Practice
Telepsychiatrists are held to the same professional standards as those practicing medicine in traditional, in-person settings. This includes obtaining informed consent from patients before initiating telehealth services and the need to obtain consent in accordance with state guidelines, especially regarding patient identity verification and the sharing of protected health information. Maintaining strict confidentiality and delivering high-quality, evidence-based care remain essential. Professional organizations, such as the American Psychiatric Association, have developed guidelines to ensure that telepsychiatry upholds the integrity of the physician-patient relationship, even when care is delivered virtually. In some cases, an in person examination may be required before telepsychiatry services can be provided, particularly for certain diagnoses or to establish the practitioner-patient relationship. Telepsychiatrists must also comply with all relevant state laws, particularly those governing the prescribing medication, including the prescription of controlled substances, and ensure they have the necessary certifications, such as DEA registration, to prescribe medication legally. Most states require that telehealth services comply with the same professional practice standards as in-person services. By adhering to these standards, telepsychiatrists can provide safe, effective, and ethical care while leveraging the benefits of telehealth technologies.
Consent and Privacy in Virtual Mental Health Care
Ensuring patient privacy and obtaining informed consent are foundational to providing telepsychiatry and other telehealth services. Before beginning treatment, healthcare professionals must clearly explain the nature of telepsychiatry, including potential risks, benefits, and alternatives, so that patients can make informed decisions about their care. Protecting the confidentiality of medical records is also paramount, requiring strict adherence to federal regulations like the Health Insurance Portability and Accountability Act (HIPAA) as well as applicable state laws. The Department of Health and Human Services plays a key role in establishing national standards for telehealth privacy and consent, helping to streamline compliance across jurisdictions. Additionally, coordination among human services is essential to support privacy protections and ensure consistent consent practices in telepsychiatry. Telepsychiatrists must use secure platforms for virtual visits and take steps to safeguard sensitive medical information from unauthorized access. By prioritizing informed consent and privacy, providers can foster trust, support patient autonomy, and ensure that virtual mental health care meets the highest standards of ethical and legal practice.
Meeting Post-COVID Expectations and Enhancing Care
Interstate licensing compacts have revolutionized healthcare by promoting professional mobility, standardizing licensure, and easing DEA registration hurdles. By eliminating redundant barriers that don’t enhance care quality, they ensure better access to mental health services, particularly in psychiatry and psychology.
Post-COVID, patients expect seamless access to all healthcare providers, including psychiatrists and counselors, regardless of location, a demand driven by the widespread adoption of telehealth during the pandemic. [Companies like FasPsych](https://faspsych.com/blog/best-telepsychiatry-provider-for-cmhcs-2025/), with providers licensed within the NLC, IMLC, and Counseling Compact, are ideally positioned to meet telepsychiatry needs for medical facilities nationwide.
FasPsych’s large, diverse provider pool—including psychiatric nurse practitioners, psychiatrists, and counselors—enhances affordability by optimizing resource allocation and reducing overhead costs compared to hiring local providers. This larger pool improves care quality by matching patients with specialists suited to their needs, such as those with expertise in specific mental health conditions or cultural competencies. Telepsychiatry providers are expected to uphold the same responsibilities and standards of care as they would during in person care or face to face visits, including proper documentation of follow up care, and must maintain professional liability insurance to ensure coverage for both virtual and in person visits. FasPsych’s inclusion of Spanish-speaking providers and diverse professionals ensures equitable access, addressing linguistic and cultural barriers in underserved communities. By offering specialized mental health services and diverse provider expertise, FasPsych meets the growing demand for accessible, high-quality virtual mental health care across the nation, with compacts enabling continued expansion as telehealth evolves.
Frequently Asked Questions (FAQ)
What are interstate licensing compacts?
Interstate licensing compacts are agreements among U.S. states allowing healthcare professionals to practice across state lines with a single license or privilege, streamlining licensure and DEA registration.
How do compacts benefit telemedicine?
Compacts enable providers to offer virtual mental health care across states without multiple licenses, expanding access to telepsychiatry and teletherapy, reducing delays, and addressing psychiatry and psychology shortages. Interstate telehealth and interstate telehealth practice allow telehealth providers to deliver telehealth services across state lines, provided they meet telehealth registration and registration requirements.
Why were compacts created?
Compacts address workforce shortages, particularly in mental health, enhance professional mobility, and improve access to telehealth services by removing time-consuming licensing barriers that don’t improve care quality.
Which states participate in these compacts?
As of 2025, the NLC includes over 40 states and territories, the IMLC covers 39 states, the District of Columbia, and Guam, and the Counseling Compact includes over 20 states, with more joining through legislation. Some states, such as California, require a current California license for telehealth providers, while others, like Arkansas, require compliance with the Arkansas State Medical Board.
Are there efforts to expand these compacts?
Yes, advocacy from groups like the American Nurses Association, Weill Cornell Medicine, and the American Counseling Association drives legislation, such as in Michigan and New York for the NLC and IMLC, and Texas for the Counseling Compact. Provincial psychology boards and physical therapists are also exploring interstate telehealth practice through similar compacts.
Do compacts compromise care quality?
No, compacts maintain high standards, including clean disciplinary records and background checks, ensuring care quality while eliminating redundant processes. Physician assistants and other health care professionals must still meet all licensure and registration requirements, including those related to medical school credentials and professional standards.
How do compacts address psychiatry and psychology shortages?
Compacts like the IMLC and Counseling Compact enable psychiatrists and counselors to practice across states via telemedicine, reducing wait times and providing on-demand mental health services in areas with severe provider shortages. Advances in real time telehealth technologies enable providers to prescribe controlled substances when authorized, provided they follow all legal requirements, including providing informed consent and obtaining consent from patients.
How does FasPsych leverage compacts for telepsychiatry?
FasPsych’s providers, licensed within the NLC, IMLC, and Counseling Compact, offer affordable, high-quality telepsychiatry with specialized and diverse expertise, including Spanish-language support, meeting the needs of medical facilities nationwide.