Licensing and Liability Coverage


Licensing guidelines for providing telemental health services vary depending on the jurisdiction (e.g., state, country) in which the therapist and client are located. Therapists should familiarize themselves with the specific licensing regulations and requirements applicable to their practice location(s) and seek guidance from licensing boards, professional associations, and legal experts as needed to ensure compliance with applicable laws and regulations.

Here are some general considerations and common requirements therapists should be aware of:

  • Licensure Requirements: Therapists must be licensed to practice in the jurisdiction where their client is located. This typically means holding a valid license in the state or country where the client resides, even if the therapist is physically located elsewhere.
  • Cross-State Practice: If therapists wish to provide services to clients located in a different state or country than their own, they may need to obtain additional licensure or meet specific requirements for practicing across state or international borders. Some jurisdictions have reciprocity agreements or temporary practice provisions that allow licensed professionals to provide services on a temporary basis without obtaining full licensure in that jurisdiction. See resources below for more information.
  • Telehealth Regulations: Many jurisdictions have specific regulations or guidelines governing the practice of telehealth, including telemental health. These regulations may address issues such as informed consent, privacy and security standards, technology requirements, and professional conduct in the telehealth setting.
  • Informed Consent: Therapists should obtain informed consent from clients specifically for telemental health services. This consent should include information about the potential risks and benefits of teletherapy, confidentiality measures, emergency procedures, and limitations of technology.

Informed Consent Resource

This Telehealth Informed Consent Checklist from TheraNest provides a list of things to consider when creating an informed consent document for clients. For sample informed consent forms, see the Sample TMH Program Documents page.

  • HIPAA Compliance: In the United States, therapists providing telemental health services must comply with the Health Insurance Portability and Accountability Act (HIPAA) regulations regarding the protection of client privacy and security of electronic protected health information (ePHI). This may involve using HIPAA-compliant telecommunication platforms and implementing appropriate security measures to safeguard client data. 
  • Continuing Education and Training: Some jurisdictions require therapists to complete continuing education or training related to telehealth practices as a condition of licensure renewal. This may include courses on teletherapy ethics, best practices, and legal considerations. 
  • Professional Associations and Guidelines: Therapists should consult professional associations and organizations in their field (e.g., American Psychological Association, National Association of Social Workers) for guidance on telemental health practice and adherence to professional standards and ethical guidelines. 

Cross-State Practice Resources

These resources provide some guidance on legal issues to consider when providing TMH services across state lines.

Licensing compacts are a possible answer to recruiting clinicians from different states. The level of national engagement in compacts differs by type of licensure but is steadily increasing for all types of practitioners. Click the links below to learn more about existing and developing compacts.

Liability Insurance

Therapists providing telemental health services typically require liability insurance that specifically covers the risks associated with delivering mental health care remotely. Clinicians and CACs should carefully review their insurance policies and consult with insurance providers specializing in mental health or telemedicine to ensure they have adequate coverage for their telemental health practice. It’s essential to understand policy exclusions, coverage limits, and any requirements or restrictions related to telehealth services. Regularly reviewing and updating insurance coverage as the practice evolves can help therapists mitigate risks and protect their professional and financial well-being.  

Here are some types of liability insurance that clinicians and CACs may need for telemental health practice: 

  • Professional Liability Insurance (PLI): Also known as malpractice insurance, PLI protects therapists against claims of negligence, errors, or omissions in the course of providing professional services. For telemental health practice, therapists should ensure their PLI policy explicitly covers services delivered via telecommunication platforms. 
  • Cyber Liability Insurance: Cyber liability insurance provides coverage for data breaches, cyberattacks, and other cybersecurity incidents that may compromise sensitive client information transmitted electronically during telemental health sessions. This insurance can help cover costs associated with notifying affected clients, regulatory fines, and legal expenses related to data breaches. 
  • General Liability Insurance: General liability insurance protects therapists against claims of bodily injury or property damage that may occur in their office or during therapy sessions, including those conducted remotely. While not specific to telemental health, general liability insurance is still important for overall practice coverage. 
  • Telemedicine Liability Insurance: Some insurance providers offer specialized telemedicine liability insurance policies tailored to the unique risks associated with providing healthcare services remotely. These policies may include coverage for telecommunication technology failures, licensure issues across multiple jurisdictions, and other telemental health-specific liabilities. 
  • Business Owner’s Policy (BOP): A BOP combines various types of insurance, such as general liability, property insurance, and business interruption insurance, into a single package tailored for small businesses. CACs may benefit from a BOP that includes coverage for both in-person and telemental health services.
  • Additional Coverage Options: Depending on the nature of their practice and specific risks, therapists may consider additional coverage options such as sexual misconduct liability insurance, vicarious liability insurance (covering liability for actions of employees or subcontractors), or employment practices liability insurance (covering claims related to employment disputes). 

The Telehealth Certification Institute offers this guidance to telemental health providers on things to consider when purchasing professional liability insurance. 

Page Last Updated: June 2024

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