In this episode, The Top Legal and Privacy Tips Every Traveling Therapist, we’re tackling the biggest questions about teletherapy across borders—this is also a sneak peek into the Portable Practice Method that’s coming soon, this is a condensed version of the module, “Work From Anywhere Legally”. Hop on the waitlist here.
When practicing in different states or countries, protecting client confidentiality and staying compliant with privacy regulations like HIPAA in the U.S. or GDPR in the EU are top priorities. Choosing an EHR that supports compliance, even when you’re abroad, is essential. Platforms like SimplePractice, Sessions Health, and Owl Practice offer time zone toggling features, which makes scheduling easier across locations and helps you stay on track no matter where you’re practicing.
Navigating licensure requirements across regions is crucial. For example, if you’re licensed in one state but want to work with clients in another, you’ll need to confirm that your license covers the client’s location and meets that state’s regulations. This is even more complex internationally; offering services to clients in Europe, for example, requires compliance with GDPR, which may involve revising paperwork to meet those standards. Each session involves a quick checklist—confirming your license validity, tech compliance, and privacy protection—to keep your practice safe, legal, and smoothly adaptable as a Traveling Therapist.
Key Points
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Sponsored by Alma: Managing a private practice can be challenging. There are obstacles at every turn — from navigating the credentialing process, to managing finances, to finding new clients. That’s where Alma can help. Alma is on a mission to simplify access to mental health care by focusing first and foremost on supporting clinicians. https://helloalma.com/kym
Connect with me:
Instagram: @thetravelingtherapist_kym
The Traveling Therapist Membership:
https://kymtolson.kartra.com/page/travelingtherapistmembership
Revolutionize Your Private Practice with AI Course:
https://kymtolson.kartra.com/page/ai
Signup to learn more about life as Traveling Therapist:
https://www.portablepracticemethod.com/free-training
The Traveling Therapist Facebook Group:
https://www.facebook.com/groups/onlineandtraveling/
Bill Like A Boss Insurance Billing Community:
https://kymtolson.kartra.com/page/blab
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TRANSCRIPT:
00:00
Welcome to this very important lesson on navigating the challenges of practicing therapy internationally and domestically. Whether you're considering taking your practice across borders or expanding your services within your own country, it's crucial to understand the legal landscape to ensure that you stay compliant and protect your practice. So let's start by looking at the key legal challenges you're going to face when practicing therapy in different regions. These challenges can be very significant depending on whether you're working internationally or within your home country. For instance, if you're licensed in the United States, but wish to offer services to clients in the European Union, you'll need to comply with both us regulations and the strict privacy laws of the EU such as GDPR, this requires understanding not only your own country's laws, but also the legal requirements of the countries where your clients are located, every country and often, each state or region has its own regulatory bodies that govern therapy practices. These bodies, such as state licensing boards in the United States or health ministries in Europe, are responsible for setting the standards for practice, including education, ethics and licensing. It's important to understand which regulatory bodies oversee your profession in a new region, and it's crucial to do the research ahead of time. You'll need to ensure that your qualifications meet their requirements. In some cases, you might need to obtain additional certifications or even a new license if you want to practice in a new location and see clients within that location. Now, if you're in the United States and you want to travel to other countries, you're going to need to pay attention to the licensing board where your clients are sitting at the time of the session. So in the United States, for example, I'm licensed in Virginia. I'm allowed to be located anywhere in the world as long as my client is physically sitting in the state of Virginia during the time of recession. I discovered that by reaching out to my licensing board and asking them the question about, where does the client need to be located, and where am I required to be located during the time of the session? This general rule does apply. Regardless of what country you're in. You still have to check with your regulatory boards about offering telehealth services remotely to your clients and what the restrictions are around them, and then additionally reaching out to the country or the state or the location that you're sitting in and asking if there are any restrictions against me seeing my clients back in your state of licensure or my country of licensure while I'm sitting in your state or in your country. So we'll dig in a little bit deeper, but I just want to clarify that in the beginning, one potential solution in practicing in multiple regions is licensing reciprocity. Some regions have agreements that allow your license to be recognized without additional certifications. However, these agreements are not universal. For example, a license from one US state might not be recognized in another state, let alone another country. So before expanding your practice, it's really essential to check whether your current license is valid in the new region, and what steps are required if it isn't. And that mainly goes for if you want to start seeing new clients in that new place that you're located. Now, if you're like me, a digital nomad, I have no need for that, because I am licensed in the state of Virginia, my clients are sitting in the state of Virginia, and I don't need to do anything else, as long as my board says it's okay. My insurance contracts say it's okay, and the country or location I'm sitting in says it's okay. I'm okay to see my clients. It depends on your preferences and what you want to do in your traveling therapist lifestyle. Some people want to move to Belgium and see only clients that live in Belgium, and they are, you know, originally licensed in the United States. There's a process to that. It really depends on you your traveling therapist, lifestyle, where you're licensed and where you want to be practicing when you're seeing your clients as a traveling therapist. And as I said before, another key consideration is client jurisdiction. So when you offer services across borders, the laws of your client's location often take precedence over your own location, so this can impact everything from the legality of your services to the type of insurance that you need to protect yourself. Professional Liability is also a significant concern. You must ensure that your insurance policy covers the regions where you're offering services, so without proper coverage, you could be exposed to legal risks such as malpractice claims that could really threaten your practice, your license, your well being and your ability to practice as a therapist. For me, my example is I have CPH and Associates. I reached out to them and said, Here's my situation. I'm going to be located wherever because my Licensing Board says I can't be. I want to know, how am I covered under this liability insurance that I have with you, and do I need to add any additional riders on? So they wrote me back, and they said, as long as you're following your state licensing laws and seeing your clients within those licensing laws, you will be COVID. Covered for the clients you're seeing in that location, meaning, if a client decides to sue me or anything like that, we would have to go to court in the state of Virginia, because that's where I'm licensed. That's where my liability insurance covers me, and that is where I only see clients, clients that are sitting in that state at the time of service. There are other international policies. Generally, if you want to see clients internationally, your liability insurance is not going to cover that. If you're sitting in the United States or in your state and you decide you want to start seeing expats that live in Japan, you probably can do that, but your liability insurance is not going to cover you if you do that. But generally, you're safest if you're in the United States practicing to see your clients in your state of licensure, regardless of where you're sitting at the time of the session. Internationally, there are other countries, if you've got a visa there, if you've got residency there, where you can get liability insurance in that country, it's all about research. Realizing that you need to be covered liability wise is super important for your license and the future of your business and your practice as a as a therapist. Let's talk about telehealth. Teletherapy, or telehealth, introduces unique challenges, particularly when you're practicing across borders. So for instance, maintaining client confidentiality is more complex when using digital platforms, especially these platforms do not comply with privacy laws like HIPAA or GDPR regulations, depending on where you're sitting at the time of the session and what type of clients you're seeing. And you're also going to need to navigate time zones, time zone differences, to ensure that your communication methods are secure and legally compliant. So using an EHR that allows you to toggle between time zones is super important for this. I use simple practice. I know sessions health does it. I know our practice suite does it. They allow you to toggle between time zones, which is super helpful for me and for simple practice, for example, if I download the mobile app, I can switch to my local time zone and then switch back to my client time zone when I'm trying to schedule them. So that helps me keep that straight. The thing to also consider about the technology that you're using, does the software that you're using allow you to be out of the country, practicing if you're in the United States, using software based in the United States, does it allow you to still have HIPAA compliance if you're in another country? These are questions to ask before you even decide to sign up for EHR management platform to find out if you're allowed to be out of the country, and how do you navigate that? There's a lot of nuances around this. There's tons in the traveling therapist Facebook group around this and how people are navigating it, but I wanted to touch on that for HIPAA reasons and compliance reasons with your liability insurance. So let's look at a couple of case studies. For example, consider a therapist licensed in the United States and they want to offer services to clients in Europe, not only do they need to comply with the US regulations, but they also must adhere to the EU's strict data protection laws, which might require changes in how they store and manage client information. They also must adhere to the EU strict data protection laws which might require changes to your paperwork templates and the paperwork that you give out, the confidentiality agreements they are going to have to comply with GDPR requirements instead of HIPAA requirements if that clinician wants to see clients over in the EU these are all things to consider. In another case, a therapist might be licensed in California and they want to provide telehealth to a client in New York. So even within the same country. Differences in state laws mean that the therapist must verify their license validity in New York and comply with the state specific regulations of New York. So in this situation, you would more than likely either need to get licensed in the state of New York to be able to see clients sitting in New York, regardless of where you're sitting, or you're going to need to see if New York has some reciprocity with California licensing, or sometimes the boards in other states will grant you permission to be able to see clients, maybe for 10 sessions while you're sitting in that state. But even then, you have to check with California to make sure it's okay that you're doing that in another state, that you're allowed to be sitting in California and see clients in New York, so you have to check both ways, and mainly in the United States, generally, you must be licensed to see the client in the state where the client is sitting at the time of the session. So, as you can see, practicing across different regions requires careful consideration and thorough preparation. But by staying informed and proactive, you can navigate these challenges and expand your practice successfully and legally. Take a look down below at all the resources. Make sure that your license allows you to be out of your state or country, practicing and seeing clients where you want to see your clients, and make sure you check the regulations of where you'll be sitting at the time of the session, whether it's a different country, a different state. All of that matters. You have to check those three things every single time if you're going to be seeing clients as a traveling therapist.