Telehealth Across the Border
You are an LPC licensed only in Oregon, practicing via telehealth from your home in Salem. A client, M., has been in weekly video sessions for five months. M. relocates to Vancouver, Washington, for a nine-month job assignment and asks to continue sessions. M.'s insurance is an Oregon plan; M.'s employer is in Washington. M. also asks you to write a letter supporting a workplace accommodation for anxiety. Your professional disclosure statement lists your Oregon license and says services are provided to clients located in Oregon. You have never checked Washington's licensure rules. M. says the sessions are 'just talking' and asks you to keep seeing them without telling the insurer about the move.
1. May you continue seeing M. while M. is physically in Washington? What must you verify first?
Read the worked answer
An Oregon license authorizes practice with clients located in Oregon; it does not automatically authorize practice in Washington. Because M. will be physically in Washington during sessions, you need to determine Washington's licensure requirements before continuing. Do not assume the Oregon license or the insurance network is enough. Check the Washington board's rules on out-of-state licensees, temporary practice, and telehealth. If you are not authorized, refer M. to a Washington-licensed provider or pause until authorization is obtained. The client's Oregon insurance plan does not resolve the licensure question. Document your analysis. Do not agree to hide the move from the insurer; that could create billing and fraud problems.
2. If you are authorized to continue, what informed-consent and emergency-planning changes are needed?
Read the worked answer
Update the informed consent and professional disclosure statement to reflect M.'s location, the telehealth platform, emergency contacts in Washington, and the limits of confidentiality. Verify M.'s physical location at each session, identify local emergency resources, and confirm a local emergency contact. Explain how records and fees will be handled across state lines. If you are not authorized, provide a referral and a summary as permitted. Do not continue silently while M. is in Washington. Document the location verification and the updated consent.
3. What should you consider before writing the workplace accommodation letter?
Read the worked answer
The letter must be based on your assessment and be accurate; write only what you can support. Avoid promising that the employer will grant the accommodation. Discuss with M. what will be disclosed and obtain written authorization. If you are not licensed in Washington and the letter is for a Washington workplace, consider whether writing it is part of practicing in Washington; consult the board or refer. Do not exaggerate M.'s condition or disclose unnecessary clinical details. Document the request, the authorization, and your rationale. If you decline, explain the licensure or scope reason and offer an appropriate referral.