Most Lucrative States To Get Licensed In For Telepsychiatry (PMHNP)

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Specializes in MSN, FNP-C, PMHNP, CEN, CCRN, TCRN, EMT-P.

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Starting to license in other states to do remote psych.  What are the most lucrative states or ones with the biggest need?

Florida, Texas, California, Oregon are definite states for me.

MentalKlarity, BSN, NP

Specializes in Psychiatry. Has 8 years experience.

Licensing in a state without Independent practice such as TX means you'll need a TX physician supervisor and register a supervisory agreement. Not exactly easy to do. You'll also need a DEA for each state and have to follow each states prescribing laws.

verene, MSN

Specializes in mental health / psychiatic nursing.

California and Texas both require supervising physicians so not good states to try doing remote work in as you would need a supervising physician in each state. 

Independent practice states are likely going to offer more opportunities for independent telehealth practice and offer better reimbursement rates (though not universally) for services if you are billing insurance. 

You'll need to meet the requirements for licensure in each state (some have weird quirks), have a separate DEA number (which may require a physical address within state that you are affiliated with), for each state, and need to know the laws and practice regulations for each state (and some states require that you be physically in the same state as the patient even when providing telehealth - e.g. I believe Washington operates this way). 

You'll also want to see if there are in-person visit requirements even when offering telehealth services. Not sure current/covid exemption practice, but at least historically in Oregon, you still had to see telehealth clients every so many months in-person, particularly if you are prescribing them controlled substances -- so you'll need to have a plan for how to meet this if it is a requirement.   Also need to make sure you have a way to monitor vital signs and to handle psychiatric emergencies, and adverse medication reactions, for every geographic location in which you are treating patients. 

Honestly have licenses and clients in more than a couple of states seems like it would likely be more headache than it is worth, but you do you.

GordonGekko, MSN

Specializes in MSN, FNP-C, PMHNP, CEN, CCRN, TCRN, EMT-P.

On 9/11/2021 at 4:54 PM, verene said:

California and Texas both require supervising physicians so not good states to try doing remote work in as you would need a supervising physician in each state. 

Independent practice states are likely going to offer more opportunities for independent telehealth practice and offer better reimbursement rates (though not universally) for services if you are billing insurance. 

You'll need to meet the requirements for licensure in each state (some have weird quirks), have a separate DEA number (which may require a physical address within state that you are affiliated with), for each state, and need to know the laws and practice regulations for each state (and some states require that you be physically in the same state as the patient even when providing telehealth - e.g. I believe Washington operates this way). 

You'll also want to see if there are in-person visit requirements even when offering telehealth services. Not sure current/covid exemption practice, but at least historically in Oregon, you still had to see telehealth clients every so many months in-person, particularly if you are prescribing them controlled substances -- so you'll need to have a plan for how to meet this if it is a requirement.   Also need to make sure you have a way to monitor vital signs and to handle psychiatric emergencies, and adverse medication reactions, for every geographic location in which you are treating patients. 

Honestly have licenses and clients in more than a couple of states seems like it would likely be more headache than it is worth, but you do you.

I am looking to do 1099 work for practices in need.  I’ve been told the in person requirement can be any provider in the practice.  Thanks for info though good things to think about 

verene, MSN

Specializes in mental health / psychiatic nursing.

11 minutes ago, GordonGekko said:

I am looking to do 1099 work for practices in need.  I’ve been told the in person requirement can be any provider in the practice.  Thanks for info though good things to think about 

Oh yeah, if you are doing like a contract/agency type telehealth coverage across multiple states that makes more sense than just trying to do telehealth across multiple states. Not sure that there are agencies that help be the umbrella for multiple clinics contracts but that may be something to look into particularly if they would help with license requirements/DEA etc - like what travel agencies do but for telehealth contract coverage. 

GordonGekko, MSN

Specializes in MSN, FNP-C, PMHNP, CEN, CCRN, TCRN, EMT-P.

15 hours ago, verene said:

Oh yeah, if you are doing like a contract/agency type telehealth coverage across multiple states that makes more sense than just trying to do telehealth across multiple states. Not sure that there are agencies that help be the umbrella for multiple clinics contracts but that may be something to look into particularly if they would help with license requirements/DEA etc - like what travel agencies do but for telehealth contract coverage. 

Companies like Cerebral and Iris are becoming larger across more states.  They usually want multiple licenses.  I would pay out of pocket if need be.