Interstate Medical Licensure Compact and PSYPACT To Debut in Connecticut: New Laws Meant to Streamline Physician Licensure and Broaden Mental Health Access
Having learned some difficult lessons from the clinical shortages that have accompanied the Covid-19 pandemic, Connecticut’s General Assembly passed two important pieces of legislation last session to provide physicians with an expedited process for obtaining licensure in multiple states while giving psychologists the opportunity to practice across state lines without being licensed in the state where the patient is located. These professional licensing changes go into effect on October 1, 2022, when Connecticut joins both the Interstate Medical Licensure Compact (“IMLC”) pursuant to Section 43 of Public Act 22-81 and the Psychology Interjurisdictional Compact (known as “PSYPACT”) pursuant to Section 42 of Public Act 22-81.
About the IMLC
The Interstate Medical Licensure Compact is an agreement among participating U.S. states and territories to work together to streamline the licensing process for qualified physicians who want to practice in the multiple states that make up the IMLC (the “Compact States”). Its purpose, as borne out by the staffing problems that have plagued hospitals and other healthcare providers during the pandemic, is not only to ease the paperwork burden necessary to obtain licensure, but also to improve access to both in-person and telemedicine services for Compact State patients.
Importantly, however, although the IMLC creates an alternative pathway for licensure in the Compact States (Connecticut will join approximately 36 other states who either fully participate or are in some stage of the IMLC implementation process), it does not otherwise change a state's existing licensure requirements for physicians. In fact, the IMLC’s processes affirm that the practice of medicine occurs where the patient is located at the time of the physician-patient encounter and, therefore, requires the physician to be under the jurisdiction of the state medical licensing board where the patient is located. The result is that state licensing boards that participate in the IMLC retain the jurisdiction to impose an adverse action against a physician who obtained his or her license to practice medicine through the IMLC’s procedures.
Physicians must meet certain eligibility requirements to avail themselves of the IMLC’s uniform application process. In essence, these requirements are that the physician hold an unrestricted license in a Compact State that can serve as a declared State of Principal License (SPL) and have no disciplinary history, including against their DEA registration. Physicians seeking licensure through the IMLC first must apply to the licensing board of their SPL, which can be either their state of primary residence, the state where at least 25% of their practice of medicine occurs, the location of their employer or, if none of the three previous criteria apply, the state of their residence for federal income tax purposes. Once the SPL determines that a physician meets the eligibility standards of the IMLC, the physician can qualify to practice medicine in multiple states by completing just one application through the IMLC and submitting it for review and approval of the respective licensing boards of each Compact State in which they intend to practice. If a physician does not meet the IMLC eligibility requirements for any reason, he/she may still obtain a license in a member state if they meet all the other requirements (outside of the IMLC requirements) for licensure in that jurisdiction.
While making it easier for physicians to obtain licenses in Compact States, the IMLC also enhances the ability of member states to share investigative and disciplinary information. The Commission responsible for administering the IMLC (made up of representatives from each Compact State) maintains a database of all physicians licensed, or who have applied for licensure, using its processes. Member licensing boards report to the Commission any public action or complaint against such physicians. If a license granted to a physician by the licensing board in the physician’s SPL is revoked, surrendered or relinquished in lieu of discipline, or suspended, then all licenses issued to the physician by Compact State member boards are automatically placed on the same status. On the other hand, if disciplinary action is taken by a Compact State board other than the physician’s SPL, the licensing boards of the other Compact States in which the physician is licensed may exercise their discretion to impose the same or similar discipline or seek to institute their own form of discipline against the licensee. In addition, Compact State licensing boards may participate in joint investigations of physicians licensed through the IMLC.
The passage of the legislation permitting Connecticut to enter the Psychology Interjurisdictional Compact is even more far reaching for psychologists than the IMLC legislation is for physicians as the explicit goal of PSYPACT is to authorize psychologists to practice both telehealth and in-person services across state lines without requiring licensure in the state where the patient is located. Under PSYPACT’s rules, qualified psychologists are able to practice via telehealth (referred to as “telepsychology” by PSYPACT) in states where they are not licensed for an unlimited amount of time while being able to provide in-person, face-to-face services for a more limited period of 30 days per year per participating state. Through PSYPACT, psychologists can apply for authorization to engage in either or both of these types of patient encounters.
Aside from Connecticut, approximately 33 other states currently participate in PSYPACT. To apply for authorization under PSYPACT’s rules, a psychologist must hold a graduate psychology degree (defined as a doctorate level degree) from an institution that meets certain specified accreditation or similar requirements and have an unrestricted license to practice in a Compact State. The state(s) in which the psychologist holds such an unrestricted licensed is referred to as the psychologists’ “home state.” In addition, the psychologist’s home state licensure authorizes the psychologist to practice telepsychology or temporary in-person services only if the home state meets various criteria, such as having a mechanism to receive and investigate complaints about the licensed professional and requiring an “E.Passport” in order for the psychologist to provide telepsychology services or an Interjurisdictional Practice Certificate (“IPC”) in order to perform temporary in-person services in the various Compact States.
The Association of State and Provincial Psychology Boards (“ASPPB”) is responsible for issuing both the E.Passport and the IPC under PSYPACT, and each of these certifications must be renewed annually and requires payment of a fee. The E.Passport authorizes the psychologist to practice telepsychology in what PSYPACT calls a “receiving state”, which is the state where the patient is physically located at the time of the telepsychology encounter. This certificate also requires three hours of continuing education annually on the use of technology in psychology.
The IPC grants the psychologist temporary authority to provide in-person psychology services in Compact States where he or she is not licensed. This can be done however, only after the psychologist notifies that “distant state’s” psychology regulatory authority of his or her intention to practice in that state and their professional qualifications are verified. The term “distant state” is used in PSYPACT’s nomenclature to describe the Compact State where the psychologist is physically present at the time to perform the temporary in-person, face-to-face services.
PSYPACT also gives the home, receiving and distant states the ability to take disciplinary action against a psychologist’s license. If an action is taken by any one of these states, the E.Passport or IPC is revoked. Similar to the IMLC, PSYPACT also provides for a coordinated licensure information system that enable Compact States to report any disciplinary action taken against a psychologist, to all Compact States.
Should you have questions regarding the IMLC or PSYPACT legislation or how to apply for participation in either of these licensure compacts, please contact members of Pullman & Comley’s Health Care Group.