One of the most common questions providers ask when expanding their telehealth practice is whether they can see patients in other states. The short answer is: it depends on your profession, the states involved, and whether an interstate compact applies. Getting this wrong is not a minor compliance issue. A provider must hold a valid, active license in every state where their patients are located. The patient’s physical location determines the required license, not their home address. That single rule catches many providers off guard, particularly those whose patients travel frequently, attend college in another state, or spend part of the year at a second residence. securevideo
Here is what every telehealth provider needs to understand about cross-state licensure in 2026.
The Core Rule: Care Occurs Where the Patient Is
According to the Center for Connected Health Policy, the physical location of the patient at the time of the telehealth visit determines which state’s license requirements apply. This means if your patient is in Florida for the winter and you are licensed only in Illinois, you are practicing in Florida without a license, regardless of how long the patient has been your patient or where they normally reside. Every telehealth provider needs a system for verifying and documenting patient location at the time of each visit. Vimeo
Interstate Compacts: The Current Landscape by Profession
Interstate compacts are the primary mechanism for expanding cross-state telehealth practice without applying for full individual state licenses. The compact landscape varies significantly by profession:
Physicians (IMLC)
The Interstate Medical Licensure Compact (IMLC) can expedite multi-state licensing for eligible physicians across approximately 42 participating states. A critical distinction: the IMLC is an expedited pathway to obtain multiple separate state licenses, not a single multistate license. Each state still issues, renews, and regulates its own license. About 80% of U.S. physicians are eligible. California does not participate, which is a significant gap for practices with West Coast patients. securevideoLeadIQ
Psychologists (PSYPACT)
The Psychology Interjurisdictional Compact (PSYPACT) is a mature compact framework for cross-state practice that supports telepsychology across participating jurisdictions. The compact currently has 43 participating states and districts, and psychologists who hold a license in good standing in a PSYPACT state and obtain PSYPACT authorization can provide telepsychology services to patients in any participating state without needing to apply for dozens of separate licenses. PSYPACT is widely cited as the model other professions are working toward because of its genuine license portability for telehealth. LeadIQ
Nurses (NLC)
The Nurse Licensure Compact authorizes registered nurses and licensed practical nurses to hold a multistate license covering all NLC member states under a single home state license. The NLC currently covers 43 member states. The compact is reciprocal and largely automatic for eligible nurses in participating states. securevideo
Licensed Professional Counselors (Counseling Compact)
The Counseling Compact has been enacted in 38 states as of March 2026, with operational implementation rolling out. LPCs and LMHCs who are licensed in a compact member state can practice telehealth and in-person counseling in other member states through the compact’s privilege to practice. Note that the Counseling Compact applies to Licensed Professional Counselors and equivalent titles only, not to MFTs or social workers. LinkedIn
Social Workers (Social Work Licensure Compact)
The Social Work Licensure Compact has been enacted in 25 or more states and is in early implementation. Multistate licenses are beginning to be issued as the compact’s infrastructure comes online. Social workers should monitor their state’s implementation status directly before relying on the compact for cross-state practice. LinkedIn
Physical Therapists, Occupational Therapists, and Other Allied Health Professions
Separate compacts exist for physical therapists (PT Compact), occupational therapists (OT Compact), audiologists and speech-language pathologists (ASLP-IC), and physician assistants (PA Compact), each with different member state maps and eligibility requirements. Capterra
When No Compact Applies
When a provider’s profession does not have an applicable compact, or when a patient is located in a state not covered by the relevant compact, the only option is individual state licensure. Some states offer:
- Telehealth-only registration: A handful of states including Arizona, Colorado, Delaware, and Vermont allow out-of-state providers to register for a telehealth-specific authorization without obtaining full state licensure. Colorado’s telehealth provider registration framework took effect under SB 129 in the 2025 legislative session and explicitly allows out-of-state behavioral health providers to register and provide telehealth services to Colorado residents without obtaining a full Colorado license. LinkedIn
- Licensure by endorsement: States not in any compact often offer an expedited process for providers already licensed in good standing in another state
Common Mistakes to Avoid
Several misconceptions consistently get telehealth providers into compliance trouble:
- Assuming compact membership means one license: For the IMLC, compact membership means faster processing for separate state licenses, not a single portable license
- Using the patient’s home address instead of their current location: A patient whose home address is in your licensed state but who is traveling in another state when they connect for their session is legally in that other state
- Not tracking patient location at the time of each visit: Document the patient’s location at the start of every session as part of your standard clinical note. This protects you if a licensing board ever questions your cross-state practice
- Assuming emergency telehealth waivers are still active: Nearly all emergency telehealth licensure waivers from the pandemic era have expired. Practices that relied on waivers for cross-state care must now operate under regular licensure rules SecureVideo.com Blog
How a HIPAA-Compliant Platform Supports Licensure Compliance
A purpose-built telehealth platform contributes to licensure compliance in practical ways. SecureVideo’s session records include timestamps, session documentation, and audit logs that support your compliance documentation if a licensing board ever requests evidence of your practice patterns. E-documents allow you to collect and store patient location consent forms at the start of each session as part of your standard intake workflow.
For practices that have expanded to serve patients across multiple states, SecureVideo’s scheduling system and system integration capabilities help maintain the administrative clarity needed to track which providers are licensed in which states and which appointments are compliant.
Staying Current as the Compact Landscape Evolves
Telehealth has expanded access and altered the way care is delivered, but licensure remains largely state-bound. Most clinicians still face fragmented rules and administrative complexity despite the progress compacts represent. The compact landscape is changing frequently, with new states joining, implementation timelines shifting, and new professions adding compact frameworks. The Center for Connected Health Policy’s Telehealth Policy Finder is the most reliable resource for current state-by-state policy breakdowns across all 50 states. LeadIQ
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