Interesting times:

"This is what is currently happening in the House of Representatives explained by Democratic Rep. Jeff Jackson" (via r/BeAmazed)

2024 Apr 17 (recorded April 16): Democratic Rep. Jeff Jackson [NC] on TikTok: https://www.tiktok.com/@jeffjacksonnc/video/7358844815272021294

2 minutes, 25 seconds.

Strong recommend.

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Okay, so. A lot of wild and crazy things happen to me today, but the wildest and craziest, by far, is this.

To contextualize this, I just want to mention in passing that I just pivoted from arranging a destination wedding synchronized with an uncompromisingly inexorable celestial event that precludes using a caterer to the next extremely large, high time-pressure, high stress project, on which I have been grinding in parallel for a year, and which just blew up on me in unexpected spectacular success six days after the wedding, occasioning what is basically an all-hands on deck three alarm fire in my life. I have gotten ten hours sleep across the last two nights.

I am so exhausted I wouldn't entirely be certain that I hadn't hallucinated this, except that I really do seem to have the receipts, and other people out on the internet are confirming that it happened to them too.

Today I found out that about two weeks ago, the state of New Hampshire licensed me as a clinical mental health counselor there.

Which license I have never applied for.

When the pandemic started, one of the responses states of the US had to the abrupt shuffling of the population around the country was to throw together provisions by which people who had suddenly relocated – college students, for instance, who had been sent home – could continue to see their therapists.

The problem was, therapists, across the various different professions that practice psychotherapy, are licensed by individual states. And most states – the vast majority, I hear tell – have laws that say you cannot treat a client physically located in that state unless that state has license to you.

So, for instance, if you came to Massachusetts to go to Boston University, and you started seeing a therapist here in Massachusetts, but then abruptly had to return home to, say, Nebraska, unless your therapist coincidentally happened to also be licensed in Nebraska, it would be illegal for them to offer you telehealth sessions while you were in Nebraska.

You might reasonably wonder, well, how hard would it be for a therapist in Massachusetts to also get licensed in Nebraska? The answer is: I have no idea because there are 50 different states, and several different territories, all of which have completely different rules for how you get a license in them. Generally speaking, it ranges from pretty involved all the way up to provably impossible; also it's expensive, and it can take months for the approval to actually happen – a timeline that was actually much worse at the start of the pandemic. Generally speaking (I know of no counterexamples) getting licensed in a state is time-consuming, expensive, and typically stressful process. And that's even when you are using license by reciprocity, and not trying to get a license for the first time. The processes are heavyweight, and burdensome. And they are often baroque and opaque.

So all around the country, in response to the pandemic, states did things to make it legal for psychotherapists in other states to continue to see their clients when those clients relocated to them, without those psychotherapists having actually go through these heavyweight licensure processes.

No fees. No documentation. No application review process. They just verified that you were licensed, and in good standing, in whatever state you indicated you were licensed in.

In many states, they threw up a web form on their state website, and you just filled it out with your name, address, and licensure number and state of license for them to vet. Some states, you mailed them a form with the info.

And that was that: they automatically registered you as authorized, and typically granted you a temporary license, valid for the duration of the state of emergency. They often turned it around in 24 hours.

I went through this process with three states. One of them was New Hampshire.

Over the last two years I have been watching as the various individual states' state of emergency executive orders have fallen by the wayside, and with them, these temporary licenses that they granted to psychotherapists.

I kept not hearing from the state of New Hampshire though. I kept, every six months or so, looking myself up on their licensure website. And it kept saying that my temporary emergency license was valid, and not expiring yet. In fact, I seem to recall it said that my temporary license would not be expiring until 2024.

Well, today, I got an email from the New Hampshire Office of Professional Licensure and Certification. "Ah," I thought, when I saw it in my inbox, "Here we go. They're finally getting around to revoking the temporary COVID SoE licenses."

Oh, no. No, no, no.

New Hampshire went and did something spectacularly weird.

The Live Free or Die State passed a law making the temporary licenses permanent.

Yall. Effective from the beginning of April: I? Am a fully licensed NH LCMHC in good standing.

Without my ever having applied to New Hampshire for an LCMHC license.

Now, they are using a mighty curious definition of "permanent". This new permanent license expires June 3rd. This year.
If I want to keep it, New Hampshire invites me to go through the ordinary license renewal process.

Which I have apparently six weeks to do.

I have no idea if it is possible to fulfill the requirements for renewing this license in the next six weeks. At the very least, I would have to figure out how to get 10 more hours of continuing education credit, because NH requires 10 more than MA. But that's even assuming that my most recent MA CEs would be valid in NH. Are they? I have not the faintest idea.

I have no idea if it's going to make a problem in my life if I just do nothing. If I do nothing, the license is going to get canceled for non-payment. I don't know if that's going to get me in trouble somehow. Like, I may need to call my malpractice and liability insurance company and ask for a legal consult.

But also, this is an absolute minimal stress way of getting a license in another state. Do I want to take advantage of this?

Thing is, I don't have any patients in New Hampshire anymore. I don't know that there's a lot of patients in New Hampshire that would need or want to see a therapist like me, or be able to afford me. I specialize in treating nerds, and Massachusetts seems to have an abundance of nerds, so I don't particularly feel the need to spread my net any wider. Maintaining another license in another state is often a pain in the butt. I have to keep track of all of their relevant laws and regulations, as they change.

But then there's another thing, that's a bit of a long shot, but then this entire thing is from out of left field so... who knows?

That other thing is the Counseling Compact.

Thirty-four states (and I think DC) have passed laws – and eight further states have legislation pending – making them signatories to an interstate compact that facilitates licensed clinical mental health counselors like me being able to practice in all of those states without having to apply for a license in each one. The way it works – all right, the way it's supposed to work, they are still hammering out the implementation details – is that a therapist who lives in and is licensed by one of the member states can apply for an interstate license that is valid for practice in all of the Compact states.

Massachusetts is not a member state. Massachusetts doesn't even have pending legislation to become one.

But New Hampshire is.

Right now, the way the Compact is specified, a counselor has to have a permanent residence in a member state, as well as being licensed by that state, to get a Compact interstate license.

But, as we therapists like to point out, things change.

It is not impossible that at some point in the not terribly distant future, the rules will change such that you don't have to reside in the Compact member state in which you are licensed. Counselors who live in non-member states could then apply for licenses the tedious old-fashioned way in some individual member state, and then use that license to qualify for an interstate license valid in 36 and counting other states.

Or they could, you know, just happen to be given an LCMHC license on a silver platter as a side effect of COVID state of emergency executive orders by a member state, and use that to qualify for an interstate license.

This entire thing is completely hilarious and mind-boggling to begin with. Massachusetts' attitude towards interstate practice might best be described as "shoot to kill", so I could not possibly be more shocked by New Hampshire's apparent attitude of "catch and release".

But wouldn't it be an absolute gas for it to turn out that I could manage to parlay my Massachusetts license in to a nationwide license by, more or less, just being in the right place at the right time. I don't particularly want to have clients from outside of Massachusetts, but, boy, it would sure be nice to be able to continue to treat my Massachusetts clients when they traveled about the country without having to worry about whether or not it was legal for me to do so.

I will look into this further when I've had a full night's sleep.

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Well, that was fast. Remember when I told you about the US having a National Free Paxlovid Telehealth Service back in January? It's shutting down in two days.

2024 Apr 8: Forbes: "Important Program For Covid Patients Closes, Leaving Many Stranded" by Judy Stone:

The home “Test to Treat” program is closing April 16, leaving disabled and vulnerable Covid-19 patients without good options for accessing timely diagnosis and care.

Those of you here in Massachusetts still have access to the mass.gov Paxlovid telehealth service.

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