A bill that would allow licensed psychologists to practice telehealth and temporary face-to-face care across state lines failed after it was tabled at a subcommittee meeting in late January. A companion bill in the Senate was assigned to a subcommittee but never received a hearing.
House File 24 would have allowed Iowa to join the Psychology Interjurisdictional Compact, otherwise known as PSYPACT. The compact allows psychologists to work freely across state lines in the 33 states that currently participate. Seven more states, including Iowa, are currently considering legislation that would allow them to join.
Spurred by a renewed push for the expansion of mental health services during the pandemic, PSYPACT was launched by seven states – including Nebraska, Illinois and Missouri – in July 2020. Minnesota, Kansas and Wisconsin are also participants.
“We don’t have enough psychiatrists, psychologists, social workers, nurses…we didn’t have enough before the pandemic, [and] the pandemic made it worse,” said Peggy Hupert, the Director of Iowa’s chapter with the National Alliance on Mental Illness (NAMI). “So, NAMI recognizes the crisis that exists, and we are going to be in favor of any legislation that aims to make it easier for someone to offer services in Iowa.”
Iowa Republican legislators have proposed bills addressing interstate psychological services multiple times since 2018. The bill was recommended for passage by the Human Resources subcommittee in 2020 but stalled in 2021.
“I’m interested in addressing some of the heightened need in services in addiction, mental health concerns,” said Rep. Michael Bergan, R-Dorchester, the author of the current bill and a licensed social worker. “We’ve seen an increase with the pandemic in anxiety and depression.”
Psychology licensure varies from state to state. But while other professional fields like nursing established interjurisdictional compacts years ago, mental health professionals are largely confined to practice in states in which they are licensed. As it stands, psychologists licensed in another state cannot provide services in Iowa, even via telehealth.
PSYPACT would impact the nearly 29% of U.S. mental health professionals considered clinical and counseling psychologists, according to the latest available data from the Department of Labor’s Bureau of Labor Statistics. Compacts for social workers and counselors – the next largest categories of mental health professionals – have also been proposed in legislatures across the country, including the Iowa Senate, but no state has approved either compact.
As of this writing, NAMI Iowa and Wellmark Inc. are the only organizations registered in support of the bill. Representatives from the Iowa Psychological Association (IPA), the only organization registered against the bill, expressed concern that PSYPACT makes it harder for psychologists to be held accountable for cases in which a patient discloses that they plan to end their life, hurt people in a public area or engage in other harmful actions.
“PSYPACT oversight does not require that psychologists practicing across state lines follow the regulations of the state in which their patients reside,” wrote Nicole Keedy, former IPA president, in an email to Rep. Shannon Lundgren, R-Dubuque. “Therefore, within this compact, Iowans could receive services from psychologists who would not be required to report abuse or to warn others of threats to their safety.”
IPA representatives also referenced that the IPA already permits out-of-state psychologists to practice in the state for 60 days, as opposed to the 30 days proposed under PSYPACT. Though the IPA recognizes the plight of college students and frequent out-of-state travelers, according to lobbyist Amy Campbell, they don’t believe PSYPACT is the solution.
“We have member psychologists that work in university clinics and were frustrated that they could not maintain connection during the pandemic, or similarly, we share concerns that someone could not continue to see a therapist from their home state via telehealth,” Campbell said. “I think we just see other options to making this happen. Some universities have contracted with a national telehealth group to provide on-campus and back-home services [and] our board of psychology makes it very easy, very fast to get licensed.”
Dr. Paul Ascheman, the State Advocacy Coordinator for the IPA, said the association would support a compact that requires psychologists to adhere to the regulations of the state in which their patient resides, such as the newly introduced Counselors Licensure Compact currently making its way through the Senate.
As the professional association representing those impacted by the bill, Hupert said the IPA has an outsized influence on its fate.
“If [a bill] has to do with professional licensure and who can practice – scope of practice, who can practice where and doing what – they’re gonna look to the professional groups, first and foremost,” Hupert said.
