Published September 6, 2026
Telehealth Across State Lines and the Counseling Compact: The Jurisdiction Rule, the Privilege to Practice, and Telehealth Consent
By David Zimmerman · 9 min read · Clinical content
Telemental health guidelines, ensuring a legal platform, and license portability rules are named tasks on NBCC’s 2027 outline[6], and they are also the questions counselors ask most in practice: can I see my client who moved, and what is the Compact? This post gives the jurisdiction rule, explains the Counseling Compact from its own materials[1][2], walks through the ACA telehealth requirements[3][4] and HIPAA platform rules[5], and ends with seven scenarios. Where it matters, the answer is “check the state and the Compact site today,” because membership and rules change.
The jurisdiction rule
Where the client is
The Counseling Compact
| Question | Answer (from the Compact's published materials) |
|---|---|
| What is it? | An interstate agreement among member states that lets eligible licensed professional counselors obtain a privilege to practice in other member states, in person or by telehealth, without a full new license |
| Who is eligible? | Counselors holding an unencumbered, independent clinical license in a member home state who meet the Compact's requirements (a qualifying degree, passing a national exam such as the NCMHCE or NCE, a background check, and other conditions set by the Compact and its rules) |
| Does it cover every state? | No. Only enacting member states participate, and the privilege applies only between them; the map on the Compact's site shows current membership and status |
| Whose rules apply? | The laws and rules of the state where the client is located (the remote state) govern the practice; the remote state can discipline the privilege and the home state the license |
| Is it operational? | Implementation has proceeded in stages (commission, rules, data system, then privileges); check counselingcompact.org for whether privileges are currently being issued and how to apply |
| Associates? | The privilege is for independently licensed counselors; associate and provisional licensees are not covered |
Two cautions the exam and real life share: the Compact does not change what counts as practice in the remote state, and it does not substitute for knowing that state’s mandated-reporting, duty-to-protect, and minor-consent rules.
Telehealth requirements
- Consent (ACA H.2): benefits and limitations of distance counseling, technology risks and security, the client’s and counselor’s locations, emergency procedures and local emergency contacts, what happens when technology fails, and how to reach the counselor between sessions[3].
- Competence: training in telehealth delivery and the platform; the NBCC Code addresses distance services as well[4].
- Platform: HIPAA-compliant with a business associate agreement, encryption, and access controls; no consumer apps that will not sign a BAA[5].
- Suitability: assess whether telehealth fits this client (risk level, privacy at home, technology access, cognitive or sensory needs) and re-assess as needed.
- Emergency plan: confirmed location each session, a backup phone number, an emergency contact, and local emergency numbers; see the service disruption post.
- Boundaries and records: the same documentation and confidentiality rules apply; texting and email only through consented, secure channels.
Telehealth and AI ethics items are free Domain 6 drills
Consent, platform, and jurisdiction questions with rationales for every option. 18 free drills.
Scenarios
Interactive
Telehealth across state lines and the Compact
A counselor licensed in State A provides video sessions to a client who has moved permanently to State B, where the counselor holds no license or Compact privilege. This is:
Related
Sources
- Counseling Compact — interstate licensure portability for professional counselors
- Counseling Compact — member states map and status
- American Counseling Association — ACA Code of Ethics (2014) and ethics resources
- NBCC Code of Ethics
- U.S. Department of Health & Human Services — HIPAA
- NBCC — NCMHCE Examination Specifications, effective July 1, 2027 (domain weighting, format, scaled scoring)
Frequently asked questions
Can I see a telehealth client who moved to another state?
Only if you are authorized to practice where the client is physically located during the session: a license in that state, a Counseling Compact privilege to practice (if both states are members and you qualify), or that state's specific temporary-practice allowance. Client consent and the modality do not change this.
What is the Counseling Compact?
An interstate agreement among member states that lets counselors with an unencumbered, independent clinical license in a member home state obtain a privilege to practice in other member states, in person or by telehealth, subject to the remote state's laws and the Compact's rules. It covers only member states and only independently licensed counselors; check counselingcompact.org for current membership and whether privileges are being issued.
What must telehealth informed consent include?
Per ACA Section H: the benefits and limitations of distance counseling, technology risks and security, the client's and counselor's locations, emergency procedures and local emergency contacts, what happens if the technology fails, and how to reach the counselor between sessions, along with a HIPAA-compliant platform under a business associate agreement.
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