How to expand your therapy practice to another state! Interview with Margarita Khosh

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Welcome back to the Psyched Up About Money blog. In this interview with Margarita Khosh of MK Medical Solutions, we discuss the important points about how to expand your therapy practice to another state and understand the licensing requirements involved with that.

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We’ll discuss:

·       How was COVID a gamechanger for therapists in a good way?

·       Why should therapists get licensed in another state?

·       How does license portability work for therapists?

·       How does all of this work in terms of insurance?

·       Are their states where you can practice as a therapist without becoming fully credentialed?

How did COVID change the practice of therapy?

COVID propelled telehealth adoption in a way that we were about 7-10 years away from, especially in the mental health realm. What we have found over the past year in terms of licensure is that there have been executive orders issued not just by the government (Centers for Medicare and Medicaid, presidential orders, etc.), but by the actual states themselves.

These state orders allowed for certain provisions that we historically did not have, which were a result of the executive orders of the federal government. Take, for example, the state of Wisconsin where they expanded temporary licensure to practice in the state for mental health therapists until June 30th, 2021.

It has underscored the importance of therapists understanding licensure and what states they need to be licensed in.

How does a therapist figure out which state licenses they need?

It’s important to understand that no two states are alike. Licensures for therapists in different states looks different. Therapists have to know the questions to ask.

Margarita says that many therapists going to practice in other states don’t even know where to start when trying to figure out which state licenses they need. Therapists looking to expand to another state should ask themselves:

·       Is it a scope of practice issue?

·       Are you looking to find out if there is a continuity of care in whatever state you are going into?

·       Are you looking to find out whether or not your licensure type is acceptable in that state without continuity of care?

·       Do you have to get a temporary licensure, or a full-blown licensure?

·       What is involved with practicing “everywhere” so to speak?

It’s not just about what insurance covers. According to Margarita, what it often comes down to is that most state licensing legislature will be concerned with where your patient is located. It’s not where you are located. If your patient is on vacation, you need to understand what the rules and regulations are of that state.

All of this is specific to the therapist. Therapists should consult a lawyer or practice consultant for specific advice relevant to their situation as nothing in this blog or video interview may be interpreted as legal advice.    

Is it realistic for a therapist to practice in all 50 states?

Yes, some people are doing it. But they’re not doing it alone; they have clinical care teams because they are going to need other therapists. It is likely a group practice.

It is possible for a therapist to be licensed in all 50 states, you just have to be sure that you are welcoming to the licensing standards of all those states. Usually, it’s not efficient or financially solvent for them to pay all this money to the licensing boards.

It really comes down to the type of caseload you want and if you can maintain a profitable therapy practice operating this way. Many therapists got into the practice because they wanted to help people and not do math all day, but the math of your practice does matter. You want to grow, but you want to grow the right way, in a fashion that allows you to financially take care of yourself, your retirement planning, and your employees and their retirement and financial goals. At the same time, you want to maintain a healthy profit margin so that your practice can sustain itself and provide the highest quality of service to clients in the short and long term.

What are the biggest changes in terms of interstate licensure for therapists?

The Secretary of Health and Human Services put into place certain executive measures to relax telehealth laws from the HIPAA perspective. This measure was called the 1135 waiver of the Social Security Act. When executive orders are relaxed at a time when we are no longer in a state of national emergency, it will be interesting to see if the rubber band bounces back.

Before the pandemic, patients at home were essentially not allowed to use telehealth services. Medicare wouldn’t pay for them. It will be interesting to see what happens post pandemic now that we’ve had this experiment and seen that it works.

It would behoove therapists to advocate for maintaining this measure by reaching out to legislators while we are still in the pandemic. We have a responsibility to keep innovation moving forward to result in better patient outcomes.

Are states adding this to their licensure?

Some states are. Before the pandemic, Florida made a registry for out of state telehealth services. It essentially says that you are carrying your license to practice in the state of Florida, regardless of your state. This is because Florida is the ‘snowbird capital of the world’ and there would be continuity of care issues and people vacationing there would have to switch all their doctors if this weren’t in place.


We hope that you enjoyed this article on how to expand your therapy practice to another state. If so, please feel free to watch the full interview video at

Margarita offers support to therapists who want to make sense of interstate licensing, credentialing, contracting, EHR implementation, and other healthcare implementation operations. To learn about her services please visit MK Medical Solutions

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Therapists should consult a lawyer for specific relevant to their situation as nothing in this blog or video interview may be interpreted as legal advice.