Providing mental health care to patients out of state has been a conundrum facing Rhode Island practitioners for as many years as there have been regulations in place regarding the practice.
While the COVID-19 pandemic brought temporary relief, through emergency allowances for telehealth visits across state lines, it also magnified the need for a permanent solution.
Many in the field say that the pandemic also accelerated Rhode Island’s joining of the Psychology Interjurisdictional Compact – otherwise known as PSYPACT – an interstate organization that allows psychologists to treat patients via virtual appointment across state lines.
It’s a major milestone in improving access to mental health care in the Ocean State, PSYPACT supporters say.
“It’s a win-win-win as far as I’m concerned,” said Rhode Island-based clinical psychologist Joseph J. Trunzo. “It’s a good thing for Rhode Island, for the profession, but more importantly, the [patient] population.”
Trunzo, whose private practice specializes in treating anxiety disorders, including obsessive-compulsive disorder, and those coping with chronic illness, is a professor of psychology and associate director for the School of Health and Behavioral Sciences at
Bryant University.
He will assume the presidency of the Rhode Island Psychological Association in January. Among his first priorities will be to provide statewide education surrounding PSYPACT to psychologists.
Rhode Island is the 36th state to join PSYPACT, which allows psychologists – but not other licensed mental health care professionals – to treat patients wherever either of them is inside the United States, as long as they are both in a PSYPACT member state.
State Sen. Alana M. DiMario, D-North Kingstown, co-sponsored the bill. She is also a licensed mental health counselor. She pointed to PSYPACT’s ability to protect Rhode Island’s psychological licensure regulations, which, she said, are in place to protect both practitioner and patient.
“I think it was the demonstration during COVID of how valuable telehealth was that tipped the scales,” she said, referring to the seven-year process to get PSYPACT through the state legislature.
Peter M. Oppenheimer, a practicing clinical psychologist in Barrington and chairman of the board of directors for RIPA’s professional affairs, was at the forefront of the effort.
Speaking from Washington, D.C., where he had traveled for a conference, he noted that he wouldn’t have been able to treat patients while out of state prior to PSYPACT, without being allowed an exception for an in-crisis patient.
“Patients move. People want mobility. Part of this is to be reflective of the modern world,” he said.
PSYPACT will make it possible for out-of-state patients to seek help from Rhode Island psychologists who specialize in treatment areas for which there isn’t an expert in their home state – and vice versa for Rhode Islanders.
Across the U.S., Oppenheimer says, about 5,000 psychologists are currently PSYPACT members. Enrolling is a two-step process and psychologists can apply to provide telehealth services or in-person, temporary services in a state in which they are not licensed.
Both require obtaining an E-Pass from the Association of State and Provincial Psychology Boards, which costs $400 for telehealth and $200 for in-person services. Both e-passports require an annual renewal fee.
PSYPACT membership is $40 for each service type, with a $20 annual renewal fee.
DiMario is focused on opening up membership in interstate compacts for other health care professionals. She introduced a bill last session to allow mental health counselors to join such a compact. It wasn’t passed, but she plans to reintroduce it this year.
The hope is that membership in interstate compacts will positively impact Rhode Island’s ability to attract skilled clinicians and other mental health workers to build their practices here.
Oppenheimer, who opened his first practice in 1991, identified a workforce crisis in the mental health profession.
The high cost of education and rising startup costs, as well as low insurance reimbursement rates, are all factors that, he says, drive new psychologists and other professionals away from full-time private practice.
“There’s less of us and we’ve been swamped since COVID,” he said. “I think people are getting how expensive it is to get trained and licensed. My friends and I have trouble hiring because we can’t pay enough.”
Trunzo says making it worthwhile for psychologists to stay in Rhode Island, with such things as PSYPACT, is an important component of building up the workforce, pointing to the state’s ability to train skilled practitioners through many higher education programs, including at Bryant.
Some health insurers, he and Oppenheimer say, have made great strides in working to increase reimbursement rates.
“[We need] to come up with treatment and reimbursement models that work mostly for the patients to have easy access to services, but they also have to work for the clinician and the insurance company,” Trunzo said. “There are very good, smart and well-intentioned people on all sides and all of those stakeholders are working hard to improve that.”
