Lawmakers consider interstate compact for mental health counselors

Some state and federal officials and mental health professionals are pushing Vermont to join an agreement that would allow mental health workers’ licenses to be recognized across state lines. 

The Interstate Counseling Compact, which creates reciprocal licensure for licensed clinical mental health counselors, has the backing of 17 states, including New Hampshire and Maine. 

Representatives from the U.S. Department of Defense and the Vermont Office of Professional Regulation were among those advocating for Vermont’s participation in the compact during a hearing before the House Committee on Health Care on Tuesday. 

The compact would increase Vermonters’ access to mental health services, Office of Professional Regulation General Counsel Lauren Layman told lawmakers. But the workforce implications were unclear, she said, as the compact could make it easier for Vermont counselors to move out of state.

Some committee members questioned whether Vermont providers’ ability to discuss abortion or gender-affirming care could be threatened if the state joined the compact. Those issues have largely fallen to the states after the Supreme Court overturned federal abortion protections in 2022.

Lauren Hibbert, deputy secretary of state, and Layman said that was unlikely. Vermont providers could simply decide not to extend their practice to states with more restrictive laws, Layman told the committee. 

“We want to make sure that counselors providing care to Vermonters adhere to our laws too,” Hibbert told the committee. “It goes both ways, right? So it's a bit of a legal kerfuffle.”

The most likely scenario, Layman said in an interview, would be a provider in another state, such as Florida, getting disciplined in their home state for providing gender-affirming care, against their home-state laws. 

Under the compact’s rules, as written, any sanctions on a license in the provider’s home state would require other states to take disciplinary action as well. In Vermont, to go so far as removing a license requires a legal proceeding. 

However, states in the agreement form an interstate commission with its own rule-making process, Layman said, and the commission could decide to grant states discretion whether or not they pursue reciprocal disciplinary action. 

States have enacted such a compromise before, Layman said, in the Interstate Medical Licensure Compact.

The basis of that compromise is, “we're not going to withdraw your license for a law that we see as inconsistent with our values,” Layman said. 

Layman encouraged lawmakers to enter Vermont into the compact early, so the state could have a seat on the commission as it crafts those rules. She also noted to lawmakers that Vermont providers could simply choose not to expand their practice into certain states where they’d face different legal requirements. 

The Department of Defense testified in support of the bill, arguing it would make it easier for service members and military spouses to continue their careers as their family moved from state to state. 

About 14% of military spouses relocate across state lines each year, according to the defense department’s submitted testimony. About a third of military spouses work in a field that requires professional licensure. 

Various professions, particularly within health care, are now seeking to forge interstate compacts, Layman and Hibbert told lawmakers, as the workforce adapts to telehealth and other changes. Vermont joined the interstate nursing compact last year. The Office of Professional Regulation is currently working on similar compact agreements for occupational therapists, social workers, audiologists and speech pathologists. 

“All these states have different rules, but people want to move between states, and people who need care want to move between states,” said committee chair Lori Houghton, D-Essex Junction, in an interview. “We have to start reflecting that in the legislation that we have. So I think the compacts, as dry as they are, are pretty exciting.”