Illinois AI Psychotherapy Law (Public Act 104-0054): What Therapists Need to Know About AI Documentation Tools

Illinois became the first state to explicitly regulate AI in psychotherapy with Public Act 104-0054 (the Wellness and Oversight for Psychological Resources Act). This guide explains what the law requires, who is in scope, how different AI documentation tools are classified, what a compliant consent process looks like, and implications for telehealth therapists seeing Illinois clients from out of state.

In August 2025, Illinois became the first state in the country to enact a law that explicitly regulates the use of artificial intelligence in psychotherapy. The Wellness and Oversight for Psychological Resources Act (commonly abbreviated as WOPRA), signed as Public Act 104-0054, creates a new compliance layer for any licensed mental health professional in Illinois who uses AI tools in clinical work.

This is not a HIPAA amendment. It is a separate state law with separate requirements and separate penalties. If you are a licensed therapist practicing in Illinois, or a telehealth therapist seeing clients located in Illinois, this law applies to you now.

This guide explains what the law actually says, which tools it covers and which it does not, what a compliant consent process looks like, and what the emerging national regulatory landscape means for practices that operate across state lines.

What the Law Actually Requires

The core obligation under WOPRA is straightforward: before using any AI system that records or transcribes a psychotherapy session, a licensed provider must obtain explicit written client consent.

"Explicit" carries real meaning here. A general consent form that references technology in passing, or a terms-of-service acknowledgment embedded in intake paperwork, does not satisfy the standard. The law requires that the client be specifically informed that AI will be used to record or transcribe the session, understand that the recording or transcript will be processed by an AI system, and affirmatively consent in writing before the first session in which that tool is used.

The consent must be documented and retained as part of the client's record.

Penalties for non-compliance reach $10,000 per violation. Each session conducted without proper consent is a separate potential violation, not a single administrative infraction. For a practice that adopted an ambient scribe tool in September 2025 and never updated its intake forms, the exposure compounds quickly.

The law also requires that providers inform clients of their right to withdraw consent at any time and that withdrawal of consent must be honored without affecting the therapeutic relationship or the client's access to care.

Who Is in Scope

WOPRA applies to all licensed mental health professionals who provide psychotherapy services in Illinois. The scope covers:

Licensed Clinical Social Workers (LCSWs)
Licensed Clinical Professional Counselors (LCPCs)
Licensed Psychologists
Licensed Marriage and Family Therapists (LMFTs)
Licensed Professional Counselors (LPCs) providing clinical services

Notably, the law covers the provision of psychotherapy services, not simply licensure in Illinois. This is the provision that creates compliance obligations for out-of-state providers seeing Illinois-based clients via telehealth, which this guide addresses separately below.

Psychiatrists and other medical professionals who provide psychotherapy as part of their practice are also subject to the requirements when their work falls within the statutory definition of psychotherapy.

How the Law Classifies AI Documentation Tools

The compliance burden under WOPRA is not uniform across all AI tools. The law draws a meaningful distinction based on whether the tool records or transcribes session audio.

Any AI tool that records audio of a therapy session, transcribes spoken content in real time, or processes session audio after the fact to generate notes requires explicit written consent under WOPRA.

This category includes what the industry calls ambient scribes: tools where a microphone captures the therapy session as it happens, an AI transcription engine processes the spoken content, and a note is generated from the transcript. It also includes tools where the therapist records the session independently and then uploads the audio to an AI platform for note generation.

The recording or transcription is the trigger. The consent requirement attaches to the act of capturing spoken session content via AI, not to the act of using AI to format or organize notes.

Consider this scenario: Dr. Sofia Reyes is an LCSW in Chicago who adopted an ambient AI scribe in early 2025. Her intake packet included a general technology disclosure but no specific AI consent language. Under WOPRA, every session she conducted with a client who had not signed a compliant AI consent form after the law's effective date would be a separate potential violation. Updating her intake forms and obtaining signed consent from existing clients before continuing to use the tool is the correct remediation.

A separate category of AI documentation tools works differently: the therapist writes a post-session summary in their own words, and the AI organizes or structures that text into a formatted clinical note. No session audio is recorded. No client speech is transcribed. The AI processes text the therapist has already written, not audio the client has spoken.

This architectural distinction matters under WOPRA. Because these generation-based AI tools do not record or transcribe session content, they fall outside the specific written consent requirement the law establishes for recording and transcription.

This does not mean these tools have no documentation implications. Standard informed consent for therapy should still reference how clinical notes are created and stored, including whether any third-party platforms are involved. It also does not mean these tools carry no privacy considerations. But the WOPRA-specific written consent requirement for AI recording and transcription does not attach to them.

NotuDocs, for example, is a generation-based tool where the clinician writes their own post-session notes and the AI structures the output, with no session recording involved. That architecture sidesteps the WOPRA recording consent requirement. (Note: NotuDocs does not sign Business Associate Agreements and is not HIPAA compliant, which is a separate and important compliance consideration for any practice evaluating it.)

The category distinction is a useful decision framework for any Illinois practice currently evaluating AI documentation tools:

Does the tool record or transcribe session audio? If yes, WOPRA written consent is required before use.
Does the tool process text the therapist writes after the session? If yes, the WOPRA recording consent requirement does not apply, though other informed consent and privacy practices still apply.

The law requires explicit written consent, but it does not prescribe the exact format of the consent document. Based on the statutory requirements, a compliant consent process should include the following elements.

1. A specific description of the AI tool being used. Generic language like "technology-assisted documentation" is insufficient. The consent should name or describe the category of tool (e.g., "an AI transcription tool that records our sessions and uses that transcript to generate my clinical notes").

2. A plain-language explanation of how session content is processed. This includes where audio is transmitted, whether the transcript is stored, how long it is retained, and who has access to the transcript or the AI-generated note.

3. A clear statement of the client's right to decline. The client must understand that declining AI recording will not affect their access to care or the quality of their treatment.

4. A clear statement of the client's right to withdraw consent at any time. This includes what withdrawal means in practice (the therapist will not use the AI recording tool in future sessions).

5. Signature, date, and therapist name. The consent is a record that must be retained.

The following is example language that addresses the statutory requirements. This is a starting point for review by your legal or ethics consultant, not a finished legal document:

"I, [client name], understand that my therapist, [therapist name], uses [name or description of AI tool] to assist with clinical documentation. This tool [records audio of our sessions / transcribes spoken content during our sessions] and uses that content to generate clinical notes. [Describe storage, retention, and access policies for audio/transcripts here.]

I understand that I may decline to have this tool used during our sessions and that declining will not affect my care. I also understand that I may withdraw this consent at any time by informing my therapist, and that withdrawal will be honored in all future sessions.

I am signing this form voluntarily after having the opportunity to ask questions."

If you are transitioning existing clients from a non-recording workflow to a recording AI tool, consent cannot be retroactive. Each client must sign before the first session in which the AI recording tool is active.

Illinois was already one of approximately thirteen states with an all-party consent (also called two-party or multi-party consent) requirement for recording conversations. Under Illinois law, recording a private conversation without the consent of all parties has long been prohibited.

The all-party consent framework is the reason therapist-initiated session recordings already required client consent before WOPRA. What WOPRA adds is the specificity around AI processing, the written consent requirement (rather than just verbal acknowledgment), and the structured penalties of up to $10,000 per violation.

The current all-party consent states include California, Connecticut, Delaware, Florida, Illinois, Maryland, Massachusetts, Michigan, Montana, New Hampshire, Oregon, Pennsylvania, and Washington. Therapists in these states were already operating under a general obligation not to record sessions without consent. WOPRA layered explicit AI-specific requirements on top of that baseline for Illinois practitioners.

Implications for Telehealth Therapists Seeing Illinois Clients

This is where the law becomes more complex for many practitioners.

Consider this scenario: Dr. Marcus Webb is an LCPC licensed in both Illinois and Indiana. He maintains a brick-and-mortar office in Chicago but also sees clients remotely. He has one client, Priya, who relocated to Chicago two years ago. Dr. Webb's license is current in Illinois, and Priya is physically located in Illinois during their telehealth sessions. WOPRA applies to these sessions.

Now consider a slightly different scenario: Dr. Elena Torres is licensed only in California but has recently begun seeing a client, James, who moved to Chicago. James is located in Illinois during their telehealth sessions, even though Dr. Torres practices from her California office. Whether WOPRA applies to Dr. Torres depends on how Illinois regulates out-of-state telehealth providers, which remains an active area of regulatory interpretation. Practitioners in this situation should consult with a licensed attorney familiar with Illinois mental health law before assuming they are outside the statute's reach.

The conservative approach for any telehealth therapist whose clients may be physically located in Illinois during sessions: treat WOPRA as applicable and implement compliant consent practices regardless of where your own office is located. The practical cost of doing so (updating an intake form) is substantially lower than the risk exposure if a violation is alleged.

Out-of-State Therapists: Practical Steps

If you are an out-of-state therapist seeing Illinois clients via telehealth and currently using an ambient AI scribe:

Verify client location at the start of each session and document it. Your notes should reflect where the client was physically located.
If a client is in Illinois, WOPRA's requirements should be treated as applicable until you have received legal guidance indicating otherwise.
Obtain signed AI-specific consent from any Illinois-located client before using a recording or transcription AI tool.
Keep records of signed consent forms organized by client, not just by date.

The National Regulatory Landscape: Illinois Is Not Alone

WOPRA did not emerge in a vacuum. Across the country, legislatures have been examining AI use in healthcare and mental health care specifically.

New York Senate Bill S.8484, introduced by Senator Kristen Gonzalez, proposes requirements for AI transparency and consent in healthcare settings that include mental health care. If enacted, it would establish requirements that parallel WOPRA in several respects.

According to tracking by Manatt Health, there are more than 40 active or recently introduced AI-related healthcare bills across at least 25 states. The pace of legislation in this space has accelerated sharply since 2024, and the trend line suggests that what is currently an Illinois-specific compliance requirement may become a multi-state or federal standard within the next several years.

For practices that serve clients across multiple states, building a consent process that meets the highest current standard (WOPRA's explicit written consent requirement) now reduces the compliance burden as other states follow. The administrative cost of adding a specific AI consent document to your intake process is minimal compared to the cost of retrofitting consent practices retroactively across a large client panel.

Common Mistakes to Avoid

Using a general technology disclosure instead of AI-specific consent. Most existing therapy intake forms reference technology, telehealth platforms, or electronic records in general terms. That language does not satisfy WOPRA. You need a document that specifically addresses AI recording or transcription.

Assuming HIPAA compliance covers WOPRA compliance. HIPAA is a federal privacy framework. WOPRA is a state law with different requirements. A signed HIPAA authorization does not substitute for WOPRA consent.

Continuing to use a recording AI tool with existing clients without updated consent. If you adopted an ambient scribe before the law's effective date and your existing clients signed only a general technology consent, you need AI-specific consent from each of them before your next session using the recording tool.

Assuming verbal consent is sufficient. WOPRA requires written consent. A verbal acknowledgment at the start of a session is not compliant, even if the client says "sure, that's fine."

Not retaining the consent document in the client's record. Consent documentation must be retrievable. If a complaint is filed, you need to produce the signed form.

Applying consent only to new clients. The law applies to sessions, not just to the initiation of a therapeutic relationship. Any session in which a recording AI tool is used requires prior written consent.

Compliance Checklist for Illinois Therapists

Use this checklist to assess your current practices and identify gaps.

Immediate: Audit Your Current AI Tool

Identify every AI documentation tool you are currently using in your practice
For each tool, determine whether it records or transcribes session audio (recording/transcription = WOPRA recording consent required)
For generation-based tools that process only therapist-written text, confirm no session audio is captured at any point in the workflow
Review the vendor's data practices: where is audio or transcript data stored, how long is it retained, and who has access

Draft or obtain an AI-specific consent form that addresses all statutory elements (tool description, data handling, right to decline, right to withdraw)
Have the consent language reviewed by a licensed attorney or your professional liability carrier
Add the AI consent form to your intake packet for all new clients before the first session using any recording AI tool
Identify all existing clients currently using sessions with a recording AI tool and schedule signed consent before the next session
Retain all signed consent forms in each client's permanent record
Document the client's right to withdraw consent in your informed consent for therapy generally

Session-Level Practices

Before each session using a recording AI tool, confirm that signed consent is on file for that client
Document the AI tool used in your session note or in the client record
If a client withdraws consent during the therapeutic relationship, document the withdrawal, stop using the recording tool with that client, and retain the withdrawal notice in the file

Telehealth-Specific Steps

For telehealth sessions, document the client's physical location at the start of each session
For clients physically located in Illinois, apply WOPRA's written consent requirements regardless of your own licensure state
Consult with legal counsel if you are licensed only outside Illinois but have clients located in Illinois during sessions

Practice Infrastructure

Train all clinical staff and supervisees on WOPRA requirements before they begin using any AI documentation tool
Update your practice's technology policy and informed consent for therapy to reference AI documentation tool practices
Set a calendar reminder to review your AI tool's vendor terms annually, as data handling practices change and regulatory requirements may expand

The Illinois law is the first of its kind in the United States, but it will not be the last. The practices that handle this compliance layer now, with specific consent forms and clear documentation of which tools they use and how, are the same practices that will be well-positioned as other states follow. Getting ahead of this now is less work than catching up after the next state passes a similar statute.

For additional context on AI documentation workflows, see our guides on how social workers evaluate AI documentation tools, what insurance auditors look for in AI-generated therapy notes, and concurrent documentation in therapy.