Offer Letters for Behavioral Health Hires: What to Include

An offer letter is the written deal: the role, the pay, the benefits, the start date, the contingencies, and the employment status you intend.

An employment agreement is the binding contract that carries the full clause set — restrictive covenants, records custody, fee-turnover and similar terms — and it comes later in the packet.

Keep the two consistent.

Whatever the letter promises is what the agreement has to match, and a promise that lives only in the letter — a bonus, a schedule, a "just cause" sentence — can be argued to bind you even where the contract is silent on it.

Have employment counsel read the packet as a whole rather than assuming the agreement supersedes the letter.

The offer stage also carries disclosure duties of its own.

Several states require a non-compete or non-solicit to be disclosed in or before the offer.

Illinois voids non-competes and non-solicits unless the employer advises the employee in writing to consult a lawyer and gives at least 14 calendar days to review.

Maine requires the employer to disclose before an offer that a non-compete will be required and to provide a copy at least 3 business days before requiring signature — and Maine has gone further for health care practitioners generally, barring non-competes outright for practitioners who have no ownership interest in their employer.

The practical translation: if your agreement will include a restrictive covenant, put the covenant in the offer packet with the notice period your state sets, rather than producing it at onboarding.

The state-by-state enforceability rules live in the non-competes guide.

When the hire's authority to work depends on a license, a check or an enrollment you have not cleared yet, the offer should be conditional, and the letter should say so in one list: license verification, background check, exclusion screening, references, and — where the role bills insurance — payer credentialing and panel enrollment.

Name each condition, name what happens if one fails, and label the offer contingent in the first paragraph rather than burying the conditions at the end.

License verification is the one to run before the letter, not after: check the credential against the issuing board's own records, not a photocopy of it — the lookup process is covered in the hiring screen.

Exclusion screening is a separate check with its own lists and rhythm, covered in the exclusion-screening guide.

Background checks are one place an offer gets withdrawn, so decide before the letter goes out what you will do with a finding.

Make the offer contingent on the check, and if a result comes back, run the required sequence before you revoke — withdrawing an offer has its own steps, and skipping them is the expensive part.

If the role carries a post-offer medical examination or inquiry, the ADA rules let you require it after making the offer and before work starts, and condition the offer on the results, as long as all entering employees in the same job category are subject to it.

The results have to be collected and kept on separate forms and in separate medical files and treated as a confidential medical record — so the exam paperwork does not go in the same folder as the application.

State the pay rate and its basis — hourly, salary, or a productivity or commission method — plus full-time or part-time status, the scheduled hours, and which benefits apply from which date.

If the pay depends on anything measured, the letter should say what is measured and the agreement should say how it is computed; the pay structures themselves are compared in the pay models guide.

Say how you are classifying the role.

The analysis behind exempt and non-exempt status is its own project — the exempt vs non-exempt guide walks it.

The letter's job is narrower: state the classification you landed on, and make sure the pay basis in the letter matches it.

One state rule reaches into the pay paragraph directly.

In California, an employment contract whose pay method involves commissions must be in writing and must set out how commissions are computed and paid, and the employer must give a signed copy and get a signed receipt.

Whether per-session or fee-split clinician pay counts as a commission under that rule was not verified for this guide — if you pay California clinicians on any production-based method, treat that as a question for employment counsel rather than assuming either answer.

If your hires are at-will, the letter should say it in one clean sentence: employment is at-will, either side may end it at any time, and nothing in the letter is a contract for a fixed term.

Then keep the rest of the letter honest with that sentence — a "just cause" or "annual term" phrase elsewhere in the letter can be argued to undercut the at-will position you just stated, which is why employment counsel should read the letter as a whole.

The verified statutory limit on that sentence is Montana.

Montana's Wrongful Discharge from Employment Act makes a discharge wrongful if it was retaliation for refusing to violate or reporting a violation of public policy, if it was not for good cause after the probationary period, or if the employer materially violated its own written personnel policy.

An at-will paragraph in an offer letter does not displace that statute for a Montana hire — so for Montana positions, set any probationary period in writing and keep the personnel policy you publish consistent with how you actually discharge people.

Montana is the exception this research verified directly.

Other states recognize exceptions of their own — doctrines that vary by state and that we have not counted here — so have employment counsel read the at-will paragraph against your state's law instead of treating it as boilerplate.

California and New York both put a hire-time wage notice on the employer, and in both states the notice can travel with the offer packet.

California: Labor Code 2810.5 requires employers, at the time of hiring, to give each employee a written notice stating pay rates and basis (hourly, salary, commission, and so on), allowances, the regular payday and other listed information.

When any of that information changes, California employers must notify employees in writing within seven calendar days, unless an exception applies — for example, the change appears on a timely wage statement.

New York: Labor Law 195(1) requires employers to give employees at hiring a written notice, in English and in the employee's primary language, of pay rate(s) and basis, allowances claimed, the regular payday and employer details.

New York also requires a signed and dated written acknowledgment of the notice, which the employer preserves and maintains for six years.

Operationally, the simplest route is to send the state notice alongside the offer letter — the required items have to reach the employee at hire, and the New York acknowledgment has to come back signed and dated before you file it.

Whether the required items can be folded into the offer letter itself in place of a standalone notice is a formatting question this guide did not verify; take it to employment counsel.

The same goes for your own state: whether it adds its own hire-time notice requirement is a question for your state labor department or employment counsel — this guide verified California and New York only.

Tie the start date to the credentialing timeline, not to hope.

"Start date: the first of the month" reads badly when panel enrollment is still open; an anticipated start date that explicitly may move if a listed contingency — license verification, background check, payer enrollment — takes longer than expected reads honestly and holds up better when it slips.

Decide before the letter goes out what the hire does between day one and full credentialing, and write the arrangement into the letter: which duties start immediately and which wait on enrollment.

How much a clinician can do before payer enrollment clears is a payer-by-payer question, and the enrollment sequence itself — NPI, CAQH, Medicare and Medicaid — is walked through in the credentialing guide.

When a contingency slips, tell the candidate early and reset the date in writing.

A payer enrollment that runs long leaves the hire in limbo, and the letter's contingency list gives you the vocabulary to have that conversation without renegotiating the whole offer.

From the first job ad to the first shift, the whole sequence lives in the behavioral health hiring hub.