Licensure. As a rule of thumb, a clinician must be licensed in the state where the patient/client is physically located at the time of service. Some states have adopted limited licensure exemptions as well as alternatives to full in-state licensure for out-of-state telehealth providers. Limited licensure exceptions vary widely (both between states and professions), as do alternative telehealth licensure and registration processes. The Center for Connected Health Policy (CCHP) has created this video discussing licensure as it pertains to telehealth:
CCHP has also created this Frequently Asked Questions on Licensure video:
A few additional resources from CCHP:
- The Cross-State Licensure Continuum: Out-of-State Telehealth Provider Policies - July 2024
- Out-of-State Telehealth Provider Policies Trend Map
- Cross-State Licensing policies by State
- Telehealth Policy Finder where you can look up all telehealth-related policies and regulations across all 50 states and the District of Columbia, as well as at the federal level.
For a deeper dive, check out this webinar from August 2, 2024 on Cross-State Licensure & Compacts:
The Cicero Institute has developed a 50-state telehealth innovation report card looking at telehealth laws that prioritize quality, affordability and innovation.
Resources:
- Provider Bridge is a platform developed to streamline the process for mobilizing health care professionals during the COVID-19 pandemic and for future public health emergencies. It will offer a dedicated customer service hub to help clinicians navigate current state licensure requirements, including those specific to telehealth during states of emergency and provide access to a database of information for verified, betted, volunteer clinicians willing to provide telehealth services during emergencies.
- Several professional organization that have been tracking and updating state licensure policies and policy changes for their specific professions. These include:
- Association of Social Work Boards Laws and Regulations Database
- National Society of Genetic Counselors State Licensure for Genetic Counselors
- The Multi-Discipline Licensure Resource Project has been developed to serve as an information hub for Occupational Therapists, Physical Therapists, Psychologists and Social Workers
If you are a behavioral health professional, the Telehealth Certification Institute has created a resource for locating States' Telemental Health Laws, Rules and Regulations for counselors, social workers, marriage and family therapists and psychologists.
Other Policy Considerations for Interstate Telehealth Practice: When providing telehealth services across state lines, it's essential to understand more than just state-specific telehealth law. Here are some other key policy considerations:
- Interstate Licensure Compacts: As telehealth has expanded, many professions and states have taken steps to facilitate interstate practice. A state that participates in a compact is known as a 'compact state'. These states have joined with other states to allow licensed professionals to obtain a multi-state compact license. To participate in a compact, a state must first enact legislation to authorize participation. Compact structures vary by profession. For example, nurses, physicians, psychologists, physical therapists, and other professionals each have their own compacts and structures. Learn more....
- Scope of practice laws: Each state defines the scope of practice for licensed providers differently. Practitioners licensed in multiple states and providing telehealth services must adhere to the scope of practice laws in the patient’s location at the time of service.
- The NCSL Scope of Practice Policy website offers state-by-state information on the scope of practice for behavioral health providers, nurse practitioners, oral health providers, pharmacists, and physician assistants.
- In some states, certain providers must have collaborative practice agreements with physicians. In these cases, the collaborating physician must also be licensed in the state where the patient is located, with occasional exceptions.
- Malpractice coverage:Providers (and collaborating physicians, if applicable) should confirm with their malpractice carriers that their coverage includes telemedicine services across state lines. Most malpractice policies cover telehealth, but some require an additional rider for interstate services. Coverage limits vary widely by state; some impose caps on damages, while others have none. The best practice is to maintain coverage that meets or exceeds the highest damage cap in any state where you are licensed.
