Risk Perspectives in Telehealth: Licensing
Laura M. Cascella, MA
Technology has created opportunities for physicians, surgeons, dentists, and other healthcare practitioners to extend the reach of their professional practice beyond the physical limitations of geography. Through the use of telehealth technologies, providers can evaluate, diagnose, and treat patients in other localities, which can increase access to, convenience of, and choices in care.
Yet, despite bridging a gap in distance, telehealth does not transcend the boundaries of state laws. Each state has its own statutes and regulations associated with clinical practice and the delivery of healthcare. Because of this, licensing is recognized as a significant barrier for telehealth, and it represents a key area of risk for telehealth providers because of legal and regulatory variations by state. For example, states might:
- Require full licensure for telehealth practice
- Offer an abbreviated telehealth licensing process
- Allow licensed out-of-state doctors to provide telehealth services within the state without obtaining a state-specific license (often with limitations)
- Participate in an interstate compact (i.e., the Nurse Licensure Compact or the Interstate Medical Licensure Compact) that allows providers to have one license that is viable in participating states or sets forth an expedited licensure process in participating states
Because of the complexity associated with telehealth licensing, healthcare providers must be cognizant of the laws and regulations in their states and the states in which their patients are receiving services. Further, the American Society for Healthcare Risk Management notes that “Organizations that provide telemedicine services in multiple states must . . . navigate and meet multiple, potentially disparate requirements.”1
To further complicate matters, some states have specific nuances to their telehealth laws and regulations. For example, some states allow for patients’ homes to serve as originating sites, but only for specific specialties or services, such as mental health therapy. The types of telehealth technology permitted — e.g., live video, store-and-forward imaging, remote patient monitoring, etc. — also can vary by service or specialty across states. Additionally, some states might restrict the types of providers that can be reimbursed for providing telehealth services.2
Another layer of complexity is introduced when healthcare providers and organizations venture into international telehealth services. In these cases, both U.S. laws and the laws of the other country must be understood and implemented as part of the telehealth program. As ECRI Institute explains, “Facilities considering international telemedicine must ensure that their programs comply with both the selected country's regulations and U.S. regulations.”3
Although cumbersome and time-consuming, understanding state-specific — and international, if applicable — telehealth laws and regulations, practice acts, and standards of care is vital for healthcare providers and organizations participating in telehealth programs. Failure to do so could have legal and disciplinary implications.
To learn more about laws and regulations in the state(s) in which you practice, visit the Center for Connected Health Policy’s State Laws and Reimbursement Policies webpage, which breaks down current laws and policies for all 50 states and Washington, D.C. and provides information about pending legislation and regulations. Additionally, healthcare providers can contact state medical, osteopathic, dental, or nursing boards for information related to telehealth regulations.
1 Russell, D., Boisvert, S., & Borg, J. D. (Eds.). (2018). Telemedicine risk management considerations. The American Society for Healthcare Risk Management. Chicago, IL: ASHRM.
2 Center for Connected Health Policy. (2018). State telehealth laws and reimbursement policies: A comprehensive scan of the 50 states and The District of Columbia. Retrieved from https://www.cchpca.org/sites/default/files/2018-10/CCHP_50_State_Report_Fall_2018.pdf
3 ECRI Institute. (2015, May 26). Telemedicine. Healthcare Risk Control.
