Risk Perspectives in Telehealth: Licensing
Laura M. Cascella, MA, CPHRM
Technology has created opportunities for physicians, dentists, and other healthcare practitioners to extend the reach of their professional practice beyond the physical limitations of their practice settings. 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 barrier for telehealth, and it represents an 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 providers to provide telehealth services within the state without obtaining a state-specific license (often with limitations)
- Participate in an interstate compact (e.g., 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
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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 explains, “Facilities considering international telemedicine must ensure that their programs comply with both the selected country’s regulations and U.S. regulations, as well as global best practices.”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 website, which tracks laws and policies for all 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands and provides information about pending legislation. Additionally, healthcare providers can contact state medical, osteopathic, dental, or nursing boards for information related to telehealth regulations.
Endnotes
1 Russell, D., Boisvert, S., & Borg, J. D. (Eds.). (2018). Telemedicine risk management considerations. The American Society for Health Care Risk Management. Retrieved from www.ashrm.org/sites/default/files/ashrm/TELEMEDICINE-WHITE-PAPER.pdf
2 Center for Connected Health Policy. (2024). State telehealth laws and Medicaid program policies summary report: The highlights & findings of a comprehensive scan of 50 states, D.C., Puerto Rico and the Virgin Islands. Retrieved from www.cchpca.org/2024/11/Fall2024_ExecutiveSummaryFINAL.pdf
3 ECRI. (2022, February 18). Regulatory and liability considerations for telehealth. Health System Risk Management. Retrieved from www.ecri.org
