Licensing across state lines
As telehealth has expanded, states are taking steps to coordinate the licensure process for out-of-state providers to practice telehealth across state lines. This page provides information on the types of state licenses that allow an out-of-state provider to deliver telehealth services.
State licensure policies
An increasing number of health care providers are delivering telehealth in states where the provider is not licensed. This trend advanced with the COVID-19 public health emergency (PHE), when all 50 states and Washington, D.C. used emergency authority to waive some aspects of their state licensing requirements. As state PHE orders end, some states discontinued cross-state licensing waivers; whereas, other states have enacted legislation to make the waivers permanent or extend them for a specified period of time.
Did you know?
A wide range of health care providers can deliver and be reimbursed for providing interstate telehealth services due to flexibilities (PDF), including:
- Audiologists and speech-language pathologists
- Emergency medical services personnel
- Occupational therapists
- Physical therapists
Temporary practice laws
Establishing a patient-provider relationship and ensuring continuity of care for patients across state lines can be challenging for providers treating more transient patient populations, such as young adults attending college in a different state or retirees who live in different states during certain seasons.
Some states have temporary practice laws to support existing provider-patient relationships and minimize gaps in care. These laws allow a provider to practice for a limited amount of time, usually less than 30 days, in another state if their patient is temporarily visiting that state for business, a family visit, or other reasons.
The Association of State and Provincial Psychology Boards is an example of an organization that supports and tracks state temporary practice laws for psychologists.
A full license granted by a state health care professional licensing board permits a provider to legally practice in that state. In most states, a health care professional seeking a full license is required to pass a background check, achieve required education and supervision requirements, and pass the exams related to that specialty.
The approval process to receive a full state license to practice often takes a long time. As an example, according to the American Medical Association (AMA), physicians should anticipate at least 60 days between when they submit their application and when they are granted their license. All health providers face similar wait times from application submission to receiving a license. Initial registration and renewal fees as well as continuing education credits are additional requirements to receive and maintain a state license.
Given these time delays and costs associated with licensure, states are increasingly taking steps to coordinate the licensing process to enable providers who practice in one state to provide telehealth in other states.
Tip: The Federation of State Medical Boards Workgroup on Telemedicine (PDF) advises that to meet appropriate standards of care, providers should always: (1) verify the state where the patient is located before each telehealth appointment; (2) disclose their location and applicable credentials; and (3) obtain consent from patient after describing the telehealth delivery models and treatment methods or limitations.
Licensure by endorsement and mutual agreement
Some states allow providers from another state to provide telehealth services in their state if they share a common border. In addition, some states are adding an exception to state licensure for health care providers in specific situations to help preserve continuity of care. For example, a state may allow care to continue through telehealth if there is a pre-existing patient-provider relationship and the provider has performed an in-person exam of the patient within the previous 12 months.
Telehealth-specific license and registration
A number of states have passed legislation to permanently allow out-of-state physicians to practice telehealth in their state if they follow the state’s requirements. Some states allow out-of-state physicians and other providers to practice telehealth in their state if they are already licensed in another state. Other states require out-of-state telehealth license recipients to pass an exam.
Providers should refer to state licensing boards to determine if that state offers a telehealth registration option, and if so, what are the requirements.
Contact the Center for Connected Health Policy for additional information about telehealth registration.