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  1. Licensure

Licensure during the COVID-19 public health emergency

During the COVID-19 public health emergency (PHE), states and federal entities modified policies to allow health care providers to deliver telehealth services across state lines. The Administration’s plan is to end the COVID-19 public health emergency on May 11, 2023.

Out-of-state telehealth services allowed under the PREP Act

The national Public Readiness and Emergency Preparedness Act (PREP Act) of 2005 authorizes the Secretary of the U.S. Department of Health and Human Services to issue declarations in response to a public health emergency. A PREP Act declaration provides immunity from liability, except in cases of willful misconduct, to individuals and organizations involved in preventing or treating the medical conditions associated with the public health emergency.

PREP Act declarations have been issued many times in the past when there is a PHE. In 2020, the 4th Amendment Declaration was issued to allow broader use of telehealth to ensure continued access to health care during the COVID-19 pandemic. The PREP Act declaration provides federal exemptions for health care providers to deliver care under COVID-19 covered countermeasures using telehealth across state lines without obtaining an additional state license.

In 2021, HHS approved additional amendments to the Declaration under the PREP Act, which expanded the types of health care providers allowed to prescribe, administer, or dispense health care services related to COVID-19. The additional amendments also allow providers to deliver care related to COVID-19 using telehealth services to a patient in another state as long as they follow the laws of the state where the provider is licensed.

The PREP Act declarations allow federal exemptions to state licensure. These exemptions will continue while the PHE is in effect, or until October 1, 2024, whichever comes first.

For more details:

The Center for Connected Health Policy has a fact sheet (PDF) on the 4th Amendment Declaration under the PREP Act.

Licensure and telehealth visits during the PHE

Recent legislation (PDF) authorized an extension of many of the telehealth flexibilities outlined in the COVID-19 public health emergency through December 31, 2024.

Telehealth policy changes after the COVID-19 public health emergency shares more about permanent and temporary telehealth flexibilities.

Privacy of protected health information during the PHE

All providers delivering telehealth services, including out-of-state providers, must be compliant with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and state data privacy laws, when applicable. Providers should establish telehealth policies and procedures that meet the same standard as in-person care. Policies and procedures should be maintained and periodically reviewed.

In preparation for the end of the PHE, the HHS Office of Civil Rights (OCR) has issued guidance to help providers and health plans understand HIPAA-compliant telehealth technologies, including for remote and audio-only communications.


Legal Considerations provides more information about OCR guidance, HIPAA, and other privacy compliance issues.

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