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Telehealth licensing requirements and interstate compacts

Providers can deliver telehealth services across state lines, depending on rules set by state and federal policies. Interstate compacts simplify cross-state telehealth for specialists in participating states.

State licensing policies

Almost every state has modified licensure requirements/renewal policies for health care providers in response to COVID-19, including out-of-state requirements for telehealth.

For emerging updates and the latest requirements for each state, see:

U.S. States and Territories Modifying Requirements for Telehealth in Response to COVID-19 (PDF) — from the Federation of State Medical Boards
U.S. States and Territories Modifying Licensure Requirements for Physicians in Response to COVID-19 (PDF) — from the Federation of State Medical Boards
COVID-19 Related State Actions — from the National Policy Center - Center for Connected Health Policy

Exceptions for interstate telehealth practice and liability under the PREP Act

The 2005 Public Readiness and Emergency Preparedness Act (PREP Act) authorizes HHS to make declarations that provide immunity from liability in certain emergency circumstances. On December 3, 2020, HHS published Amendment 4 to the PREP Act to preclude state and local governments from enforcing more restrictive policies that keep “qualified persons” from administering countermeasures recommended by a PREP Act declaration. Specifically, this allows for interstate practice of telemedicine to improve public health outcomes in an emergency. This amendment provides liability protection when delivering specific COVID-19 related services, expands telehealth access, and makes it easier to treat and prevent COVID-19.

Many states already allow providers to deliver out-of-state telehealth services. The new Declaration, however, ensures specific COVID-19 “covered countermeasures” can be provided or ordered via telehealth across state lines without additional state licensure. The countermeasures covered by liability immunity include:

Qualified products used to treat, diagnose, cure, prevent, or mitigate COVID-19
Drugs, biological products, or devices authorized for COVID-19 emergency use
Respiratory-protective devices approved by the National Institute for Occupational Safety and Health

This exception from state licensure and liability protection applies only to providers ordering or administering the specific covered countermeasures. For more details, see: 4th Amendment to the Declaration Under the PREP Act (PDF) — from the National Policy Center - Center for Connected Health Policy.

In 2021, HHS ratified additional amendments to the Declaration under the PREP ACT. Amendments 5 through 8 expand on the definition of “qualified persons”. Amendment 8 clarifies that if a practitioner is providing covered COVID-19 countermeasures to a patient in another state, the laws of the state where the practitioner is licensed apply. For more details, see: 8th Amendment to the Declaration Under the PREP ACT section V (e) - from the Federal Register.

Interstate compacts

Interstate compacts (agreements between two or more states) make it easier for health care providers to practice in multiple states — expediting the licensing process or allowing members to practice under a single multistate license. The list below includes some of the larger compacts backed by well-established regulatory boards. Many also meet the federal licensing requirements of the Centers for Medicare & Medicaid Services. For details, see Medicare Clarifies Recognition of Interstate License Compacts .

For physicians

The Interstate Medical Licensure Compact (IMLC) streamlines the licensing process for physicians so they can practice medicine in multiple states. About 80% of physicians meet the criteria for licensure through the Compact, according to the Interstate Medical Licensure Compact Commission (IMLCC) . For a list of participating states, see the Compact state map .

For nurses

The Nurse Licensure Compact (NLC) authorizes eligible nurses to practice across multiple member states while maintaining a single license. For a list of member states, see Nurse Licensure Compact (NLC) .

For psychologists

The Psychology Interjurisdictional Compact (PSYPACT) authorizes eligible psychologists to practice telepsychology across member states. For a list of member states, see legislative resources map . The Multi-Discipline Licensure Resource Project also offers online and phone support to address psychology licensure questions.

For physical therapists

The PT Compact authorizes eligible physical therapists to work in multiple member states under a single license. For a list of member states, see Compact map . The Multi-Discipline Licensure Resource Project also offers online and phone support to address physical therapy licensure questions.

For Emergency Medical Services (EMS) workers

The EMS Compact authorizes EMS personnel to work in multiple member states under a single license. For a list of member states, see EMS Compact member states & commissioners.

For speech language therapists

The Audiology and Speech-Language Pathology Interstate Compact (ASLP-IC) authorizes telehealth and in-person practice across state lines. For a list of member states, see Compact map – ASLPCompact .

Last updated: September 8, 2021