The use of telecommunication to complement health care delivery services is growing. Many health systems and providers are interested in developing a telehealth component as part of their offerings. With these expansions, professional licensure portability and practice standards for providers can be a significant challenge due to the conflicting and disparate requirements for practice standards under state laws. Therefore, many providers are unable to fully take advantage of telemedicine.
Over the past year, more than twenty-five states have considered proposals to revise health professional standards and licensure requirements for telemedicine. Notably, some state medical boards have adopted practice standards for telemedicine with more stringent requirements than in-person care.
One contentious issue for health care providers is licensure portability, which is the ability for health care providers to practice out-of-state using one license. As most states require that a physician be licensed in the state where the physician’s patient is located, this requirement arguably prevents some patients from receiving critical medical services across the state line. Additionally, these restrictions create economic trade barriers, which artificially protect markets from competition.
Most states have a policy imposing burdens for practicing telemedicine across state lines, regardless of whether telemedicine is used. Michigan, North Dakota, Pennsylvania and South Dakota are the only states that do not allow some type of licensure exemption for physician-to-physician out-of-state consultation. The only states that allow licensure reciprocity for bordering states are Maryland, New York, Virginia and the District of Columbia. Alabama, Louisiana, Minnesota, Nevada, New Mexico, Ohio, Oregon, Tennessee and Texas are the only states that extend a conditional or telemedicine license to out-of-state physicians.
Notably, Montana enacted a law this year to discontinue a specialized “telemedicine license” as of July 1, 2015, which had been required for providers to practice telemedicine in the state1. This telemedicine license limited the scope of practice for telemedicine.
State Telemedicine – A Range of Licensure Portability Options
To further explain telemedicine licensure portability, an illustration of the differing state requirements for licensure of a physician providing telemedicine is provided below.
Alabama. Alabama has a specialized telemedicine license that allows for a medical professional in another state to apply to the Alabama State Medical Board for a “special purpose license” to practice in Alabama, though the provider may not practice in Alabama more than 10 times per year or more than one percent of their total practice2. This specialized license is not required for an informal consultation between a licensed physician located in Alabama and an out-of-state physician provided that the consultation is conducted without compensation to either physician and does not result in the formal rendering of a written or otherwise documented medical opinion concerning the diagnosis or treatment of a patient by the out-of-state physician.
Mississippi. A full, unrestricted Mississippi medical license is required to practice telemedicine in the state; however, a state license is not required if reading for consultation only3. As such, a Mississippi medical license is not required where a physician licensed in Mississippi requested the consultation, and the physician requesting the consultation has already established a physician/patient relationship with the patient.
Ohio. Ohio law defines “telemedicine” as “the practice of medicine in [Ohio] through the use of any communication, including oral, written, or electronic communication by a physician outside this state”4. An out-of-state provider must obtain a telemedicine certificate in order to practice within Ohio. To be eligible for a telemedicine certificate, the applicant must hold a current, unrestricted license to practice medicine or osteopathic medicine and surgery issued by another state that requires license holders to complete at least fifty hours of continuing medical education every two years. In addition, the applicant’s principal place of practice is located in that state”5.
It should be noted that a holder of a telemedicine certificate may not practice medicine in person in the state of Ohio without either obtaining a special activity certificate or converting the telemedicine certificate to a full certificate issued by the state licensing board.
Oregon. Oregon allows for “telemonitoring” and “telemedicine” status for physicians outside of the state. Telemonitoring status is for physicians whose practice is the intraoperative monitoring of data collected during surgery and is transmitted to them in a location outside of Oregon via a telemedicine link. Telemonitoring requires a letter from a hospital or surgical center requesting telemonitoring status.
Alternatively, telemedicine status is for physicians outside of Oregon who directly treat patients, provide them with a written or documented medical opinion concerning diagnosis or treatment in Oregon and have a physician-patient relationship with the patients. This requires completion of the Practice Across State Lines Practice Description Form6.
Texas. Texas allows for out-of-state providers to engage in telemedicine when the provider has obtained a telemedicine license7. However, this telemedicine license is limited exclusively to the interpretation of diagnostic testing and reporting results to a physician fully licensed and located in Texas or for the follow-up of patients where the majority of patient care was rendered in another state.
As the role of telemedicine in health care delivery continues to evolve, it is critical for providers to stay up to date on the legal requirements. Those interested in engaging in a multistate telehealth operation should understand which states limit the use of telemedicine. Additionally, as the health care marketplace will continue to reflect the barrier implemented by state law, providers should take advantage of opportunities available in states with limited barriers to the practice of telemedicine.