Telehealth

The MIEC policy provides medical professional liability coverage for members practicing under the scope of their licensure, including state licensure, and that includes telehealth practice activities as defined by state licensing authorities.

Importantly, the licensure requirement for a health care provider is determined by the licensing board of the state in which a patient is physically located at the time of treatment. These requirements also apply to telehealth, and they can vary considerably from state to state. For instance, most states require full, unrestricted licensure for any treatment provided in the state, including by telehealth. Some states offer telehealth-only licensure or registration; others allow physicians to provide short-term telehealth treatment without licensure for patients who are traveling or who have relocated from outside the state. Some states specifically include or exclude audio-only (telephone) encounters as part of telehealth; others do not address it.

In addition to licensing, it is important to understand individual state’s telehealth regulations which can vary greatly from state to state.

MIEC members are covered for telehealth activities as long as they are practicing with full licensure or practice authority as determined by the state in which a patient is physically located at the time of treatment. See the map below for a list of 13 western states, with more information about their individual licensure requirements and telehealth regulations.

Members who are interested in practicing telehealth in other states that are not listed should contact Underwriting at underwriting@miec.com.

Telehealth licensure information for 13 western states in the following categories:

Telephone calls included: Whether the state’s statutory definition of telehealth/telemedicine specifically includes audio-only telephone calls.

Medicaid telephone reimbursement: Whether the state Medicaid program reimburses for audio-only telemedicine encounters (useful when audio-only is not otherwise addressed in the telemedicine definition, if reimbursed then it is likely considered to be the practice of medicine in the state).

Email excluded: Whether the state’s statutory definition of telehealth/telemedicine specifically excludes email communication. Generally, email is not included in the definition of telemedicine.

Consent required: Whether the state has a requirement for physicians to obtain informed consent from patients for telemedicine.

Licensure requirement: What type of license is required for out-of-state telemedicine practitioners.

Exceptions: What, if any, exceptions there are to the licensure requirement for out-of-state telemedicine.

Licensure compact: Whether the state belongs to the Interstate Medical Licensure Compact (IMLC).

Medical board: Contact information for state medical board.

Telemedicine resources: Links to state-specific telemedicine resources.

Alaska

Telephone calls included: Included

Medicaid telephone reimbursement: Yes

Email excluded: No

Consent required: Yes

Licensure requirement: Full licensure

Exceptions: Yes, see additional information below.

Licensure Compact: No

Medical Board contact: https://www.commerce.alaska.gov/web/cbpl/professionallicensing/statemedicalboard.aspx

Telemedicine resources: https://health.alaska.gov/dph/Emergency/Pages/healthcare/telehealth/default.aspx

Additional link: https://www.commerce.alaska.gov/web/cbpl/ProfessionalLicensing/TelemedicineBusinessRegistry.aspx

Note: For all states, physicians must follow the licensing requirements for the state in which a patient is physically located at the time of treatment.

Additional state exception information for Alaska:

A physician licensed in another state may provide health care services through telehealth to a patient located in Alaska, under the following conditions:

Ongoing treatment or follow-up care related to health care services previously provided by the physician to the patient and applies only if:
- the physician and the patient have an established physician-patient relationship; and
- the physician has previously conducted an in-person visit with the patient.
A visit regarding a suspected or diagnosed life-threatening condition for which:
- the patient has been referred to the physician licensed in another state by a physician licensed in this state and that referral has been documented by the referring physician; and
- the visit involves communication with the patient regarding diagnostic or treatment plan options or analysis of test results for the life-threatening condition.

All physicians, including in-state physicians, must register with the Alaska Division of Commerce – Telehealth Business Registry before providing telehealth services in the state.

California

Telephone calls included: Unclear

Medicaid telephone reimbursement: Yes

Email excluded: No

Consent required: Yes

Licensure requirement: Full licensure

Exceptions: Consulting with an in-state physician

Licensure Compact: No

Medical Board contact: https://www.mbc.ca.gov/

Telemedicine resources: https://www.mbc.ca.gov/Resources/Medical-Resources/telehealth.aspx

Note: For all states, physicians must follow the licensing requirements for the state in which a patient is physically located at the time of treatment.

Hawaii

Telephone calls included: Excluded

Medicaid telephone reimbursement: No

Email excluded: Excluded

Consent required: Yes

Licensure requirement: Full licensure

Exceptions: Consulting with an in-state physician

Licensure Compact: No

Medical Board contact: https://cca.hawaii.gov/pvl/boards/medical/

Telemedicine resources: https://www.pbtrc.org/policies-and-regulations/state-of-hawaii-policies-and-regulations/

Note: For all states, physicians must follow the licensing requirements for the state in which a patient is physically located at the time of treatment.

Idaho

Telephone calls included: Excluded*

Medicaid telephone reimbursement: No

Email excluded: Excluded**

Consent required: Yes

Licensure requirement: Full licensure

Exceptions: None

Licensure Compact: IMLC

Medical Board contact: https://elitepublic.bom.idaho.gov/IBOMPortal/BoardPage.aspx?Board=BOM

Telemedicine resources: https://isb.idaho.gov/wp-content/uploads/150402_hea_materials4.pdf

* Does not include audio in isolation without access to and review of patient's medical records

** Does not include email messages that are not in compliance with HIPAA

Note: For all states, physicians must follow the licensing requirements for the state in which a patient is physically located at the time of treatment.

Washington

Telephone calls included: Excluded*

Medicaid telephone reimbursement: Yes

Email excluded: Excluded

Consent required: Yes

Licensure requirement: Full licensure

Exceptions: Yes, see additional information below.

Licensure Compact: IMLC

Medical Board contact: https://wmc.wa.gov/

Telemedicine resources: https://wmc.wa.gov/sites/default/files/public/Telemedicine%20policy%2011%2019%2021.pdf

* Audio-only telemedicine does not include services customarily delivered via audio and not separately billed, such as sharing of lab results

Note: For all states, physicians must follow the licensing requirements for the state in which a patient is physically located at the time of treatment.

Additional state exception information for Washington:

The Washington Medical Commission does not require a license when a physician:

Consults with a Washington-licensed practitioner who remains responsible for diagnosing and treating the patient in Washington.
Reviews medical records and provides an opinion, but not treatment, regarding a patient’s care as part of a specialty consultation while the patient is located in the state.
Provides care to an established patient who is located in Washington in one of the following situations:
- patient travels to Washington for a limited time (e.g., vacation, business, or education) and requires medical care.
- patient moves to Washington and has not yet established a relationship with a local practitioner, and the patient requires immediate medical care for a condition the out-of-state physician has been treating; should last no longer than 12 months.
- patient has received specialty care outside the state, and requires follow-up care after returning home to Washington.

Oregon

Telephone calls included: Unclear

Medicaid telephone reimbursement: Yes

Email excluded: No

Consent required: Yes

Licensure requirement: Telemedicine license

Exceptions: Yes, see additional information below.

Licensure Compact: No

Medical Board contact: https://www.oregon.gov/omb/pages/default.aspx

Telemedicine resources: https://www.oregon.gov/omb/topics-of-interest/pages/telemedicine.aspx

Note: For all states, physicians must follow the licensing requirements for the state in which a patient is physically located at the time of treatment.

Additional state exception information for Oregon:

A physician or physician assistant licensed in another state may provide care via telemedicine without obtaining Oregon licensure if the provider is:

Consulting directly with another physician or physician assistant licensed in Oregon if they do not undertake the primary responsibility for diagnosing or rendering treatment.
Providing care through an established provider-patient relationship with a person who is in Oregon temporarily for the purpose of business, work, education, or vacation and who requires direct medical treatment.
Providing temporary or intermittent follow-up for continuity of care if the patient regularly receives in-person care with that provider.
A team physician traveling with their out-of-state athletic team.
Providing emergency care.
Providing care through the U.S. Armed Forces, U.S. Public Health Service, or U.S. Department of Veterans Affairs

Nevada

Telephone calls included: Included

Medicaid telephone reimbursement: Yes

Email excluded: Excluded

Consent required: Yes

Licensure requirement: Telemedicine license

Exceptions: None

Licensure Compact: IMLC

Medical Board contact: https://medboard.nv.gov/

Telemedicine resources: https://www.leg.state.nv.us/Division/Research/Documents/Telehealth_in_Nevada.pdf

Note: For all states, physicians must follow the licensing requirements for the state in which a patient is physically located at the time of treatment.

Arizona

Telephone calls included: Included*

Medicaid telephone reimbursement: Yes

Email excluded: Excluded

Consent required: Yes

Licensure requirement: Telehealth registration

Exceptions: Yes, see additional information below

Licensure Compact: IMLC

Medical Board contact: https://www.azmd.gov/

Telemedicine resources: https://www.azleg.gov/viewdocument/?docName=https://www.azleg.gov/ars/36/03606.htm

Note: For all states, physicians must follow the licensing requirements for the state in which a patient is physically located at the time of treatment.

* Includes the use of an audio-only telephone encounter if an audio-visual telehealth encounter is not reasonably available due to the patient’s functional status, the patient’s lack of technology or telecommunications infrastructure limits, as determined by the health care provider

Additional state exception information for Arizona:

Out-of-state physicians are not subject to the Arizona telemedicine registration requirements if either of the following applies:

The services are provided under one of the following circumstances:
- in response to an emergency medication condition.
- in consultation with a health care provider who is licensed in the state and who has the ultimate authority over the patient's diagnosis and treatment.
- to provide after-care specifically related to a medical procedure that was delivered in person in another state.
- to a person who is a resident of another state and the telehealth provider is the primary care provider or behavioral health provider located in the person's state of residence.
The healthcare provider provides fewer than ten telehealth encounters in a calendar year.

Utah

Telephone calls included: Unclear

Medicaid telephone reimbursement: Yes

Email excluded: No

Consent required: Yes

Licensure requirement: Full licensure

Exceptions: Volunteering, other requirements

Licensure Compact: IMLC

Medical Board contact: https://dopl.utah.gov/md/

Telemedicine resources: https://le.utah.gov/xcode/Title58/Chapter67/58-67-S305.html?v=C58-67-S305_2018050820180508

Note: For all states, physicians must follow the licensing requirements for the state in which a patient is physically located at the time of treatment.

Montana

Telephone calls included: Included

Medicaid telephone reimbursement: No

Email excluded: Excluded

Consent required: Yes

Licensure requirement: Full licensure

Exceptions: None

Licensure Compact: IMLC

Medical Board contact: https://boards.bsd.dli.mt.gov/medical-examiners/

Telemedicine resources: https://rules.mt.gov/gateway/RuleNo.asp?RN=24%2E156%2E813

Note: For all states, physicians must follow the licensing requirements for the state in which a patient is physically located at the time of treatment.

Wyoming

Telephone calls included: Unclear

Medicaid telephone reimbursement: No

Email excluded: No

Consent required: Yes

Licensure requirement: Full licensure

Exceptions: Consulting with in-state physician (max 12 days/year)

Licensure Compact: IMLC

Medical Board contact: https://wyomedboard.wyo.gov/

Telemedicine resources: https://www.wyoleg.gov/InterimCommittee/2018/10-20181119WyomingtelehealthpolicyFINAL.pdf

Note: For all states, physicians must follow the licensing requirements for the state in which a patient is physically located at the time of treatment.

Colorado

Telephone calls included: Unclear

Medicaid telephone reimbursement: Yes

Email excluded: No

Consent required: Yes

Licensure requirement: Full licensure

Exceptions: None

Licensure Compact: IMLC

Medical Board contact: https://dpo.colorado.gov/Medical

Telemedicine resources: https://www.cchpca.org/colorado/?category=professional-requirements&topic=cross-state-licensing-professional-requirements

Note: For all states, physicians must follow the licensing requirements for the state in which a patient is physically located at the time of treatment.

New Mexico

Telephone calls included: Included

Medicaid telephone reimbursement: Yes

Email excluded: No

Consent required: Yes

Licensure requirement: Telemedicine license

Exceptions: None

Licensure Compact: No

Medical Board contact: https://www.nmmb.state.nm.us/index.html

Telemedicine resources: https://www.cchpca.org/new-mexico/?category=professional-requirements&topic=cross-state-licensing-professional-requirements

Note: For all states, physicians must follow the licensing requirements for the state in which a patient is physically located at the time of treatment.

Health care providers should consider the following when providing telehealth services:

Health care providers must be licensed or have legal authority to practice in the state in which patients are physically located at the time of treatment.

Be aware of state laws and regulations regarding telehealth. In general, before prescribing medications, providers must establish a treatment relationship with new patients through evaluation and/or examination. These evaluations can be accomplished through in[1]person visits or videoconferencing, according to state laws and/or the applicable standard of care. Avoid prescribing medications to new patients based solely on a telephone conversation or online questionnaire.

With limited exceptions, pursuant to federal law, Schedule II-V controlled substances should only be prescribed to new patients following a thorough in-person evaluation. During the COVID state of emergency, this requirement has been modified to allow the initial evaluation to occur via videoconference. For more information, see the DEA’s Controlled Substance Prescribing Guidance During COVID. Providers should note that the in-person evaluation requirement will be reinstated when the federal public health emergency expires, and applicable standards of care may require initial or periodic in-person evaluations when possible.

Telehealth does not alter applicable standards of care, and providers should consider what clinical presentations or types of evaluation and treatment are best performed in person. Providers should develop protocols for referring patients for in-person care, and dealing with emergencies that might arise during virtual patient encounters.

Providers should maintain complete and accurate medical records for telehealth visits, in the same manner as for in-person visits.

Patients must provide informed consent for telehealth, and that consent should be documented in the patient’s records (sample consent forms can be found to the right).

Providers should remember to take reasonable steps to protect patient privacy and confidentiality during telehealth visits, and when communicating electronically with patients. Whenever possible, avoid sending Protected Health Information (PHI) via text message or unsecured email.