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, physicians who provide virtual care through telehealth must verify that they are fully licensed, or have practice authority, wherever they deliver remote care.

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.  The licensure requirements apply to all types of medical treatment, including prescribing and 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 their regulations.

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

MIEC Coverage:

The MIEC policy provides medical professional liability coverage for members practicing under the scope of their licensure, including state licensure, which includes telehealth practice activities as defined by state licensing authorities.  With few exceptions, licensure is necessary in the state in which a patient is physically located at the time of treatment, regardless of where the patient resides full-time or where the physician is located at the time of a telehealth visit. 

MIEC members who are interested in coverage for telehealth outside their primary state of coverage need to first contact Underwriting at underwriting@miec.com to confirm coverage.  Generally, members with full licensure or practice authority will be approved for coverage in Alaska, California, Hawaii, Idaho, and 9 additional states in the Western U.S.  The map below highlights all 13 Western states, with more information about each state’s individual licensure requirements and telehealth regulations.

MIEC will also consider, on a case-by-case basis, coverage for telehealth activities in states that are not on this list.  Please contact Underwriting for more information.

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

Licensure requirement:  What type of license is required for out-of-state telemedicine practitioners, and whether there are exceptions to the licensure requirement.

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

Telephone calls included: Whether the state’s statutory definition of telemedicine specifically includes telephone calls, also referred to as “audio-only” telehealth.

Email excluded: Whether the state’s statutory definition of 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.

Medical board: Contact information for state medical board.

Telemedicine resources: Links to state-specific telemedicine resources.

Licensure requirement:  Full licensure (see exceptions below)

Licensure Compact member:  No

Telephone calls included:  Included

Email excluded:  No

Consent required:  Yes

 

Medical Board:

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

Telemedicine resources: 

https://www.akleg.gov/PDF/32/Bills/HB0265Z.PDF

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

 

Exceptions to licensure requirement:

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

  1. 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.
  2. 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.

Licensure requirement:  Full licensure (see exceptions below)

Licensure Compact member:  No

Telephone calls included:  Unclear

Email excluded:  No

Consent required:  Yes

 

Medical Board:

https://www.mbc.ca.gov/

Telemedicine resources: 

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

 

Exceptions to licensure requirement:

Out of state physicians may consult with a licensed California physician via telehealth without needing a California license.

AB 1369 (2023) allows out of state physicians to treat patients diagnosed with a disease or condition that is "immediately life-threatening" and who have consented to telehealth care.

Licensure requirement:  Full licensure (see exceptions below)

Licensure Compact member:  SB 674 (2023) officially adopted the IMLC, implementation is still pending.

Telephone calls included:  Excluded

Email excluded:  Excluded

Consent required:  Yes

 

Medical Board:

https://cca.hawaii.gov/pvl/boards/medical/

Telemedicine resources: 

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

 

Exceptions to licensure requirement:

Consulting with an in-state physician

Licensure requirement:  Full licensure

Licensure Compact member:  IMLC member

Telephone calls included:  Telehealth does not include audio-only without access to and review of patient's medical records.

Email excluded:  Does not include email messages that are not in compliance with HIPAA.

Consent required: Yes

 

Medical Board:

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

Telemedicine resources: 

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

 

Exceptions to licensure requirements:

The Idaho Virtual Care Access Act (2023) allows licensed out of state physicians to provide telehealth services to Idaho patients without a state license, provided that the physician meets one of the following criteria:

 

  1. Has established a patient-provider relationship with a person who is in Idaho temporarily for business, work, education, vacation, or other reasons and such person requires health care services from that provider;

 

  1. Has established a patient-provider relationship with a person and provides temporary or short-term follow-up health care services to such person to ensure continuity of care;

 

  1. Is employed by or contracted with an Idaho facility or hospital to provide care services for which the provider has been privileged and credentialed;

 

  1. Renders health care services in a time of disaster and provides follow-up health care services to ensure continuity of care;

 

  1. Provides health care services in preparation for a scheduled in-person care visit; or

 

  1. Consults with or refers a patient to an Idaho licensed provider.

Licensure requirement:  Full licensure (see exceptions below)

Licensure Compact member:  IMLC member

Telephone calls included:  Audio-only telemedicine does not include services customarily delivered via audio and not separately billed, such as sharing of lab results.

Email excluded:  Excluded

Consent required:  Yes

 

Medical Board contact:

https://wmc.wa.gov/

Telemedicine resources:

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

https://wmc.wa.gov/sites/default/files/public/Newsletter/2022Summer/2.edreport.pdf

 

Exceptions to licensure requirement:

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

  1. Consults with a Washington-licensed practitioner who remains responsible for diagnosing and treating the patient in Washington.
  2. 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.
  3. 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.

Licensure requirement: Telemedicine license, exceptions to licensure (see below)

Licensure Compact member:  No

Telephone calls included:  Unclear

Email excluded:  No

Consent required:  Yes

 

Medical Board contact:

https://www.oregon.gov/omb/pages/default.aspx

Telemedicine resources:

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

https://www.oregon.gov/omb/OMBForms1/mddo-telemedicine-request.pdf

 

Exceptions to licensure requirement:

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

  1. Consulting directly with another physician or physician assistant licensed in Oregon if they do not undertake the primary responsibility for diagnosing or rendering treatment.
  2. 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.
  3. Providing temporary or intermittent follow-up for continuity of care if the patient regularly receives in-person care with that provider.
  4. A team physician traveling with their out-of-state athletic team.
  5. Providing emergency care.
  6. Providing care through the U.S. Armed Forces, U.S. Public Health Service, or U.S. Department of Veterans Affairs

Licensure requirement:  Telemedicine license

Licensure Compact member:  IMLC member

Telephone calls included:  Included

Email excluded:  Excluded

Consent required:  Yes

 

Medical Board contact:

https://medboard.nv.gov/

Telemedicine resources:

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

Licensure requirement:  Telehealth registration, exceptions to licensure (see below)

Licensure Compact member:  IMLC member

Telephone calls included:  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.

Email excluded:  Excluded

Consent required:  Yes

 

Medical Board contact:

https://www.azmd.gov/

Telemedicine resources:

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

https://azmbfileblob.blob.core.windows.net/azmd/MD_202203071635_6d27d795274d4362b3d0a51d7380809c.pdf?sv=2019-12-12&ss=bf&srt=sco&sp=rx&se=2031-01-01T03:00:00Z&st=2020-10-16T15:00:00Z&spr=https&sig=DZ6kk7nb6zpFJW1mchdxMtcPNH7fdLq17fijyG1few8%3D

 

Exceptions to licensure requirement:

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

  1. 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.
  2. The healthcare provider provides fewer than ten telehealth encounters in a calendar year.

Licensure requirement:  Full licensure (see exceptions below), limited registration for behavioral health providers

Licensure Compact member:  IMLC member

Telephone calls included:  Unclear

Email excluded:  No

Consent required:  Yes

 

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

 

Exceptions to licensure requirement:

Pro bono telemedicine:

An out-of-state physician may practice without a Utah license if:

  1. The physician is licensed in another state, with no licensing action pending and at least 10 years of professional experience;
  2. The services are rendered as a public service and for a noncommercial purpose;
  3. No fee or other consideration of value is charged, expected or contemplated, beyond an amount necessary to cover the proportionate cost of malpractice insurance; and
  4. The physician does not otherwise engage in unlawful or unprofessional conduct.

Licensure requirement:  Full licensure (see exceptions below)

Licensure Compact member:  IMLC member

Telephone calls included:  Included

Email excluded:  Excluded

Consent required:  Yes

 

Medical Board contact:

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

Telemedicine resources:

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

https://leg.mt.gov/bills/mca/title_0370/chapter_0030/part_0010/section_0030/0370-0030-0010-0030.html

 

Exceptions to licensure requirement:

As of 2023, Montana allows “the rendering of services in this state by a physician lawfully practicing medicine in another state or territory. However, if the physician does not limit the services to an occasional case or if the physician has any established or regularly used hospital connections in this state or maintains or is provided with, for the physician's regular use, an office or other place for rendering the services, the physician must possess a license to practice medicine in this state.”

Licensure requirement:  Full licensure (see exceptions below)

Licensure Compact member:  IMLC member

Telephone calls included:  Unclear

Email excluded:  No

Consent required:  Yes

 

Medical Board contact:

https://wyomedboard.wyo.gov/

Telemedicine resources:

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

 

Exceptions to licensure requirement:

Consulting with an in-state physician (maximum 12 days/year)

Licensure requirement:  Full licensure

Licensure Compact member:  IMLC member

Telephone calls included:  Unclear

Email excluded:  No

Consent required:  Yes

 

Medical Board contact:

https://dpo.colorado.gov/Medical

Telemedicine resources:

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

Licensure requirement:  Telemedicine license (see exceptions below)

Licensure Compact member:  No

Telephone calls included:  Included

Email excluded:  No

Consent required:  Yes

 

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

 

Exceptions to licensure requirement:

Consultation with an in-state physician on an irregular or infrequent basis.

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

  • Healthcare providers must be licensed or have legal authority to practice in the state in which patients are physically located at the time of treatment, including when providing care through telehealth.
  • Physicians should work to set patient expectations early in the course of treatment, especially when providing care through telehealth. Patients should understand the geographic limitations in terms of where they can receive care, and they should make plans accordingly when traveling or relocating to other states. Proactive communication can help providers and patients determine whether it might be possible to continue care in another state, or if the patient should transition care to another provider.
  • Be aware of state laws and regulations pertaining specifically to 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-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. This requirement was temporarily changed to allow initial evaluations through videoconferencing, and this was extended through 2024. For more information, see Telehealth and Prescribing Controlled Substances.
  • 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 for addressing 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 (links to sample consent forms can be found below).
  • 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.

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