Telemedicine Licensing Factsheet - 7 Things You Need to Know to Avoid Losses

Physicians, hospitals, and other Healthcare providers increasingly rely on telemedicine programs to improve access for patients, especially underserved populations and those living in remote, rural areas.

However, licensing issues can threaten these programs, especially when telemedicine allows doctors and other healthcare personnel to connect with patients across state lines. Below are seven facts you need to know if your practice or facility is interested in delivering telehealth services beyond your own state’s borders.

Lack of License Portability is Major Obstacle to Improved Healthcare Access

Nearly all states require physicians providing telemedicine services to be licensed in the state of the patient receiving care. Most also require any site delivering telehealth services to fully credential – ensure the provider's license, education, insurance, etc., meet the facility's standards --every remote physician treating patients within the facility.

Telemedicine licensing and credentialing requirements help keep patients safe by ensuring all distant providers have complied with state regulations and hospital policies. However, applying for, receiving, and renewing a separate telemedicine license for multiple states can be a time-consuming and costly process, especially for rural providers with limited resources.

As a result, a lack of license portability continues to be a significant barrier to improving healthcare access through the use of telemedicine technology.

Each State Handles Telemedicine Licensing Differently

While many medical boards require interstate telemedicine providers to become fully licensed in their states before offering remote care to their residents, a handful have special-purpose licenses that extend privileges to out-of-state physicians seeking to do so. However, the specific requirements and privileges granted by a special-purpose telemedicine license vary greatly from state to state.

For example, the Florida telemedicine license allows out-of-state doctors full privileges to provide remote care to patients within the state's borders, so long as a physician is fully licensed to practice medicine elsewhere. On the other hand, the Texas telemedicine license only allows out-of-state practitioners to interpret and report diagnostic test results to doctors fully licensed by the Texas Medical Board or provide follow-up care to in-state patients who received the majority of their treatment in another state.

 Other states have enacted laws that don’t specifically address telemedicine licensing but make allowances for licensing of physicians in contiguous states or in certain situations where a temporary license might be issued, so long as the specific state's licensing conditions are met.

Why is there no Federal Telemedicine License?

A single federal telemedicine license that would allow healthcare professionals and facilities to provide remote care across state lines would go a long way towards improving patient access. Unfortunately, state medical boards have been reluctant to give up their authority over licensing, arguing that the power to license and discipline is vital to ensuring patient safety. Licensing is also a source of state revenue.

With the emergence of COVID-19, all 50 states did enact temporary licensing waivers for out-of-state doctors. However, according to the Alliance for Connected Care, just 24 states still had such waivers in place as of January 21, 2022.

Interstate Compacts Have Streamlined Some Telemedicine License Requirements

Many states participate in interstate compacts for healthcare professionals, facilitating multi-state licensing among the participating states.

The Interstate Medical Licensure Compact Commission, for example, offers a voluntary, expedited pathway to licensure for physicians who wish to practice in multiple states. Eligible doctors can qualify to practice medicine in multiple states by completing just one application within the Compact, receiving separate licenses from each state in which they intend to practice.

So far, more than half the states, the District of Columbia, and the Territory of Guam have joined the Interstate Medical Licensure Compact.   Others are currently in the process of approving legislation to join the Compact.

Additional interstate medical license compacts include:

• Nursing Licensure Compact
• Physical Therapy Compact
• Psychology Interjurisdictional Compact,
• Audiology and Speech-Language Pathology Interstate Compact
• Emergency Medical Services Personnel Licensure Interstate Compact.

FSMB Resources to Expedite Interstate Licensing

Aside from Interstate Compacts, the Federation of State Medical Boards offers the Federation Credentials Verification Service and the Uniform Application for Licensure, which streamlines the application process for physicians and physician assistants.

Finally, Provider Bridge offers a technology platform that rural communities can use to quickly mobilize telemedicine providers during states of emergency.

Credentialing by Proxy and Telehealth Licensing

The Joint Commission recently changed its rules to enable more hospitals and telemedicine companies to utilize the streamlined “credentialing by proxy” process. Under the change, the distant-site telemedicine entity must be accredited with The Joint Commission or enrolled in the Medicare program. Previously, the rules required both the originating site hospital and the distant site entity to be accredited with The Joint Commission.

Both rural and originating site hospitals, as well as telemedicine companies offering professional services to those hospitals, stand to benefit from this rule change.

Where Can I Obtain Additional Information?

These resources offer additional information about state telemedicine licensing requirements.

• The Telehealth Resource Centers website answers several frequently asked questions about Licensure and Scope of Practice and Credentialing and Licensing.
• The American Medical Association has up-to-date information on physician licensure requirements across all states and jurisdictions.
• The National Council of State Boards of Nursing offers licensure information and information about state boards of nursing.
• The American Telemedicine Association’s State Telemedicine Policy Center compiles state-specific information about telemedicine policy.

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