Licensure Laws
Licensed where the patient is.
When care is delivered by telehealth, it is considered rendered at the physical location of the patient — so a provider typically needs to be licensed in the patient's state. Interstate compacts are what make multi-state practice possible.
The Core Rule
Where care is rendered.
Because a telehealth visit is considered to take place where the patient is located, the provider generally must hold a license in the patient's state — and establish a valid practitioner-patient relationship as defined by that state's licensure board.
For the provider, that means
- Establish the relationship — as defined by the state licensure board where the patient is located.
- Meet the standard of care — the initial examination must satisfy the medical standard of care and the state's exam requirements.
- Follow the DEA — prescribing controlled substances also means complying with the DEA and the Ryan Haight Act.
- Follow-up flexibility — providers keep flexibility for subsequent encounters for the same medical condition.
Across State Lines
Out-of-state providers
Telehealth by nature makes it possible for providers to deliver services across state lines — so long as they are properly licensed in the state the patient is located in. How Medicaid programs treat those out-of-state providers, though, varies from state to state.
How states differ
- Some Medicaid programs restrict out-of-state providers, requiring some form of in-state presence.
- Others explicitly allow them — as long as the provider is licensed in the state and enrolls with the Medicaid program.
- Compacts offer a path — joining an interstate compact lets a provider reach patients across many state lines.
The Compacts
Six interstate licensure compacts
Because getting licensed in every state is burdensome, many states have adopted interstate compacts. These let specific providers practice in states where they are not licensed — as long as they hold a license in good standing in their home state.
The Interstate Medical Licensure Compact
For physicians practicing across participating states.
Nurses Licensure Compact
For nurses seeking to practice across member states.
Physical Therapy Compact
For physical therapists working across state lines.
Psychology Interjurisdictional Compact
For psychologists providing care in participating states.
Audiology and Speech-Language Pathology Interstate Compact
For audiologists and speech-language pathologists.
Emergency Medical Services Personnel Licensure Interstate Compact
For emergency medical services (EMS) personnel.
Licensure is where every telehealth visit begins.
Know the rules in every state you serve.
CTeL members get round-the-clock intelligence on licensure, compacts, and cross-state practice.