As the reach of telemed­i­cine services expands, questions arise regarding the permitted scope of practice, licen­sure require­ments and HIPAA compli­ance, among other regula­tory-based inquiries.

The questions and responses below provide basic infor­ma­tion to practi­tioners and are intended to serve as a catalyst for further inquiry into the federal and state regula­tory frame­work for telemedicine/​telehealth (TMH).

What quali­fies as TMH?

TMH involves the use of electronic commu­ni­ca­tions and infor­ma­tion technology to deliver health-related services at a distance, typically in real time. States have different laws concerning when and how TMH may be practiced, so it’s impor­tant to check state statutes, regula­tions and policies, as well as state licen­sure boards regarding practice limita­tions before initi­ating services. In addition, the Centers for Medicare & Medicaid Services provide infor­ma­tion on the scope of Medicare telehealth services. 

Who can provide care via TMH?

It is essen­tial to verify with the relevant state profes­sional licensing board the practi­tioners who can legally practice TMH. Depending on the state, autho­rized practi­tioners may include physi­cians, clinical nurse special­ists, nurse practi­tioners, physi­cian assis­tants and licensed counselors and thera­pists, among others. 

Is a patient/​client relation­ship estab­lished with TMH?

A patient/​client provider relation­ship is estab­lished via TMH in the same manner in which it is estab­lished in an in-person office/​hospital setting. 

Is it neces­sary to secure a license in both states with deliv­ering TMH across state lines?

Some states require practi­tioners who practice TMH to be licensed in the state where the patient/​client is located, and abide by the licen­sure and practice require­ments of that state. Before embarking on inter­state TMH, practi­tioners must review the state practice act of the state where the patient/​client resides. If a state practice act is silent regarding TMH, or published opinions or inter­pre­ta­tions regarding the subject of licen­sure have not been issued by recog­nized sources, then poten­tial TMH practi­tioners should contact their state profes­sional licensing board for clari­fi­ca­tion with respect to inter­state practice and their licen­sure status. Certain states also have entered into inter­state compacts, creating a new pathway to expedite the licensing of a practi­tioner seeking to practice in multiple states. For additional infor­ma­tion, check the respec­tive state licensing board to deter­mine if the state has joined a compact. 

Should a special consent-to-treat form be utilized when performing TMH?

Obtaining a patient’s/client’s consent to TMH services is an essen­tial step in the care process, and is a recom­mended best practice of the American Telemed­i­cine Associ­a­tion. A general consent-to-treat form lacks speci­ficity regarding the poten­tial benefits, constraints and risks unique to TMH, including equip­ment failures and privacy and security breaches. In addition, a general form is lacking in standard language regarding patient/​client rights and respon­si­bil­i­ties relating to TMH. See section Informed Consent: Disclose Risks Unique to the Practice of Telemed­i­cine” for a link to sample TMH consent forms. 

Does a practi­tioner need to abide by HIPAA regulations?

TMH services must comply with the same HIPAA-related rules and regula­tions at the federal and state levels, as well as business policies, that apply to the delivery of in-person services. Practi­tioners should be conver­sant with the HIPAA Breach Notifi­ca­tion Rule and technology encryp­tion require­ments. In the case of inter­state practice, if require­ments for privacy, security and informed consent differ between states, practi­tioners are encour­aged to follow the most restric­tive laws and regulations.