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.