Cross-State Licensing in Telehealth: Challenges, Solutions, and Opportunities

Since 2020, telehealth has emerged as a transformative force in healthcare, offering patients unprecedented access to care across geographic boundaries. But despite the increased prevalence of telehealth as a vital form of care delivery, providers wanting to treat out-of-state patients must remain mindful of state-specific licensing requirements, creating a significant obstacle for treating patients. This requires providers to navigate a complex web of laws, regulations, and administrative processes to deliver care across state lines. This article offers an overview into the challenges providers face in navigating cross-state licensure requirements, and steps your practice can take to ensure compliance with applicable state licensure laws when treating patients outside your state.

Cross-State Licensing: State Requirements and Restrictions

Traditionally, licensure of medical providers—including physicians—has been a function of state law. Each state promulgates licensure requirements for its providers through the state’s medical licensing board, and any provider seeking to treat patients in that state must satisfy these requirements in order to obtain a medical practice license. But telehealth providers face additional hurdles. Generally, federal and state law require telehealth providers to be licensed in both the state where they deliver care (i.e. the “distant site”) and the state in which the patient is located (i.e. the “originating site”).

With the rapid expansion in the use of telehealth in recent years, many states have created special licensure pathways or exceptions to traditional licensure requirements to more easily facilitate virtual care by out-of-state providers. The bad news? Cross-state licensure laws vary greatly by state, meaning providers must carefully scrutinize the licensure requirements for the state where a patient is located to determine they are appropriately licensed before rendering care. This process can be time-consuming and expensive, further complicating the process for providers who wish to render care outside their state of licensure.

Further, licensing requirements impact different specialties in distinct ways, creating additional challenges for telehealth providers. Behavioral health professionals often face complex state privacy and consent regulations, which can vary widely. Some states require providers to obtain explicit consent for telehealth sessions, while others impose additional record-keeping mandates. Primary care providers frequently encounter restrictions on prescribing controlled substances remotely. Prior to the DEA’s relaxation of in-person consultation requirements for prescribing of controlled substances, the Ryan Haight Act, as well as certain state-specific prescribing rules, required an in-person appointment before controlled substances can be prescribed virtually. And specialists—particularly those managing chronic conditions or rare diseases—face barriers when coordinating follow-up care for out-of-state patients. Licensing restrictions can delay treatment and disrupt continuity, especially for patients in underserved regions.

The current regulatory landscape makes it incredibly challenging for providers to care for out-of-state patients without running afoul of state licensing laws. But with the right guidance and tools, providers can address these challenges with ease.

Navigating Cross-State Licensing Laws: The IMLC and Other Initiatives

Providers seeking to treat patients across state lines have options available to them that can simplify the licensure process. For one, many states participate in multi-state licensure compacts, which allow providers a streamlined process to apply for a practice license in a participating state. The most notable of these compacts is the Interstate Medical Licensure Compact (IMLC). With 40 participating states, the IMLC allows providers to apply for and receive a license to practice in a compact state as long as the provider holds an unrestricted license to practice in their state of licensure and meets additional eligibility requirements. Similar compacts exist for other types of providers, including nurses, physical and occupational therapists, and psychologists.

Some states also offer a telehealth-specific registration process to telehealth providers seeking to offer virtual care from outside the state. While each state’s requirements vary, states generally allow telehealth providers to register to provide out-of-state telehealth services if the provider has a valid, unrestricted license to practice in another state, has not been the subject of any disciplinary proceeding, carries professional liability insurance, and agrees not to provide in-person services in that state.

Other pathways to simplify cross-state licensure are on the horizon. Policymakers and industry advocates are currently exploring other solutions to make interstate practice more efficient, particularly for telehealth providers. One promising initiative is the Interstate Medical Telemedicine Registration Compact (IMTRC). Unlike traditional compacts like the IMLC, which help providers obtain full licensure in other states, the IMTRC would create a telehealth-specific registration process, enabling providers to offer remote care across participating states without navigating separate licensing processes.

Additionally, while some states offer other exceptions to traditional licensure for telehealth providers, efforts are also underway to create standardized exceptions to state licensing requirements. These exceptions would allow providers to deliver follow-up care, participate in clinical trials, or handle specialty referrals across state lines without the need for full licensure. Such policies could reduce delays in care delivery and improve patient outcomes, particularly for those in rural or underserved areas.

Treating patients in other states doesn’t have to be complicated. By understanding the licensure pathways and exceptions applicable in your desired state of licensure, your practice can treat patients across state lines with confidence.

Delivering Interstate Telehealth Services: Compliant Strategies for Providers

The challenges of cross-state licensing are significant, but they are not insurmountable. Providers can overcome these obstacles by tailoring strategies to their specialties, leveraging technology to streamline compliance, and taking advantage of initiatives that simplify the licensure process.

First, identify the challenges that your specialty poses in complying with cross-state licensing requirements. For behavioral health practitioners needing to comply with state privacy and consent laws, investing in technology that automates compliance processes and maintaining a thorough understanding of state-specific laws can help ensure seamless operations. For primary care providers who prescribe controlled substances, the DEA/HHS joint rule provides relief from the in-person consultation requirement through 2025; however, providers should be sure to review state prescribing requirements to ensure compliance. Finally, specialists should consider collaborations with in-state partners to maintain continuity of care in patients’ treatment plans.

Technology also plays a crucial role in helping providers navigate cross-state licensing complexities. Compliance management platforms, for example, automate the tracking of license renewals, application deadlines, and state-specific regulations. Credentialing tools like FCVS provide centralized access to verified credentials, simplifying multi-state operations. For behavioral health providers, telehealth platforms that integrate consent management and ensure compliance with state-specific privacy laws can reduce administrative overhead. Similarly, tools that support remote prescribing compliance can help primary care providers navigate the complexities of controlled substance regulations. By adopting these technologies, providers can focus more on patient care and less on administrative tasks, enabling them to expand their reach confidently.

Finally, evaluate whether there are available licensure pathways or exceptions that apply to your practice. Licensure compacts like the IMLC and state-level exceptions to traditional licensure requirements can present significant time and cost savings for providers, giving you peace of mind that your practice is providing legally-compliant care.

Conclusion

Cross-state licensing shouldn’t prevent your telehealth practice from thriving. By staying informed, investing in technology, and adapting to specialty-specific challenges, telehealth practitioners can continue to provide high-quality care and improve patient outcomes—all while minimizing their legal risk. Whether you’re applying for licensure through a compact or looking to qualify for a traditional licensure exception in another state, our attorneys at Health Law Alliance can help you navigate the challenges of cross-state licensing confidently.

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