In this installment of "Your Questions Answered," Psych Congress Steering Committee member Edward Kaftarian, MD, responds to questions about your medical license and telehealth. Dr. Kaftarian is chief executive officer of Orbit Health Telepsychiatry, Calabasas, California, a member of the American Psychiatric Association’s Telepsychiatry Committee, and former vice chair of mental health for the American Telemedicine Association.
Q: Who is responsible for licensing physicians and nurse practitioners?
A: Generally speaking, the granting of licenses is regulated on a state-by-state basis, not by the federal government. States are responsible for the licensing and regulation of health care professionals, and most broadly delegate this authority to special regulatory bodies. Each health care subspeciality (medicine, nursing, psychology, etc) has its own state regulatory board with plenary authority over its licensees (for example, the regulation of doctors is overseen by a “Board of Medicine”).
Q: The state where a conventional health care provider and patient meet for an in-person session will have authority over their professional interactions. But what about remote telehealth sessions where the provider and patient are in different jurisdictions?
A: In telehealth, the state regulatory board with authority is the one in the patient’s location, not the provider’s. Some states clearly legislate this rule while other states have only issued guidance to this effect. A few are entirely silent on the matter, but at this time, no states seem to assign authority to the provider’s location.
Thus, the rule to follow is that telehealth practitioners must be licensed in the same state where their patient is located at the time of their appointment. Otherwise, it can be considered practicing without a valid license, which exposes you to liability.
Q: Are there exceptions to this rule?
A: Some states provide limited exceptions to the general rule that a doctor must be licensed in the same state as their patient at the time of care. No 2 states take an identical approach to exceptions, and regardless, these exceptions are only applicable to doctors (not to other health care professionals).
Q: What are some examples of licensure exceptions?
A: The following are some of the more commonly encountered licensure exceptions:
• Consults: In some states, a physician unlicensed in a given state may consult peer-to-peer with another physician licensed in that state.
• Bordering state: Some states may permit a physician licensed in a bordering state to practice within its borders.
• Special license or registration: Some states offer an abbreviated license or registration for telehealth-only doctors.
• Follow-up care: Several jurisdictions permit a physician to provide follow-up care via telehealth to an out-of-state patient they previously treated in-person.
• Endorsement: Some states will fast-track a license for a doctor licensed in another state.
Conditions apply to these exceptions so you should not make assumptions or assume you meet these exceptions unless you have done your due diligence and have a good understanding of the rules of each state.
Q: Are there licensure exceptions related to COVID-19?
A: In response to the Public Health Emergency declared by the United States Department of Health and Human Services, some states have waived licensure altogether, or have diminished the licensing requirements to enable more physicians to provide remote care via telehealth during the pandemic. Once again, terms and conditions apply so you should be knowledgeable. Orbit University offers telehealth training which can get you up to speed on many of these issues.