TeleHealth Licensure Compliance Changes in Response to COVID-19 in Each U.S. State – Master Reference

In response to the COVID-19 pandemic and the unprecedented circumstances it caused, every U.S. state made changes to their TeleHealth licensure rules for physicians and other healthcare clinicians. Many states chose to loosen licensure regulations, and they made changes such as permitting temporary licenses to out-of-state physicians, waiving meeting and relationship requirements that are usually necessary to provide services, allowing interstate virtual appointments, and more. Although some of these changes were only temporary and have been dropped since the beginning of the pandemic, other changes have been made permanent or are still active given the increased utilization and popularity of TeleHealth.

Listed below are the current waiver statuses of each state (as of October 27, 2021):

StateState Of EmergencyWaiver StatusTemporary or Active ChangesPermanent Changes
AlabamaNo – ended July 6, 2021Rescinded at the end of the Alabama State of EmergencyN/AN/A
AlaskaNo – ended April 30, 2021Rescinded at the end of the Alaska State of Emergency– Out-of-state physicians can apply for an Emergency Courtesy License which lasts for 6 months and can be renewed for 6 months if an urgent situation existsN/A
ArizonaYes – end date TBDRescinded on May 5, 2021N/A– Out-of state providers who are in good standing and are not subject to current or past disciplinary actions can practice telemedicine with Arizona patients
ArkansasNo – ended May 30, 2021Rescinded at the end of the Arkansas State of EmergencyN/A– “Creating Opportunities now for Necessary and Effective Care Technology (CONNECT) for Health Act” introduced
– Emergency Management Assistance Compact ratified
CaliforniaYes – end date TBDActive – currently set to expire at the end of 2022.– Out-of-state physicians can be approved to assist in the COVID-19 response during the state of emergency; permission is subject to the approval of the Director of EMS Authority and Director of Office of Emergency Services
– Medical providers may use video chat and similar applications for medical appointments
– Healthcare providers do not need to obtain or document verbal or written consent before use of TeleHealth services

– Physicians can work without risk of being penalized for inadvertent release of patient data
– Out-of-state physicians can be approved to assist in the COVID-19 response during the state of emergency; permission is subject to the approval of the Director of EMS Authority and Director of Office of Emergency Services
– Medical providers may use video chat and similar applications for medical appointments
– Healthcare providers do not need to obtain or document verbal or written consent before use of TeleHealth services
ColoradoNo – ended July 8, 2021Rescinded at the end of the Colorado State of EmergencyN/A– SB 20-212: There is expanded access to TeleHealth for Colorado residents by 1. prohibiting insurers from requiring an established in-person practitioner/patient relationship, 2. imposing location or additional licensure requirements, and 3. preventing limitations on the use of HIPAA-compliant technologies to deliver TeleHealth
Connecticut– Out-of-state and in-state mental health care providers can provide in-person and telemedicine services throughout the emergency as long as they have an active license and are in good standingRescinded when NO. 12B expiredN/AN/A
DelawareNo – ended July 12, 2021Active only for mental health care providers – end date TBD– Out-of-state and in-state mental health care providers can provide in-person and telemedicine services throughout the emergency as long as they have an active license and are in good standing– HB 348: eliminates approval process for out-of-state
practitioners to practice telemedicine in Delaware with the exception of
mental health care providers
– Telehealth Access Preservation and Modernization Act of 2021: first-time encounters can occur via TeleHealth and establish an adequate provider/patient relationship (brings DE into Interstate Medical Licensure Compact)
FloridaNo – ended June 26, 2021Rescinded on July 1, 2021N/A– Florida Law § 2019-137: out-of-state physicians can practice telemedicine for Florida residents as long as they are registered with the state’s Medical Board
GeorgiaNo – ended July 1, 2021Rescinded October 20, 2021N/A– Insurance companies cannot require patients to have an in-person consultation before meeting with a physician virtually or place additional restrictions regarding prescription of medications
GuamN/AN/AN/A– 10 GCA § 12202: Physicians who are licensed somewhere in the United States can practice telemedicine in Guam
HawaiiYes – ending November 30, 2021Active – currently set to expire at the end of the Hawaii State of Emergency– In-state and out-of-state physicians can practice Telehealth without an in-person consultation or a prior provider-patient relationship, as long as they have never had their license revoked or suspended and are hired by a state or county agency or facility or by a hospital– SB 970: a TeleHealth interaction can establish a provider/patient relationship as long as the physician is licensed to practice in Hawaii
IdahoYes – ending November 14, 2021Rescinded April 24, 2021N/A– Zoom, Facetime and similar applications that make it easier for providers to offer TeleHealth services will be allowed, and out-of-state providers with valid licenses can treat Idaho residents through TeleHealth
IllinoisYes – ending November 14, 2021Active for established patients only – currently set to expire at the end of the Disaster Proclamation– Out-of-state physicians can provide services via TeleHealth if there is a previously established provider/patient relationship
– Telehealth Services include all health care, psychiatry, mental health treatment, substance use disorder treatment, and related services provided to a patient regardless of the patient’s location
– Any site that allows for the patient to use a
communication or technology system as defined above may be an originating site, even if this is not in Illinois
– Health insurers may not impose utilization review requirements, prior authorization requirements for in-network providers providing Telehealth Services related to COVID-19, or cost-sharing obligations for Telehealth Services provided by in-network providers
– Insurers must cover the costs of Telehealth Services rendered by in-network providers
– House Bill 3498 proposal
IndianaYes – ending October 31, 2021Active – currently set to expire at the end of the Indiana State of Emergency– There is a suspension of the requirement that a healthcare provider must hold an Indiana license if he/she 1. has an equivalent license from another State, and 2. is not suspended or barred from practice in that State or any State
– The Initial Telemedicine Provider Certification Request must be completed and accepted by the
Indiana Professional Licensing Agency before the provider may establish a provider-patient relationship or issue a prescription to an Indiana patient
– Licensed mental health professionals can conduct their work via TeleHealth
– The prohibition against audio-only telemedicine services is waived and allows for physical, speech and occupational therapists to provide telemedicine services; physicians must use secure video conferencing
– DEA-registered providers who have not conducted an in-person medical evaluation of a patient may issue a prescription to that patient for any schedule II-V controlled substance as long as the prescription is issued for a legitimate medical purpose, the telemedicine communication is conducted using an audio-visual, realtime, two-way interactive communication system, and all other applicable laws are followed
N/A
IowaYes – ending November 14, 2021Active – currently set to expire at the end of the Iowa State of Emergency– Out-of-state physicians may perform in-person or telemedicine services as long as he/she holds at least one active medical license in another United State jurisdiction, and all medical licenses held by the physician in other United States jurisdictions are in good standing, without restrictions or conditions
– All rules which establish preconditions, limitations, or restrictions on TeleHealth in Iowa, including the use of audio-only telephone transmissions,
are suspended
– All rules which require face-to-face interactions with health care providers, and impose requirements for residential and outpatient substance use disorder
treatment and for face-to-face visitations, are suspended
N/A
KansasNo – ended June 15, 2021Rescinded at the end of the Kansas State of EmergencyN/A– SB 14: physicians can prescribe prescriptions without having a prior in-person examination
– Licensed physicians in any state may practice telemedicine to treat Kansas patients, as long as that physician receives a telemedicine waiver
KentuckyYes – ending January 15, 2022Active – currently set to expire at the end of the Kentucky State of Emergency– Out-of-state physicians can register to practice in Kentucky
– No prior in-person examination is necessary to provide TeleHealth services
– Medicaid has waived requirements that out-of-state providers be licensed and located in Kentucky, as long as they are licensed by another state’s Medicaid agency
– Providers can deliver services via phone and TeleHealth
N/A
LouisianaYes – ending October 27, 2021Active – currently set to expire 90 days after the Public Health Emergency– Out-of-state medical professionals can apply for a temporary license, and LSBME has an approved list of out-of-state telemedicine permits
– It is not a violation of licensing standards to provide a service via TeleHealth
– Prescribing of any controlled substance via TeleHealth must be medically appropriate, well-documented, and conform to rules related to the prescription of such medications
– Providers must use secure, HIPAA-compliant platform to offer TeleHealth services
– There is currently no formal limitation on the
originating site
N/A
MaineNo – ended June 30, 2021Rescinded at the end of the Maine State of EmergencyN/A– Legislation being introduced
MarylandNo – ended July 1, 2021Rescinded August 15, 2021N/A– Physicians licensed by and residing in another jurisdiction may practice in Maryland
MassachusettsNo – ended June 15, 2021Rescinded at the end of the Massachusetts State of EmergencyN/A– No prior in-person visit is required and TeleHealth encounters must have the same standard of care as in-person ones
MichiganNo – ended October 12, 2020RescindedN/AN/A
MinnesotaNo – ended July 1, 2021Rescinded at the end of the Peacetime Emergency (May 6, 2021)N/AN/A
MississippiYes – ending November 10, 2021Rescinded as of January 31, 2021N/AN/A
MissouriYes – ending December 31, 2021Active – currently set to expire at the end of the Missouri State of Emergency– Licensed out-of-state physicians and surgeons can provide care to Missouri citizens in-person or through TeleHealth, as long as they are actively licensed in another state and their license is in good standing
– There is a temporary suspension of rules requiring a physical exam and maintaining a contemporaneous record
– Physicians can establish a physician-patient relationship via a telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines
N/A
MontanaNo – ended June 30, 2021Rescinded at the end of the Montana State of EmergencyN/A– HB 43: no need for previous provider/patient relationship, no geographic restrictions, allow audio and audio-only communication
NebraskaNo – ended June 30, 2021Rescinded July 30, 2021N/A– Legislation being made
NevadaYes – end date TBDActive – currently set to expire at the end of the Nevada State of Emergency– Certain licensing requirements to allow the practice of currently unlicensed skilled medical professionals are waived during the federal COVID-19 emergency
– The waiver and exemption of professional licensing requirements shall apply to qualified providers of medical services who currently hold a valid license in good standing in another state
N/A
New HampshireNo – ended June 12, 2021Rescinded at the end of the New Hampshire State of EmergencyN/A– The definition of telemedicine is changed to include audio-only modalities; requires Medicaid and private payers to reimburse for TeleHealth services on the same basis as for in-person care; ends restrictions on originating and distant sites for TeleHealth services; expands the list of care providers able to use TeleHealth to encompass physicians, PAs, APRNs, psychologists, dentists, and mental health practitioners, among others; and enables access to medication assisted treatment (MAT) in specific settings by telemedicine
New JerseyNo – ended June 4, 2021Rescinded at the end of the New Jersey State of EmergencyN/A– Senate Bill 2559: makes many of the temporary changes to TeleHealth during the pandemic permanent
New MexicoYes – ending November 12, 2021Rescinded July 1, 2021N/A– SB 279: a physician may receive a telemedicine license in order to practice across state lines
New YorkNo- ended June 24, 2021Active – currently set to expire October 27, 2021– Any healthcare site can be used for delivery and payment
– Healthcare workers can receive waivers to practice in the state, as long as they are in good standing
– SB 8416: audio-only TeleHealth is allowed
North CarolinaNo – ending January 5, 2022Active – currently set to expire at the end of the North Carolina State of Emergency– Out-of-state physicians whose licenses are in good standing in another U.S. jurisdiction can apply for emergency licenses and if eligible, can deliver services in North Carolina
– Laws that restrict the use of TeleHealth have been waived
Rescinded at the end of the Oklahoma State of Emergency
North DakotaNo – ended April 30, 2021Rescinded at the end of the North Dakota State of Emergency N/A– Legislation being made
Northern Mariana IslandsN/AActive – end date TBD– A physician licensed to practice in a foreign country other than Canada can obtain a license to practiceN/A
OhioNo – ended June 18, 2021No waivers for license reciprocityN/A– Ohio Administrative
Code §5160-1-18: TeleHealth now includes telephone calls and remote patient monitoring, there are less geographic restrictions, more types of services are paid by Medicaid
OklahomaNo – ended May 4, 2021Active – end date TBD– Telemedicine can be used for the prescribing of opiates and other controlled substances for non-established patients
– Inactive and out-of-state physicians in good standing can apply to quickly receive a temporary license
– Legislation being made
OregonNo – ended June 30, 2021Rescinded at the end of the Oregon State of EmergencyN/A– Legislation being made
PennsylvaniaNo – ended June 10, 2021Active – currently set to expire March 31, 2022– Out-of-state physicians can provide services in Pennsylvania through telemedicine without a Pennsylvania license during the COVID-19 emergency; they must be in good standing in their home jurisdiction, and they must provide the Pennsylvania Board their name, mailing address, telephone number and email address, license type, license number and other identifying information
– No requirement of face-to-face contact before admission to treatment for clients who receive buprenorphine treatment, and DDAP has also suspended the requirement that NTPs have narcotic treatment physician services onsite
N/A
Puerto RicoN/AActive – end date TBD– Out-of-state physicians can apply to practice during the emergency
– There is extended flexibility for physicians who are authorized to practice in Puerto Rico to use telemedicine and telephone medical consultations
N/A
Rhode IslandYes – ending November 5, 2021Rescinded on July 6, 2021N/A– Legislation being made
South CarolinaNo – ended June 6, 2021Rescinded at the end of the South Carolina State of EmergencyN/AN/A
South DakotaYes – end date TBDRescinded on June 30, 2021– Physicians who hold valid licenses in another state can be licensed by reciprocity as long as the applicant has completed a residency program in the U.S. or Canada, has passed a licensure examination, and is in good standing– The extension of emergency TeleHealth rules enacted during the coronavirus pandemic through two bills, one to keep in place TeleHealth access and coverage rules and the other to “make permanent the recognition of certain out-of-state healthcare licenses”
TennesseeYes – ending November 5, 2021Rescinded on April 28, 2021N/AN/A
TexasYes – ending October 28, 2021Active – currently set to expire November 27, 2021– Out-of-state physicians may acquire a Texas limited emergency license or hospital-to-hospital credentialing for no more than 30 days from the date the physician is licensed or until the Disaster Declaration ends
– Physicians who have an established chronic pain patient can refill valid prescriptions for treatment of chronic pain over the telephone
– Audio-only telemedicine encounters are temporarily allowed
– State-regulated health plans in Texas will reimburse for TeleHealth services at the same rate as in-person care
N/A
UtahYes – end date TBDActive – currently set to expire at the end of the Utah State of emergency– Out-of-state physicians may practice without a Utah license if: 1. the physician is licensed in another state and in good standing, 2. the services are rendered as a public service and for a noncommercial purpose, 3. no fee or other consideration of value is charged, expected, or beyond an amount necessary to cover the proportionate cost of malpractice insurance, and 4. the physician does not otherwise engage in unlawful or unprofessional conduct
– Medical providers that offer TeleHealth services that do not comply with HIPAA or HITECH must inform the patient that the service does not comply with those federal acts, give the patient an opportunity to decline use, and take reasonable care to ensure the privacy of the service
– Aspects of the Utah Telehealth Act continue to be suspended, including allowing HIPAA exceptions
N/A
VermontNo – ended on June 15, 2021Active – currently set to expire on March 31, 2022– Out-of-state physicians can be approved to be licensed to practice in Vermont (in-person or through telemedicine) as long as 1. the physician is licensed in at least one US jurisdiction and in good standing, 2. the physician is not subject to any professional disciplinary proceedings, and 3. the physician is not barred from practice in Vermont for reasons of fraud or abuse, patient care, or public safety
– Extended waivers for reimbursement parity for audio-only telephone, early prescription refill, authorization to prescribe buprenorphine, and allowing professionals with inactive licenses to practice in Vermont as a volunteer member of the Medical Reserve Corps or as part of the staff of a licensed facility or federally qualified health center
U.S. Virgin IslandsN/AActive – end date TBD– Physicians not licensed in this Territory can register to provide healthcare services as long as they have an active license and are in good standingN/A
VirginiaNo – ended June 30, 2021Rescinded at the end of the Virginia State of EmergencyN/A– Virginia’s governor has amended the Commonwealth’s TeleHealth laws to eliminate originating site restrictions and the requirement that the patient be accompanied by a care provider during the TeleHealth session
WashingtonYes – end date TBDActive – currently set to expire at the end of the Washington State of Emergency– Volunteers that are registered in the volunteer health practitioner system and are verified to be in good standing where they are licensed can practice in Washington without obtaining a Washington license once assigned by DOH; out-of-state physicians may become volunteers by registering and completing Emergency Volunteer Health Practitioners Application
– Out-of-state physicians can use the Interstate Medical License Compact to get an expedited Washington license
– Face-to-face requirements for home health care must be met using telemedicine or TeleHealth services 
– Ohio Administrative
Code §5160-1-18: TeleHealth now includes telephone calls and remote patient monitoring, there are less geographic restrictions, more types of services are paid by Medicaid
Washington, DCNo – ended July 25, 2021Rescinded on July 25, 2021– Volunteers that are registered in the volunteer health practitioner system and are verified to be in good standing where they are licensed can practice in Washington without obtaining a Washington license once assigned by DOH; out-of-state physicians may become volunteers by registering and completing Emergency Volunteer Health Practitioners Application
– Out-of-state physicians can use the Interstate Medical License Compact to get an expedited Washington license
– Face-to-face requirements for home health care must be met using telemedicine or TeleHealth services 
West VirginiaYes – end date TBDActive – currently set to expire at the end of the West Virginia State of Emergency– Out-of-state physicians who are not licensed in West Virginia can practice telemedicine, as long as they possess a license within their own state
– The requirement that telemedicine be performed by video only is suspended
– Expansion of audio-visual TeleHealth for non-emergent E&M services to Medicaid members for mental health visits and health centers and clinics
– The prohibition on establishing a provider-patient relationship via audio-only communication is suspended; if audio-only satisfies the standard of care for a patient, it can be used to establish relationship and provide care
– WV HB 2024: licensed physicians who are in good standing can pay a fee to become an interstate TeleHealth practitioner and provide services to West Virginia residents
WisconsinNo – ended March 31, 2021Rescinded on April 5, 2021 N/AN/A
WyomingYes – end date TBDActive – currently set to expire at the end of the Wyoming State of Emergency – Out-of-state physicians can work in Wyoming through the consultation exemption during the health emergency; approved physicians can initiate a physician-patient relationship with new patient
– Physicians can practice telemedicine but must first apply for an out-of-state telemedicine permit
– If a physician has a relationship with a patient who cannot travel to the doctor’s state due to the emergency, the physician can provide care via TeleHealth without a Wyoming physician license 
– Physicians cannot provide care that treats a new diagnosis or condition without a Wyoming physician license if they have not met with the patient for it in a face-to-face meeting
– Legislation being made

The increased usage of TeleHealth is considered a major achievement for the healthcare industry, as more Americans are better able to access and receive care when they otherwise may not have been able to. With President Biden in office, Telehealth proponents hope that the eased telemedicine restrictions will become permanent even following the end of the COVID-19 emergency, and analysts predict that the Biden Administration will make this happen.

Sources: https://www.fsmb.org/siteassets/advocacy/pdf/states-waiving-licensure-requirements-for-telehealth-in-response-to-covid-19.pdf and https://www.nashp.org/governors-prioritize-health-for-all/

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