Telemedicine Laws: Cash-Only Businesses And Legal Compliance

Telemedicine laws vary by state, and it is important to consult state medical boards and other state-specific laws for updated and accurate information on legal requirements. In general, a license is required to practice medicine in the state where the patient is located. However, some states have created specific guidelines and exemptions for telemedicine services. For example, some states have temporary practice laws that allow out-of-state providers to practice for a limited time if their patient is visiting that state. Other states have licensure reciprocity, which allows providers from another state to provide telemedicine services if they share a common border. Additionally, multi-state licensure compacts streamline the licensing process across states, and some states offer telehealth registration pathways for out-of-state providers. It is important to note that noncompliance with telehealth legal requirements can result in civil, criminal, and administrative penalties.

Telemedicine laws vary by state

• Consent: Many states have specific guidelines on how physicians should obtain consent for telemedicine services, often requiring verbal or written consent to be documented in the patient's medical record. Some states also mandate verifying the patient's identity and location, disclosing the limitations of telemedicine, and obtaining consent to share protected health information.
• Online Prescribing: There is variation in how states approach online prescribing of controlled substances. Some states require an established patient-physician relationship, while others mandate an in-person evaluation. Certain states, like Arkansas, Indiana, Iowa, and Texas, have specific restrictions on online prescribing of abortion-inducing medication.
• Cross-State Licensing: To practice medicine in a different state, physicians typically need to obtain a license from that state's medical board. However, some states offer flexibility through special telehealth licenses, participation in interstate medical licensure compacts, or by not requiring a license for infrequent telehealth treatment.
• Professional Board Standards: Most states do not have specific professional board standards for telemedicine, but a few emphasize the importance of providing the same standard of care as in-person visits.
• State-Specific Requirements: Each state has its own unique requirements and regulations for telemedicine. For example, Texas, known for its detailed and restrictive regulations, initially required an in-person relationship with patients before offering remote medical services. However, recent changes, such as the 2017 Senate Bill 1107, have made it easier for healthcare professionals to provide telemedicine services in Texas.

Telemedicine laws apply to both in-person and remote services

In the United States, the delivery of health care services via telemedicine is considered to be rendered at the physical location of the patient. Therefore, a provider typically needs to be licensed in the patient’s state. However, some states have licenses or telehealth-specific exceptions that allow an out-of-state provider to render services via telemedicine in a state where they are not located.

In some states, there are laws that don't specifically address telehealth and/or telemedicine licensing but make allowances for practicing in contiguous states or in certain situations where a temporary license might be issued provided the specific state’s licensing conditions are met.

Telemedicine services carry the same malpractice risks as in-person services, but with an increased exposure to violations of state law (such as offering treatment across state borders) and failing to meet the required standards of care.

In addition, there are several stipulations and requirements that must be met for a practitioner to be able to practice telemedicine. For example, in some states, a practitioner must establish an in-person relationship with a patient before offering them telemedicine services. In other states, a practitioner must obtain informed consent from the patient or other individuals authorized to make healthcare decisions for the patient before offering telemedicine and telehealth services.

It is important to note that the use of telemedicine coverage and virtual care became prevalent during the COVID-19 pandemic, with over a third (37%) of adults reporting that they have used telemedicine services in 2021. This trend is expected to grow, with the worldwide telehealth industry projected to reach over $450 billion by 2030.

Telemedicine laws require compliance with HIPAA and state privacy laws

The specific requirements for complying with HIPAA and state privacy laws can vary depending on the state in which the telemedicine services are being provided. In general, however, there are several key components to ensuring compliance with these laws.

Firstly, it is important to obtain patient consent for the use of telemedicine services. This can include verbal or written consent, and it may be necessary to document this consent in the patient's medical record. Additionally, patients should be informed of the risks and benefits of telemedicine, including any potential privacy and confidentiality risks associated with sharing personal health information.

Another important aspect of complying with HIPAA and state privacy laws is ensuring the security and protection of patient information. This includes maintaining the confidentiality of patient records, as well as implementing appropriate technical safeguards to protect electronic health information. This is especially important when using telecommunications or information technology to deliver healthcare services remotely.

Complying with HIPAA and state privacy laws may also involve following specific guidelines for prescribing medications via telemedicine. In some states, an in-person evaluation may be required within a certain timeframe for online prescribing to take place. It is important to review the relevant state laws and regulations to ensure compliance with prescribing requirements.

Additionally, it is important to maintain accurate and up-to-date medical records for patients receiving telemedicine services. This includes documenting telemedicine encounters in the same way as in-person visits, as well as providing patients with access to their medical records and visit summaries.

Finally, it is crucial to stay informed about any changes or updates to HIPAA and state privacy laws, as well as any specific regulations related to telemedicine. This can help ensure ongoing compliance with legal requirements and avoid potential penalties or consequences for non-compliance.

Telemedicine laws require consent from patients

Informed consent is required by the majority of states in their statute, administrative code, and/or Medicaid policies. This requirement sometimes applies to the Medicaid program, a specific specialty, or all telehealth encounters that occur in the state, depending on how and where the policy is written.

Consent can be given verbally or in writing, but it must be documented in the patient's medical record. In some states, consent is implied upon establishing a practitioner-patient relationship, so you do not have to worry about storing documents with explicit written consent from each patient. However, it is good practice to verbally obtain consent for telemedicine and document it in the patient's file.

In addition to consent, patients must be informed of the privacy and confidentiality risks associated with sharing personal health information via the telemedicine solution they're using. Practitioners must explain the complaint process in the event of any alleged misconduct.

Telemedicine laws require compliance with state licensing laws

To reduce the risk of legal issues related to licensing, it is important to determine the states in which telemedicine services will be provided and ensure that all members of the care team have the proper licenses. Licensure compacts can streamline the process of securing medical licenses in multiple states, and some states have temporary practice laws that allow providers to practice for a limited time in another state that their patient is visiting. Additionally, some states have reciprocity agreements that allow providers from another state to offer telehealth services if they share a common border.

When it comes to obtaining a cross-state telemedicine license, Texas provides an example of a state with detailed and restrictive regulations. Texas law allows out-of-state healthcare professionals to obtain a telemedicine license to provide remote services to patients in Texas under specific circumstances. These circumstances include the interpretation of diagnostic testing and reporting results to a licensed Texas physician and the follow-up of patients who received the majority of their patient care in another state. Out-of-state practitioners with a Texas telemedicine license must abide by the same rules as fully licensed Texas-based practitioners.

To summarise, compliance with state licensing laws is crucial for practising telemedicine. Healthcare providers should be aware of the varying requirements across states and take steps to ensure proper licensing for their team members. Licensure compacts and reciprocity agreements can facilitate cross-state practices, but it is essential to understand the specific regulations in each state.

Frequently asked questions