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BOSTON -- Here's the situation: State medical boards -- and the legislatures that create each state's rules of the healthcare road -- control licensing for physicians and nurses. That means health systems and their tech-vendor partners must, in order to practice and prescribe over state lines and provide national patient access to their practitioners, license their doctors in every state.
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Today more than 100 telemedicine bills are before state legislatures, many of them deal with matters of reimbursement but some of them include verbiage about telemedicine licensure.
Confused yet? Christa Natoli, vice president of telemed research firm CTel Innovations, gave an update of the state-to-state telemedicine licensure landscape at the mHealth + Telehealth World 2014 conference. In order to cut to the chase, we've distilled her detailed, complex presentation down to 13 must-know facts as of today.
- Thirty-six states require full medical licensure to practice telemedicine, but nine have a special telemedicine license or process.
- Twenty-eight states have exceptions for "infrequent" or "occasional" consults.
- Five states define "occasional," including Delaware (fewer than six per year), New Mexico (no more than 10 per year) and Wyoming (no more than seven days in any 52-week period).
- Nine states that require special telemedicine licensure: Alabama, Louisiana, Montana, Nevada, New Mexico, Ohio, Tennessee, Texas and Wyoming.
- Some states add requirements to their telemedicine license, such as the doctor practicing telemedicine must be fully licensed in another state, can't have a physical office in the state where he practices telemedicine and hasn't been found guilty of any ethics violations.
- Iowa permits "incidental" advisory consultations requested by Iowa physicians of licensed out-of-state doctors and the consultant doctor cannot practice in Iowa more than 10 consecutive days or 20 days in one year.
- In Missouri, out-of state consults are permitted "as long as the Missouri-licensed physician retains ultimate authority and responsibility for the patient's care, or if he is merely evaluating the patient."
- Vague language in the laws, Natoli said, makes for loopholes and gives rise to companies that exploit it. Some "diagnose and prescribe" companies are performing cursory diagnoses and prescribing drugs much like the "spam Viagra mills" of the 1990s, she added, soiling the reputations of legitimate telemedicine practices.
- To counter this, 41 states require a physical exam or pre-existing physician-patient relationship before diagnosing, treating and prescribing.
- Fourteen states allow physical exams to take place electronically, including California, Hawaii, Kansas, Louisiana, Maryland, Nevada, New Mexico, North Carolina, Ohio, South Dakota, Texas, Virginia, Vermont and Indiana.
- Prior to Internet or telemedicine prescribing, 29 states require a practitioner to take a patient medical history.
- That being said, 14 states allow for emergency prescribing.
- What's a "history?" That varies from state to state, too, but 30 states specifically prohibit medical questionnaires or patient-provided histories as the sole basis for writing a prescription.
Now that you're updated on the patchwork quilt that is U.S. state telemedicine law, here's your disclaimer: As the licensure landscape is rapidly changing, double-check your state's current requirements -- as well as those of the states in which your practitioners will deliver care. Natoli pointed out, too, that her organization's research, compiled at the end of 2013 state legislature sessions, currently is under review by state medical boards for confirmation.
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