Telehealth

Are You Licensed Where Your Patient is Located?

Insight about if a physician can provide telemedical care to a patient that is located in another state at the time of the encounter.


MICA members and practices have over a year of clinical telemedicine experience under their belts, but still have questions about the maze of legal, regulatory, and reimbursement requirements. Federal and state regulators have relaxed, waived, or modified telemedicine requirements during the pandemic, especially during shut-downs. As enforcement of these regulations resumes, practices and clinicians should review their telemedicine processes to ensure compliance.

Variations on a Theme

One of MICA members’ most frequent telemedicine questions has many variations, but can be summarized as whether a physician or advanced health care practitioner licensed and located in one state can provide telemedical care to a patient in another state at the time of the encounter.

Illustrating Questions about the Patient’s Location

    • Dr. Acton (licensed and practicing in Arizona) has an established patient, Jenny, who lives in Arizona and is on a 3-day business trip in New Hampshire. Jenny wants a telemedicine appointment while she is away.
    • Dr. Bonet’s (licensed and practicing in Utah) long-time pediatric patient, Jimmy, resides with his mother in Utah. Jimmy is visiting his father in North Dakota for the summer. Jimmy’s mother requests a telemedicine appointment while Jimmy is in North Dakota and his mother is in Utah.

    • Dr. Camara’s (licensed and practicing in Arizona) established patient, Ann, lives in Michigan but spends winters in Arizona. Ann wants Dr. Camara to continue treating her via telemedicine during the months she is in Michigan.
    • Nevada-based nurse practitioner Divata has taken care of a pediatric patient for many years. The patient and her family are in California for a week-long vacation. The mom asked for a video visit for assessment and treatment of a rash on the patient’s arm.

Location and Licensure Answers

When the patient is out of state, even temporarily, the answer is always the same. Physicians, advanced health care practitioners, and other licensed health care professionals have always had to comply with federal and state laws as well as state licensing requirements where the care is received—known as the originating site. In the examples above, the clinicians are not located or licensed in the state where the patient is located. Each state licensing agency oversees and disciplines the professionals it regulates. A physician providing care to a patient in Nebraska is subject to the rules and regulations of the Nebraska medical board, and if the physician is not properly licensed in Nebraska, the physician may be practicing medicine in Nebraska without a license and subject to discipline.

An Arizona-licensed and -located clinician treating an Arizona resident visiting Nebraska could also be subject to other Nebraska laws and court rules. Should the patient file a medical professional liability lawsuit in Nebraska, the Arizona physician may be required to defend a lawsuit there.

Risk Solutions

The patient’s location

Physicians, advanced health care practitioners, and practices should prepare now for patient requests for out-of-state medical care by considering the workflows for appointment scheduling, telephone triage, and telemedicine appointments. For telephone triage and telemedicine encounters:

    • before a clinician begins a telemedicine appointment or a telephone triage call, confirm the patient’s physical and geographic location and document in the medical record; and

    • screen for the patient’s anticipated geographic location during scheduling;

    • if the patient’s physical location is inappropriate, e.g., driving or steering a car, and the patient cannot immediately relocate, e.g., pull over and park, staff should reschedule the appointment.

As part of telemedicine appointment workflows, staff should also confirm:

    • the patient or representative provided their informed consent for the telemedicine appointment and their consent is documented;

    • intake forms or questionnaires are completed;

    • the practice provided instructions for connection problems; and

    • if appropriate, reasonable accommodations are in place for patients with disabilities.

Interstate medical licensure

Another consideration for workflows is the Interstate Medical Licensure Compact, in which member states have agreed to streamline and expedite licensure for out of state physicians. Physicians must have a full, unrestricted medical license in a Compact member-state. Physicians may designate that state as their State of Principal License (SPL) if one of the following applies:

    • the physician’s primary residence is in the SPL;

    • at least 25% of the physician’s medical practice occurs in the SPL;

    • the physician is employed to practice medicine by a person, business, or organization located in the SPL; and

    • the physician uses the SPL as the state of residence for U.S. federal income taxes.

In addition to meeting the SPL requirements, physicians applying for licensure through the Compact must not have a history of licensure disciplinary actions, a criminal history, a history of controlled substance actions against their license, or a license currently under investigation.

The Compact does not actually issue a single interstate medical license. Instead, participating states issue individual licenses. Physicians can select multiple Compact member states where they wish to be licensed, but only need to complete one application. Member states include Alabama, Arizona, Colorado, Georgia, Idaho, Iowa, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Hampshire, North Dakota, South Dakota, Tennessee, Utah, Vermont, Washington, West Virginia, Wisconsin, and Wyoming.

Between April 2017 and August 2021, the Compact licensed 23,321 physicians. Details about eligibility, participating states, application, renewal, and costs (an initial non-refundable fee for the Compact and then the individual cost of a license in each state) are available on the Compact’s website. Under the compact and under state law, medical care is provided and received where the patient is physically located.

Assistance and Resources

 Many of the state public health emergency orders that temporarily waived telehealth licensing requirements have ended. Others are on the verge of expiring. As a result, physicians, advanced health care practitioners, and practices should consider their workflows and licenses before patients call for out-of-state care.

For state-specific telehealth and licensing information, consult these resources from the Federation of State Medical Boards and Center for Connected Health Policy:

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MICA’s Risk Management Consultants remain available to answer calls and e-mails about telehealth. Call the Risk Management Hotline at 800.705.0538, or email rm_info@mica-insurance.com. MICA members should contact their insurance agent or MICA Underwriting customer service representative about practicing telemedicine under the MICA medical professional liability policy. Call 602-808-2111 or (877)215-MICA to speak to a MICA customer service representative.


The content of this publication or presentation is intended for educational purposes only; is not an official position statement of Mutual Insurance Company of Arizona (MICA); and should not be considered or relied upon as professional, medical, or legal advice or as a substitute for your professional judgment. Consult your attorney about your individual situation and the applicable laws. The authors, presenters, and editors made a reasonable effort to ensure the accuracy of the information at the time of publication or presentation but do not warrant or guarantee accuracy, completeness, or currency of such information. As medical and legal information is constantly changing and evolving, check for updated information and consult your attorney before making decisions.

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