Page 11 Unlocking The Potential of Physician to Patient Telehealth Services The Information Technology & Innovation Foundation

State Licensure Requirements
State licensing boards establish the conditions under which health care providers may
practice within their state. In general, states require practitioners to be licensed in the state
in which they practice medicine. Before the advent of telehealth, the state where
practitioners worked and the state where patients received treatment were almost always the
same. However, since telehealth allows practitioners and patients to be located in different
locations—a patient in Florida may want to seek treatment from a doctor in New York—
this condition is no longer necessarily true. This has raised legal challenges for providers
wishing to provide telehealth services as the rules for licensing vary by jurisdiction. In
addition, since health care providers cannot practice medicine without a proper license, a
telehealth provider would potentially have to obtain a separate license for every state. These
legal complexities create a costly and cumbersome process that impairs the widespread
adoption of telehealth.

Although the purpose of state licensure is to protect patients from unqualified or unsuitable
practitioners, there is generally little substantive difference between physicians licensed in
one state versus ones licensed in another. Thus, it makes little sense to require doctors to
obtain a new license for every state where they might see a patient. States can reduce the
licensure burden associated with telehealth by recognizing the licenses granted to
practitioners in other states. Different options to achieve this include: special purpose
licenses, licensure by endorsement, reciprocal licensing, and mutual recognition of licenses.
Each of these is explained below.

The most common option is for states to grant health care providers licensed in another
state a special purpose or limited license to practice telehealth. To obtain this special
purpose license, the provider must typically register with each state separately. In addition,
states often have specific requirements to ensure that the telehealth license does not become
a backdoor to allowing providers physically located within the state to avoid that state’s
licensing requirements. For example, Washington does not allow out-of-state doctors using
the special telehealth license to meet with patients or make phone calls to patients while the
doctor is within the state.

Another option is to allow licensure by endorsement whereby a state will grant a license to
a provider who is already licensed by another state. States may restrict these licenses to
certain states with similar testing requirements, require certain documentation, and require
providers to meet additional requirements before granting the licensing. For example,
Alabama allows doctors from any of the other fifty states and the District of Columbia to
obtain a license by endorsement provided that they have passed their home state’s licensing
examination.

Reciprocal licensing occurs when two states recognize the license of each other and grant
the other state’s licensed providers the privilege to practice within their state. Unlike
licensure by endorsement, providers do not have to have their credentials subjected to
further review. Instead, their out-of-state license is accepted as sufficient. Some states, such
as North Dakota, have given their state medical boards the authority to enter into

THE INFORMATION TECHNOLOGY & INNOVATION FOUNDATION | MAY 2014 PAGE 11