Risk Management Tools & Resources


Risk Perspectives in Telehealth: Licensing


Laura M. Cascella, MA, CPHRM

Technology has created opportunities for physicians, dentists, and other healthcare practitioners to extend the reach of their professional practice beyond the physical limitations of their practice settings. Through the use of telehealth technologies, providers can evaluate, diagnose, and treat patients in other localities, which can increase access to, convenience of, and choices in care.

COVID-19 and Telehealth

Although technological advances made telehealth an option, the COVID-19 pandemic made it a necessity. As a result of the pandemic, the federal government and many states eased restrictions and limitations placed on telehealth, including those related to licensing (e.g., obtaining licenses, practicing across state lines, renewing licenses, establishing a provider–patient relationship, etc.). As the pandemic recedes, these temporary policies may expire, or states may choose to make them permanent. For information about states’ temporary COVID-19 telehealth policies, visit the Center for Connected Health Policy’s Telehealth in the time of COVID-19 webpage.

Yet, despite bridging a gap in distance, telehealth does not transcend the boundaries of state laws. Each state has its own statutes and regulations associated with clinical practice and the delivery of healthcare. Because of this, licensing is recognized as a significant barrier for telehealth, and it represents a key area of risk for telehealth providers because of legal and regulatory variations by state. For example, states might:

Telehealth Terminology
  • The location from which the provider is delivering services often is referred to as the hub site or distant site.
  • The location where the patient is receiving services often is referred to as the spoke site or the originating site.
  • Require full licensure for telehealth practice
  • Offer an abbreviated telehealth licensing process
  • Allow licensed out-of-state providers to provide telehealth services within the state without obtaining a state-specific license (often with limitations)
  • Participate in an interstate compact (i.e., the Nurse Licensure Compact or the Interstate Medical Licensure Compact) that allows providers to have one license that is viable in participating states or sets forth an expedited licensure process in participating states

Because of the complexity associated with telehealth licensing, healthcare providers must be cognizant of the laws and regulations in their states and the states in which their patients are receiving services. Further, the American Society for Healthcare Risk Management notes that “Organizations that provide telemedicine services in multiple states must . . . navigate and meet multiple, potentially disparate requirements.”1

To further complicate matters, some states have specific nuances to their telehealth laws and regulations. For example, some states allow for patients’ homes to serve as originating sites, but only for specific specialties or services, such as mental health therapy. The types of telehealth technology permitted — e.g., live video, store-and-forward imaging, remote patient monitoring, etc. — also can vary by service or specialty across states. Additionally, some states might restrict the types of providers that can be reimbursed for providing telehealth services.2

Another layer of complexity is introduced when healthcare providers and organizations venture into international telehealth services. In these cases, both U.S. laws and the laws of the other country must be understood and implemented as part of the telehealth program. As ECRI explains, “Facilities considering international telemedicine must ensure that their programs comply with both the selected country's regulations and U.S. regulations, as well as global best practices.”3

Although cumbersome and time-consuming, understanding state-specific — and international, if applicable — telehealth laws and regulations, practice acts, and standards of care is vital for healthcare providers and organizations participating in telehealth programs. Failure to do so could have legal and disciplinary implications.

To learn more about laws and regulations in the state(s) in which you practice, visit the Center for Connected Health Policy website, which breaks down current laws and policies for all 50 states and the District of Columbia and provides information about pending legislation and regulations. Additionally, healthcare providers can contact state medical, osteopathic, dental, or nursing boards for information related to telehealth regulations.


1 Russell, D., Boisvert, S., & Borg, J. D. (Eds.). (2018). Telemedicine risk management considerations. The American Society for Healthcare Risk Management. Chicago, IL: ASHRM.

2 Center for Connected Health Policy. (2021). State telehealth laws and Medicaid program policies executive summary: A comprehensive scan of 50 states and D.C. findings & highlights. Retrieved from www.cchpca.org/resources/state-telehealth-laws-and-reimbursement-policies-report-fall-2021/

3 ECRI. (2022, February 18). Regulatory and liability considerations for telehealth. Health System Risk Management. Retrieved from www.ecri.org

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