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Policies on Legality of Telemedicine Across State Lines

For years doctors have, without a second thought, engaged in telemedicine across state lines when patients traveling away from their home states needed to talk to their physicians by telephone about symptoms, treatments or side effects. In recent years however some states have tightened their policies. The idea that practice of medicine occurs where the patient, not the doctor, is located has gained general acceptance. Some physicians have engaged in, for example, prescribing using the Internet, for patients they have never examined face-to-face. To the extent that a state might deem that I am practicing without a license by consulting with my traveling patient by phone or video conference I may have to choose between abandoning my patient if I refuse to contact them and facing criminal charges if I do.

To collect data about this I have contacted state licensing boards in my own state and in states where patients told me they expected to travel. I typically explain the situation by email or telephone, and someone at the board provides at least an informal opinion. I ask whether it makes a difference whether I charge a fee for the consultation and whether it makes a difference whether there is video as well as audio transmission. Please note that such policy can change over time, so do not relay on information contained in the table below. There may also exist extenuating circumstances. For example some states may loosen their policies when the state line cuts through a major metropolitan area. This is not legal advice. You should contact the board in the state where your patient plans to travel to ascertain the current policy.

I do not treat patients who have moved permanently to another state via telemedicine. They must find local providers. I do not initiate a relationship with a patient expect by evaluation in person in my office.
 

STATE DATE POLICY GRADE
Alaska 5/2010

"If the patient is only here temporarily..., you’re fine."

A-
California 7/2010 "You can call in prescriptions. You can talk to them on the phone and it doesn't matter where they are because you have that patient physician relationship so there's no issues with you calling your patient while there in California or prescribing the medication." A+
Connecticut 4/2013

Regardless of whether you charge a fee or use video as well as audio it is not considered practice without a license provided you have an established relationship with the patient at your location and the patient is not a permanent CT resident (6 months or more).

A-
Idaho 2/2016 It’s OK unless it's the initial encounter with no prior patient-physician relationship. A
Louisiana 8/2012 Regardless of whether you charge a fee or use video as well as audio it is not considered practice without a license provided you have an established relationship with the patient at your location. A
Maine   Technically practicing without a license, but probably look the other way as long as the patient stays in state only a short time. A-
Michigan 6/2010 The physician does not need a Michigan license provided the patient stays in the state for 30 days or less and the physician writes a letter to the Bureau of Health Professions prior to the visit. A-
Mississippi 8/2012 Email from Frances Carrillo at the Mississippi medical Board, responding to my inquiry: “I will forward to the Board attorney on Monday.  You have not received a response by the end of next week send me an email.” No attorney contacted me, and Ms. Carrillo did not respond to a follow up email. When I called the board the receptionist would only send me to Ms. Carrillo’s voice mail. It appears that out of state physicians contact their patients traveling in Mississippi do so at their own risk. F
Missouri 7/2010 Probably OK according to statute:
334.150. “It is not intended by sections 334.010 to 334.140 to prohibit isolated or occasional gratuitous service to and treatment of the afflicted”
Board MD concurred.
A+
Montana 2/2016 Even a touirist traveling in Montana puts the physician back home in another state at risk of practicing without a license with a phone call. F
Nevada 5/2011 Even telephone contact with a patient visiting the state is illegal practice without a license, regardless of whether the patient is charged a fee. F
New York 5/2010 “Who would know?” (Even telephone contact constitutes practicing without a license.) F
Oregon 7/2010 OK provide there is established relationship. A+
Virginia 3/2011 According to Board attorney: prohibited, but violation results only in a letter to the licensing board of the state(s) in which you have a license.
§ 54.1-2902. Unlawful to practice without license.
Exception for emergencies:
§ 54.1-2901. Exceptions and exemptions generally.
7. The rendering of medical advice or information through telecommunications from a physician licensed to practice medicine in Virginia or an adjoining state to emergency medical personnel acting in an emergency situation
F
Washington 7/2010 “There is no restriction on doctors licensed in another state treating an established patient of theirs who happens to be traveling in Washington.” A+