State Telehealth Policies for Online Prescribing - CCHP (original) (raw)

Federal

Last updated 07/17/2024

Temporary Rule

*Temporary rule regarding controlled substance prescribing does the …

Temporary Rule

*Temporary rule regarding controlled substance prescribing does the following:

During the period May 12, 2023, through December 31, 2024, a DEA-registered practitioner is authorized to prescribe schedule II-V controlled substances via telemedicine, as defined in 21 CFR 1300.04(i), to a patient without having conducted an in-person medical evaluation of the patient if all of the conditions listed in paragraph (e) of this section are met.

SOURCE: Drug Enforcement Agency, Second Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications, Federal Register RIN 1117-AB40 and 1117-AB78, 21 CFR Part 1307, (Accessed Jul. 2024).

Rules addressing prescribing of controlled substances without an in-person medical evaluation and expansion of induction of buprenorphine via telemedicine encounters have been proposed and are under revision. They will be integrated into this section if and when they are final.

Controlled Substance Act

No controlled substance that is a prescription drug as determined under the Federal Food, Drug, and Cosmetic Act [21 U.S.C. 301 et seq.] may be delivered, distributed, or dispensed by means of the Internet without a valid prescription. … Nothing in this subsection shall apply to the delivery, distribution, or dispensing of a controlled substance by a practitioner engaged in the ‘practice of telemedicine’ [see definition in section above].

SOURCE: 21 USCS Sec. 829, (Accessed Jul. 2024).

Note that the practice of telemedicine is allowed to be used in prescribing controlled substances during a public health emergency declared by the Secretary under section 247d of title 42; and involves patients located in such areas, and such controlled substances, as the Secretary, with the concurrence of the Attorney General, designates, provided that such designation shall not be subject to the procedures prescribed by subchapter II of chapter 5 of title 5.

SOURCE: 21 USCS Sec. 802, (Accessed Jul. 2024).

See Definitions section for all telemedicine exceptions.

The Attorney General may issue to a practitioner a special registration to engage in the practice of telemedicine for purposes of section 802(54)(E) of this title if the practitioner, upon application for such special registration—

Regulations. Not later than 1 year after October 24, 2018, in consultation with the Secretary, the Attorney General shall promulgate final regulations specifying—

SOURCE: 21 USCS Sec. 831, (Accessed Jul. 2024).

* The US Health and Human Services Administration maintains a website that summarizes information related to prescribing controlled substances.

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Alabama

Last updated 06/18/2024

Practitioners’ Responsibilities

A physician has the same duty to exercise …

Practitioners’ Responsibilities

A physician has the same duty to exercise reasonable care, diligence, and skill whether providing services in-person or via telehealth, including when appropriate, to:

Before providing telehealth medical services, the physician must:

In-Person Visit Requirement

If a physician or practice group provides telehealth services more than four times in a 12-month period to the same patient for the same medical condition without resolution, the physician shall either:

The provision of telehealth services that includes video communication to a patient at an originating site with the in-person assistance of a licensed physician, physician assistant, certified registered nurse practitioner, certified nurse midwife, or other person licensed by the Alabama Board of Nursing shall constitute an in-person visit for this purpose.

This requirement does not apply to the provision of mental health services as defined in state law (Ala. Code § 22-50-1).

Prescribing via Telemedicine

A prescriber may prescribe a legend drug, medical supplies, or a controlled substance via telehealth if the prescriber is authorized to do so under state and federal law.

A prescription for a controlled substance may only be issued via telehealth if:

SOURCE: Alabama Board of Medical Examiners & Medical Licensure Commission, Telemedicine (Accessed Jun. 2024).

Telehealth medical services may only be provided following the patient’s initiation of a physician-patient relationship, or pursuant to a referral made by a patient’s licensed physician with whom the patient has an established physician-patient relationship, in the usual course of treatment of the patient’s existing health condition. The physician-patient relationship may be formed without a prior in-person examination.

Prior to providing any telehealth medical service, the physician, to the extent possible, shall do all of the following:

If a physician or practice group provides telehealth medical services more than four times in a 12-month period to the same patient for the same medical condition without resolution, the physician shall do either of the following:

The provision of telehealth medical services that includes video communication to a patient at an originating site with the in-person assistance of a person licensed by the Board of Medical Examiners or by the Board of Nursing pursuant to Chapter 21 of Title 34 of the Code of Alabama 1975, shall constitute an in-person visit for the purposes of this subsection.

This section does not apply to the provision of telehealth medical services provided by a physician in active consultation with another physician who is providing in-person care to a patient.

This section shall not apply to the provision of mental health services as defined in Section 22-50-1.

A prescriber may prescribe a legend drug, medical supplies, or a controlled substance to a patient as a result of a telehealth medical service if the prescriber is authorized to prescribe the drug, supplies, or substance under applicable state and federal laws. To be valid, a prescription must be issued for a legitimate medical purpose by a prescriber acting in the usual course of his or her professional practice.

A prescription for a controlled substance may only be issued as a result of telehealth medical services if each of the following apply:

This subsection shall not apply in an in-patient setting.

A physician shall be exempt from the requirements of subsection (b) and may issue a prescription for a controlled substance to a patient if the prescription is for the treatment of a patient’s medical emergency, as further defined by rule by the Board of Medical Examiners and the Medical Licensure Commission.

SOURCE: AL Code Sec. 34-24-703 & 704, (Accessed Jun. 2024).

The Alabama Board of Medical Examiners & Medical Licensure Commission

It is the position of the Board that, when prescribing medications to an individual, the prescriber, when possible, should personally examine the patient. Before prescribing a medication, a physician should make an informed medical judgment based on appropriate medical history, the circumstances of the situation and on his or her training and experience. This process must be documented appropriately.

Prescribing medications for a patient whom the physician has not personally examined may be suitable under certain circumstances. These circumstances may include, but not be limited to, electronic encounters such as those in telemedicine; admission orders for a patient newly admitted to a health care facility, prescribing for a patient of another physician for whom the prescribing physician is taking call, continuing medication on a short-term basis for a new patient prior to the patient’s first appointment, or prescribing for the sexual partner(s) of a patient in accordance with an Expedited Partner Therapy (EPT) and/or Patient Delivered Partner Therapy (PDPT) protocol for the prevention of transmission and spread of sexually transmitted diseases.

Licensees are expected to adhere to all federal and state statutes regarding the prescribing of controlled substances and all Alabama Board of Medical Examiners’ Rules regarding the prescribing of controlled substances.

SOURCE: AL Admin. Code. r. 540-X-9-.11, (Accessed Jun. 2024).

Board of Optometry

The provision of optometric diagnosis, treatment, or other services to a patient through telemedicine at an established treatment site may be used for all patient visits, including initial evaluations to establish an optometrist-patient relationship between a provider and a patient.

A distant site provider who provides telemedicine services to a patient that is not present at an established treatment site shall ensure that a proper provider-patient relationship is established, which shall include at least the following:

Evaluation, treatment, and consultation recommendations made via telemedicine, including, but not limited to the issuance of prescriptions, shall be held to the same standards of practice as those in traditional in-person clinical settings. The provision of optometric diagnosis, treatment, or other services through telemedicine shall comply with the requirements of the Alabama Code, this chapter, and these regulations. Failure to comply with such requirements shall be considered a failure to meet standard of care as required by 630-X-12-.06 herein.

SOURCE: AL Admin Code 630-X-13-.02. (Accessed Jun. 2024).

Telemedicine services provided at an established treatment site may be used for all patient visits, including initial evaluations to establish a proper doctor-patient relationship between a provider and a patient.

A distant site provider who provides telemedicine services to a patient that is not present at an established treatment site shall ensure that a proper provider-patient relationship is established, which at a minimum includes all of the following:

Evaluation, treatment, and consultation recommendations made in a telemedicine setting, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional in-person clinical settings.

SOURCE: Code of Alabama Sec. 34-22-83, (Accessed Jun. 2024).

A registered certifying physician is prohibited from utilizing any form of telemedicine when certifying or recommending, or recertifying or re-recommending, a patient for the use of medical cannabis, or when conducting any examination associated therewith.

SOURCE: Code of Alabama Sec. 540-X-25-.09 as amended by recently adopted rule, (Accessed Jun. 2024).

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Alaska

Last updated 06/19/2024

A health care provider licensed in this state may provide …

A health care provider licensed in this state may provide health care services within the health care provider’s authorized scope of practice to a patient in this state through telehealth without first conducting an in-person visit.

A physician licensed in another state may provide health care services through telehealth to a patient located in the state as provided in this subsection, subject to the investigative and enforcement powers of the department under AS 08.01.087, and subject to disciplinary action by the State Medical Board under AS 08.64.333. The privilege to practice under this subsection extends only to

  1. ongoing treatment or follow-up care related to health care services previously provided by the physician to the patient and applies only if
    1. the physician and the patient have an established physician patient relationship; and
    2. the physician has previously conducted an in-person visit with the patient; or
  2. a visit regarding a suspected or diagnosed life-threatening condition for which
    1. the patient has been referred to the physician licensed in another state by a physician licensed in this state and that referral has been documented by the referring physician; and
    2. the visit involves communication with the patient regarding diagnostic or treatment plan options or analysis of test results for the life threatening condition.

If a health care provider determines in the course of a telehealth encounter with a patient under this section that some or all of the encounter will extend beyond the health care provider’s authorized scope of practice, the health care provider shall advise the patient that the health care provider is not authorized to provide some or all of the services to the patient, recommend that the patient contact an appropriate provider for the services the health care provider is not authorized to provide, and limit the encounter to only those services the health care provider is authorized to provide. The health care provider may not charge for any portion of an encounter that extends beyond the health care provider’s authorized scope of practice.

A fee for a service provided through telehealth under this section must be reasonable and consistent with the ordinary fee typically charged for that service and may not exceed the fee typically charged for that service.

A physician, podiatrist, osteopath, or physician assistant licensed under AS 08.64 may prescribe, dispense, or administer through telehealth under this section a prescription for a controlled substance listed in AS 11.71.140 — 11.71.190 if the physician, podiatrist, osteopath, or physician assistant complies with state and federal law governing the prescription, dispensing, or administering of a controlled substance.

An advanced practice registered nurse licensed under AS 08.68 may prescribe, dispense, or administer through telehealth under this section a prescription for a controlled substance listed in AS 11.71.140 — 11.71.190 if the advanced practice registered nurse complies with state and federal law governing the prescription, dispensing, or administering of a controlled substance.

Except as authorized under (e) and (f) of this section, a health care provider licensed under this title may not prescribe, dispense, or administer through telehealth under this section a controlled substance listed in AS 11.71.140 — 11.71.190.

SOURCE: AK Statute Sec. 08.02.130, (Accessed Jun. 2024).

The nursing board shall

SOURCE: AK Statute Sec. 08.68.100, (Accessed Jun. 2024).

Nursing

The board may not impose disciplinary sanctions on an advanced practice registered nurse for rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug that is not a controlled substance to a person without conducting a physical examination if

The board may not impose disciplinary sanctions on an advanced practice registered nurse for prescribing, dispensing, or administering a prescription drug that is a controlled substance if the requirements under (a) of this section and 15 AS 08.68.705 are met and the advanced practice registered nurse prescribes, dispenses, or administers the controlled substance.

Notwithstanding (a) and (b) of this section, an advanced practice registered nurse may not prescribe, dispense, or administer a prescription drug in response to an Internet questionnaire or electronic mail message to a person with whom the advanced practice registered nurse does not have a prior provider-patient relationship.

SOURCE: AK Statute Sec. 08.68.710, (Accessed Jun. 2024).

The guiding principles for telemedicine practice in the American Medical Association (AMA), Report 7 of the Council on Medical Service (A-14), Coverage of and Payment for Telemedicine, dated 2014, and the Federation of State Medical Boards (FSMB), Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine, dated April 2014, are adopted by reference as the standards of practice when providing treatment, rendering a diagnosis, prescribing, dispensing, or administering a prescription or controlled substance without first conducting an in-person physical examination under AS 08.64.364.

During a public health emergency declared by the governor or commissioner of health and social services, an appropriate licensed health care provider need not be present with the patient to assist a physician or physician assistant with examination, diagnosis, and treatment if the physician or physician-assistant is prescribing, dispensing, or administering buprenorphine to initiate or continue treatment for opioid use disorder and the physician or physician assistant

SOURCE: AK Admin. Code, Title 12, Sec. 40.943 (Accessed Jun. 2024).

The board may not impose disciplinary sanctions on a physician or physician assistant for rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug that is not a controlled substance to a person without conducting a physical examination if

The board may not impose disciplinary sanctions on a physician or physician assistant for prescribing, dispensing, or administering a prescription drug that is a controlled substance if the requirements under (a) of this section and AS 08.64.363 are met.

Notwithstanding (a) and (b) of this section,

SOURCE: Alaska Statute Sec. 08.64.364 (Accessed Jun. 2024).

For purposes of AS 08.64.240(b) and AS 08.64.326, “unprofessional conduct” means an act or omission by an applicant or licensee that does not conform to the generally accepted standards of practice for the profession for which the applicant seeks licensure or a permit under AS 08.64 or which the licensee is authorized to practice under AS 08.64. “Unprofessional conduct” includes the following:

SOURCE: AK Admin. Code, Title 12, Sec. 40.967. (Accessed Jun. 2024).

Nursing

In accordance with the American Association of Nurse Practitioners, Position Statement: Telehealth, dated 2022, adopted by reference, an APRN shall, for the purpose of rendering a diagnosis, providing treatment, or prescribing, dispensing, or administering a prescription drug to a person without conducting a physical examination under AS 08.68.710, provide the same standard of care to a patient who is at a different location as would be provided to that patient in person.

An APRN may practice telehealth if

For a telehealth encounter, an APRN must complete and document

An APRN practicing telehealth shall comply with P.L. 104 – 191 (Health Insurance Portability and Accountability Act of 1996 (HIPAA)) and medical record retention rules. Transmissions, including patient electronic mail, prescriptions, and laboratory results must be secure within existing technology, including the use of password-protected, encrypted electronic prescriptions or other reliable authentication techniques.

In this section, a “provider-patient relationship” is established when there is an in-person health examination or examination by telehealth technology of the patient by the APRN or another licensed health care provider and the patient record is available to the treating APRN.

SOURCE: AK Admin Code Title 12, 44.925 (Accessed Jun. 2024).

Optometry Board

An optometrist conducting a patient visit through telehealth

SOURCE: AK Admin Code Title 12, 48.370, (Accessed Jun. 2024).

Who may prescribe a controlled substance via telehealth? Under what conditions?

When an initial in-person exam is not required:

SOURCE: Alaska Department of Commerce, Community and Economic Development, Division of Corporations, Business and Professional Licensing, Telehealth Information, (Accessed Jun. 2024)

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Arizona

Last updated 05/29/2024

Medical Board

Unprofessional conduct includes prescribing, dispensing or furnishing a …

Medical Board

Unprofessional conduct includes prescribing, dispensing or furnishing a prescription medication or a prescription-only device to a person unless the licensee first conducts a physical or mental health status examination of that person or has previously established a doctor-patient relationship. The physical or mental health status examination may be conducted through telehealth with a clinical evaluation that is appropriate for the patient and the condition with which the patient presents, unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of title 36, chapter 28.1. This subdivision does not apply to:

SOURCE: Arizona Revised Statute Sec. 32-1401 (Accessed May 2024).

Osteopathic Physicians and Surgeons

Prescribing, dispensing or furnishing a prescription medication or a prescription-only device to a person if the licensee has not conducted a physical or mental health status examination of that person or has not previously established a physician-patient relationship. The physical or mental health status examination may be conducted through telehealth as defined in section 36-3601 with a clinical evaluation that is appropriate for the patient and the condition with which the patient presents, unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of title 36, chapter 28.1. This paragraph does not apply to:

SOURCE: Arizona Revised Statute Sec. 32-1854 (Accessed May 2024).

For schedule II drugs, a health care provider regulatory board or agency may not enforce any statute, rule or policy that would require a health care provider who is licensed by that board or agency and who is authorized to write prescriptions or dispense or administer prescription drugs and devices to provide an in-person examination of the patient before issuing a prescription except as specifically prescribed by federal law. A physical or mental health status examination may be conducted during a telehealth encounter. Schedule II drugs may be prescribed only after an in-person or audio-visual examination and only to the extent allowed by federal and state law.

Services provided through telehealth are subject to this state’s laws and rules governing the health care provider’s scope of practice and the practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607.

SOURCE: Arizona Revised Statute Sec. 36-3602 (Accessed May 2024).

Naturopathic Physicians

Prescribing, dispensing or furnishing a prescription medication or a prescription-only device as defined in section 32-1901 to a person unless the licensee first conducts a physical examination of that person or has previously established a doctor-patient relationship. The physical examination may be conducted through telehealth as defined in section 36-3601 unless the examination is for the purpose of obtaining a written certification from the physician for the purposes of title 36, chapter 28.1. This subdivision does not apply to:

SOURCE: Arizona Revised Statute Sec. 32-1501, (Accessed May 2024).

Pharmacy

Unprofessional conduct includes knowingly dispensing a drug on a prescription order that was issued in the course of the conduct of business of dispensing drugs pursuant to diagnosis by mail or the internet, unless the order was any of the following: …

SOURCE: Arizona Revised Statute Sec. 32-1901.01.01 (Accessed May 2024).

Veterinarians

Veterinarian client patient relationship means a relationship between a veterinarian and a client or the owner or caretaker of an animal in which the veterinarian meets all the following:

Notwithstanding any other law and except for an animal that is used in commercial food production that is regulated under title 3, a veterinarian may establish a veterinarian client patient relationship through electronic means if all of the following apply:

A veterinarian may prescribe drugs or medications after establishing a veterinary client patient relationship through electronic means, except that:

Veterinarian services provided through electronic means are subject to the rules adopted pursuant to section 32-2275 relating to the practice of veterinary medicine.

SOURCE: Arizona Revised Statute 32-2240.02 (Accessed May 2024).

A health care provider shall not use telehealth to provide an abortion.

SOURCE: Arizona Revised Statute Sec. 36-3604 (Accessed May 2024).

If a health professional believes that a patient requires more than ninety morphine milligram equivalents per day and the patient is not exempt from the limit pursuant to subsection B of this section, the health professional shall first consult with a physician who is licensed pursuant to chapter 13 or 17 of this title and who is board-certified in pain, or an opioid assistance and referral call service, if available, that is designated by the department of health services. The consultation may be done by telephone or through telehealth.

SOURCE: Arizona Revised Statute Sec. 32-3248.01, (Accessed May 2024).

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Arkansas

Last updated 05/27/2024

A distant site provider will not utilize telemedicine to treat …

A distant site provider will not utilize telemedicine to treat a patient located in Arkansas unless a professional relationship exists between the healthcare provider and the patient or as otherwise meets the definition of a professional relationship as defined in Section 17-80-402. Existence of a professional relationship is not required in the following circumstances:

“Professional relationship” means at a minimum a relationship established between a healthcare professional and a patient when:

A professional relationship cannot be established only through:

See statute for additional avenues to establish the professional relationship.

SOURCE: AR Code 17-80-402 & 403 (Accessed May 2024).

A physician-patient relationship must be established in accordance with Regulation 2.8 before the delivery of services via telemedicine. A patient completing a medical history online and forwarding it to a physician is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology. See regulation for additional requirements.

A Provider using telemedicine may NOT issue a prescription for any controlled substances defined as any scheduled medication under schedules II through V unless the Provider has seen the patient for an in-person exam or unless a relationship exists through consultation or referral; on-call or cross-coverage situations; or through an ongoing personal or professional relationship.

SOURCE: AR Rules and Regulation. Sec. 060.00.16-005 (060 01 CARR 001), (Accessed May 2024).

When mifepristone or another drug or chemical regimen is used to induce an abortion, the initial administration of the drug or chemical shall occur in the same room and in the physical presence of the physician who prescribed, dispensed, or otherwise provided the drug or chemical to the patient.

SOURCE: AR Code Annotated Section 20-16-603(b)(1). (Accessed May 2024).

When mifepristone or another drug or chemical regimen is used to induce an abortion, the initial administration of the drug or chemical shall occur in the same room and in the physical presence of the physician who prescribed, dispensed, or otherwise provided the drug or chemical to the patient.

SOURCE: AR Medical Board: Rule 36 – Abortion Procedures, (007 33 CARR 012) (Accessed May 2024).

Without a prior and proper patient-provider relationship, providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consultation, or a telephone consultation.

“Proper practitioner-patient relationship” means that before the issuance of a prescription, a practitioner, physician, or other prescribing health professional performs a history and in-person physical examination of the patient adequate to establish a diagnosis and to identify underlying conditions or contraindications to the treatment recommended or provided unless:

SOURCE: AR Code Annotated Sec. 17-92-1003(14)(B). (Accessed May 2024).

Medical Board

Requiring minimum standards for establishing Patient/Provider relationships. Provider is defined as a person licensed by the Arkansas State Medical Board. A Provider exhibits gross negligence if he provides and/or recommends any form of treatment, including prescribing legend drugs, without first establishing a proper Patient/Provider relationship.

Appropriate follow-up be provided or arranged, when necessary, at medically necessary intervals.

Exceptions – Recognizing a Provider‘s duty to adhere to the applicable standard of care, the following situations are hereby excluded from the requirement of this regulation:

SOURCE: AR Regulations, 060 01 CARR 001, (Accessed May 2024).

A Patient/Provider relationship must be established in accordance with Rule 2.8 before the delivery of services via telemedicine. Provider is defined as a person licensed by the Arkansas State Medical Board. A patient completing a medical history online and forwarding it to a Provider is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.

A physician shall not issue a written medical marijuana certification to a patient based on an assessment performed through telemedicine. A Patient/Provider relationship established under Rule 2.8 may be utilized for medical marijuana recertification by telehealth. “Telehealth certification” means the electronic assessment of a patient by a provider in connection with an application for a registry identification card under the Arkansas Medical Marijuana Amendment of 2016.

Telemedicine does not include the use of audio-only electronic technology by a provider to renew a written certification that was previously issued to the same patient.

SOURCE: AR Rule 239.02.22-003 – Rule 38, Telemedicine, (Accessed May 2024).

Medical Marijuana Certification

“Telehealth certification” means the electronic assessment of a patient by a practitioner in connection with an application for a registry identification card under § 5 of the Arkansas Medical Marijuana Amendment of 2016, Arkansas Constitution, Amendment 98.

SOURCE: AR Code 17-80-402 (Accessed May 2024)

Drug-induced, chemical and surgical abortions shall not be performed by telemedicine.

SOURCE: AR Admin Code 007.05.009 (Accessed May. 2024).

When a physician or other licensed prescriber authorizes or provides new prescriptions or refill medications to a pharmacy that is not physically located in this state or to a pharmacy that utilizes common carriers to deliver medications through the mail for a new patient who has not previously received pharmacist services or prescriptions filled through that pharmacy, that pharmacy shall:

SOURCE: AR Code 17-92-120 (Accessed May 2024).

Social Work

A social worker/client relationship must be established in accordance with Ark. Code Ann. §§ 17-80-402 & 403 and Rule XIV before the delivery of services via telemedicine. A client completing a psychosocial history online and forwarding it to a social worker is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology. A social worker exhibits gross negligence if he or she provides and/or recommends any form of treatment via telemedicine without first establishing a proper social worker/client relationship.

“Professional relationship” does not include a relationship between a social worker and a client established only by the following:

See regulations for further requirements.

SOURCE: Rules and Regulations, Social Work Licensing Board, Sec. XIV (120 00 CARR 001), (Accessed May 2024).

Licensed Counselor or Marriage Family Therapist

A licensed counselor or marriage and family therapists/client relationship must be established in accordance with Ark. Code Ann. §§ 17-80-402 & 403 and Section 12.3 & 12.4 before the delivery of services via telemedicine. A client’s completing a psychosocial history online and forwarding it to a licensed counselor or marriage and family therapist is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology. A licensed counselor or marriage and family therapist exhibits gross negligence if he or she provides and/or recommends any form of treatment via telemedicine without first establishing a proper licensed counselor or marriage and family therapist/client relationship.

“Professional relationship” does not include a relationship between a licensed counselor or marriage and family therapist and a client established only by the following:

See regulations for further requirements.

SOURCE: Rules and Regulations, Board of Examiners in Counseling, Rule XII, Sec. 12.2 (122 00 CARR 001), (Accessed May 2024).

Dietitians

“Professional relationship” does not include a relationship between a licensed dietitian and a client established only by the following:

SOURCE: Rules and Regulations, Dietetics Licensing Board Sec. 239.00.22-002 (007 33 CARR 045), (Accessed May 2024).

Establishing a Licensed Dietitian/Client Relationship -A licensed dietitian/client relationship must be established in accordance with Ark. Code Ann. §§ 17-80-402 & 403 and Section VII before the delivery of services via telemedicine. A client’s completing a nutrition history online and forwarding it to a licensed dietitian is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology. A licensed dietitian exhibits gross negligence if he or she provides and/or recommends any form of treatment via telemedicine without first establishing a proper licensed dietitian/client relationship.

Minimum Requirements for Licensed Dietitian/Client Relationship – For purposes of this regulation, a proper licensed dietitian/client relationship, at a minimum requires that:

When a Licensed Dietitian/Client Relationship is Deemed to Exist- For the purposes of this regulation, a proper licensed dietitian/client relationship is deemed to exist in the following situations:

Exceptions -Recognizing a licensed dietitian’s duty to adhere to the applicable standard of care and to comply with mandatory reporting laws, the following situations are excluded from the requirement of this regulation by Ark. Code Ann. § 17-80-403(a)(2):

Professional Relationship Exceptions- Under Ark. Code Ann. § l 7-80-403(c), “Professional relationship” does not include a relationship between a licensed dietitian and a client established only by the following:

See regulation for additional requirements.

SOURCE: AR Rules and Regulations, Board of Dietetics, Sec. 007.45.24-001, (Accessed May 2024).

APRN

The APRN shall establish a proper APRN/patient relationship prior to providing any patient care. A proper APRN/patient relationship, at a minimum requires that:

A proper APRN/patient relationship is also deemed to exist in the following situations:

Recognizing a Providers duty to adhere to the applicable standard of care, the following situations are hereby excluded from the requirement of this regulation:

An APRN/patient relationship shall be established in accordance with Chapter 4, Section XIII before the delivery of services via telemedicine. A patient completing a medical history online and forwarding it to an APRN is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.

An APRN using telemedicine may NOT issue a prescription for any controlled substances defined as any scheduled medication under schedules III through V and only hydrocodone combination products which were reclassified from Schedule III to Schedule II as of October 6, 2014 unless the APRN has seen the patient for an in-person exam or unless a relationship exists through consultation or referral; or on-call or cross-coverage situations.

SOURCE: Rule 007.34.22-003, Sec XV (067 00 CARR 004) (Accessed May 2024).

Physical Therapy

“Professional relationship” means at a minimum a relationship established between a licensee and a patient when:

A licensee at a distant site shall not utilize telehealth with respect to a patient located in Arkansas unless a professional relationship exists between the licensee and the patient or the licensee otherwise meets the requirements of a professional relationship as defined in Section 1.(5) of this rule.

The existence of a professional relationship is not required in the following circumstances: (A) Emergency situations where the life or health of the patient is in danger or imminent danger; or(B) Simply providing information of a generic nature, not meant to be specific to an individual patient.

“Professional relationship” does not include a relationship between a licensee and a patient established only by the following:

SOURCE: Telehealth Rule, AR Physical Therapy Website. (Accessed May 2024).

Psychology

A psychologist/psychological examiner exhibits gross negligence if he provides and/or recommends any form of treatment/service, without first establishing a proper psychologist/psychological examiner-patient/client relationship.

For purposes of this rule, a proper psychologist/psychological examiner- patient/client relationship, at a minimum requires that:

For the purposes of this rule, a proper psychologist/psychological examiner-patient/client relationship is deemed to exist in the following situations:

Exceptions — Recognizing a psychologist/psychological examiner’s duty to adhere to the applicable standard of care, the following situations are hereby excluded from the requirement of this rule:

A Patient/client/Provider relationship must be established in accordance with Rule 19.1 before the delivery of services via telepsychology. Provider is defined as a person licensed by the Arkansas Psychology Board who has documented training in telepsychology. A patient/client completing a history online and forwarding it to a Provider is not sufficient to establish the relationship, nor does it qualify as store-and-forward technology.

SOURCE: Rules and Regulations Board of Psychology, Sec. 007.00.22-001, (074 00 CARR 001), (Accessed May 2024).

Speech-Language Pathology and Audiology

“Professional relationship” means at a minimum a relationship established between a licensee and a patient when:

“Professional relationship” does not include a relationship between a licensee and a patient established only by the following:

SOURCE: AR Board of Examiners in Speech-Language Pathology and Audiology Rules, Section 12: Telepractice, (Accessed May 2024).

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California

Last updated 07/01/2024

Prescribing, dispensing, or furnishing dangerous drugs as defined in Section …

Prescribing, dispensing, or furnishing dangerous drugs as defined in Section 4022 without an appropriate prior examination and a medical indication, constitutes unprofessional conduct. An appropriate prior examination does not require a synchronous interaction between the patient and the licensee and can be achieved through the use of telehealth, including, but not limited to, a self-screening tool or a questionnaire, provided that the licensee complies with the appropriate standard of care.

SOURCE: CA Business & Professions Code Sec. 2242 (a). (Accessed Jul. 2024).

Remote Dispensing Site Pharmacies

Remote dispensing site pharmacies are permitted to dispense or provide pharmaceutical care services in medically underserved areas. A supervising pharmacy must provide telepharmacy services to the remote dispensing site pharmacy and shall not be located greater than 150 road miles from the remote dispensing site pharmacy.

SOURCE: CA Business & Professions Code Sec. 4130-4135 (Accessed Jul. 2024).

Occupational Therapy

An occupational therapist shall determine whether an in-person evaluation or in-person interventions are necessary considering: the complexity of the patient’s/client’s condition; his or her own knowledge, skills, and abilities; the nature and complexity of the intervention; the requirements of the practice setting; and the patient’s/client’s context and environment.

SOURCE: CA Code of Regulations, Title 16, Div. 39, Art. 8, Sec. 4172(c). (Accessed Jul. 2024).

Veterinarians

A veterinarian shall not prescribe, dispense, or administer a drug, medicine, application, or treatment of whatever nature for the prevention, cure, or relief of a wound, fracture, bodily injury, or disease of animals unless a veterinarian-client-patient relationship exists or as otherwise permitted by law, except when the animal patient is a wild animal or the owner of the animal patient is unknown. A veterinarian-client-patient relationship exists if all of the following conditions are met:

A veterinarian possesses sufficient knowledge of the animal patient if the veterinarian has recently seen, or is personally acquainted with, the care of the animal patient by doing any of the following:

Synchronous audio-video communication is not required for the delivery of veterinary medicine via telehealth after a veterinarian-client-patient relationship has been established unless the veterinarian determines that it is necessary in order to provide care consistent with prevailing veterinary medical practice.

A veterinarian-client-patient relationship shall not be established solely by audio-only communication or by means of a questionnaire.

Only a person who holds a current license to practice veterinary medicine in this state is authorized to practice veterinary medicine via telehealth on an animal patient located in this state.

Before delivering veterinary medicine via telehealth, the veterinarian shall inform the client about the use and potential limitations of telehealth and obtain consent from the client to use telehealth, including acknowledgment of all of the following:

A veterinarian who practices veterinary medicine via telehealth shall do all of the following:

A veterinarian shall not prescribe a drug for a duration of time that is inconsistent with the medical condition of the animal patient or the type of drug prescribed.

A veterinarian who established the required veterinarian-client-patient relationship by examining the animal patient in person or by making medically appropriate and timely visits to the premises on which the animal patient is kept shall not prescribe a drug for a duration of time that is longer than one year from the date that the veterinarian examined the animal patient in person or visited the premises and prescribed the drug.

Except as provided in paragraphs (4) to (8), inclusive, a veterinarian who practices veterinary medicine via telehealth may order, prescribe, or make available drugs, as defined in Section 11014 of the Health and Safety Code, in accordance with all relevant state and federal regulations.

A veterinarian who established the required veterinarian-client-patient relationship using synchronous audio-video communication shall not prescribe a drug to the animal patient for use for a period longer than six months from the date upon which the veterinarian examined the animal patient or prescribed the drug. The veterinarian shall not issue another prescription to the animal patient for the same drug unless they have conducted another examination of the animal patient, either in person or using telehealth.

A veterinarian who established the required veterinarian-client-patient relationship using synchronous audio-video communication shall not prescribe an antimicrobial drug to the animal patient for a period longer than 14 days of treatment. The veterinarian shall not issue any further antimicrobial drug prescription, including a refill, to treat the condition of the animal patient unless the veterinarian has conducted an in-person examination of the animal patient.

The veterinarian shall not order, prescribe, or make available a controlled substance, as defined in Section 4021, or xylazine, unless the veterinarian has performed an in-person physical examination of the animal patient or made medically appropriate and timely visits to the premises where the animal patient is kept.

The veterinarian shall notify the client that some prescription drugs or medications may be available at a pharmacy and, if requested, the veterinarian shall submit a prescription to a pharmacy that the client chooses.

A veterinarian shall not prescribe via telehealth any drug or medication for use on a horse engaged in racing or training at a facility under the jurisdiction of the California Horse Racing Board pursuant to Chapter 4 (commencing with Section 19400) of Division 8.

As used in this section, “drug” means any controlled substance, as defined in Section 4021, or any dangerous drug, as defined in Section 4022.

A veterinarian is permitted to use telehealth without establishing a veterinarian-client-patient relationship in order to provide advice in an emergency, as defined in Section 4840.5.

SOURCE: CA Business and Professions Code Section 4826.6. (Accessed Jul. 2024).

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Colorado

Last updated 08/14/2024

Colorado Medical Board

Provider-patient relationships may be established using telehealth …

Colorado Medical Board

Provider-patient relationships may be established using telehealth technologies so long as the relationship is established in conformance with generally accepted standards of practice. Where an existing provider-patient relationship is not present, a provider must take appropriate steps to establish a provider-patient relationship consistent with the guidelines identified in Board Policy 40-3 and listed below.

The Board defines “Provider” to include licensees regulated by the Board and the “Provider-Patient Relationship” as the mutual understanding, between a provider and patient, of the shared responsibility for the patient’s healthcare. This relationship is established when:

A “Provider-Patient Relationship” has not been established when either the identity of the provider is unknown to the patient, or the identity of the patient is not known to the provider.

SOURCE: The Colorado Medical Board Policies, 40-03, page 57. Colorado Medical Board Policy Statement Regarding the Provider/Patient Relationship. 8/20/15. (Accessed Aug. 2024).

It is the position of the Colorado Medical Board that it is unprofessional conduct for a provider to provide treatment and consultation recommendations, including issuing a prescription, via any means, unless a provider-patient relationship, as defined in Board Policy 40-3, has been established.

Prescribing for a patient whom the provider has not personally examined may or may not be suitable under certain circumstances. Such circumstances may include, but are not limited to, admission orders for a newly hospitalized patient, prescribing for a patient of another provider for whom the provider is taking call, or continuing medication on a short-term basis for a new patient prior to the patient’s first appointment. Providers of medical care through telehealth technologies should adhere to the guidelines articulated in Board Policy 40-27.

SOURCE: The Colorado Medical Board Policies, 40-09, page 63. Guidelines for Prescribing for Unknown Patients. 8/20/15. (Accessed Aug. 2024).

An appropriate medical evaluation and review of relevant clinical history, commensurate with the presentation of the patient to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided, should be performed prior to providing treatment, including issuing prescriptions, electronically or otherwise. Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional (encounter in person) settings. Treatment, including issuing a prescription based solely on an online questionnaire, does not constitute an acceptable standard of care.

Prescribing medications, in-person or via telehealth technologies, is at the professional discretion of the provider. The indication, appropriateness, and safety considerations for each telehealth visit prescription must be evaluated by the provider in accordance with current standards of practice and consequently carry the same professional accountability as prescriptions delivered during an encounter in person. However, where such measures are upheld, and the appropriate clinical consideration is carried out and documented, providers may exercise their judgment and prescribe medications as part of telehealth encounters.

The recommendation of medical marijuana via telehealth technologies is prohibited.

Pharmacists

A pharmacist shall not dispense a prescription drug if the pharmacist knows or should know that the order for such drug was issued without a valid preexisting patient-practitioner relationship. Such relationship need not involve an in-person encounter between the patient and practitioner if otherwise permissible under Colorado law. A pharmacist may, in good faith, dispense an opiate antagonist pursuant to an order that was issued without a valid preexisting patient-practitioner relationship that is approved by the Federal Food and Drug Administration for the treatment of a drug overdose.

SOURCE: 3 CO Code of Regulation 719-1. 3.00.21, p. 9. (Accessed Aug. 2024).

Medical Marijuana Program

“Bona fide physician-patient relationship”, for purposes of the medical marijuana program, means:

A physician and a patient have a treatment or counseling relationship, in the course of which the physician has completed a full in-person assessment of the patient’s medical history, including an assessment of the patient’s medical and mental health history to determine whether the patient has a medical or mental health issue that could be exacerbated by the use of medical marijuana and reviewing a previous diagnosis for a debilitating or disabling medical condition, and current medical condition, including an appropriate personal physical examination. If the physician is not the patient’s primary care physician, the recommending physician shall review the existing records of the diagnosing physician or licensed mental health provider. This does not require a mental health examination prior to making a recommendation per requirements established in § 25.1.5-106, C.R.S.

SOURCE: 5 CO Regs. Rule 1006-2; CO Revised Statute 25-1.5-106. (Accessed Aug. 2024).

Psychologists

In regard to licensed psychologists prescribing psychotropic medication for the treatment of mental health disorders, practice requirements for telemedicine include:

SOURCE: 3 CCR 721-1. (Accessed Aug. 2024).

Veterinarians

“Veterinarian-client-patient relationship” means the relationship established when:

A veterinarian-client-patient relationship established according to the above may extend to other licensed veterinarians working out of the same physical practice location as the veterinarian who established the veterinarian-client-patient relationship if the other licensed veterinarians have access to and have reviewed the patient’s medical records.

SOURCE: CO Revised Statute 12-315-104 as proposed to be amended by HB 24-1048 (2024 Legislative Session). (Accessed Aug. 2024).

Only a licensed veterinarian may establish a veterinarian-client-patient relationship in this state. A veterinarian-client-patient relationship must be established by an in-person, physical examination of the animal or timely visits to the premises where the animal is kept. A veterinary specialist may use telecommunications technology to see a patient under another veterinarians previously established veterinarian-client-patient relationship pursuant to 12-315-306. An established veterinarian-client-patient relationship may be maintained through examinations that occur using telecommunications technology in between appropriate in-person physical examinations or visits to the premises where the patient is kept.

A licensed veterinarian shall not recommend treatment of care for an animal based solely on a client’s responses to an online questionnaire.

Only a licensed veterinarian with an established veterinarian-client-patient relationship may prescribe medication through telemedicine.

A licensed veterinarian who does not have an established veterinarian-client-patient relationship with an animal and its owner may use telemedicine to administer, distribute, or dispense a prescription drug that has been prescribed by another licensed veterinarian who has an established veterinarian-client-patient relationship.

Telereferral – A veterinarian with an established veterinarian-client-patient relationship may refer a patient to a veterinary specialist. A veterinary specialist to whom a patient is referred may provide veterinary services using telecommunications technology for the patient and client under the referring veterinarian’s veterinarian-client-patient relationship. A veterinary specialist to whom a patient is referred shall not prescribe medications to the patient unless the veterinary specialist establishes a veterinarian-client-patient relationship through an in-person, physical examination of the patient.

See legislation for additional information applicable to veterinarian use of telehealth.

SOURCE: CO Revised Statute 12-315-302; 12-315-304; 12-315-305; 12-315-306 as proposed to be added by HB 24-1048 (2024 Legislative Session). (Accessed Aug. 2024).

Recently Passed Legislation – Out-of-State Telehealth Providers

A registered provider providing health-care services through telehealth to a patient located in this state shall provide health-care services in compliance with the professional practice standards applicable to a licensee, certificate holder, or registrant who provides comparable in-person health-care services in this state. Professional practice standards and laws applicable to the provision of in-person health-care services in this state, including standards and laws relating to prescribing medication or treatment, identity verification, documentation, informed consent, confidentiality, disclosures, privacy, and security, apply to the provision of health-care services through telehealth in Colorado.

A registered provider shall not prescribe a controlled substance, as defined in section 12-280-402 (1).

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Connecticut

Last updated 07/17/2024

No telehealth provider shall prescribe any schedule I, II or …

No telehealth provider shall prescribe any schedule I, II or III controlled substance through the use of telehealth, except a schedule II or III controlled substance other than an opioid drug, as defined in section 20- 14o, in a manner fully consistent with the Ryan Haight Online Pharmacy Consumer Protection Act, 21 USC 829(e), as amended from time to time, for the treatment of a person with a psychiatric disability or substance use disorder, as defined in section 17a-458, including, but not limited to, medication-assisted treatment. A telehealth provider using telehealth to prescribe a schedule II or III controlled substance pursuant to this subsection shall electronically submit the prescription pursuant to section 21a-249, as amended by this act.

SOURCE: CT General Statute 19a, Sec. 906(c) as proposed to be amended by HB 5198 (Public Act 24-110 – 2024 Session). (Accessed Jul. 2024).

Notwithstanding any provision of the general statutes or any regulation of Connecticut state agencies concerning the certification of qualifying patients through telehealth services, a physician, physician assistant or advanced practice registered nurse may issue a written certification to a qualifying patient and provide any follow-up care utilizing telehealth services, provided all other requirements for issuing such written certification to the qualifying patient, including, but not limited to, all recordkeeping requirements, are satisfied.

SOURCE: CT General Statute 21a-408c (f) as proposed to be added by HB 6768 (2023 Session), Sec. 13. (Accessed Jul. 2024).

A licensed practitioner shall not be required to electronically transmit a prescription when:

SOURCE: CT General Statute 21a-249 (c) as proposed to be amended by HB 5198 (Public Act 24-110 – 2024 Session). (Accessed Jul. 2024).

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Delaware

Last updated 07/26/2024

Health-care providers may not deliver health-care services by telehealth and …

Health-care providers may not deliver health-care services by telehealth and telemedicine in the absence of a health-care provider-patient relationship. A health-care provider-patient relationship may be established either in-person or through telehealth and telemedicine but must include all of the following:

Health-care services delivered by telehealth and telemedicine may be synchronous or asynchronous using store-and-forward technology. Telehealth and telemedicine services may be used to establish a provider-patient relationship only if the provider determines that the provider is able to meet the same standard of care as if the health-care services were being provided in-person.

Treatment and consultation recommendations delivered by telehealth and telemedicine shall be subject to the same standards of appropriate practice as those in traditional (in-person encounter) settings. In the absence of a proper health-care provider-patient relationship, health-care providers are prohibited from issuing prescriptions solely in response to an Internet questionnaire, an Internet consult, or a telephone consult.

Telehealth and telemedicine may be practiced without a health-care provider-patient relationship during:

  1. Informal consultation performed by a health-care provider outside the context of a contractual relationship and on an irregular or infrequent basis without the expectation or exchange of direct or indirect compensation.
  2. Furnishing of assistance by a health-care provider in case of an emergency or disaster when circumstances do not permit the establishment of a health-care provider-patient relationship prior to the provision of care if no charge is made for the medical assistance.
  3. Episodic consultation by a specialist located in another jurisdiction who provides such consultation services at the request of a licensed health-care professional.
  4. Circumstances which make it impractical for a patient to consult with the health-care provider in-person prior to the delivery of telemedicine services.

A mental health provider, behavioral health provider, or social worker licensed in another jurisdiction who would be authorized to deliver health-care services by telehealth or telemedicine under this chapter if licensed in this State pursuant to Chapter 30 (Mental Health and Chemical Dependency Professionals), Chapter 35 (Psychologists), or Chapter 38 (Social Workers) of this title may provide treatment to Delaware residents through telehealth and telemedicine services. The Division of Professional Regulation shall require any out-of-state health-care provider practicing in this State pursuant to this section to complete a Medical Request Form and comply with any other registration requirements the Division of Professional Regulation may establish.

Delaware Board of Medical Licensure has specific requirements for electronic prescribing.

SOURCE: DE Admin Code, Title 24, Sec. 1700(19). (Accessed Jul. 2024).

Consulting Physician

Consultation may be done telephonically, electronically or in person. Consultation shall ordinarily consist of a history and physical examination, review of records and imaging pathology or similar studies. Consultation includes providing opinions and recommendations. An active Delaware certificate is required of any out of state physician who comes into Delaware to perform a consultation more than twelve (12) times per year. A physician who comes into Delaware to perform consultations must be actively licensed in another State or country on a full and unrestricted basis. Any consultations done for teaching and/or training purposes may include active participation in procedures and treatment, whether surgical or otherwise, provided a Delaware licensed physician remains responsible as the physician of record, and provided the patient is not charged a fee by the consultant.

SOURCE: DE Admin Code, Title 24, Sec. 1700, 6. (Accessed Jul. 2024).

Pharmacists

Telehealth may be used for patient counseling only.

SOURCE: 24 DAC 2500, 5.2. (Accessed Jul. 2024).

Pharmacists practicing within or outside of the state are prohibited from dispensing prescription drug orders through an Internet pharmacy if the pharmacist knows that the prescription order was issued solely on the basis of an Internet consultation or questionnaire, or medical history form submitted to an Internet pharmacy through an Internet site or that the prescription was issued by a practitioner who does not have a patient-practitioner relationship with the Delaware patient.

SOURCE: DE Code, Title 16, Chapter 47, Sec. 4744(d)(1)(a-b). (Accessed Jul. 2024).

Optometrists

All initial evaluations shall be performed face to face and not through telehealth or internet unless another Delaware-licensed optometrist or ophthalmologist is present at the originating site with the patient at the time of the diagnosis, or the provider meets the standard of service required by applicable professional societies in guidelines developed for establishing a health-care provider-patient relationship as part of an evidenced-based clinical practice in telemedicine.

SOURCE: 24 DAC 2100, 5. (Accessed Jul. 2024).

NOTE: DE Professional Boards have different and varying requirements related to establishing a patient-provider relationship. See Professional Board Standards section for references and additional Board telehealth practice requirements.

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District of Columbia

Last updated 06/05/2024

A physician shall perform a patient evaluation to establish diagnoses …

A physician shall perform a patient evaluation to establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication for a patient utilizing the appropriate standards of care, except when performing interpretive services.

If a physician-patient relationship does not include a prior in-person interaction with a patient, the physician may use real-time telemedicine to allow a free exchange of protected health information between the patient and the physician to establish the physician-patient relationship and perform the patient evaluation.

SOURCE: DC Reg Sec. 17-4618.3 & 4 (Accessed Jun. 2024).

A health professional licensed, registered, or certified in the District pursuant to this act may provide a telehealth service to a District resident or person located in the District if doing so is:

A practitioner-patient or practitioner-client relationship may be established through telehealth in accordance with the appropriate standard of care and the practitioner’s competence and scope of practice; provided, that the Mayor may through rulemaking issue additional requirements for specific health professionals to establish a practitioner-client relationship, including an initial in-person physical examination.

A health professional providing telehealth services who is authorized to prescribe medications shall comply with the Prescription Drug Monitoring Program Act of 2013, effective February 22, 2014 (D.C. Law 20-66; D.C. Code § 48-853.01 et seq.), and all District or federal laws and rules related to prescription and controlled substances.

SOURCE: DC Code Sec. 1201.05 as proposed to be added by B 25-0545 (2024 Session). (Accessed Jun. 2024).

Medical Marijuana

Authorized practitioners may provide telehealth medicine services to qualifying patients, including recommending the use of medical marijuana in accordance with this title, consistent with the laws and regulations governing their medical practice.

SOURCE: DC Regs. Sec. 22-C-807.1 as added by Alcoholic Beverage and Cannabis Administration – Notice of Final Rulemaking – Amending 22-C DCMR Ch. 1, etc. – Medical Marijuana, (Mar. 2024). (Accessed Jun. 2024).

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Florida

Last updated 06/11/2024

A telehealth provider may use telehealth to perform a patient …

A telehealth provider may use telehealth to perform a patient evaluation. If a telehealth provider conducts a patient evaluation sufficient to diagnose and treat the patient, the telehealth provider is not required to research a patient’s medical history or conduct a physical examination of the patient before using telehealth to provide health care services to the patient.

A telehealth provider may not use telehealth to prescribe a controlled substance listed in Schedule II of s. 893.03 unless the controlled substance is prescribed for the following:

  1. The treatment of a psychiatric disorder;
  2. Inpatient treatment at a hospital licensed under chapter 395;
  3. The treatment of a patient receiving hospice services as defined in s. 400.601; or
  4. The treatment of a resident of a nursing home facility as defined in s. 400.021.

SOURCE: FL Statute 456.47. (Accessed Jun. 2024).

Effective once certain contingencies are met:

Only a physician may perform or induce a termination of pregnancy. A physician may not use telehealth as defined in s. 456.47 to perform an abortion, including, but not limited to, medical abortions. Any medications intended for use in a medical abortion must be dispensed in person by a physician and may not be dispensed through the United States Postal Service or by any other courier or shipping service.

SOURCE: FL Statute Sec. 390.0111, (see notes section for contingencies) (Accessed Jun. 2024).

Medical Marijuana

A qualified physician may issue a physician certification only if the qualified physician:

A qualified physician must evaluate an existing qualified patient at least once every 30 weeks before issuing a new physician certification. A qualified physician who has issued a certification to the patient after conducting an in-person physical examination as defined in subparagraph (a)1. may conduct the evaluation through telehealth as defined in s. 456.47. A physician must:

SOURCE: FL Statute Sec. 381.986, (Accessed Jun. 2024).

Dental

An advertisement of dental services provided through telehealth as defined in s. 456.47(1) must include a disclaimer that reads, in a clearly legible font and size, “An in-person examination with a dentist licensed under chapter 466, Florida Statutes, is recommended before beginning telehealth treatment in order to prevent injury or harm” for each of the following services, if advertised:

SOURCE: FL Statute Sec. 466.019, & House Bill 855 (2024 Session), (Accessed Jun. 2024).

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Georgia

Last updated 05/24/2024

In order for a physician to practice within the minimum …

In order for a physician to practice within the minimum standards of practice while providing treatment and/or consultation recommendations by electronic or other such means, all the following conditions must be met:

This rule should not be interpreted to interfere with care and treatment by telephonic communication in an established physician-patient relationship, call coverage for established physician-patients relationships, or telephone and internet consultations between physicians, nurse practitioners, physician assistants, other health care providers or child protection agencies.

This rule does not authorize the prescription of controlled substances for the treatment of pain or chronic pain by electronic or other such means. All treatment of pain or chronic pain must be in compliance with Rule 360-3-.06.

SOURCE: GA Rules & Regulations revised 360-3-.07. (Accessed May. 2024).

Unprofessional conduct shall include but not be limited to prescribing controlled substances and/or dangerous drugs for a patient based solely on a consultation via electronic means with the patient, patient’s guardian or patient’s agent. This shall not prohibit a licensee from prescribing a dangerous drug for a patient pursuant to a valid physician­ patient relationship in accordance with O.C.G.A. 33-24-56.4 or a licensee who is on-call or covering for another licensee from prescribing up to a 30-day supply of medications for a patient of such other licensee nor shall it prohibit a licensee from prescribing medications when documented emergency circumstances exist.

This shall also not prevent a licensed physician from prescribing Schedule II sympathomimetic amine drugs for the treatment of attention deficit disorder to a patient in the physical presence of a licensed nurse, provided the initial diagnosis was made and an initial prescription was issued in accordance with 21 U .S .C. § 829(e), as amended from time to time, including but not limited to the following:

Providing treatment via electronic or other means is considered unprofessional conduct unless a history and physical examination of the patient has been performed by a Georgia licensee. This shall not prohibit a licensee who is on call or covering for another licensee from treating and/or consulting a patient of such other licensee. Also, this paragraph shall not prohibit a patient’s attending physician from obtaining consultations or recommendations from other licensed health care providers.

SOURCE: GA Rules & Regulations revised 360-3-.02. (Accessed May. 2024).

Contact Lenses & Spectacles

No person in this state shall sell, dispense, or serve as a conduit for the sale or dispensing of contact lenses or spectacles to the ultimate user of such contact lenses or spectacles except persons licensed and regulated by Chapter 29, 30, or 34 of Title 43.

No person in this state shall write a prescription for contact lenses or spectacles unless he or she is a prescriber.

No person in this state shall write a prescription for contact lenses or spectacles unless an eye examination is conducted or, pursuant to the conditions in subsection (d) of this Code section, an eye assessment is performed.

An assessment mechanism to conduct an eye assessment or to generate a prescription for contact lenses or spectacles in this state shall:

“Eye assessment” means an assessment of the ocular health and visual status of a patient that may include, but is not limited to, objective refractive data or information generated by an automated testing device, including an autorefractor, in order to establish a refraction diagnosis for the correction of vision disorders. This may include synchronous or asynchronous telemedicine technologies.

“Eye examination” means a real-time examination, which includes the use of telemedicine, in accordance with the applicable standard of care of the prescriber, of the ocular health and visual status of an individual that does not consist solely of objective refractive data or information generated by an automated testing device, including an autorefractor or kiosk, in order to establish a medical diagnosis or refractive diagnosis for the establishment of refractive error, conducted with the patient and prescriber in the same physical location or via telemedicine. If the eye examination is conducted via telemedicine, the patient and prescriber shall be required to be in synchronous verbal and visual contact during such parts of the examination necessary to ensure that the examination is, at a minimum, equivalent to an eye examination conducted in person.

“Assessment mechanism” means automated or virtual equipment, application, or technology designed to be used on a telephone, a computer, or an internet accessible device that may be used either in person or via telemedicine to conduct an eye assessment, and includes artificial intelligence devices and any equipment, electronic or nonelectronic, that are used to conduct an eye assessment.

SOURCE: GA OCGA Section 31-12-12. (Accessed May. 2024).

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Hawaii

Last updated 06/03/2024

Medicaid

All providers prescribing controlled substances must be located in …

Medicaid

All providers prescribing controlled substances must be located in the State of Hawai’i.

Until December 31, 2024, Federally Qualified Health Center (FQHC) behavioral health providers may be located at a non-HRSA approved site or satellite within the United States and the United States’ territories. If the FQHC provider is prescribing controlled substances, they must be located in the State of Hawai’i.

SOURCE: HI Med-QUEST Memo QI-2338/FFS 23-22/CCS-2311. (Accessed Jun. 2024).

Prescribing providers must have a provider-patient relationship prior to prescribing. This includes:

SOURCE: HI Revised Statutes § 329-1. (Accessed Jun. 2024)

Treatment recommendations made via telehealth, including issuing a prescription via electronic means, shall be held to the same standards of practice as traditional settings that do not include a in-person visit but in which prescribing is appropriate, including on-call telephone encounters and encounters for which a follow-up visit is arranged.

Issuing a prescription based solely on an online questionnaire is not treatment for the purposes of this section and does not constitute an acceptable standard of care.

A physician-patient relationship may be established via a telehealth interaction; provided that the physician has a license to practice medicine in the State. Once a physician-patient relationship is established, a patient or physician licensed in this State may use telehealth for any authorized purpose, including consultation with a medical provider licensed in another state, authorized by this section or as otherwise provided by law.

For the purposes of prescribing opiates or medical cannabis, a physician-patient relationship shall only be established after an in-person consultation between the prescribing physician and the patient.

SOURCE: HI Revised Statutes § 453-1.3. Amended by HB 907 (To be repealed December 31, 2025). (Accessed Jun. 2024).

For purposes of prescribing medical cannabis, a bona fide physician-patient relationship may be established via telehealth, and a nurse-patient relationship can be established via telehealth; provided that treatment recommendations that certify a patient for the medical use of cannabis via telehealth shall be allowed only after an initial in-person consultation between the certifying physician or advanced practice registered nurse and the patient.

SOURCE: HI Revised Statutes § 329-126. (Accessed Jun. 2024).

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Idaho

Last updated 06/18/2024

A provider may provide virtual care to a patient if …

A provider may provide virtual care to a patient if such provider has first established a provider-patient relationship with the patient, the patient has a provider-patient relationship with another provider in the provider group, the provider is covering calls for a provider with an established relationship with the patient, or the provider is performing any activities set forth in section 54-1733(2), Idaho Code. A provider-patient relationship may be established by use of virtual care technologies, provided that the applicable Idaho community standard of care is satisfied.

SOURCE: ID Code 54-5705. (Accessed Jun. 2024).

When delivering health care services via virtual care, including a prescription drug order or prescription medical device order, a provider shall obtain and document a patient’s relevant clinical history and current symptoms to establish the diagnosis and identify underlying conditions and contraindications to the treatment recommended. A provider delivering health care services via virtual care has a duty to practice in a manner consistent with the provider’s scope of practice and shall be held to the applicable Idaho community standard of care that applies in an in-person setting. Treatment based solely on a static online questionnaire does not constitute an acceptable standard of care.

SOURCE: ID Code 54-5706. (Accessed Jun. 2024).

A provider with an established provider-patient relationship, including a relationship established pursuant to section 54-5705, Idaho Code, may issue prescription drug orders and prescription medical device orders via virtual care within the scope of the provider’s license and according to any applicable state and federal laws, rules, and regulations, including the Idaho community standard of care. However, the prescription drug shall not be a controlled substance unless prescribed in compliance with 21 U.S.C. A prescription drug order and prescription medical device order must be issued for a legitimate medical purpose by a provider acting in a manner consistent with the provider’s scope of practice.

Nothing in this chapter shall be construed to expand or restrict the prescriptive authority of any provider beyond what is authorized by the applicable licensing boards.

SOURCE ID Code Section 54-5707 (Accessed Jun. 2024).

Prescribers must have prescriber-patient relationship, which includes a documented patient evaluation adequate to establish diagnoses and identify underlying conditions and/or contraindications to the treatment. A valid prescriber-patient relationship may be established through virtual care technologies, provided that the applicable Idaho community standard of care must be satisfied.

Prescriptions based solely on static online questionnaires does not constitute a legitimate medical purpose.

SOURCE: ID Code § 54-1733. (Accessed Jun. 2024).

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Illinois

Last updated 07/12/2024

An optometrist treating a patient through telehealth must perform at …

An optometrist treating a patient through telehealth must perform at least a minimum eye examination as required by 68 Ill. Adm. Code 1320.90 before prescribing eyeglasses or contact lenses to the patient. Nothing in this Section authorizes an eye examination that:

To be repealed Jan. 1, 2027.

SOURCE: Illinois Consolidated Statute 225, 80/15.4. (Accessed Jul. 2024).

A person age 18 or older must be evaluated by a hearing instrument professional in person or via telehealth before receiving a prescription for a hearing aid. A person age 18 or older may not waive evaluation by a hearing instrument professional unless he or she is replacing a lost or stolen hearing aid that is subject to warranty replacement.

SOURCE: Illinois 225 ILCS 50/4.6. (Accessed Jul. 2024).

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Indiana

Last updated 08/07/2024

A documented patient evaluation, including history and physical evaluation adequate …

A documented patient evaluation, including history and physical evaluation adequate to establish diagnoses and identify underlying conditions or contraindications to the treatment recommended or provided, must be obtained prior to providing treatment, including issuing prescriptions, electronically or otherwise.

SOURCE: IN Admin. Code, “Article 5” Title 844, 5-3-2. p. 10 (Accessed Aug. 2024).

Telehealth may not be used to provide any abortion, including the writing or filling of a prescription for any purpose that is intended to result in an abortion.

SOURCE: IN code, 16-34-1-11 & 25-1-9.5-8(a)(4) & 25-1-9.5-0.5. (Accessed Aug. 2024).

A practitioner who:

shall be held to the same standards of appropriate practice as those standards for health care services provided at an in-person setting.

A practitioner who uses telehealth shall, if such action would otherwise be required in the provision of the same health care services in a manner other than telehealth, ensure that a proper provider-patient relationship is established. The provider-patient relationship by a practitioner who uses telehealth must at a minimum include the following:

  1. Obtain the patient’s name and contact information (see regulation for other related requirements);
  2. Disclose the practitioner’s name and practitioner’s licensure, certification or registration;
  3. Obtain informed consent from the patient;
  4. Obtain the patient’s medical history and information necessary to establish a diagnosis;
  5. Discuss with the patient the diagnosis, evidence for the diagnosis and risks and benefits of the various treatment options;
  6. Create and maintain a medical record for the patient. If a prescription is issued for the patient, and subject to the consent of the patient, the prescriber shall notify the patient’s primary care provider of any prescriptions the provider has issued (see regulation for other related requirements);
  7. Issue proper instructions for appropriate follow-up care
  8. Provide a telehealth visit summary to the patient, including information that indicates any prescriptions that is being prescribed.

SOURCE: IN Code, 25-1-9.5-7. (Accessed Aug. 2024)

A prescription for a controlled substance can be issued for a patient the prescriber has not previously examined if the following conditions are met:

  1. The prescriber has satisfied the applicable standard of care in the treatment of the patient.
  2. The issuance of the prescription is within the prescriber’s scope of practice and certification
  3. The prescription meets the requirements outline in the following section and it is not an opioid. However, opioids may be prescribed if the opioid is a partial agonist that is used to treat or manage opioid dependence.
  4. The prescription is not for an abortion inducing drug

If the prescription is for a medical device, including an ophthalmic device, the prescriber must use telehealth technology that is sufficient to allow the provider to make an informed diagnosis and treatment plan that includes the medical device being prescribed.

Additionally, the following conditions must be met for a prescription for a controlled substance:

SOURCE: IN Code 25-1-9.5-8. (Accessed Aug. 2024).

A pharmacy does not violate this chapter if the pharmacy fills a prescription for an opioid and the pharmacy is unaware that the prescription was written or electronically transmitted by a prescriber providing telehealth services under this chapter.

SOURCE: IN Code 25-1-9.5-11. (Accessed Aug 2024)

A prescriber may not issue a prescription for an ophthalmic device unless the following conditions are met:

SOURCE: IN Code 25-1-9.5-13. (Accessed Aug. 2024)

If a veterinarian is required to establish a veterinarian-client-patient relationship to perform a health care service, the veterinarian shall ensure that a proper veterinarian-client-patient relationship is established, when providing the service using telehealth.

SOURCE: IN Code 25-1-9.5-15. (Accessed Aug. 2024)

Telehealth Services Pilot Program

Prescriptions may not be issued for a controlled substance or an abortifacient.

Telehealth shall not include any encounter in which the patient is assured that any outcome, including the issuance of a prescription, will be issued as a quid pro quo for the payment of the provider’s consultation fee or solely on the basis of an online questionnaire.

SOURCE: IN Code, 844-Article 5-8-3, p. 31. (Accessed Aug. 2024).

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Iowa

Last updated 08/26/2024

Generally, a licensee shall perform an in-person medical interview and …

Generally, a licensee shall perform an in-person medical interview and physical examination for each patient. However, the medical interview and physical examination may not be in-person if the technology utilized in a telemedicine encounter is sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in-person. Prior to providing treatment, including issuing prescriptions, electronically or otherwise, a licensee who uses telemedicine shall interview the patient to collect the relevant medical history and perform a physical examination, when medically necessary, sufficient for the diagnosis and treatment of the patient. An Internet questionnaire that is a static set of questions provided to the patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview, does not constitute an acceptable medical interview and physical examination for the provision of treatment, including issuance of prescriptions, electronically or otherwise, by a licensee.

Under certain circumstances, whether or not such circumstances involve the use of telemedicine, a licensee may treat a patient who has not been personally interviewed, examined and diagnosed by the licensee. See rule.

SOURCE: Iowa Admin Code, Sec. 653-13.11, (Accessed Aug. 2024).

When inducing an abortion by providing an abortion-inducing drug, a physician must be physically present with the woman at the time the abortion-inducing drug is provided.

SOURCE: IA Admin. Code, 653 13.10(3) (Accessed Aug. 2024).

Specific requirements apply for mental health professionals establishing a provider-patient relationship in a school-based setting. See full law text for details.

A mental health professional with prescribing authority who provides telehealth services in accordance with this section shall not prescribe any new medication to a student during a telehealth session. However, a mental health professional with prescribing authority may initiate new prescriptions, alter the dosage of an existing medication, or discontinue an existing medication for the treatment of the student’s behavioral health condition after consultation with the student’s parent or guardian.

SOURCE: IA Code Chapter 280A.4 (Accessed Aug. 2024).

If a mental health professional provides behavioral health services via telehealth on school/AEA premises, the mental health professional will first establish a valid provider-patient relationship. The provider-patient relationship is established when:

If a provider-patient relationship is established and the student has not yet reached the age of majority, parent or guardian consent will be obtained prior to the student receiving behavioral health services via telehealth in a school or AEA setting and is necessary each academic year that the student receives telehealth services.

SOURCE: IA Admin Code 281.14.22, (Accessed Aug. 2024).

Behavioral health services provided via telehealth in a school setting: Iowa Code section 280A.4 is incorporated by this reference.

[see code above]

SOURCE: IA Admin Code 281.14.23, (Accessed Aug. 2024).

The pharmacy and professional pharmacy staff shall ensure that the prescription drug or medication order, regardless of the means of transmission, has been issued for a legitimate medical purpose by a prescriber acting in the usual course of the prescriber’s professional practice. A pharmacist shall not dispense a prescription drug if the pharmacist knows or should have known that the prescription was issued solely on the basis of an Internet-based questionnaire.

SOURCE: IA Admin. Code, 657 8.19(5). (Accessed Aug. 2024).

Physician Assistant-Patient Relationship

A licensee who uses telemedicine will establish a valid physician assistant-patient relationship with the person who receives telemedicine services. The physician assistant-patient relationship begins when:

A valid physician assistant-patient relationship may be established by:

Generally, a licensee will perform an in-person medical interview and physical examination for each patient. However, the medical interview and physical examination may not be in person if the technology utilized in a telemedicine encounter is sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed in person. Prior to providing treatment, including issuing prescriptions, electronically or otherwise, a licensee who uses telemedicine will interview the patient to collect the relevant medical history and perform a physical examination, when medically necessary, sufficient for the diagnosis and treatment of the patient. An Internet questionnaire that is a static set of questions provided to the patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview, does not constitute an acceptable medical interview and physical examination for the provision of treatment, including issuance of prescriptions, electronically or otherwise, by a licensee.

See rule for circumstances where the standard of care may not require a licensee to personally interview or examine a patient.

Prescribing to a patient based solely on an Internet request or Internet questionnaire (i.e., a static questionnaire provided to a patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview) is prohibited. Absent a valid physician assistant-patient relationship, a licensee’s prescribing to a patient based solely on a telephonic evaluation is prohibited, with the exception of the circumstances described in subrule 327.9(21).

SOURCE: Iowa Admin Code, Sec. 645-327.6, (Accessed Aug. 2024).

Nursing – ARNPs

Prior to providing services through telehealth, the licensee shall first establish a practitioner-patient relationship. A practitioner-patient relationship is established when:

A practitioner-patient relationship can be established through an in-person encounter, consultation with another licensee or health care provider, or telehealth encounter.

Notwithstanding paragraphs 7.9(5) “a” and “b,” services may be provided through telehealth without first establishing a practitioner-patient relationship in the following settings or circumstances:

  1. Institutional settings;
  2. Licensed or certified nursing facilities, residential care facilities, intermediate care facilities, assisted living facilities, and hospice settings;
  3. In response to an emergency or disaster;
  4. Informal consultations with another health care provider performed by a licensee outside of the context of a contractual relationship, or on an irregular or infrequent basis, without the expectation or exchange of direct or indirect compensation;
  5. Episodic consultations by a specialist located in another jurisdiction who provides consultation services upon request to a licensee;
  6. A substitute licensee acting on behalf and at the designation of an absent licensee or other health care provider in the same specialty on an on-call or cross-coverage basis; or
  7. When a sexually transmitted disease has been diagnosed in a patient, a licensee prescribes or dispenses antibiotics to the patient’s named sexual partner(s) for the treatment of the sexually transmitted disease as recommended by the U.S. Centers for Disease Control and Prevention.

A licensee providing services through telehealth may issue a prescription to a patient as long as the issuance of such prescription is consistent with the standard of care applicable to the in-person setting.

SOURCE: IA Admin Code Sec. 655-7.9(152), (Accessed Aug. 2024).

Nursing – Midwives

Prior to initiating contact with a client for the purpose of providing services to the client using telehealth, a CPM shall:

Prior to providing services through telehealth, the CPM shall first establish a CPM-client relationship. A CPM-client relationship is established when:

A CPM-client relationship can be established through an in-person encounter, consultation with another CPM or health care provider, or telehealth encounter.

Notwithstanding paragraphs 16.7(5)“a” and “b,” services may be provided through telehealth without first establishing a CPM-client relationship in the following settings or circumstances:

SOURCE: IA Admin Code Sec. 655-16.7, (Accessed Aug. 2024).

A licensee under the purview of the board who provides treatment for the correction of malpositions of human teeth or the initial use of orthodontic appliances shall not begin orthodontic treatment on a new patient unless one of the following conditions is met:

SOURCE: Iowa Annotated Statute Sec. 153.24, (Accessed Aug. 2024).

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Kansas

Last updated 07/03/2024

The same laws and regulations that apply to a healthcare …

The same laws and regulations that apply to a healthcare provider prescribing drugs, including controlled substances, by means of in-person contact with a patient shall apply to prescribing drugs, including controlled substances, by means of telemedicine.

SOURCE: KS Admin. Regs., Sec. 100-77-3. (Accessed Jul. 2024).

Telemedicine may be used to establish a valid provider-patient relationship.

SOURCE: KS Statute Ann. § 40-2,212(b). (Accessed Jul. 2024).

“Legitimate medical purpose,” when used regarding the dispensing of a prescription drug, means that the prescription for the drug was issued with a valid preexisting patient-prescriber relationship rather than with a relationship established through an internet-based questionnaire.

SOURCE: KS Admin. Regs., Sec. 68-2-20(2). (Accessed Jul. 2024).

“Telepharmacy” means the practice of pharmacy by a pharmacist located in Kansas using telecommunications or other automations and technologies to deliver personalized, electronically documented, real-time pharmaceutical care to patients or their agents, who are located at sites other than where the pharmacist is located, including prescription dispensing and counseling and to oversee and supervise telepharmacy outlet operations.

A pharmacist shall be in attendance at the telepharmacy outlet by connecting to the telepharmacy outlet via computer link, video link and audio link or other functionally equivalent telecommunications equipment and shall be available to consult with and assist the pharmacy technician in performing activities.

Not later than January 1, 2023, the board shall adopt rules and regulations necessary to specify additional criteria for a managing pharmacy and telepharmacy outlet under this section, including, but not limited to:

Application requirements;

SOURCE: KS Statute Sec. 65-16, 130, (Accessed Jul. 2024).

Out-of-state physician practice

A physician practicing telemedicine in accordance with this subsection shall conduct an appropriate assessment and evaluation of the patient’s current condition and document the appropriate medical indication for any prescription issued.

SOURCE: KS Statute Ann. Sec. 65-28, 135, (Accessed Jul. 2024).

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Kentucky

Last updated 07/08/2024

As used in KRS 311.595(9), “dishonorable, unethical, or unprofessional conduct

…

As used in KRS 311.595(9), “dishonorable, unethical, or unprofessional conduct of a character likely to deceive, defraud, or harm the public or any member thereof” shall include but not be limited to the following acts by a licensee:

Prescribes or dispenses any medication:

For the purposes of this paragraph, an electronic, on-line, or telephonic evaluation by questionnaire is inadequate for the initial evaluation of the patient or for any follow-up evaluation.

SOURCE: KY Revised Statutes § 311.597. (Accessed Jul. 2024).

“Good-faith prior examination,” as used in KRS Chapter 218A and for criminal prosecution only, means an in-person medical examination of the patient conducted by the prescribing practitioner or other health-care professional routinely relied upon in the ordinary course of his or her practice, at which time the patient is physically examined and a medical history of the patient is obtained. “In-person” includes telehealth examinations. This subsection shall not be applicable to hospice providers licensed pursuant to KRS Chapter 216B.

SOURCE: KY Revised Statute § 218A.010(18). (Accessed Jul. 2024).

A practitioner-patient relationship may commence via telehealth. An in-person initial meeting shall not be required unless the provider determines it is medically necessary to perform those services in person as set forth in KRS 211.336(2)(a). A licensed health care practitioner may represent the licensee at the initial meeting.

See rule for additional requirements.

SOURCE: KY 201 KAR 17:110. (Accessed Jul. 2024).

A physician performing or inducing an abortion shall be present in person and in the same room with the patient. The use of telehealth as defined in 304.17A-005 shall not be allowed in the performance of an abortion.

SOURCE: KY Revised Statute Sec. 311.728. (Accessed Jul. 2024).

Veterinarians

A VCPR shall not be established solely by telehealth means. In the absence of a VCPR, any advice provided through telehealth shall be general and not specific to a patient, diagnosis, or treatment. Veterinary telemedicine shall only be conducted within an existing VCPR, with the exception for advice given in an emergency care situation until that patient can be seen in person by a licensed veterinarian.

SOURCE: KY Revised Statute Sec. 321.185, (Accessed Jul. 2024).

Counselors

A counselor-client relationship may commence via distance counseling. An in-person meeting shall not be required unless the provider determines it is medically necessary to perform those services in person as established in KRS 211.336(2) (a). A licensee using distance counseling to deliver counseling services or who practices distance counseling shall, upon initial contact complete certain tasks (see regulation).

SOURCE: KY Admin Regulations Title 201 KAR 36:045, (Accessed Jul. 2024).

Controlled Substances – Medical Cannabis

A bona fide practitioner-patient relationship may be established following a referral from the patient’s primary care provider and may be maintained via telehealth. However, a bona fide practitioner-patient relationship shall not be established via telehealth.

An initial written certification for the use of medicinal cannabis shall be provided during the course of an in-person examination of the patient by the medicinal cannabis practitioner. Subsequent written certifications, including for the purpose of renewing a registry identification card, may be provided electronically or during the course of a telehealth consultation.

For the purpose of applying for a registry identification card, a written certification provided under this section shall be valid for a period of not more than sixty (60) days. The medicinal cannabis practitioner may renew a written certification for not more than three (3) additional periods of not more than sixty (60) days each. Thereafter, the medicinal cannabis practitioner may issue another certification to the patient only after an in-person examination or an examination conducted via telehealth of the patient by the medicinal cannabis practitioner.

SOURCE: KY Revised Statute Sec. 218B.050, (Accessed Jul. 2024).

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Louisiana

Last updated 06/04/2024

Physicians utilizing telemedicine shall establish a proper physician-patient relationship by:…

Physicians utilizing telemedicine shall establish a proper physician-patient relationship by:

Telemedicine shall not be utilized by a physician with respect to any individual located in this state in the absence of a physician-patient relationship.

The practice of medicine by telemedicine, including the issuance of any prescription via electronic means shall be held to the same prevailing and usually accepted standards of medical practice as those in traditional (face-to-face) settings. An online, electronic or written mail message does not satisfy the standards of appropriate care.

A physician using telemedicine may be at any location at the time the services are provided. A patient receiving medical services by telemedicine may be in any location at the time that the services are received.

SOURCE: LA Admin. Code 46: XLV.7503-05. p. 249-250 (Accessed Jun. 2024).

No physician shall utilize telemedicine:

  1. for the treatment of non-cancer related chronic or intractable pain, as set forth in §§6915-6923 of the board’s rules;
  2. for the treatment of obesity, as set forth in §§6901-6913 of the board’s rules;
  3. to authorize or order the prescription, dispensation or administration of any controlled substance unless;
    1. the physician has had at least one in-person visit with the patient within the past year; provided, however, the requirement for an in-person visit shall not apply to a physician who holds an unrestricted license to practice medicine in LA and who practices telemedicine upon any patient being treated at a healthcare facility that is required to be licensed pursuant to the laws of LA and which holds a current registration with the U.S. Drug Enforcement Administration;
    2. the prescription is issued for a legitimate medical purpose;
    3. the prescription is in conformity with the standard of care applicable to an in-person visit; and
    4. the prescription is permitted by and in conformity with all applicable state and federal laws and regulations.

The board may grant an exception to the limitations of §7513.C in an individual case that is supported by a physician’s written application stating how and why he or she proposes to deviate from §7513.C. If an exception is granted by the board it shall be stated in writing and specify the manner and extent to which the physician shall be authorized to depart from §7513.C.

SOURCE: LA Admin. Code 46: XLV.7513. p. 251 (Accessed Jun. 2024).

All of the following restrictions and authorizations apply to a physician who holds an unrestricted license to practice medicine from the board and who utilizes telehealth for any patient who is being treated at a healthcare facility that is required to be licensed pursuant to the laws of this state and which holds a current registration with the United States Drug Enforcement Administration:

The physician may prescribe any controlled dangerous substance without necessity of conducting an appropriate in-person patient history or physical examination of the patient as otherwise would be required by R.S. 40:1223.4.

The physician shall not be subject to any regulatory prohibition or restriction on the utilization of telehealth, including prohibitions or restrictions related to prescribing controlled dangerous substances, which are in any manner more restrictive than the prohibitions and restrictions that are otherwise applicable to the entire practice of medicine.

SOURCE: LA Statute Sec. 37:1271.1, (Accessed Jun. 2024).

Except as otherwise provided in Paragraph (6) of this Subsection, a healthcare provider shall not be required to conduct an in-person patient history or physical examination of the patient before engaging in a telehealth encounter but shall provide a referral to a healthcare provider in this state or arrange for follow-up care in this state as necessary.

Except as authorized by R.S. 37:1271.1 or otherwise by rule promulgated by a state agency or professional or occupational licensing board or commission, no healthcare provider shall prescribe any controlled dangerous substance prior to conducting an appropriate in-person patient history or physical examination of the patient as determined by the appropriate state agency or professional or occupational licensing board or commission.

A healthcare provider may use interactive audio without the requirement of video if, after access and review of the patient’s medical records, the healthcare provider determines that he is able to meet the same standard of care as if the healthcare services were provided in person.

Creation of a record on each patient. The record shall be made available, upon request, to the state agency or professional or occupational licensing board or commission that regulates the practice of the healthcare provider.

SOURCE: LA Revised Statute 40:1223.4 (Accessed Jun. 2024).

Except as authorized by R.S. 37:1271.1 [see above] or otherwise by rule promulgated by the board, no physician practicing telemedicine pursuant to this Subsection shall prescribe any controlled dangerous substance prior to conducting an appropriate in-person patient history or physical examination of the patient as determined by the board.

SOURCE: LA Revised Statutes 37:1271(B)(3). (Accessed Jun. 2024).

Teledentistry

Controlled substances may not be prescribed via teledentistry except in emergency situations where the dentist determines:

In an emergency situation the prescription for a controlled substance must be limited to the amount adequate to treat the patient during the emergency period.

SOURCE: LA Admin. Code LAC 46:XXXIII.203 (Accessed Jun. 2024).

Board of Optometry

Evaluation, treatment, and consultation recommendations made in an optometric telemedicine setting, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional in-person clinical settings.

SOURCE: LA Admin Code LAC 46:LI.509, (Accessed Jun. 2024).

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Maine

Last updated 05/20/2024

Insurers may not place any restriction on the prescribing of …

Insurers may not place any restriction on the prescribing of medication through telehealth by a provider whose scope of practice includes prescribing medication that is more restrictive than any requirement in state and federal law for prescribing medication through in-person consultation.

The carrier shall require that a clinical evaluation is conducted either in person or through telehealth before a provider may write a prescription that is covered.

SOURCE: Maine Revised Statutes Annotated, Title 24-A, Sec. 4316 (Accessed May 2024).

Board of Licensure in Medicine, State Board of Nursing, & Board of Osteopathic Licensure

A licensee who uses telehealth in providing health care shall establish a valid licensee-patient relationship with the person who receives telehealth services. The licensee-patient relationship begins when:

A valid licensee-patient relationship may be established between a licensee who uses telehealth in providing health care and a patient who receives telehealth services through any of the following circumstances:

Medical History and Physical Examination

Generally a physician, physician assistant, and advanced practice registered nurse shall perform an in-person clinical interview and physical examination for each patient. However, the clinical interview and physical examination may not be in-person if the technology utilized in a telehealth encounter is sufficient to establish an informed diagnosis as though the clinical interview and clinician examination had been performed in-person. Prior to providing treatment, including issuing prescriptions, electronically or otherwise, a licensee who uses telehealth in providing health care shall interview the patient to collect the relevant medical history and perform a pertinent physical examination as defined by the standard of care for the purpose of the visit, when clinically necessary, sufficient for the diagnosis and treatment of the patient. An internet questionnaire that is a static set of questions provided to the patient, to which the patient responds with a static set of answers, in contrast to an adaptive interactive and responsive online interview, does not constitute an acceptable clinical interview and physical examination for the provision of treatment, including issuance of prescriptions, electronically or otherwise, by the licensee.

Prescribing Based Solely on an Internet Request, Internet Questionnaire or a Telephonic Interview Prohibited

Prescribing to a patient based solely on an Internet request or Internet questionnaire (i.e. static questionnaire provided to a patient, to which the patient responds with a static set of answers, in contrast to an adaptive, interactive and responsive online interview) is prohibited. Absent a valid licensee-patient relationship, a licensee’s prescribing to a patient based solely on a telephonic evaluation is prohibited, with the exception of the circumstances described in Section 3, subsection 20, subparagraph A(3) of this rule.

Telehealth technologies, where prescribing may be contemplated, must implement measures to uphold patient safety in the absence of traditional physical examination. Such measures should guarantee that the identity of the patient and provider is clearly established and that detailed documentation for the clinical evaluation and resulting prescription is required. Measures to assure informed, accurate and error prevention prescribing practices (e.g. integration with e-Prescription systems) are encouraged. All applicable law shall be complied with.

Prescribing medications, in-person or via telehealth, is at the professional discretion of the licensee. The licensee prescribing via telehealth must ensure that the clinical evaluation, indication, appropriateness, and safety consideration for the resulting prescription are appropriately documented and meet the applicable standard of care. Consequently, prescriptions via telehealth carry the same accountability as prescriptions delivered during an encounter in person. However, where such measures are upheld, and the appropriate clinical consideration is carried out and documented, licensees may exercise their judgment and prescribe medications as part of telehealth encounters.

Circumstances Where the Standard of Care May Not Require A Licensee to Personally Interview or Conduct a Nursing Assessment or Physical Examination of a Patient

Under the following circumstances, whether or not such circumstances involve the use of telehealth in providing health care, a licensee may treat a patient who has not been personally interviewed, examined, assessed and diagnosed by the licensee:

  1. Situations in which the licensee prescribed medications on a short-term basis for a new patient and has scheduled an appointment to personally examine the patient;
  2. For institutional settings, including writing initial admission orders for a newly hospitalized patient;
  3. Call situations in which a licensee is taking call for another licensee who has an established licensee-patient relationship with the patient;
  4. Cross-coverage situations in which a licensee is taking call for another licensee who has an established licensee-patient relationship with the patient;
  5. Situations in which the patient has been examined in person by an advanced practice registered nurse or a physician assistant or other licensed practitioner with whom the licensee has a supervisory or collaborative relationship;
  6. Emergency situations in which the life or health of the patient is in imminent danger;
  7. Emergency situations that constitute an immediate threat to the public health including, but not limited to, empiric treatment or prophylaxis to prevent or control an infectious disease outbreak;
  8. Situations in which the licensee has diagnosed a sexually transmitted disease in a patient and the licensee prescribes or dispenses antibiotics to the patient’s named sexual partner(s) for the treatment of the sexually transmitted disease as recommended by the U.S. Centers for Disease Control and Prevention;
  9. Situations where the patients are in a licensed or certified long term care facility, nursing facility, residential care facility, intermediate care facility, assisted living facility or hospice setting and doing so is within the practice standards for that setting; and
  10. Circumstances in which a patient’s treating clinician determines that a radiology or pathology consultation is warranted

SOURCE: ME Regulation Sec. 02-373 Ch. 11, 02-380; Ch. 11, 02-383 Ch. 11. (Accessed May 2024).

Teledentistry

Prior to establishing a patient relationship as defined by Board Rules, Chapter 1(I)(N) and prior to providing teledentistry services, a dentist, denturist, or a dental hygienist (when the dental hygienist is providing services as an independent practice dental hygienist, public health dental hygienist, dental therapist, or and provisional dental therapist) must take reasonable steps to verify the patient’s physical location.

Practice Requirements Specific to Prescribing Medications (Dentistry)

SOURCE: ME Regulation Sec. 02-313 Ch. 15, (Accessed May 2024).

Optometrists

“Optometrist-patient relationship” includes the relationship established between a licensee who uses telehealth in providing optometric care and a patient who receives telehealth services through consultation with another licensee or other health care provider who has an established relationship with the patient upon agreement to participate in, or supervise, the patient’s care through telehealth, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telehealth practice guidelines that address the clinical and technological aspects of telemedicine.

SOURCE: ME Statute Ch. 151, Subch. 1, 19601, (Accessed May 2024).

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Maryland

Last updated 05/27/2024

A health care practitioner may establish a practitioner-patient relationship through …

A health care practitioner may establish a practitioner-patient relationship through either a synchronous telehealth interaction or an asynchronous telehealth interaction, if the health care practitioner:

A health care practitioner shall perform a clinical evaluation that is appropriate for the patient and the condition with which the patient presents before providing treatment or issuing a prescription through telehealth. Synchronous or asynchronous telehealth interaction may be used for the clinical evaluation.

A health care practitioner may not prescribe a Schedule II controlled substance that is an opiate for the treatment of pain through telehealth unless:

A health care practitioner who prescribes a controlled substance through telehealth is subject to federal and state prescribing laws.

SOURCE: MD Code Health Occupations Sec. 1-1002, Section 1-1003. (Accessed May 2024).

Before performing telehealth services, a telehealth practitioner shall develop and follow a procedure to:

Except when providing store and forward telehealth services, remote patient monitoring, or other asynchronous telehealth services, a telehealth practitioner shall:

SOURCE: Code of Maryland Admin. Regs. Sec. 10.32.05.04. (Accessed May 2024).

A telehealth practitioner shall perform a synchronous, audio-visual patient evaluation adequate to establish diagnoses and identify underlying conditions or contraindications to recommended treatment options before providing treatment or prescribing medication. A telehealth practitioner may use surrogate examiner; or a patient evaluation performed by another licensed health care practitioner providing coverage.

These requirements do not apply to:

SOURCE: Code of Maryland Admin. Regs. Sec. 10.32.05.05. (Accessed May 2024).

A telehealth practitioner may not treat a patient or prescribe medication based solely on an online questionnaire.

A telehealth practitioner may not prescribe opioids for the treatment of pain through telehealth except if the patient is in a health care facility as defined in Health-General Article, §19-114(d)(1), Annotated Code of Maryland.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.32.05.06. (Accessed May 2024).

Audiologists, Hearing Aid Dispensers, Speech-Language Pathologists, Music Therapists

Except when providing asynchronous telehealth services or remote patient monitoring, a telehealth practitioner shall:

If the evaluation is adequate to comply with §A of this regulation, a telehealth practitioner may use:

A telehealth practitioner shall comply with all applicable laws and regulations governing referrals, testing, and evaluation of patients including, but not limited to, the requirements of:

A telehealth practitioner may not treat a patient based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.41.06.05. (Accessed May 2024).

Podiatrists

Except when providing asynchronous telehealth services or remote patient monitoring, a telehealth practitioner shall:

If the evaluation is adequate to comply with §A of this regulation, a telehealth practitioner may use:

A telehealth practitioner may not treat a patient or issue a prescription based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.40.12.05. (Accessed May 2024).

Occupational and Physical Therapists

An occupational or physical therapist who practices telehealth shall:

A telehealth practitioner may not treat a patient based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.46.08.05; 10.38.13.05. (Accessed May 2024).

Massage Therapists

A telehealth practitioner shall:

A telehealth practitioner may not treat a client based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.65.10.05. (Accessed May 2024).

Chiropractors

A telehealth practitioner shall:

A telehealth practitioner may not treat a patient based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.43.17.05. (Accessed May 2024).

Professional Counselors and Therapists and Social Workers

A teletherapy practitioner shall:

A teletherapy practitioner may not treat a client based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.58.06.05; 10.42.10.05. (Accessed May 2024).

Dieticians

A dietician who practices telehealth shall:

A telehealth practitioner may not treat a patient based solely on an online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.56.10.05. (Accessed May 2024).

Optometrists

Subject to the provisions of Health Occupations Article, §11-208, Annotated Code of Maryland, a telehealth practitioner shall:

A telehealth practitioner may not treat a patient or issue a prescription based solely on a static online questionnaire.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.28.01.05. (Accessed May 2024).

Psychologists

Before engaging in the practice of psychology using telepsychology, a psychologist or psychology associate shall evaluate the client to determine that delivery of telepsychology is appropriate considering at least the following factors:

The client evaluation set forth in §A of this regulation shall take place at an initial in-person session, unless the psychologist or psychology associate documents in the record the reason for not meeting in person.

SOURCE: Code of Maryland Admin. Regs. Sec. 10.36.10.05. (Accessed May 2024).

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Massachusetts

Last updated 08/07/2024

The practice of medicine shall not require a face-to-face encounter …

The practice of medicine shall not require a face-to-face encounter between the physician and the patient prior to health care delivery via telemedicine. The standard of care applicable to the physician is the same whether the patient is seen in-person or through telemedicine.

SOURCE: “Policy on Telemedicine,” Board of Registration in Medicine. Oct. 6, 2022. (Accessed Aug. 2024).

To be valid, a prescription must be issued in the usual course of the physician’s professional practice, and within a physician-patient relationship that is for the purpose of maintaining the patient’s well-being. In addition, the physician must conform to certain minimum standards of patient care, such as taking an adequate medical history, doing a physical and/or mental status examination and documenting the findings. This rule applies to any prescription, issued by any means, including the Internet or other electronic process. Prescribing that does not meet these requirements is unlawful.

SOURCE: Prescribing Practices Policy and Guidelines Policy 15-05 (Adopted Oct. 8, 2015), (Amended June 15, 2023). (Accessed Aug. 2024).

A prescription for a controlled substance to be valid shall be issued for a legitimate medical purpose by a practitioner acting in the usual course of his professional practice.…An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is not a prescription within the meaning and intent [of this act]. M.G.L. c. 94C, Section 19(a)

This statutory language sets forth the minimum requirements that must be met in order for a prescription to be valid in the Commonwealth. To satisfy the requirement that a prescription be issued by a practitioner in the usual course of his professional practice, there must be a physician-patient relationship that is for the purpose of maintaining the patient’s well-being and the physician must conform to certain minimum norms and standards for the care of patients, such as taking an adequate medical history and conducting an appropriate physical and/or mental status examination and recording the results. Issuance of a prescription, by any means, including the Internet or other electronic process, that does not meet these requirements is therefore unlawful.

SOURCE: “Internet Prescribing,” MA Board of Registration in Medicine. Dec. 17, 2003, (Accessed Aug. 2024).

Cannabis Control Commission

Clinical Visit means an in-person or telehealth visit during which a Certifying Healthcare Provider establishes a Bona Fide Healthcare Provider Patient Relationship and conducts a full assessment of the Patient’s medical history and current medical condition, including the Debilitating Medical Condition, and explains the potential benefits and risks of Marijuana use. A Clinical Visit for an initial Certificate of Registration shall be performed in-person.

SOURCE: MA Regulations, Cannabis Control Commission, Ch. 935 CMR 501.002. (Accessed Aug. 2024).

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Michigan

Last updated 09/04/2024

Before dispensing a drug or device pursuant to a prescription

…

Before dispensing a drug or device pursuant to a prescription under this subsection, the pharmacist, in the exercise of his or her professional judgment, must determine all of the following:

A pharmacist or a prescriber shall dispense a drug or device pursuant to a prescription only if the prescription falls within the scope of practice of the prescriber.

A pharmacist shall not knowingly dispense a drug or device pursuant to a prescription after the death of the prescriber or patient.

A pharmacist shall not dispense a drug or device pursuant to a prescription transmitted by facsimile or created in electronic format and printed out for use by the patient unless the document is manually signed by the prescriber.

See statute for additional requirements.

SOURCE: MI Compiled Laws Sec. 333.17751(2)(a). (Accessed Sept. 2024).

A licensed prescriber shall not prescribe a controlled substance listed in schedules 2 to 5 unless the prescriber is in a bona fide prescriber-patient relationship with the patient for whom the controlled substance is being prescribed.

If a licensed prescriber prescribes a controlled substance under this subsection, the prescriber shall provide follow-up care to the patient to monitor the efficacy of the use of the controlled substance as a treatment of the patient’s medical condition. If the licensed prescriber is unable to provide follow-up care, he or she shall refer the patient to the patient’s primary care provider for follow-up care or, if the patient does not have a primary care provider, he or she shall refer the patient to another licensed prescriber who is geographically accessible to the patient for follow-up care.

SOURCE: MI Compiled Laws Sec. 333.7303a. (Accessed Sept. 2024).

A health professional providing telehealth service to a patient may prescribe the patient a drug if both the following are met:

A health professional who prescribes a drug under subsection (1) shall comply with both of the following:

SOURCE: MI Compiled Laws, Sec. 333.16285. (Accessed Sept. 2024).

Podiatric Medicine

A podiatrist providing a telehealth service may prescribe a drug if the podiatrist is a prescriber acting within the scope of his or her practice and in compliance with section 16285 of the code, MCL 333.16285, if he or she does both of the following:

A podiatrist providing any telehealth service must do both of the following:

SOURCE: MI Administrative Code 338.8145, (Accessed Sept. 2024).

Genetic Counseling, Medicine, Otheopathic Medicine

A licensee providing a telehealth service may prescribe a drug if the licensee is a prescriber acting within the scope of the licensee’s practice and in compliance with section 16285 of the code, MCL 333.16285, and if the licensee does both of the following:

A licensee providing any telehealth service shall do both of the following:

SOURCE: MI Administrative Code R. 338.2455, MI Administrative Code R 338.2407 & MI Administrative Code R 338.114, (Accessed Sept. 2024).

Counseling

A licensee providing any telehealth service shall do both of the following:

SOURCE: MI Administrative Code R 338.1758, (Accessed Sept. 2024).

Optometry

An optometrist providing a telehealth service may prescribe a drug if the optometrist is a prescriber acting within the scope of the optometrist’s practice and in compliance with section 16285 the code, MCL 333.16285, if the optometrist does both of the following:

An optometrist may provide a telehealth service only when the optometrist complies with all of the following:

SOURCE: MI Administrative Code 338.306, (Accessed Sept. 2024).

Veterinary Medicine

A veterinarian providing a telehealth service may prescribe a drug if the veterinarian is a prescriber acting within the scope of his or her practice and in compliance with section 16285 of the code, MCL 333.16285.

SOURCE: MI Administrative Code R 338.4901a, (Accessed Sept. 2024).

Dentistry

A licensee who is authorized to prescribe may prescribe a drug during a telehealth service if the licensee complies with all of the following:

SOURCE: MI Administrative Code R 338.11615, (Accessed Sept. 2024).

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Minnesota

Last updated 06/24/2024

“Telehealth” has the meaning given in section 62A.673, subdivision 2, …

“Telehealth” has the meaning given in section 62A.673, subdivision 2, paragraph (h).

A physician-patient relationship may be established through telehealth.

A physician providing health care services by telehealth in this state shall be held to the same standards of practice and conduct as provided in this chapter for in-person health care services.

SOURCE: MN Statute 147.033. (Accessed Jun. 2024).

A prescription drug order for the following drugs is not valid, unless it can be established that the prescription drug order was based on a documented patient evaluation, including an examination, adequate to establish a diagnosis and identify underlying conditions and contraindications to treatment:

The requirement for an examination shall be met if:

An in-person examination has been completed in any of the following circumstances:

The prescription order is for a drug listed in paragraph (d), clause (6), or for substance use disorder treatment with medications for opioid use disorder, and the prescribing practitioner has completed an examination of the patient via telehealth as defined in section 62A.673, subdivision 2, paragraph (h).

Nothing in paragraph (d) or (e) prohibits a licensed practitioner from prescribing a drug through the use of a guideline or protocol pursuant to paragraph (a).

SOURCE: MN Statute Sec. 151.37 Subd. 2(d) & (e).(Accessed Jun. 2024).

Optometry

For the purposes of a provider prescribing ophthalmic goods to a patient, the provider must establish a provider-patient relationship through an examination pursuant to paragraph (c).

An examination meets the requirements of paragraph (b) if it takes place:

  1. In person;
  2. through face-to-face interactive, two-way, real-time communication; or
  3. through store-and-forward technologies when all of the following conditions are met:
    1. The provider obtains an updated medical history and makes a diagnosis at the time of prescribing;
    2. the provider conforms to the standard of care expected of in-person care as appropriate to the patient’s age and presenting condition, including when the standard of care requires the use of diagnostic testing and performance of a physical examination, which may be carried out through the use of peripheral devices appropriate to the patient’s condition;
    3. the ophthalmic prescription is not determined solely by use of an online questionnaire;
    4. the provider is licensed and authorized to issue an ophthalmic prescription in MN; and
    5. upon request, the provider provides patient records in a timely manner in accordance with state and federal requirements.

This subdivision does not apply to the sale of over-the-counter eyeglasses, also known as readers, that are not designed to address the visual needs of the individual wearer.

SOURCE: MN Statute Sec. 145.713, Subd. 4, (Accessed Jun. 2024).

Medical Cannabis

Before issuing a written certification of qualifying condition, a health care practitioner must: …

SOURCE: MN Administrative Rule. 4770.4014, Subpart 2(B)(1). (Accessed Jun. 2024).

Controlled Substances – Medical Cannabis

A health care practitioner may utilize telehealth, as defined in section 62A.673, subdivision 2, for certifications and recertifications.

SOURCE: MN Statute Sec. 152.28, (Accessed Jun. 2024).

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Mississippi

Last updated 08/05/2024

A prescription for a controlled substance based solely on a …

A prescription for a controlled substance based solely on a consumer’s completion of an online medical questionnaire is not a valid prescription.

SOURCE: MS Code Annotated 41-29-137. (Accessed Aug. 2024).

Subject to the limitations of the license under which the individual is practicing, a health care practitioner licensed in this state may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations to a patient after having performed an appropriate examination of the patient either in person or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically. Treatment recommendations made via electronic means, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional provider-patient settings.

SOURCE: MS Code Sec. 41-127-1, (Accessed Aug. 2024).

Patients with Terminal Disease Pain

The medical director of a licensed hospice, in his or her discretion, may prescribe controlled substances for a patient of the hospice for terminal disease pain without having an in-person face-to-face visit with the patient before issuing the prescription. The provisions of this section supersede the provisions of any rule or regulation of a licensing agency to the contrary.

SOURCE: MS Code Sec. 41-29-137.1 (Accessed Aug. 2024).

Practice of Medicine

In order to practice any form of telemedicine, as defined in R.5.1, a valid “physician patient relationship” must be established. The elements of this valid relationship are:

Providers using telemedicine technologies to provide medical care to patients located in Mississippi must provide an appropriate examination prior to diagnosis and treatment of the patient. However, this exam need not be in person if the technology is sufficient to provide the same information to the physician as if the exam had been performed face to face.

Store-and-Forward Transfer Technology may be used to enhance, but never replace, real-time provider-patient interaction. Provider-patient interaction may be audio-visual or audio only where medically appropriate.

Other exams may be appropriate if a licensed health care provider is on site with the patient and is able to provide various physical findings that the physician needs to complete an adequate assessment. However, a simple questionnaire without an appropriate exam is in violation of this policy and may subject the physician to discipline by the Board.

Any physician utilizing the automated dispensary will be responsible for the proper maintenance and inventory/accountability requirements as if the physician were personally dispensing the medications to the patient from his or her stock in their personal practice, as required in Rule 1.9 of Part 2640. An automated dispensary may not dispense controlled substances, and refills of medications may not be issued without a follow-up visit with the physician.

Any telemedicine service devices or systems which contain automated dispensaries, containing medications ordered and maintained by physician licensees, shall be subject to the oversight of the Board and the Mississippi Board of Pharmacy, as stated in Part 2640, Rule 1.9, and may not operate in this state until approved by both Boards.

SOURCE: MS Admin. Code Title 30, Part 2635, Rule 5.4 to 5, & 9. (Accessed Aug. 2024).

Prescriptions may not be written outside of a valid licensee-patient relationship. While not all of the elements in subsection A are necessary each time a prescription is authorized (e.g., via appropriate telemedicine as defined in Rule 5.5 of Part 2635, calling in refills, taking call for a practice partner for short term care, etc.), all initial encounters, and at reasonable intervals thereafter, should conform to this rule and be done pursuant to a valid licensee-patient relationship. The elements of this valid relationship are: …

Licensees must not prescribe, administer or dispense any legend drug; any controlled substance; or any drug having addiction-forming or addiction-sustaining liability without a good faith prior examination and medical indication. A determination as to whether a “good faith prior examination and medical indication” exists depends upon the facts and circumstances in each case. One of the primary roles of a physician is to elicit detailed information about the signs and symptoms which a patient presents in order that he or she may recommend a course of treatment to relieve the symptoms and cure the patient of his or her ailment or maintain him or her in an apparent state of good health. In order for a licensee to achieve a reasonable diagnosis and treatment plan, a history and physical examination consistent with the nature of the complaint are necessary. The importance of these aspects of proper medical practice cannot be over emphasized. The paramount importance of a complete medical history in establishing a correct diagnosis is well established. Standards of proper medical practice require that, upon any encounter with a patient, in order to establish proper diagnosis and regimen of treatment, a licensee must take three steps: (a) take and record an appropriate medical history, (b) carry out an appropriate physical examination, and (c) record the results. The observance of these principles is an integral component of the “course of legitimate professional practice.”

Some of the factors used in determining the presence or absence of “good faith” may include, but are not limited to:

SOURCE: MS Admin Code Title 30, Part 2640, Rule 1.4 and 1.11, (Accessed Aug. 2024).

Optometry

The use of eye and vision telehealth services is not appropriate for establishing the doctor-patient relationship, for an initial diagnosis, as a replacement for recommended face-to-face interactions. It is therefore mandated that the doctor-patient relationship begin with an initial face-to-face encounter.

The standard of care must remain the same regardless of whether eye and vision telehealth services are provided in-person, remotely, via telehealth, or through any combination thereof. Doctors of optometry may not waive this obligation, or require patients to waive their right to receive the established standard of care in the state of Mississippi.

Eye and vision telehealth services cannot, based on current technologies and uses, replace an in-person comprehensive eye examination provided by an eye doctor. Eye and vision telehealth services provided must be consistent with and in compliance with existing rules and regulations of practice established in the State of Mississippi. In order to protect and insure patient safety, the Board recommends the use of only technology approved by the Food and Drug Administration, designed specifically for use in optometric care.

During telehealth encounters the patient must be in the presence of an onsite health provider.

An Established Treatment Site or distant site Mississippi licensed health care provider means a person licensed to provide health care to patients in Mississippi.

During telehealth encounters a Mississippi licensed optometrist must be present either onsite or distant site or both.

“Bona-fide practitioner-patient relationship” means:

SOURCE: MS Rules and Regulations, Title 30 Part 2901 Chapters 1-11.6, 12.2 Part 2901 (Accessed Aug. 2024).

Occupational Therapy

An occupational therapist using telehealth technologies to deliver health-care services to a patient must, prior to diagnosis and treatment, establish a provider-patient relationship by one of the following methods:

An appropriate occupational therapy evaluation may be composed of multiple components, tests, or measurement tools. It is the responsibility of the evaluating occupational therapist to select and utilize evaluation components that are appropriate and reliable to administer via telehealth.

See regulations for additional requirements.

SOURCE: Title 15, Part 19, Subpart 60, Rule 8.1.5 (Accessed Aug. 2024).

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Missouri

Last updated 09/06/2024

Signing a blank prescription form; or dispensing, prescribing, administering or …

Signing a blank prescription form; or dispensing, prescribing, administering or otherwise distributing any drug, controlled substance or other treatment without sufficient examination including failing to establish a valid physician-patient relationship pursuant to section 334.108, or for other than medically accepted therapeutic or experimental or investigative purposes duly authorized by a state or federal agency, or not in the course of professional practice, or not in good faith to relieve pain and suffering, or not to cure an ailment, physical infirmity or disease, except as authorized in section 334.104.

SOURCE: MO Revised Statutes § 334.100(4)(h). (Accessed Sept. 2024).

A telemedicine encounter, if the standard of care does not require an in-person encounter, and in accordance with evidence-based standards of practice and telemedicine practice guidelines that address the clinical and technological aspects of telemedicine.

SOURCE: MO Revised Statute Ch. 191 Sec. 191.1146. (Accessed Sept. 2024).

Prior to prescribing any drug, controlled substance, or other treatment through telemedicine, as defined in section 191.1145, or the internet, a physician shall establish a valid physician-patient relationship as described in section 191.1146. This relationship shall include:

The requirements of subsection 1 (see above) may be satisfied by the prescribing physician’s designee when treatment is provided in:

No health care provider, as defined in section 376.1350, shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an evaluation over the telephone; except that, a physician or such physician’s on-call designee, or an advanced practice registered nurse, a physician assistant, or an assistant physician in a collaborative practice arrangement with such physician, may prescribe any drug, controlled substance, or other treatment that is within his or her scope of practice to a patient based solely on a telephone evaluation if a previously established and ongoing physician-patient relationship exists between such physician and the patient being treated.

No health care provider shall prescribe any drug, controlled substance, or other treatment to a patient based solely on an internet request or an internet questionnaire.

SOURCE: MO Revised Statute Sec. 334.108. (Accessed Sept. 2024).

“Remote dispensing site pharmacy”, any location in this state where the practice of pharmacy occurs and that is licensed as a pharmacy to dispense prescription drugs and is staffed by one or more qualified pharmacy technicians, as defined by the board, or intern pharmacists, whose activities are supervised by a pharmacist at a supervising pharmacy through a continuous real-time audio and video link. “Remote dispensing site pharmacy” does not include the office of a dispensing prescriber or an automated device.

A remote dispensing site pharmacy shall be located at least ten miles from an existing retail pharmacy unless:

SOURCE: MO Revised Statutes Sec. 338.215, (Accessed Sept. 2024).

HealthNet Medicaid Program

In order to establish a provider-patient relationship through telemedicine—

SOURCE: MO Code of State Regulations, Title 13 Sec. 70-3.330, (Accessed Sept. 2024).

Mental Health – Division of Behavioral Health Community Treatment Program

For purposes of the provision of all services via telemedicine and audio-only, the provider-patient relationship may be established by the following:

In order to establish a provider-patient relationship via telemedicine and/or audio-only for all services:

In-Person Requirements Post Federal Declaration of Public Health Emergency (PHE)

SOURCE: MO Division of Behavioral Health, Community Treatment Program, July 8, 2022, (Accessed Sept. 2024).

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Montana

Last updated 06/03/2024

The licensee using telemedicine in the treatment and care of …

The licensee using telemedicine in the treatment and care of patients in Montana shall adhere to the same standards of care required for in-person medical care settings.

A provider-patient relationship may be established for purposes of telemedicine:

The licensee using telemedicine in patient care may prescribe Schedule II drugs in compliance with Drug Enforcement Agency requirements and 37-20-404, MCA.

The licensee using telemedicine in patient care shall:

SOURCE: Montana State Board of Medical Examiners. Administrative Rules of MT. Rule 24.156.813 Practice Requirements for Physicians Using Telemedicine. (Accessed Jun. 2024).

“Practice pharmacy by means of telehealth” means to provide pharmaceutical care through the use of information technology to patients at a distance.

SOURCE: Montana Code Annotated 37-7-101 (Accessed Jun. 2024).

Except as otherwise provided in this section, a medical practitioner:

SOURCE: MT Statute Sec. 37-2-104 (Accessed Jun. 2024).

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Nebraska

Last updated 08/05/2024

Any credential holder under the Uniform Credentialing Act may establish …

Any credential holder under the Uniform Credentialing Act may establish a provider-patient relationship through telehealth.

Any credential holder under the Uniform Credentialing Act who is providing a telehealth service to a patient may prescribe the patient a drug if the credential holder is authorized to prescribe under state and federal law.

This section does not apply to a credential holder under the Cosmetology, Electrology, Esthetics, Nail Technology, and Body Art Practice Act, the Dialysis Patient Care Technician Registration Act, the Environmental Health Specialists Practice Act, the Funeral Directing and Embalming Practice Act, the Massage Therapy Practice Act, the Medical Radiography Practice Act, the Nursing Home Administrator Practice Act, the Perfusion Practice Act, the Surgical First Assistant Practice Act, or the Veterinary Medicine and Surgery Practice Act.

SOURCE: NE Revised Statute 38-1,143. (Accessed Aug. 2024).

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Nevada

Last updated 07/15/2024

Before a provider of health care who is located at …

Before a provider of health care who is located at a distant site may use telehealth to direct or manage the care or render a diagnosis of a patient who is located at an originating site in this State or write a treatment order or prescription for such a patient, the provider must hold a valid license or certificate to practice his or her profession in this State, including, without limitation, a special purpose license issued pursuant to NRS 630.261. The requirements of this subsection do not apply to a provider of health care who is providing services within the scope of his or her employment by or pursuant to a contract entered into with an urban Indian organization, as defined in 25 U.S.C. § 1603.

A provider of health care may establish a relationship with a patient using telehealth when it is clinically appropriate to establish a relationship with a patient in that manner. The State Board of Health may adopt regulations governing the process by which a provider of health care may establish a relationship with a patient using telehealth.

SOURCE: NV Revised Statutes Sec. 629.515, (Accessed Jul. 2024).

A bona fide relationship between the patient and the person prescribing the controlled substance shall be deemed to exist if the patient was examined in person, electronically, telephonically or by fiber optics, including, without limitation, through telehealth, within or outside this State or the United States by the person prescribing the controlled substances within the 6 months immediately preceding the date the prescription was issued.

SOURCE: NV Revised Statutes Sec. 639.235(4). (Accessed Jul. 2024).

Before issuing an initial prescription for a controlled substance listed in schedule II, III or IV for the treatment of pain, a practitioner, other than a veterinarian, must:

If a practitioner, other than a veterinarian, prescribes a controlled substance listed in schedule II, III or IV for the treatment of pain, the practitioner shall not issue more than one additional prescription that increases the dose of the controlled substance unless the practitioner meets with the patient, in person or using telehealth, to reevaluate the treatment plan.

SOURCE: NV Revised Statutes Sec. 639.23911. (Accessed Jul. 2024).

Before prescribing a controlled substance listed in schedule II, III or IV to continue the treatment of pain of a patient who has used the controlled substance for 90 consecutive days or more, a practitioner, other than a veterinarian, must: …

SOURCE: NV Revised Statutes Sec. 639.23913. (Accessed Jul. 2024).

An advanced practice registered nurse may perform the acts described in paragraphs (a), (b) and (c) of subsection 2 by using equipment that transfers information concerning the medical condition of a patient in this State electronically, telephonically or by fiber optics, including, without limitation, through telehealth, as defined in NRS 629.515, from within or outside this State or the United States.

SOURCE: NV Revised Statutes Sec. 632.237(4). (Accessed Jul. 2024).

Veterinarians

A veterinarian-client-patient relationship is not established solely through veterinary telemedicine. However, once established, a veterinarian-client-patient relationship may be maintained via veterinary telemedicine between:

Advice and recommendations may be provided via veterinary telemedicine in an emergency, but only until the animal can be examined in person by a licensed veterinarian. See statute for additional requirements related to a veterinarian-client-patient relationship.

SOURCE: NV Revised Statutes Sec. 638.1521(4), (Accessed Jul. 2024).

Dentistry

A licensee who provides dental services through teledentistry, including, without limitation, providing consultation and recommendations for treatment, issuing a prescription, diagnosing, correcting the position of teeth and using orthodontic appliances, shall provide such services in accordance with the same standards of care and professional conduct as when providing those services in person or by other means.

A licensee shall not:

SOURCE: NV Revised Statute Ch. 631, (Accessed Jul. 2024).

A licensee may:

Use teledentistry to examine an existing patient for the purpose of providing a new diagnosis, or to examine a new patient if the examination is sufficient, in accordance with evidence-based standards of practice, to provide an informed diagnosis.

Collaborate in real time through teledentistry with a person who is not licensed pursuant to this chapter, including, without limitation, a community health worker, provider of health care or student who is enrolled in a program of study in dentistry, dental therapy or dental hygiene, to provide diagnostic services or plan treatment for a dental emergency.

SOURCE: NV Revised Statute Ch. 631, (Accessed Jul. 2024).

Except as otherwise provided in this subsection, a licensee must establish a bona fide relationship, as defined by regulation of the Board, with a patient before providing services to the patient through teledentistry. A licensee may establish such a relationship through teledentistry only:

SOURCE: NV Revised Statute Ch. 631, (Accessed Jul. 2024).

Optometry

Except as otherwise provided in subsection 3, a licensee may engage in synchronous or asynchronous optometric telemedicine to provide health care services to a patient only if the licensee has completed a comprehensive examination on the patient within the immediately preceding 2 years.

A licensee may engage in synchronous optometric telemedicine to perform a non-comprehensive examination of a new patient if the licensee has access to all the information obtained from a comprehensive examination of the patient that was conducted by an optometrist or ophthalmologist within the immediately preceding 2 years.

A licensee may engage in asynchronous optometric telemedicine to conduct a consultation regarding a patient on whom the licensee has not completed a comprehensive examination within the immediately preceding 2 years if:

A licensee may engage in remote patient monitoring of a patient on whom the licensee has completed a comprehensive examination within the immediately preceding 2 years for the purposes of:

A licensee may engage in optometric telemedicine to provide health care services to a patient who is located at an originating site outside this State if the licensee has completed a comprehensive examination of the patient within the immediately preceding 2 years and such action is permitted by the laws of the state in which the patient is located.

A licensee shall not engage in optometric telemedicine to provide any health care service to the patient that the licensee has determined should be provided in person.

A licensee engaging in optometric telemedicine or remote patient monitoring shall not:

SOURCE: NV Revised Statute Ch. 636, (Accessed Jul. 2024).

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New Hampshire

Last updated 07/16/2024

“Physician-patient relationship” means a medical connection between a licensed physician …

“Physician-patient relationship” means a medical connection between a licensed physician and a patient that includes an in-person exam or an exam using telemedicine, as defined in RSA 310, provided the physician:

A physician shall complete or review a history, a diagnosis, a treatment plan appropriate for the licensee’s medical specialty, and documentation of all prescription drugs including name and dosage. A licensee may prescribe for a patient whom the licensee does not have a physician-patient relationship under the following circumstances: writing admission orders for a newly hospitalized patient; for a patient of another licensee for whom the prescriber is taking call; for a patient examined by a physician assistant, nurse practitioner, or other licensed practitioner; or for medication on a short-term basis for a new patient prior to the patient’s first appointment or when providing limited treatment to a family member in accordance with the American Medical Association Code of Medical Ethics. Prescribing drugs to individuals without a physician-patient relationship shall be unprofessional conduct subject to discipline under RSA 329:17, VI. The definition of a physician-patient relationship shall not apply to a physician licensed in another state who is consulting to a New Hampshire licensed physician with whom the patient has a relationship.

SOURCE: NH Revised Statutes Annotated, Sec. 329:1-c. (Accessed Jul. 2024).

A physician licensed under this chapter may prescribe non-opioid and opioid controlled drugs classified in schedule II through IV by means of telemedicine after establishing a physician-patient relationship with the patient. When prescribing a non-opioid or opioid controlled drug classified in schedule II through IV by means of telemedicine a subsequent in-person exam shall be conducted by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually. The prescription authority under this paragraph shall be limited to a physician licensed under this chapter, or a physician assistant in accordance with RSA 328-D:3-b, and all prescribing shall be in compliance with all federal and state laws and regulations.

A physician providing services by means of telemedicine directly to a patient shall:

A physician issuing a prescription for spectacle lenses, as defined in RSA 327-A:1, III, or a prescription for contact lenses, as defined in RSA 327-A:1, IV, by means of telemedicine directly to a patient shall:

Under this section, Medicaid coverage for telehealth services shall comply with the provisions of 42 C.F.R. section 410.78 and RSA 167:4-d.

SOURCE: NH Revised Statutes Annotated, 329:1-d, (Accessed Jul. 2024).

An APRN licensed under this chapter may prescribe non-opioid and opioid controlled drugs classified in schedule II through IV by means of telemedicine after establishing an advanced practice registered nurse-patient relationship with the patient. When prescribing a non-opioid or opioid controlled drug classified in schedule II through IV by means of telemedicine a subsequent in-person exam shall be conducted by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually. The prescription authority under this paragraph shall be limited to an APRN licensed under this chapter, and all prescribing shall be in compliance with all federal and state laws and regulations.

SOURCE: NH Revised Statutes Annotated, 326-B:2 (Accessed Jul. 2024).

The prescribing of a non-opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a).

Subsequent in-person exams shall be by a practitioner licensed to prescribe the drug at intervals appropriate for the patient, medical condition, and drug, but not less than annually.

The prescribing of an opioid controlled drug classified in schedule II through IV by means of telemedicine shall be limited to prescribers as defined in RSA 329:1-d, I and RSA 326-B:2, XII(a).

The prescription authority under this paragraph shall be limited to a practitioner licensed to prescribe the drug and in compliance with all federal laws, including the United States Drug Enforcement Agency registration or waiver when required.

SOURCE: NH Revised Statutes Annotated 318-B:2(XVI). (Accessed Jul. 2024).

A physician providing services by means of telemedicine directly to a patient shall:

A physician issuing a prescription for spectacle lenses, as defined in RSA 327-A:1, III, or a prescription for contact lenses, as defined in RSA 327-A:1, IV, by means of telemedicine directly to a patient shall:

Under this section, Medicaid coverage for telehealth services shall comply with the provisions of 42 C.F.R. section 410.78 and RSA 167:4-d.

SOURCE: NH Revised Statutes Annotated, 329:1-d (Accessed Jul. 2024).

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New Jersey

Last updated 08/21/2024

Unless specifically prohibited or limited by federal or State law, …

Unless specifically prohibited or limited by federal or State law, a health care provider who establishes a proper provider-patient relationship with a patient may remotely provide health care services to a patient through the use of telemedicine. A health care provider may also engage in telehealth as may be necessary to support and facilitate the provision of health care services to patients. Nothing in this section shall be construed to allow a provider to require a patient to use telemedicine or telehealth in lieu of receiving services from an in-network provider.

Any health care provider who uses telemedicine or engages in telehealth while providing health care services to a patient, shall: (1) be validly licensed, certified, or registered, pursuant to Title 45 of the Revised Statutes, to provide such services in the State of New Jersey; (2) remain subject to regulation by the appropriate New Jersey State licensing board or other New Jersey State professional regulatory entity; (3) act in compliance with existing requirements regarding the maintenance of liability insurance; and (4) remain subject to New Jersey jurisdiction.

Telemedicine services may be provided using interactive, real-time, two way communication technologies or, subject to the requirements of below, asynchronous store-and-forward technology.

A health care provider engaging in telemedicine or telehealth may use asynchronous store-and-forward technology to provide services with or without the use of interactive,r eal-time, two-way audio if, after accessing and reviewing the patient’s medical records, the provider determines that the provider is able to meet to meet the same standard of care as if the health care services were being provided in person and informs the patient of this determination at the outset of the telemedicine or telehealth encounter.

A health care provider engaging in telemedicine or telehealth shall review the medical history and any medical records provided by the patient. For an initial encounter with the patient, the provider shall review the patient’s medical history and medical records prior to initiating contact with the patient. In the case of a subsequent telemedicine or telehealth encounter conducted pursuant to an ongoing provider-patient relationship, the provider may review the information prior to initiating contact with the patient or contemporaneously with the telemedicine or telehealth encounter.

Diagnosis, treatment, and consultation recommendations, including discussions regarding the risk and benefits of the patient’s treatment options, which are made through the use of telemedicine or telehealth, including the issuance of a prescription based on a telemedicine or telehealth encounter, shall be held to the same standard of care or practice standards as are applicable to in-person settings. Unless the provider has established a proper provider-patient relationship with the patient, a provider shall not issue a prescription to a patient based solely on the responses provided in an online static questionnaire.

In the event that a mental health screener, screening service, or screening psychiatrist determines that an in-person psychiatric evaluation is necessary to meet standard of care requirements, or in the event that a patient requests an in-person psychiatric evaluation in lieu of a psychiatric evaluation performed using telemedicine or telehealth, the mental health screener, screening service, or screening psychiatrist may nevertheless perform a psychiatric evaluation using telemedicine and telehealth if it is determined that the patient cannot be scheduled for an in-person psychiatric evaluation within the next 24 hours. Nothing in this paragraph shall be construed to prevent a patient who receives a psychiatric evaluation using telemedicine and telehealth as provided in this paragraph from receiving a subsequent, in-person psychiatric evaluation in connection with the same treatment event, provided that the subsequent in-person psychiatric evaluation is necessary to meet standard of care requirements for that patient.

The prescription of Schedule II controlled dangerous substances through the use of telemedicine or telehealth shall be authorized only after an initial in-person examination of the patient, as provided by regulation, and a subsequent in-person visit with the patient shall be required every three months for the duration of time that the patient is being prescribed the Schedule II controlled dangerous substance. However, the provisions of this subsection shall not apply, and the in-person examination or review of a patient shall not be required, when a health care provider is prescribing a stimulant which is a Schedule II controlled dangerous substance for use by a minor patient under the age of 18, provided that the health care provider is using interactive, real-time, two-way audio and video technologies when treating the patient and the health care provider has first obtained written consent for the waiver of these in-person examination requirements from the minor patient’s parent or guardian.

SOURCE: NJ Statute C.45:1-62. (Accessed Aug. 2024).

Any health care provider who engages in telemedicine or telehealth shall ensure that a proper provider-patient relationship is established. The establishment of a proper provider-patient relationship shall include, but shall not be limited to:

Telemedicine or telehealth may be practiced without a proper provider-patient relationship, as defined in subsection a. of this section, in the following circumstances:

SOURCE: NJ Statute C.45:1-63. (Accessed Aug. 2024).

A health care practitioner may initially authorize any qualifying patient for the medical use of cannabis using telemedicine or telehealth, provided that the use of telemedicine or telehealth, rather than an in-person visit, is consistent with the standard of care required for assessment and treatment of the patient’s condition. Following the initial authorization, the practitioner may provide continued authorization for the use of medical cannabis via telemedicine or telehealth if the practitioner determines that an in-person visit is not required, consistent with the standard of care. The practitioner may require in-office consultations if additional consultations are necessary to continue to authorize the patient’s use of medical cannabis.

See statute for additional requirements.

SOURCE: NJ Statute C.24:6I-5.1. (Accessed Aug. 2024).

Licensee- patient relationship

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-patient relationship by:

Prior to initiating contact with a patient for the purpose of providing services to the patient using telemedicine or telehealth, a licensee shall:

Notwithstanding (a) and (b) above, health care services may be provided through telemedicine or telehealth without a proper licensee-patient relationship if the provision of health care services is:

SOURCE: NJ Administrative Code 13:30-9.4 (Dentist), 13:34-6A.4 (Marriage and Family Therapist), 13:34-32. (Professional Counselors), 13:34C-7.4 (Alcohol and Drug Counselor), 13:35-2C.4 (Physician Assistant), 13:35-12A4 (Electrologists), 13:35-6B.4 (Physicians), 13:35-8.24 (Hearing Aid Dispensers) 13:35-10.29 (Athletic Trainer) 13:37-8A4 (Nurses), 13:39A-10.4 (Physical Therapist & Physical Therapist Assistant), 13:44-4A.4 (Veterinarians), 13:44C-11.4 (Audiology & Speech-Language Pathologist), 13:44F-11.4 (Respiratory Care), 13:44H-11.4 (Orthotics & Prosthetics), 13:44K-7.4 (Occupational Therapy), 13:44L-7.4 (Polysomnography); 13:35-2A.21 (Midwifery). (Accessed Aug. 2024).

Prior to providing services through telemedicine or telehealth, a licensee shall establish a licensee-client relationship by:

Prior to an initial contact with a client for the purpose of providing services to the client using telemedicine or telehealth, a licensee shall review the client’s history and any available records.

Prior to initiating contact with a client for the purpose of providing services through telemedicine or telehealth, licensees shall determine whether they will be able to provide the same standard of care using telemedicine or telehealth as would be provided if the services were provided in-person. The licensee shall make this determination prior to each unique client encounter.

Notwithstanding (a), (b), and (c) above, service may be provided through telemedicine or telehealth without a proper provider-client relationship if:

SOURCE: NJ Administrative Code 13:35-14.22 (Genetic Counselors); NJ Administrative Code 13:42B-7.4 (Applied Behavior Analysts); NJ Administrative Code 13:42-13.4 (Psychological Examiners); NJ Administrative Code 13:44C-11.4. (Audiology and Speech Language Pathology); NJ Administrative Code 13:44G-15.4 (Social Workers); NJ Administrative Code 13:42A-8.4 (Certified Psychoanalysts). (Accessed Aug. 2024).

Prescriptions

Notwithstanding the requirements for in-person interaction in N.J.A.C. 13:35-7 , a licensee providing services through telemedicine or telehealth may issue a prescription to a patient, if the issuance of such a prescription is consistent with the standard of care or practice standards applicable to the in-person setting.

A licensee shall not issue a prescription based solely on responses provided in an online questionnaire, unless the licensee has established a proper licensee-patient relationship.

Notwithstanding (a) above, and except as provided in (d) below, a licensee shall not issue a prescription for a Schedule II controlled dangerous substance unless the licensee has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.

The prohibition of (c) above shall not apply when a licensee prescribes a stimulant for a patient under the age of 18 years, as long as the licensee is using interactive, real-time, two-way audio and video technologies and the licensee has obtained written consent for a waiver of in-person examination requirements from the patient’s parent or guardian.

SOURCE: NJ Administrative Code 13:35-6B.6 (Board of Medical Examiners); NJ Administrative Code 13:35-2C.6 (Physician Assistants). (Accessed Aug. 2024).

Board of Veterinary Medical Examiners

A licensee providing services through telemedicine or telehealth may issue a prescription to a patient, as long as the issuance of such a prescription is consistent with the standard of care or practice standards applicable to the in-person setting.

A licensee shall not issue a prescription based solely on responses provided in an online questionnaire, unless the licensee has established a proper licensee-client-patient relationship pursuant to N.J.A.C. 13:44-4A.4.

Notwithstanding (a) above, a licensee shall not issue a prescription for a Schedule II controlled dangerous substance unless the licensee has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.

SOURCE: NJ Administrative Code 13:44-4A.6. (Accessed Aug. 2024).

Board of Medical Examiners – Limited Licenses: Midwifery

Notwithstanding requirements for in-person interaction in N.J.A.C. 13:35-7 , a certified nurse midwife (CNM) with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14 providing services through telemedicine or telehealth may issue a prescription to a patient, as long as the issuance of such a prescription is consistent with the standard of care or practice standards applicable to the in-person setting.

A CNM with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14 shall not issue a prescription based solely on responses provided in an online questionnaire, unless the CNM has established a proper licensee-patient relationship pursuant to N.J.A.C. 13:35-2A.21 .

Notwithstanding (a) above, and except as provided in (d) below, a CNM with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14 shall not issue a prescription for a Schedule II controlled dangerous substance unless the CNM has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.

The prohibition of (c) above shall not apply when a CNM with prescriptive authority pursuant to N.J.A.C. 13:35-2A.14 prescribes a stimulant for a patient under the age of 18 years, as long as the CNM is using interactive, real-time, two-way audio and video technologies and the CNM has obtained written consent for a waiver of in-person examination requirements from the patient’s parent or guardian.

SOURCE: NJ Administrative Code 13:35-2A.23. (Accessed Aug. 2024).

Board of Nursing

An advanced practice nurse providing services through telemedicine or telehealth may issue a prescription to a patient, as long as the issuance of such a prescription is consistent with the standard of care or practice standards applicable to the in-person setting.

An advanced practice nurse shall not issue a prescription based solely on responses provided in an online questionnaire, unless the advanced practice nurse has established a proper licensee-patient relationship pursuant to N.J.A.C. 13:37-8A.4.

Notwithstanding (a) above, and except as provided in (d) below, an advanced practice nurse shall not issue a prescription for a Schedule II controlled dangerous substance unless the advanced practice nurse has had an initial in-person examination of the patient and a subsequent in-person visit with the patient at least every three months for the duration of the time the patient is prescribed the Schedule II controlled dangerous substance.

The prohibition of (c) above shall not apply when an advanced practice nurse prescribes a stimulant for a patient under the age of 18 years, as long as the advanced practice nurse is using interactive, real-time, two-way audio and video technologies and the advanced practice nurse has obtained written consent for a waiver of in-person examination requirements from the patient’s parent or guardian.

SOURCE: NJ Administrative Code 13:37-8A.6. (Accessed Aug. 2024).

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New Mexico

Last updated 06/17/2024

Prescribing, dispensing or administering drugs or medical supplies to a …

Prescribing, dispensing or administering drugs or medical supplies to a patient when there is no established physician-patient relationship, including prescribing over the internet or via other electronic means that is based solely on an on-line questionnaire is unprofessional conduct, except for:

SOURCE: NM Administrative Code 16.10.8.8(L). (Accessed Jun. 2024).

APRN

Telemedicine may be used by an APRN or other licensed independent healthcare providers for assessment and face-to-face examinations provided that such use complies with any applicable state and federal law and that the quality of the video examination does not adversely affect the face-to-face assessment or diagnosis.

SOURCE: NM Administrative Code 16.12.14.10, (Accessed Jun. 2024).

Related to Medical Cannabis

Qualified patient means a resident of New Mexico who has been diagnosed by a practitioner as having a debilitating medical condition and has received written certification and a registry identification card pursuant to the Lynn and Erin Compassionate Use Act on the basis of having been diagnosed, in person or via telemedicine, by a practitioner as having a debilitating medical condition.

SOURCE: NM Administrative Code 7.34.3.7 & 7.34.2.7. (Accessed Jun. 2024).

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New York

Last updated 06/03/2024

Office of Alcoholism and Substance Abuse Services (OASAS)

Buprenorphine is …

Office of Alcoholism and Substance Abuse Services (OASAS)

Buprenorphine is a controlled substance and requires appropriate evaluation for use and ongoing monitoring. As such, buprenorphine initiation must include an evaluation by a practitioner with a valid DEA registration prior to issuance of a buprenorphine prescription; this visit may be done in person or via telehealth (an audio and video visit or an audio-only visit); all follow up visits may be done via telehealth.

SOURCE: OASAS Telehealth Standards for OASAS Designated Providers, p. 9. Aug. 2023. (Accessed Jun. 2024).

Induction and prescribing of addiction medications must be done in accordance any and all applicable Federal rules and regulations; guidance may be found in the Telepractice Standards for OASAS Designated Providers posted on the OASAS website.

SOURCE: NY Codes, Rules and Regulations, Title 14, Chapter XXI, Part 830.5. (Accessed Jun. 2024).

Mental Health

OMH Telehealth Standards outline various considerations and program-specific requirements related to prescribing medications via telehealth.

SOURCE: NY Office of Mental Health. Telehealth Services Guidance for OMH Providers. (Apr. 2023). (Accessed Jun. 2024).

Workers’ Compensation

When rendering medical treatment or care via telehealth, an Authorized Medical Provider must be available for an in-person clinical encounter with the claimant should such in-person encounter be medically necessary. This means the Authorized Medical Provider must be able to meet the claimant at the Authorized Medical Provider’s office within a reasonable travel time and distance from the claimant’s residence. Telehealth must be used in accordance with this section and any applicable New York State Medical Treatment Guideline incorporated by reference under section 324.2 of this Title.

See regulations for additional rules related to when telehealth may be rendered following an initial in-person clinical encounter and related restrictions.

SOURCE: Title 12 NYCRR Section. 325-1.26 as proposed to be added by Notice Of Adoption. (Accessed Jun. 2024).

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North Carolina

Last updated 07/09/2024

Teledentistry

The indication, appropriateness, and safety considerations for each prescription …

Teledentistry

The indication, appropriateness, and safety considerations for each prescription for medication, laboratory services, or dental laboratory services provided through the use of teledentistry shall be evaluated by the licensed dentist in accordance with applicable law and current standards of care, including those for appropriate documentation. A licensed dentist’s use of teledentistry carries the same professional accountability as a prescription issued in connection with an in‑person encounter. A licensed dentist who prescribes any type of analgesic or pain medication as part of the provision of teledentistry services shall comply with all applicable North Carolina Controlled Substance Reporting System requirements. (2021‑95, s. 1(b).)

SOURCE: NC Statute Sec. 90-30.2. (Accessed Jul. 2024).

Opioid treatment program medication unit. – A unit established as part of an opioid treatment program facility that meets all of the following criteria: …

SOURCE: NC Statute Sec. 122C-3, (Accessed Jul. 2024).

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North Dakota

Last updated 06/10/2024

“In-person medical evaluation” means a medical evaluation that is conducted …

“In-person medical evaluation” means a medical evaluation that is conducted with the patient in the physical presence of the practitioner, without regard to whether portions of the evaluation are conducted by other practitioners, and must include one of the following actions: … The referring practitioner has performed an examination in the case of a consultant practitioner issuing a prescription or drug order when providing services by means of telemedicine.

“Valid prescription” means a prescription that is issued for a legitimate medical purpose in the usual course of professional practice by a practitioner who has conducted an in-person medical evaluation of the patient.

SOURCE: ND Century Code Sec. 19-02.1-15.1.(c) & (f) (Accessed Jun. 2024).

A licensee practicing telemedicine shall establish a bona fide relationship with the patient before the diagnosis or treatment of a patient. A licensee practicing telemedicine shall verify the identity of the patient seeking care and shall disclose, and ensure the patient has the ability to verify, the identity and licensure status of any licensee providing medical services to the patient.

Before initially diagnosing or treating a patient for a specific illness or condition, an examination or evaluation must be performed. An examination or evaluation may be performed entirely through telemedicine, if the examination or evaluation is equivalent to an in-person examination.

A licensee practicing telemedicine is subject to all North Dakota laws governing the adequacy of medical records and the provision of medical records to the patient and other medical providers treating the patient.

A licensee must have the ability to make appropriate referrals of patients not amenable to diagnosis or complete treatment through a telemedicine encounter, including a patient in need of emergent care or complementary in-person care.

SOURCE: ND Century Code Sec. 43-17-44, (Accessed Jun. 2024).

A controlled substance that is a prescription drug may not be delivered, distributed, or dispensed by means of the internet without a valid prescription, but nothing in this subsection may be construed to imply that one in-person medical evaluation by itself demonstrates that a prescription has been validly issued for a legitimate medical purpose within the usual course of professional practice.

This section applies to the delivery, distribution, and dispensing of a controlled substance by means of the internet from a location whether within or outside this state to a person or an address in this state.

Nothing in this section applies to the delivery, distribution, or dispensing of a controlled substance by a practitioner engaged in the practice of telemedicine in accordance with applicable federal and state laws.

“Valid prescription” means a prescription that is issued for a legitimate medical purpose in the usual course of professional practice by a:

“Covering practitioner” means, with respect to a patient, a practitioner who conducts a medical evaluation, other than an in-person medical evaluation, at the request of a practitioner who:

SOURCE: North Dakota Century Code, Sec. 19-03.1-22.4, (Accessed Jun. 2024).

A licensee who has performed a telemedicine examination or evaluation meeting the requirements of this chapter may prescribe medications according to the licensee’s professional discretion and judgment. Opioids may only be prescribed through telemedicine if done so as a federal food and drug administration-approved medication-assisted treatment for opioid use disorder. Opioids may not be prescribed through a telemedicine encounter for any other purpose.

Licensees who prescribe controlled substances, as defined by North Dakota law, in circumstances allowed under this rule, must comply with all state and federal laws regarding the prescribing of controlled substances, and must participate in the North Dakota prescription drug monitoring program.

SOURCE: ND Admin Code Sec. 50-02-15-02, (Accessed Jun. 2024).

Medicaid – Medication for Opioid Use Disorder

For OTPs, a clinical assessment that meets the requirements in 42 CFR § 8.12(f)(4) must be conducted, face to face or by telehealth, as clinically appropriate, at least once every three months for the first year of continuous treatment, and at least once every six months for each subsequent year

The member must require at least one face-to-face or telehealth check‐in per month for prescribing or dispensing OBOT/OTP medication. For those receiving buprenorphine based treatment, the prescriber has deemed it medically necessary to treat the member’s opioid addiction with buprenorphine products.

Telehealth must be provided in accordance with applicable federal and state laws and policies and follow the Controlled Substances Act (CSA) (28 USC Part 802) for prescribing and administration of controlled substances.

SOURCE: ND Medicaid, Medication for Opioid Use Disorder, Jan. 2024, (Accessed Jun. 2024).

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Ohio

Last updated 06/05/2024

Each health care professional licensing board shall permit a health …

Each health care professional licensing board shall permit a health care professional under its jurisdiction to provide the professional’s services as telehealth services in accordance with this section. Subject to division (B)(2) of this section, a board may adopt any rules it considers necessary to implement this section. All rules adopted under this section shall be adopted in accordance with Chapter 119. of the Revised Code. Any such rules adopted by a board are not subject to the requirements of division (F) of section 121.95 of the Revised Code.

Except as provided in division (B)(2)(b) of this section, the rules adopted by a health care professional licensing board under this section shall establish a standard of care for telehealth services that is equal to the standard of care for in-person services.

Subject to division (B)(2)(c) of this section, a board may require an initial in-person visit prior to prescribing a schedule II controlled substance to a new patient, equivalent to applicable state and federal requirements.

A board shall not require an initial in-person visit for a new patient whose medical record indicates that the patient is receiving hospice or palliative care, who is receiving medication-assisted treatment or any other medication for opioid-use disorder, who is a patient with a mental health condition, or who, as determined by the clinical judgment of a health care professional, is in an emergency situation.

Notwithstanding division (B) of section 3796.01 of the Revised Code, medical marijuana shall not be considered a schedule II controlled substance.

SOURCE: Ohio Revised code 4743.09, (Accessed Jun. 2024).

When the physician, or physician assistant who holds a valid prescriber number issued by the state medical board and who has been granted physician-delegated prescriptive authority prescribes, personally furnishes, otherwise provides, or causes to be provided a prescription drug that is a controlled substance during the provision of telehealth services, the physician or physician assistant shall comply with all requirements in rule 4731-37-01 of the Administrative Code.

The physician, or physician assistant who holds a valid prescriber number issued by the state medical board and who has been granted physician-delegated prescriptive authority shall conduct a physical examination of a new patient as part of an initial in-person visit before prescribing a schedule II controlled substance to the patient except for any of the following patient medical conditions and situations:

  1. The physician or physician assistant prescribes only the amount of a schedule II controlled substance to cover the duration of the emergency or an amount not to exceed a three-day supply whichever is shorter;
  2. After the emergency situation ends, the physician or physician assistant conducts the physical examination as part of an initial in-person visit before any further prescribing of a drug that is a schedule II controlled substance; or

When prescribing a controlled substance through the provision of telehealth services under one of the exceptions in paragraph (E) of this rule, the physician or physician assistant shall document one of the reasons listed in paragraph (E) for the prescribing in the medical record of the new patient in addition to the documentation already required to meet the standard of care in rule 4731-37-01 of the Administrative Code.

SOURCE: OH Administrative Code 4731-11-09. (Accessed Jun. 2024).

For purposes of paragraph (D) of rule 4731-11-09 of the Administrative Code, “active patient” as that term is used in paragraph (C) of this rule, means that within the previous twenty-four months the physician or other healthcare provider acting within the scope of their professional license conducted at least one in-person medical evaluation of the patient or an evaluation of the patient through the practice of telemedicine as that term is defined in 21 C.F.R. 1300.04, in effect as of the effective date of this rule.

SOURCE: OAC 4731-11-01(D). (Accessed Jun. 2024).

A pharmacist may provide telehealth services in accordance with section 4743.09 of the Revised Code, except that in the case of dispensing a dangerous drug, a pharmacist shall not use telehealth mechanisms or other virtual means to perform any of the actions involved in dispensing the dangerous drug unless the action is authorized by the state board of pharmacy through rules it adopts under this chapter or section 4743.09 of the Revised Code.

SOURCE: OH Revised Code Section 4729.285. (Accessed Jun. 2024).

Certificate to recommend medical use of marijuana

For purposes of recommending use of marijuana, a physician who holds a certificate to recommend may recommend that a patient be treated with medical marijuana if all of the following conditions are met:

See Code for additional requirements.

SOURCE: OH Revised Code Section 4731.30, (Accessed Jun. 2024).

In order to practice within the minimal standards of care when recommending treatment with medical marijuana, a physician shall comply with all of the following requirements:

SOURCE: OH Admin Code Sec. 4731-32-03, (Accessed Jun. 2024).

Opioid Treatment Program – Medication Units

Medication units may also provide telecounseling services if they provide appropriate privacy and adequate space with appropriately credentialed staff in accordance with all federal and state regulation. Telecounseling services may include individual or group sessions. Medication units that choose to provide telecounseling will:

SOURCE: OAC 5122-40-15, (Accessed Jun. 2024).

Vision Professionals

An optometrist licensed under this chapter may provide telehealth services in accordance with section 4743.09 of the Revised Code.

SOURCE: OH Revised Code Section 4725.35. (Accessed Jun. 2024).

A health care professional may provide telehealth services to a patient located in a health care facility in this state. The health care professional shall comply with all of the following requirements: …

While providing telehealth services, a health care professional may only prescribe, personally furnish, otherwise provide, or cause to be provided a prescription drug that is not a controlled substance to a patient through the provision of telehealth services by complying with all requirements of this rule.

SOURCE: Ohio Administrative Code 4725-25-01. (Accessed Jun. 2024).

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Oklahoma

Last updated 07/01/2024

A valid physician-patient relationship may be established by an allopathic …

A valid physician-patient relationship may be established by an allopathic or osteopathic physician with a patient located in this state through telemedicine, provided that the physician:

Telemedicine encounters shall comply with the Health Insurance Portability and Accountability Act of 1996 and ensure that all patient communications and records are secure and confidential.

Telemedicine encounters in this state shall not be used to establish a valid physician-patient relationship for the purpose of prescribing opiates, synthetic opiates, semisynthetic opiates, benzodiazepine or carisprodol, unless the encounter is used to prescribe:

A physician-patient relationship shall not be created solely based on the receipt of patient health information by a physician. The duties and obligations created by a physician-patient relationship shall not apply until the physician affirmatively:

SOURCE: OK Statutes, Title 59, Ch. 11 Sec. 478.1, (Accessed Jul. 2024).

Unprofessional conduct includes … Prescribing or administering a drug or treatment without sufficient examination and the establishment of a valid physician-patient relationship and not prescribing in a safe, medically accepted manner;

SOURCE: OK Statute, Title 59, Sec. 509.(12), (Accessed Jul. 2024).

A physician/patient relationship is established when a physician agrees by direct or indirect contact with a patient to diagnose or treat any condition, illness or disability presented by a patient to that physician, whether or not such a presenting complaint is considered a disease by the general medical community. The physician/patient relationship shall include a medically appropriate, timely-scheduled, face-to-face encounter with the patient, subject to any supervisory responsibilities established elsewhere in these rules except the following providers are not subject to the face-to-face encounter:

SOURCE: OK Admin. Code Sec. 435:10-7-12. (Accessed Jul. 2024).

Abortion-inducing drugs shall not be provided directly to the patient through the mail, telemedicine or otherwise outside of the parameters of the Oklahoma Abortion-Inducing Drug Certification Program.

SOURCE: OK Statute, Title 63, Ch. 1, Sec.1-757.4, (Accessed Jul. 2024).

The Board has the right to refuse to issue, renew or reinstate a license and may revoke a license or impose other appropriate sanctions for unprofessional conduct. In addition to those acts of unprofessional conduct listed in Title 59 O.S., Section 637 the following acts shall be included without limiting, in any way the Board’s ability to interpret other acts as unprofessional conduct …

SOURCE: OK Admin. Code Sec. 510:5-7-1. (Accessed Jul. 2024).

Optometry

The comprehensive visual examination. The prescribing for spectacles or contacts lenses by an optometrist requires a comprehensive visual examination conducted by a physician holding a license to practice optometry in this state. Board Rule 505:10-5-9 establishes the tests and measurements that require findings on the comprehensive examination of a patient when an optometrist intends to sign a prescription for ophthalmic lenses or contact lenses. Some of these required findings must be based on an examination made in person by an optometrist physically present with the patient. Therefore, a comprehensive visual examination shall be in-person by an eye doctor with a face-to-face encounter. In the absence of an existing doctor patient relationship, a prescription for glasses or contact lenses can only be derived through the completion of a comprehensive eye examination. While technology has advanced and continues to advance, in-person care, provided by a doctor of optometry, is the criterion standard for the delivery of a comprehensive eye exam. Direct-to-patient eye and vision-related applications, based on current technologies and uses, cannot replace or replicate a comprehensive eye exam provided by a doctor of optometry who is physically present with the patient. Direct-to-patient eye and vision-related applications may provide data related to elements of a comprehensive eye exam, but do not constitute patient care and fragmentation of a comprehensive eye exam into components delivered independently is deleterious and deceptive to patients.

Telemedicine encounters in this state shall not be used to establish a valid physician-patient relationship for prescribing contact lenses and or spectacles because it is not on par with the same service delivered in person. The relationship for prescribing shall include a medically appropriate and timely scheduled face to face encounter between the patient and a physician. The prescribing physician must provide the patient with the treating physician’s identity and professional credentials. Screenings cannot be used to diagnosis or treat conditions. Screenings cannot be used to replace in person comprehensive eye examination. Refractive tests, including online vision tests and other mobile vision related applications, cannot be, based on current technologies and uses, used to provide a refractive diagnosis and/or an eyeglass or contact lens prescription.

Physicians cannot establish a doctor-patient relationship via telehealth alone. During telemedicine encounters, the distant site physician performs an exam of a patient at a separate, remote originating site location which shall be registered with the Board of Examiners in optometry by the distant site physician as a primary or branch practice location pursuant to Rule OAC 505:10-5-7. If the distant site physician deems it to be medically necessary, or if Oklahoma law requires manual procedures at the near site in order to meet legal definitions of procedures which meet the standard of care, a licensed optometrist in this state trained in the use of the equipment shall be utilized at the originating site to represent the patient, manage the camera, and perform any physical activities to successfully complete the exam.

Unprofessional conduct includes prescribing for treatment without sufficient examination as provided in Board Rule 505:10-5-9, proceeding without the establishment of a valid physician-patient relationship, violations of this telemedicine rule under the authority of 59 O.S. § 585(A). and not prescribing in a safe, medically accepted manner.

On-line refractions do NOT meet acceptable standards of care. Physicians cannot prescribe controlled substances via telehealth. Physicians cannot split fees for care. The optometrist who utilizes telemedicine in Oklahoma should be mindful of certain requirements and challenges inherent in practice via remote means, among them the following:

SOURCE: OK Admin Code Sec. 505:10-5-19. (Accessed Jul. 2024).

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Oregon

Last updated 07/22/2024

“Telepharmacy” means the delivery of pharmacy services by a pharmacist, …

“Telepharmacy” means the delivery of pharmacy services by a pharmacist, through the use of a variety of electronic and telecommunications technologies, to a patient at a remote location staffed by a pharmacy technician.

The pharmacy services for which a pharmacist may use telepharmacy include the supervision of the dispensation of prescription drugs to a patient.

The remote location at which a patient receives pharmacy services through the use of telepharmacy must be affiliated with the pharmacy where the pharmacist providing the pharmacy services through telepharmacy regularly engages in the practice of pharmacy.

The State Board of Pharmacy shall adopt rules to carry out this section. The rules adopted under this section must include rules:

SOURCE: OR Revised Statutes 689.700, (Accessed Jul. 2024).

“Telepharmacy” means the delivery of pharmacy services by an Oregon licensed Pharmacist through the use of a telepharmacy system to a patient at a remote location staffed by a Certified Oregon Pharmacy Technician or Pharmacy Technician.

“Telepharmacy system” means a system of telecommunications technologies that enables monitoring, documenting, and recording of the delivery of pharmacy services at a remote location by an electronic method which must include the use of audio and video, still image capture, and store and forward.

See rule for telepharmacy regulations.

SOURCE: OAR 855-139-0005. (Accessed Jul. 2024).

Remote Dispensing Site Pharmacy

A location in Oregon where the practice of pharmacy occurs by an Oregon licensed Pharmacist through the use of a telepharmacy system to a patient at a remote location staffed by a Certified Oregon Pharmacy Technician must be registered by the board in Oregon as a Retail Drug Outlet RDSP.

SOURCE: OAR 855-139-0010. (Accessed Jul. 2024).

Non-Resident Affiliated Pharmacies

A non-resident pharmacy includes a RDSP Affiliated Pharmacy located outside of Oregon and providing pharmacy services through a telepharmacy system to a Retail Drug Outlet RDSP located in Oregon.

Each non-resident RDSP Affiliated Pharmacy must be registered with the Oregon Board of Pharmacy.

To qualify for registration under these rules, every non-resident RDSP Affiliated Pharmacy must be registered and in good standing with the Board of Pharmacy in the pharmacy’s state of residence.

Each out-of-state non-resident RDSP Affiliated Pharmacy must designate an Oregon licensed Pharmacist-in-Charge (PIC), who is responsible for all pharmacy services and to provide supervision and control of the RDSP. To qualify for this designation, the person must:

Every non-resident RDSP Affiliated Pharmacy will have a Pharmacist-in-Charge (PIC) who is licensed in Oregon prior to initial registration of the RDSP.

The PIC must comply with the requirements of OAR 855-115-0210.

SOURCE: OAR 855-139-0030. (Accessed Jul. 2024).

The Oregon licensed Pharmacist-in-charge of the RDSP Affiliated Pharmacy is responsible for all operations at the RDSP including responsibility for the telepharmacy system and enforcing policies and procedures.

SOURCE: OAR 855-139-0050. (Accessed Jul. 2024).

Technology

A RDSP and its RDSP Affiliated Pharmacy must:

Please see rule for additional requirements.

SOURCE: OAR 855-139-0205. (Accessed Jul. 2024).

Chiropractic Physician

The use of telehealth as described in subsection (2) of this section is not an expansion of the scope of practice of chiropractic physicians. The use of telehealth establishes a doctor-patient relationship.

SOURCE: OAR 811-015-0066. (Accessed Jul. 2024).

Rules for Practice Across State Lines

A telemedicine licensee has the same duties and responsibilities and is subject to the same penalties and sanctions as any other physician or physician assistant licensed under ORS Chapter 677, including but not limited to the following:

SOURCE: OR Admin. Rules, 847-025-0000. (Accessed Jul. 2024).

Optometry

“Telehealth prescription” may only be issued on an intial spectacle or contact lens prescription only after conducting an in-person eye exam prior to delivering telemedicine.

Note: The word ‘initial’ seems to be misspelled in official regulation.

SOURCE: OAR 852-001-0002. (Accessed Jul. 2024).

A physician licensed under ORS 677.100 to 677.228, a physician assistant licensed under ORS 677.505 to 677.525 or a physician or physician assistant licensed under ORS 677.139 may use telemedicine to engage in the practice of medicine and provide health care services, including the establishment of a provider-patient relationship, the diagnosis or treatment of a medical condition or the prescription of drugs, to a patient physically located in this state. The physician or physician assistant is not required to be physically located in this state when engaging in the practice of medicine and providing health care services through telemedicine.

The practice of medicine using telemedicine occurs where the patient is physically located.

SOURCE: OR Revised Statutes Chapter 677.494, (Accessed Jul. 2024).

A telemedicine licensee [physicians practicing medicine across state lines] must not:

SOURCE: OR Admin Rules, 847-025-0030. (Accessed Jul. 2024).

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Pennsylvania

Last updated 09/10/2024

Medical Marijuana

Except as provided in subsection (b), a dispensary …

Medical Marijuana

Except as provided in subsection (b), a dispensary shall ensure that a physician or a pharmacist is available, either in person or by synchronous interaction, to verify patient certifications and to consult with patients and caregivers at all times during the hours the facility is open to dispense or to offer to dispense medical marijuana products to patients and caregivers.

If a dispensary is authorized to operate more than one facility under its permit, a physician assistant or a certified registered nurse practitioner may be available, either in person or by synchronous interaction, to verify patient certifications and to consult with patients and caregivers at each of the other locations instead of a physician or pharmacist. The physician, pharmacist, physician assistant or certified registered nurse practitioner may rotate coverage of the facilities, provided that a physician or pharmacist is always available, either in person or by synchronous interaction, at one of the facilities. Furthermore, no less than one dedicated medical professional must be present either, physically or by synchronous interaction, for each distinct dispensary facility location and shall not cover more than one dispensary facility location regardless of whether in-person coverage or synchronous interaction is used.

SOURCE: Rules and Regulations, Title 28, 1161a.25, (Accessed Sept. 2024).

See FAQ Number 13 on federal requirements for substance use disorder treatment and Medication Assisted Treatment.

SOURCE: PA Dept. of State, Professional Licensing, Telemedicine FAQs. (Accessed Sept. 2024).

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Puerto Rico

Last updated 09/05/2024

No reference found.

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Rhode Island

Last updated 05/15/2024

Treatment and consultation recommendations made in an online setting, including …

Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in face-to-face settings. Treatment, including issuing a prescription, based solely on an online questionnaire without an appropriate evaluation does not constitute an acceptable standard of care and is considered unprofessional conduct.

Sufficient security measures must be in place and documented to assure confidentiality and integrity of patient-identifiable information. Transmissions, including patient e-mail, prescriptions and laboratory results must be secure within existing technology (i.e., password protected, encrypted electronic prescriptions, or other reliable authentication techniques). Patient-physician e-mail, as well as other patient-related electronic communications that is pertinent to the diagnosis and treatment of the patient should be stored and filed in the patient’s medical record.

SOURCE: RI Department of Health. Telemedicine. (Accessed May 2024).

Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in face-to-face settings. Therefore, consistent with the definition of telemedicine, provided in § 1.2(A)(25) of this Part, treatment, including issuing a prescription, based solely on an online questionnaire without an appropriate evaluation does not constitute an acceptable standard of care and is considered unprofessional conduct. Asynchronous evaluation of a patient, without contemporaneous real-time, interactive exchange between the physician and patient, is not appropriate.

SOURCE: Code of RI Rules, 216-40-05-1, (Accessed May 2024).

This relationship is complex and based on the mutual understanding between physician and patient of the shared responsibility for the patient’s health care. The physician should recognize that the patient-physician relationship in Telemedicine and Internet medicine is inherently different. It is possible, if not probable, that the physician and patient will never meet in-person. It is the physician who has the professional responsibility to consider these differences in their evaluation and management of the patient. The BMLD defines the beginning of the physician-patient relationship as being clearly established when the physician agrees to undertake diagnosis and treatment of the patient and the patient agrees, whether or not there has been an in-person encounter between the physician (or other health care practitioner) and patient.

The physician-patient relationship is fundamental to the provision of acceptable medical care. It is the expectation of the BMLD that physicians recognize the obligations, responsibilities and patient rights associated with establishing and maintaining an appropriate physician-patient relationship whether or not face-to-face contact between physician and patient has occurred. However, whenever a patient’s clinical presentation suggests the need for an in-person physical examination, the patient should be referred for an in-person evaluation which is documented in the medical record. Failure to make necessary referrals or progressions to treatments without doing so constitutes unprofessional conduct.

Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in face-to-face settings. Treatment, including issuing a prescription, based solely on an online questionnaire without an appropriate evaluation does not constitute an acceptable standard of care and is considered unprofessional conduct. The BMLD specifically highlights that prescribing controlled substances without an established in-person physician-patient relationship is prohibited. (Exception* a covering physician may prescribe a controlled substance if an established coverage agreement is in place and the quantity reflects the prescription is for a short duration)

SOURCE: Rhode Island Board of Medical Licensure and Discipline, Guidelines for the Appropriate Use of Telemedicine and the Internet in Medical Practice, (Accessed May 2024).

Life-Saving Allergy Medication – Emergency Administration

An authorized entity that acquires a stock supply of epinephrine auto-injectors pursuant to a prescription issued in accordance with this chapter, may make such epinephrine auto-injectors available to individuals other than those trained individuals described in § 23-6.4-6, and such individuals may administer such epinephrine auto-injector to any individual believed in good faith to be experiencing anaphylaxis, if the epinephrine auto-injectors are stored in a locked, secure container and are made available only upon remote authorization by an authorized healthcare provider after consultation with the authorized healthcare provider by audio, televideo, or other similar means of electronic communication. Consultation with an authorized healthcare provider for this purpose shall not be considered the practice of telemedicine or otherwise be construed as violating any law or rule regulating the authorized healthcare provider’s professional practice.

SOURCE: RI Gen. Laws 23-6.4-5, (Accessed May 2024).

Prescribing of EpiPens

An authorized entity which chooses to acquire and stock a supply of epinephrine auto-injectors must maintain an Operations plan on the premises. The plan shall include at a minimum: …

SOURCE: RI Regulations Title 216, Sec. 20-10-5, (Accessed May 2024).

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South Carolina

Last updated 08/26/2024

A licensee who provides care, renders a diagnosis, or otherwise

…

A licensee who provides care, renders a diagnosis, or otherwise engages in the practice of medicine as defined in Section 40-47-20(36) via telemedicine as defined in Section 40-47-20(52) shall:

  1. adhere to the same standard of care as in-person medical care and be evaluated according to the standard of care applicable to the licensee’s area of specialty. The failure of a licensee to conform to the appropriate standard of care is considered unprofessional conduct under Section 40-47-110(B)(9);
  2. prescribe in accordance with Section 40-47-113;

In addition to those requirements set forth in subsection (A), a licensee who establishes and/or maintains a physician-patient relationship, provides care, renders a diagnosis, or otherwise engages in the practice of medicine as defined in Section 40-47-20(36) solely via telemedicine as defined in Section 40-47-20(53) shall:

  1. adhere to current standards for practice improvement and monitoring of outcomes and provide reports containing such information upon request of the board;
  2. provide an appropriate evaluation prior to diagnosing and/or treating the patient, which need not be done in person if the licensee considers that he is able to accurately diagnose and treat the patient in conformity with the applicable standard of care via telehealth; provided that evaluations in which a licensee is at a distant site, but a practitioner who is acting within his scope is able to provide various physical findings the licensee needs to complete an adequate assessment, is permitted;
  3. ensure the availability of appropriate follow-up care;
  4. verify the identity and location of the patient and inform the patient of the licensee’s name, location, and professional credentials;
  5. maintain the confidentiality of a patient’s records and disclose the records to the patient consistent with state and federal law; provided, that licensees practicing telemedicine must be held to the same standards of professionalism concerning medical records transfer and communication with the primary care provider and medical home as licensees practicing via traditional means;
  6. if applicable, discuss with the patient the value of having a primary care medical home and, if the patient requests, provide assistance in identifying available options for a primary care medical home;
  7. be prohibited from establishing a physician-patient relationship pursuant to Section 40-47-113(B) for the purpose of prescribing medication when an in-person physical examination is necessary for diagnosis.
  8. prescribe in compliance with all relevant federal and state laws including, but not limited to, participation in the South Carolina Prescription Monitoring Program in Article 15, Chapter 53, Title 44 and the Ryan Haight Act, within a practice setting fully compliant with this section, and subject to the following limitations:

Notwithstanding any of the provisions of this section, the board shall retain all authority with respect to telemedicine practice as granted in Section 40-47-10(I) of this chapter.

SOURCE: SC Code Annotated Sec. 40-47-37 as amended by H 4159 (2024 Session). (Accessed Aug. 2024).

A licensee who provides health care via telehealth shall, if authorized by the licensee’s respective practice act and within his scope of practice, prescribe in accordance with all applicable state and federal laws, including his respective practice act, rules and regulations, and standards required by such practice authorization; and shall maintain a controlled substances registration with South Carolina’s Bureau of Drug Control if prescribing controlled substances.

Nothing in this section may be construed to prohibit electronic communications between a licensee and patient with a preexisting licensee-patient relationship, between a licensee and another licensee concerning a patient with whom the other licensee has a licensee-patient relationship, or between a licensee and a patient when treatment is provided pursuant to an on-call situation or a cross-coverage situation.

In addition to the provisions of subsection (A), a licensee who establishes or maintains a licensee-patient relationship solely via telehealth shall:

  1. adhere to current standards for practice improvement and monitoring of outcomes and provide reports containing this information upon request of his respective licensing board;
  2. provide an appropriate evaluation before providing health care to the patient, which need not be done in person, if the licensee determines he is able to appropriately provide health care to the patient via telehealth in conformity with the same standard of care required for in-person care;
  3. ensure availability of appropriate follow-up care;
  4. verify the identity and location of the patient and inform the patient of the licensee’s name, location, and professional credentials; and
  5. only prescribe:

Notwithstanding any of the provision of this section, a licensee’s respective licensing board retains all authority with respect to telehealth practice in accordance with the authorization provided to him by his respective practice act.

SOURCE: SC Code Annotated Sec. 40-42-20 as proposed to be added by H 4159 (2024 Session). (Accessed Aug. 2024).

An advance practice registered nurse (APRN) may perform medical acts via telemedicine and telehealth pursuant to a practice agreement as defined in Section 40-33-20(45) without having to be licensed to practice medicine in this State as otherwise required in Section 40-47-37(A)(4).

An APRN who establishes a nurse-patient relationship solely by means of telemedicine shall adhere to the same standard of care as a licensee employing more traditional in-person medical care. Failure to conform to the appropriate standard of care is considered unprofessional conduct and may be subject to enforcement by the board.

An APRN may not establish a nurse-patient relationship by means of telemedicine for the purpose of prescribing medication when an in-person physical examination is necessary for diagnosis.

An APRN who establishes a nurse-patient relationship solely by means of telemedicine only may prescribe within a practice setting fully in compliance with this chapter and during an encounter in which threshold information necessary to make an accurate diagnosis is obtained in a medical history interview conducted by the prescribing licensee; provided, however, that Schedule II through V prescriptions are only permitted pursuant to a practice agreement as defined in Section 40-33-20(45) and nothing in this item may be construed to authorize the prescribing of medications via telemedicine that otherwise are restricted by the limitations in Section 40-47-37(C)(6) unless approved by a joint committee of the Board of Medical Examiners and the Board of Nursing.

An APRN who establishes a nurse-patient relationship solely by means of telemedicine shall generate and maintain medical records for each patient using those telemedicine services in compliance with any applicable state and federal laws, rules, and regulations, including the provisions of this chapter, the Health Insurance Portability and Accountability Act (HIPAA), and the Health Information Technology for Economic and Clinical Health Act (HITECH). These records must be accessible to other practitioners and to the patient in a timely fashion when lawfully requested by the patient or his lawfully designated representative.

SOURCE: SC Code Annotated Sec. 40-33-34(I) as amended by H 4159 (2024 Session). (Accessed Aug. 2024).

Physician assistants are authorized to perform telemedicine and telehealth in accordance with the requirements of Section 40-47-37 including, but not limited to, Section 40-47-37(C)(6) requiring board authorization prior to prescribing Schedule II and Schedule III prescriptions; Section 40-47-113, approved written scope of practice guidelines, and pursuant to all physician supervisory requirements imposed by this chapter without having to be licensed to practice medicine in this State as otherwise required in Section 40-47-37(A)(4).

SOURCE: SC Code Annotated Sec. 40-47-935 as amended by H 4159 (2024 Session). (Accessed Aug. 2024).

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South Dakota

Last updated 07/23/2024

Any health care professional who utilizes telehealth shall ensure that …

Any health care professional who utilizes telehealth shall ensure that a proper health provider-patient relationship is established and includes:

Exceptions to the requirements of this section include on-call, cross coverage situations, and consultation with another health care professional who has an ongoing health care provider relationship with the patient and agrees to supervise the patient’s care and emergency treatment.

SOURCE: SD Codified Laws Sec. 34-52-3 (Accessed Jul. 2024).

A health care professional using telehealth to provide medical care to any patient located in the state shall provide an appropriate face-to-face examination using real-time audio and visual technology prior to diagnosis and treatment of the patient, if a face-to-face encounter would otherwise be required in the provision of the same service not delivered via telehealth.

SOURCE: SD Codified Laws Sec. 34-52-5. (Accessed Jul. 2024).

Without a proper provider-patient relationship, a health care professional using telehealth may not prescribe a controlled drug or substance, as defined by § 34-20B-3, solely in response to an internet questionnaire or consult, including any encounter via telephone.

SOURCE: SD Codified Laws Sec. 34-52-6. (Accessed Jul. 2024).

Mifepristone and Misoprostol must be prescribed and dispensed by a licensed physician in a licensed abortion facility consistent with chapter 34-23A and in compliance with the applicable requirements in chapter 36-4.

SOURCE: SD Codified Laws Sec. 36-4-47. (Accessed Jul. 2024).

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Tennessee

Last updated 08/27/2024

For the purposes of this section, a healthcare provider-patient relationship …

For the purposes of this section, a healthcare provider-patient relationship with respect to telemedicine or telehealth is created by mutual consent and mutual communication, except in an emergency, between the patient and the provider. The consent by the patient may be expressed or implied consent; however, the provider-patient relationship is not created simply by the receipt of patient health information by a provider unless a prior provider-patient relationship exists. The duties and obligations created by the relationship do not arise until the healthcare provider:

A healthcare provider who is authorized to prescribe buprenorphine under federal law shall not prescribe via telehealth a buprenorphine product, as approved by the federal food and drug administration for use in recovery or medication-assisted treatment, unless:

SOURCE: TN Code Sec. 63-1-155, (Accessed Aug. 2024).

Prerequisites to Issuing Prescriptions or Dispensing Medications – In Person, Electronically, and Over the Internet

Except as provided in subparagraph (b), it shall be a prima facie violation of T.C.A. §63-6-214(b)(1), (4), and (12) for a physician to prescribe or dispense any drug to any individual, whether in person or by electronic means or over the Internet or over telephone lines, unless the physician, or his/her licensed supervisee pursuant to appropriate protocols or medical orders, has first done and appropriately documented, for the person to whom a prescription is to be issued or drugs dispensed, all of the following:

SOURCE: TN Rule Annotated, 0880-02-.14(7)(a). (Accessed Aug. 2024).

Except as provided under paragraphs seven (7) and eight (8) of this rule, the patient encounter to establish or maintain the physician-patient relationship via telemedicine between the physician in a remote location and the patient in Tennessee may occur with or without the use of a facilitator so long as such encounter is consistent with parts 1. and 2. of this Rule: Certain conditions apply in each case. See rule for details.

SOURCE: TN Rule Annotated, 0880-02.-16(6)(a). (Accessed Aug. 2024).

Optometry

Optometrist-patient relationship. Pursuant to T.C.A. § 63-1-155(b), an optometrist- patient relationship with respect to telemedicine or telehealth is created by mutual consent and mutual communication, except in an emergency, between the patient and the optometrist. The consent by the patient may be expressed or implied consent; however, the optometrist-patient relationship is not created simply by the receipt of patient health information by an optometrist unless a prior optometrist-patient relationship exists. The duties and obligations created by the relationship do not arise until the optometrist:

The optometrist-patient relationship established via telehealth, shall at a minimum, meet the requirements of T.C.A. § 63-1-155(b).

SOURCE: TN Rule Annotated 1045-02-.18, (Accessed Aug. 2024).

Physician Assistant

A physician assistant authorized to prescribe drugs under this section who provides services in a free or reduced fee clinic under the Volunteer Health Care Services Act, compiled in chapter 6, part 7 of this title, may arrange for required personal review of the physician assistant’s charts by a collaborating physician in the office or practice site of the physician or remotely via HIPAA compliant electronic means rather than at the site of the clinic.

A physician assistant authorized to prescribe drugs under this section who provides services in a community mental health center as defined in § 33-1-101, or federally qualified health center as defined in § 63-10-601, may arrange for the required personal review of the physician assistant’s charts by a collaborating physician, with the same authority to render prescriptive services that the physician assistant is authorized to render, in the remote office or practice site of the physician, or any required visit by a collaborating physician to any remote site, or both, via HIPAA-compliant electronic means rather than at the site of the clinic.

Except as provided above:

Protocols must also include, at a minimum, the following requirements: …

Collaborative agreements governing advance practice registered nurses who have six thousand (6,000) or more hours of documented postgraduate clinical experience and are endorsed by the board must include, at a minimum, the following: …

SOURCE: Section 63-19-107, & Title 63, Ch. 7, Part 1 as amended by HB 2318 & SB 2136, (Accessed Aug. 2024).

Optometry

Telehealth technologies, where prescribing medications and ophthalmic materials may be contemplated, shall require an optometrist to implement measures to uphold patient safety in the absence of a traditional in-person patient encounter. Such measures shall guarantee that the identity of the patient and provider is clearly established and that detailed documentation for the clinical patient encounter and resulting prescription is both enforced and independently kept.

Prescribing medications, in-person or via telehealth, is at the professional discretion of the optometrist based on licensure. The indication, appropriateness, and safety considerations for each telehealth visit prescription shall be evaluated by the optometrist in accordance with current standards of practice and consequently carry the same professional accountability as prescriptions delivered during an in-person patient encounter. However, where such measures are upheld, and the appropriate clinical consideration is carried out and documented, optometrists may exercise their judgment and prescribe medications as part of telehealth encounters.

For telehealth ophthalmic prescriptions, the same requirements exist as for fixed fee in-person services as outlined in Tenn. Comp. R. & Regs. 1045-02-.08(3).

SOURCE: Section 1045-02-.18, (Accessed Aug. 2024).

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Texas

Last updated 08/16/2024

A valid practitioner-patient relationship is present between a practitioner providing …

A valid practitioner-patient relationship is present between a practitioner providing a telemedicine medical service or a teledentistry dental service and a patient receiving the service as long as the practitioner complies with the standard of care described in Section 111.007 and the practitioner:

A practitioner who provides telemedicine medical services to a patient as described in Subsection (a)(3) shall:

Notwithstanding any other provision of this section, a practitioner-patient relationship is not present if a practitioner prescribes an abortifacient or any other drug or device that terminates a pregnancy.

The Texas Medical Board, the Texas Board of Nursing, the Texas Physician Assistant Board, and the Texas State Board of Pharmacy shall jointly adopt rules that establish the determination of a valid prescription in accordance with Section 111.005. Rules adopted under this section must allow for the establishment of a practitioner-patient relationship by a telemedicine medical service provided by a practitioner to a patient in a manner that complies with Section 111.005(a)(3).

The Texas Medical Board, the Texas Board of Nursing, the Texas Physician Assistant Board, and the Texas State Board of Pharmacy shall jointly develop and publish on each respective board’s Internet website responses to frequently asked questions relating to the determination of a valid prescription issued in the course of the provision of telemedicine medical services.

The State Board of Dental Examiners and the Texas State Board of Pharmacy shall jointly adopt rules that establish the determination of a valid prescription in accordance with Section 111.005. Rules adopted under this subsection must allow for the establishment of a practitioner-patient relationship by a teledentistry dental service provided by a dentist to a patient in a manner that complies with Section 111.005(a)(3) and must be substantially similar to the rules adopted under Subsection (a) of this section. The State Board of Dental Examiners and the Texas State Board of Pharmacy shall jointly develop and publish on each respective board’s Internet website responses to frequently asked questions relating to the determination of a valid prescription issued in the course of the provision of teledentistry dental services.

An agency with regulatory authority over a health professional may not adopt rules pertaining to telemedicine medical services, teledentistry dental services, or telehealth services that would impose a higher standard of care than the standard described in Subsection (a).

The State Board of Dental Examiners by rule shall establish limits on the quantity of a controlled substance, including an opiate, that a dentist may prescribe to a patient as a teledentistry dental service. Except as provided by Subsection (c), the rules may not authorize a dentist to prescribe more than is necessary to supply a patient for:

  1. if the prescription is for an opiate, a two-day period; or
  2. if the prescription is for a controlled substance other than an opiate, a five-day period.

For each day in a period described by Subsection (b)(1) or (2) that is a Saturday, Sunday, or national holiday, the period is extended to include the next day that is not a Saturday, Sunday, or national holiday.

SOURCE: TX Occupations Code 111.005-.009, (Accessed Aug. 2024).

Teledentistry

A dentist, dental hygienist, or dental assistant who delivers teledentistry services to a patient located in Texas must hold an active Texas license or registration issued by the Board.

A dental health professional providing a dental health care service or procedure as a teledentistry dental service:

The validity of a prescription issued as a result of a teledentistry dental service is determined by the same standards that would apply to the issuance of the prescription in an in-person setting.

This rule does not limit the professional judgment, discretion or decision-making authority of a licensed practitioner. A licensed practitioner is expected to meet the standard of care and demonstrate professional practice standards and judgment, consistent with all applicable statutes and rules when issuing, dispensing, delivering, or administering a prescription medication as a result of a teledentistry dental service.

A valid prescription must be:

Any prescription drug orders issued as the result of a teledentistry dental service, are subject to all regulations, limitations, and prohibitions set out in the federal and Texas Controlled Substances Act, Texas Dangerous Drug Act and any other applicable federal and state law.

When prescribing a controlled substance to a patient as a teledentistry dental service, a dentist must not prescribe more than is necessary to supply a patient for:

For each day in a period described by paragraph (2) of this subsection that is a Saturday, Sunday, or national holiday, the period is extended to include the next day that is not a Saturday, Sunday, or national holiday.

SOURCE: TX Administrative Code Title 22, Part 5, Ch. 108, Rule 108.16. (Accessed Aug. 2024).

Board of Medical Examiners & Board of Nursing

A valid prescription must be:

Any prescription drug orders issued as the result of a telemedicine medical service, are subject to all regulations, limitations, and prohibitions set out in the federal and Texas Controlled Substances Act, Texas Dangerous Drug Act and any other applicable federal and state law.

Limitation on Treatment of Chronic Pain. Chronic pain is a legitimate medical condition that needs to be treated but must be balanced with concerns over patient safety and the public health crisis involving overdose deaths. The Legislature has already put into place laws regarding the treatment of pain and requirements for registration and inspection of pain management clinics. Therefore, the Board has determined clear legislative intent exists for the limitation of chronic pain treatment through a telemedicine medical service.

Treatment for Chronic Pain. For purposes of this rule, chronic pain has the same definition as used in §170.2(4) of this title (relating to Definitions). Telemedicine medical services used for the treatment of chronic pain with scheduled drugs by any means other than via audio and video two-way communication is prohibited, unless a patient:

Treatment for Acute Pain. For purposes of this rule, acute pain has the same definition as used in §170.2(2) of this title. Telemedicine medical services may be used for the treatment of acute pain with scheduled drugs, unless otherwise prohibited under federal and state law.

SOURCE: TX Admin. Code, Title 22, Part 9, Ch. 174.5 & Title 22, Part 11, Ch. 217.24, [text varies slightly between two codes] (Accessed Aug. 2024).

APRNs Treating Chronic Pain

An APRN, when determining whether to utilize telemedicine medical services for the treatment of chronic pain with controlled substances as permitted by paragraph (1)(A) of this subsection, shall give due consideration to factors that include, at a minimum, the date of the patient’s last in-person visit, patient co-morbidities, and occupational related COVID risks. These are not the sole, exclusive, or exhaustive factors an APRN should consider under this rule.

If a patient is treated for chronic pain with scheduled drugs through the use of telemedicine medical services as permitted by paragraph (1)(A) of this subsection, the medical records must document the exception and the reason that a telemedicine visit was conducted instead of an in-person visit.

SOURCE: TX Admin Code, Title 22, Part 11, Ch. 217.24, (Accessed Aug. 2024).

Establishing a practitioner-patient relationship is not required for:

SOURCE: TX Admin. Code, Title 22, Part 9, Ch. 190.8(1)(L). (Accessed Aug. 2024).

An outpatient chemical dependency treatment program provided by a treatment facility licensed under Chapter 464 may provide services under the program to adult and adolescent clients, consistent with commission rule, using telecommunications or information technology.

SOURCE: TX Health and Safety Code Sec. 462.015, (Accessed Aug. 2024).

Physicians who treat and prescribe through communications technology are practicing medicine and must possess a full Texas medical license when treating residents of Texas. An out-of-state physician may provide episodic consultations without a Texas medical license, as provided in Texas Occupations Code, §151.056, §172.2(g)(4) of this title (relating to Construction and Definitions), and §172.12(f) of this title (relating to Out-of-State Telemedicine License).

SOURCE: TX Admin. Code, Title 22, Part 9, Sec. 174.8. (Accessed Aug. 2024).

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Utah

Last updated 06/25/2024

A provider offering telehealth services shall at all times:

…

A provider offering telehealth services shall at all times:

If the provider does not already have a provider-patient relationship with the patient, establish a provider-patient relationship during the patient encounter in a manner consistent with the standards of practice, including providing the provider’s licensure and credentials to the patient;

Before providing treatment or prescribing a prescription drug, establish a diagnosis and identify underlying conditions and contraindications to a recommended treatment after:

Be available to a patient who receives telehealth services from the provider for subsequent care related to the initial telemedicine services, in accordance with community standards of practice.

Be familiar with available medical resources, including emergency resources near the originating site, in order to make appropriate patient referrals when medically indicated.

Make available to each patient receiving telehealth services the patient’s medical records; and

If the patient has a designated health care provider who is not the telemedicine provider:

A provider offering telemedicine services may not diagnose a patient, provide treatment, or prescribe a prescription drug based solely on one of the following:

A provider may not offer telehealth services if:

SOURCE: UT Code, 26B-4-704. (Accessed Jun. 2024).

Except as otherwise provided in an interstate compact enacted under this title, an individual who is licensed, in good standing, to practice mental health therapy or substance use disorder counseling in a state or territory of the United States outside of Utah, and who provides mental health therapy remotely or substance use disorder counseling remotely to a client in Utah:

See cross-state licensing section for more details.

SOURCE: UT Code Sec. 58-60-107 (Accessed Jun. 2024).

It is considered unprofessional conduct to issue, or aid and abet in the issuance of, an order or prescription for a drug or device:

SOURCE: UT Code, 58-1-501. (Accessed Jun. 2024).

Supervision of Cosmetic Medical Procedures

A physician who has an unrestricted license to practice medicine, a nurse practitioner who has an unrestricted license for advanced practice registered nursing, or a physician assistant acting in accordance with Chapter 70a, Utah Physician Assistant Act, who has an unrestricted license to practice as a physician assistant, shall: …

SOURCE: UT Code Sec. 58-1-506, & House Bill 365 (2024 Session), (Accessed Jun. 2024).

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Vermont

Last updated 07/02/2024

Controlled substances for use in treatment of opioid use disorder …

Controlled substances for use in treatment of opioid use disorder may be prescribed via telehealth in accordance with federal requirements.

SOURCE: VT Statute Annotated Title 18, Sec. 4752 (Accessed Jul. 2024).

Subject to the limitations of the license under which the individual is practicing, a health care provider licensed in this State may prescribe, dispense, or administer drugs or medical supplies, or otherwise provide treatment recommendations to a patient after having performed an appropriate examination of the patient in person, through telemedicine, or by the use of instrumentation and diagnostic equipment through which images and medical records may be transmitted electronically. Treatment recommendations made via electronic means, including issuing a prescription via electronic means, shall be held to the same standards of appropriate practice as those in traditional provider-patient settings.

SOURCE: VT Statutes Annotated, Title 18 Sec. 9361(b) (Accessed Jul. 2024).

A physician shall not be subject to any civil or criminal liability or professional disciplinary action if the physician prescribes to a patient with a terminal condition medication to be self-administered for the purpose of hastening the patient’s death and the physician affirms by documenting in the patient’s medical record that all of the following occurred:

See statute for complete list

SOURCE VT Statutes Annotated, Title 18, Ch. 113, Sec. 5283, (Accessed Jul. 2024).

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Virgin Islands

Last updated 09/11/2024

The Board of Medical Examiners shall establish by rules and …

The Board of Medical Examiners shall establish by rules and regulations the requirements for telemedicine licensure in accordance with this subchapter, provided that the rules and regulations include the following: …

The physician, when examining a patient by telemedicine, shall establish a bona fide physician-patient relationship by:

SOURCE: 27 V.I. Code Section 45d(c)(2). (Accessed Sept. 2024).

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Virginia

Last updated 08/12/2024

The practitioner-patient relationship is fundamental to the provision of acceptable …

The practitioner-patient relationship is fundamental to the provision of acceptable medical care. It is the expectation of the Board that practitioners recognize the obligations, responsibilities, and patient rights associated with establishing and maintaining a practitioner-patient relationship. Where an existing practitioner-patient relationship is not present, a practitioner must take appropriate steps to establish a practitioner-patient relationship consistent with the guidelines identified in this document, with Virginia law, and with any other applicable law. While each circumstance is unique, such practitioner-patient relationships may be established using telemedicine services provided the standard of care is met.

A practitioner is discouraged from rendering medical advice and/or care using telemedicine services without (1) fully verifying and authenticating the location and, to the extent possible, confirming the identity of the requesting patient; (2) disclosing and validating the practitioner’s identity and applicable credential(s); and (3) obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding the use of telemedicine services. An appropriate practitioner-patient relationship has not been established when the identity of the practitioner may be unknown to the patient.

A documented medical evaluation and collection of relevant clinical history commensurate with the presentation of the patient to establish diagnoses and identify underlying conditions and/or contra-indications to the treatment recommended/provided must be obtained prior to providing treatment, which treatment includes the issuance of prescriptions, electronically or otherwise. Treatment and consultation recommendations made in an online setting, including issuing a prescription via electronic means, will be held to the same standards of appropriate practice as those in traditional, in-person encounters. Treatment, including issuing a prescription based solely on an online questionnaire, does not constitute an acceptable standard of care.

Prescribing controlled substances requires the establishment of a bona fide practitioner-patient relationship in accordance with § 54.1-3303 (A) of the Code of Virginia. Prescribing controlled substances, in-person or via telemedicine services, is at the professional discretion of the prescribing practitioner. The indication, appropriateness, and safety considerations for each prescription provided via telemedicine services must be evaluated by the practitioner in accordance with applicable law and current standards of practice and consequently carries the same professional accountability as prescriptions delivered during an in-person encounter. Where such measures are upheld, and the appropriate clinical consideration is carried out and documented, the practitioner may exercise their judgment and prescribe controlled substances as part of telemedicine encounters in accordance with applicable state and federal law.

Prescriptions must comply with the requirements set out in Virginia Code §§ 54.1-3408.01 and 54.1-3303(A). Prescribing controlled substances in Schedule II through V via telemedicine also requires compliance with federal rules for the practice of telemedicine. Practitioners issuing prescriptions as part of telemedicine services should include direct contact for the prescriber or the prescriber’s agent on the prescription. This direct contact information ensures ease of access by pharmacists to clarify prescription orders, and further facilitates the prescriber-patient-pharmacist relationship.

SOURCE: Telemedicine Guidance. Doc. # 85-12. VA Board of Medicine. P. 2-4 (Aug. 19, 2021). (Accessed Aug. 2024).

A practitioner who has established a bona fide practitioner-patient relationship with a patient in accordance with the provisions of this subsection may prescribe Schedule II through VI controlled substances to that patient.

A practitioner who has established a bona fide practitioner-patient relationship with a patient in accordance with the provisions of this subsection may prescribe Schedule II through VI controlled substances to that patient via telemedicine if such prescribing is in compliance with federal requirements for the practice of telemedicine and, in the case of the prescribing of a Schedule II through V controlled substance, the prescriber maintains a practice at a physical location in the Commonwealth or is able to make appropriate referral of patients to a licensed practitioner located in the Commonwealth in order to ensure an in-person examination of the patient when required by the standard of care.

A prescriber may establish a bona fide practitioner-patient relationship for the purpose of prescribing Schedule II through VI controlled substances by an examination through face-to-face interactive, two-way, real-time communications services or store-and-forward technologies when all of the following conditions are met: (a) the patient has provided a medical history that is available for review by the prescriber; (b) the prescriber obtains an updated medical history at the time of prescribing; (c) the prescriber makes a diagnosis at the time of prescribing; (d) the prescriber conforms to the standard of care expected of in-person care as appropriate to the patient’s age and presenting condition, including when the standard of care requires the use of diagnostic testing and performance of a physical examination, which may be carried out through the use of peripheral devices appropriate to the patient’s condition; (e) the prescriber is actively licensed in the Commonwealth and authorized to prescribe; (f) if the patient is a member or enrollee of a health plan or carrier, the prescriber has been credentialed by the health plan or carrier as a participating provider and the diagnosing and prescribing meets the qualifications for reimbursement by the health plan or carrier pursuant to § 38.2-3418.16; (g) upon request, the prescriber provides patient records in a timely manner in accordance with the provisions of § 32.1-127.1:03 and all other state and federal laws and regulations; (h) the establishment of a bona fide practitioner-patient relationship via telemedicine is consistent with the standard of care, and the standard of care does not require an in-person examination for the purpose of diagnosis; and (i) the establishment of a bona fide practitioner patient relationship via telemedicine is consistent with federal law and regulations and any waiver thereof. Nothing in this paragraph shall apply to (1) a prescriber providing on-call coverage per an agreement with another prescriber or his prescriber’s professional entity or employer; (2) a prescriber consulting with another prescriber regarding a patient’s care; or (3) orders of prescribers for hospital out-patients or in-patients.

SOURCE: VA Code Annotated 54.1-3303, (Accessed Aug. 2024).

A practitioner in the course of his professional practice may issue a written certification for the use of cannabis products for treatment or to alleviate the symptoms of any diagnosed condition or disease determined by the practitioner to benefit from such use. The practitioner shall use his professional judgment to determine the manner and frequency of patient care and evaluation and may employ the use of telemedicine, provided that the use of telemedicine includes the delivery of patient care through real-time interactive audiovisual technology. No practitioner may issue a written certification while such practitioner is on the premises of a pharmaceutical processor or cannabis dispensing facility. A pharmaceutical processor shall not endorse or promote any practitioner who issues certifications to patients. If a practitioner determines it is consistent with the standard of care to dispense botanical cannabis to a minor, the written certification shall specifically authorize such dispensing. If not specifically included on the initial written certification, authorization for botanical cannabis may be communicated verbally or in writing to the pharmacist at the time of dispensing.

SOURCE: VA Code Annotated Sec. 4.1-1601, (Accessed Aug. 2024).

Requirements for practitioner issuing a certification for cannabis products:

The practitioner shall use the practitioner’s professional judgment to determine the manner and frequency of patient care and evaluation, which may include the use of telemedicine, provided that the use of telemedicine:

SOURCE: VA Admin Code Title 3, Sec. 10-30-30, (Access Aug. 2024).

A pharmacist may initiate treatment with, dispense, or administer drugs, devices, controlled paraphernalia, and other supplies and equipment pursuant to this section through telemedicine services, as defined in § 38.2-3418.16, in compliance with all requirements of § 54.1-3303 and consistent with the applicable standard of care.

SOURCE: VA Code 54.1-3303.1. (Accessed Aug. 2024).

A pharmacy shall not implement or enforce a policy that prevents a pharmacist from dispensing a prescription solely on the basis of the prescriber’s use of a telemedicine platform to provide services.

A pharmacist shall not prioritize dispensing a prescription from a prescriber who does not use telemedicine over dispensing a prescription from a prescriber who does use telemedicine solely on the basis of the prescriber’s use of a telemedicine platform to provide services.

SOURCE: VA Code Sec. 54.1-3420.3 (Accessed Aug. 2024).

Teledentistry

No person shall practice dentistry unless a bona fide dentist-patient relationship is established in person or through teledentistry. A bona fide dentist-patient relationship shall exist if the dentist has:

SOURCE: VA Statute 54.1-2711. (Accessed Aug. 2024).

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Washington

Last updated 06/20/2024

The WA Medical Quality Assurance Commission has issued guidance on …

The WA Medical Quality Assurance Commission has issued guidance on the use telemedicine. Guidance does not have the force of law, but can be considered by the Commission to be the standard of practice in the state.

A practitioner who uses telemedicine must establish a valid practitioner-patient relationship with the person who receives telemedicine services. The relationship is established when the practitioner agrees to undertake diagnosis or treatment of the patient and the patient agrees that the practitioner will diagnose or treat the patient. A valid practitioner-patient relationship may be established through telemedicine if the standard of care does not require an initial in- person encounter.

Prior to providing treatment, including issuing prescriptions, a practitioner who uses telemedicine should interview the patient to collect the relevant medical history and perform a physical examination, when medically necessary, sufficient for the diagnosis and treatment of the patient. A practitioner may not delegate an appropriate history and physical examination to an unlicensed person or to a licensed individual for whom that function would be out of the scope of the license.

Once a practitioner has obtained a relevant medical history and performed a physical examination, it is within the practitioner’s judgment to determine whether it is medically necessary to obtain a history or perform a physical examination at subsequent encounters. The technology used in a telemedicine encounter must be sufficient to establish an informed diagnosis as though the medical interview and physical examination had been performed inperson by the practitioner. An on-line questionnaire does not constitute an acceptable medical interview for the provision of treatment, including issuance of prescriptions, by a practitioner. The standard of care requires direct interaction with a licensed practitioner.

SOURCE: Washington Medical Commission, Defining and Providing Guidance on Telemedicine Usage, p. 4 (November 19, 2021). (Accessed Jun. 2024).

For purposes of authorizing the medical use of marijuana, a physician must complete an in-person physical exam or a remote physical exam when certain conditions are met. Following an in-person physical examination to authorize the use of marijuana for medical purposes, the health care professional may determine and note in the patient’s medical record that subsequent physical examinations for the purposes of renewing an authorization may occur through the use of telemedicine technology if the health care professional determines that requiring the qualifying patient to attend a physical examination in person to renew an authorization would likely result in severe hardship to the qualifying patient because of the qualifying patient’s physical or emotional condition.

SOURCE: Revised Code Washington Sec. 69.51A.030. (Accessed Jun. 2024).

Uniform Telehealth Act – Effective June 6, 2024

A practitioner-patient relationship may be established through telehealth. A practitioner-patient relationship may not be established through email, instant messaging, text messaging, or fax.

SOURCE: RCW New Title 18 Chapter, as added by SB 5481 (2024 Legislative Session). (Accessed Jun. 2024).

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West Virginia

Last updated 05/18/2024

Each health care board is required to propose an emergency …

Each health care board is required to propose an emergency rule for telehealth regulation. The rule must include a prohibition of prescribing any controlled substance listed in Schedule II of the Uniform Controlled Substance Act, unless authorized by another section: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an established patient.

The standard of care shall require that with respect to the established patient, the patient shall visit an in-person health care practitioner within 12 months of using the initial telemedicine service or the telemedicine service shall no longer be available to the patient until an in-person visit is obtained. This requirement may be suspended, in the discretion of the health care practitioner, on a case-by-case basis, and it does not apply to the following services: acute inpatient care, post-operative follow-up checks, behavioral medicine, addiction medicine, or palliative care.

SOURCE: WV Statute Sec. 30-1-26. (Accessed May 2024).

“Valid patient-practitioner relationship” means the following have been established:

SOURCE: WV Code Sec. 30-5-4. (Accessed May 2024).

A physician-patient relationship may not be established through:

If an existing physician-patient relationship is not present prior to the utilization to telemedicine technologies, or if services are rendered solely through telemedicine technologies, a physician-patient relationship may only be established:

Once a physician-patient relationship has been established, either through an in-person encounter or in accordance with the above, the physician may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.

A physician or podiatrist who practices medicine to a patient solely through the utilization of telemedicine technologies may not prescribe to that patient any controlled substances listed in Schedule II of the Uniform Controlled Substances Act: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an established patient.

The prescribing limitations do not apply when a physician is providing treatment to patients who are minors, or if 18 years of age or older, who are enrolled in a primary or secondary education program and are diagnosed with intellectual or developmental disabilities, neurological disease, Attention Deficit Disorder, Autism, or a traumatic brain injury in accordance with guidelines as set forth by organizations such as the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry, or the American Academy of Pediatrics. The physician must maintain records supporting the diagnosis and the continued need of treatment.

The prescribing limitations do not apply to a hospital, excluding the emergency department, when a physician submits an order to dispense a controlled substance, listed in Schedule II of the Uniform Controlled Substances Act, to a hospital patient for immediate administration in a hospital.

A physician or podiatrist may not prescribe any pain-relieving controlled substance listed in Schedule II of the Uniform Controlled Substance Act as part of a course of treatment for chronic nonmalignant pain solely based upon a telemedicine encounter: Provided, That the prescribing limitations contained in this section do not apply to a physician or a member of the same group practice with an established patient.

A physician or health care provider may not prescribe any drug with the intent of causing an abortion.

These provisions do not prohibit the use of audio-only or text-based communications by a physician who is:

SOURCE: WV Statute Sec. 30-14-12d & 30-3-13a, (Accessed May 2024).

“Dishonorable, unethical or unprofessional conduct of a character likely to deceive, defraud or harm the public or any member thereof” includes practice of providing treatment recommendations relating to issuing prescriptions, via electronic or other means, for persons without establishing an on-going provider-patient relationship wherein the physician, podiatric physician or physician assistant has obtained information adequate to support the prescription: Provided, That this definition does not apply: in a documented emergency; or in an on-call or cross coverage situation; or where patient care is rendered in consultation with another provider who has an ongoing relationship with the patient, and who has agreed to supervise the patient’s treatment, including use of any prescribed medications.

SOURCE: WV Code of State Rules Sec. 11-1A-12.2(k) p. 21. (Accessed May 2024).

A practitioner providing medication-assisted treatment may perform certain aspects of telehealth if permitted under his or her scope of practice.

SOURCE: WV Code Sec. 16-5Y-5(r). (Accessed May 2024).

Veterinarians

A veterinarian-client-patient relationship is required for providing veterinary care in the State of West Virginia via telehealth services. The veterinary care professional shall perform an in person exam within the 12 months prior, and at least every 12 months thereafter, or the telehealth service shall no longer be available to the patient. Such relationship exists when:

A registrant shall not prescribe any controlled substance listed in Schedule II of the Uniform Controlled Substance Act via interstate telehealth services.

Final Rule (Effective until August 1st, 2027) – Dentistry

No person shall practice teledentistry unless a bona fide practitioner-patient relationship is established. A bona fide practitioner-patient relationship shall exist if the dentist has:

In cases in which a dentist is providing teledentistry, the examination required shall not be required if the patient has been examined in person by a dentist licensed by the board within the twelve months prior to the initiation of teledentistry and the patient’s dental records of such examination have been reviewed by the practitioner providing teledentistry.

SOURCE: WV Admin Law 5-16-4. (Accessed May 2024).

Final Rule (Effective until August 1st, 2027) – Medical Board

Among other ways, a provider-patient relationship is formed when a provider serves a patient’s medical needs, examines, diagnoses or treats a patient, or agrees to examine, diagnose or treat a patient.

A provider-patient relationship may be established through:

While real-time audio-only communications may be utilized to establish the provider-patient relationship, patient communication though audio-visual communication is preferable, if available or possible. Real-time audio-only communications may not be utilized when its use does not conform to the standard of care.

The provider-patient relationship may not be established through text-based communications such as email, internet questionnaires, text-based messaging, or other written forms of communication.

A telehealth provider’s selection of telemedicine technologies for a patient encounter must permit the provider to meet the standard of care for the patient’s particular health issue and presentation. Treatment, including issuing a prescription, based solely on an online questionnaire, does not conform to the standard of care.

When prescribing to a patient via telemedicine, a telehealth provider shall prescribe within the prescriptive authority of the provider’s profession in West Virginia.

A telehealth provider who provides health care to a patient solely through the use of telemedicine technologies is prohibited from prescribing a controlled substance listed in Schedule II of the Uniform Controlled Substance Act except under the following circumstances:

See rule for additional requirements for prescribing controlled substances.

A telehealth provider may not, based solely upon a telemedicine encounter, prescribe any drug with the intent of causing an abortion.

SOURCE: WV Admin Law 11-15-6, 7 & 8. (Accessed May 2024).

Final Rule (Effective until August 1st, 2033) – Board of Nursing

A practitioner-patient relationship may be established through:

While real-time audio-only communications may be utilized to establish the practitioner-patient relationship, patient communication through audio-visual communication is preferable, if available or possible. Real-time audio-only communications may not be utilized when its use does not conform to the standard of care.

The practitioner-patient relationship may not be established through text-based communications such as email, internet questionnaires, text-based messaging, or other written forms of communication.

After a practitioner-patient relationship has been established, a practitioner may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.

A telehealth provider’s selection of telemedicine technologies for a patient encounter must permit the provider to meet the standard of care for the patient’s particular health issue and presentation. Treatment, including issuing a prescription if the nurse has prescriptive authority, based solely on an online questionnaire, does not conform to the standard of care.

The standard of care for the provision of health care services is the same for health care services provided in-person and health care services provided via telemedicine technologies.

Nothing in this rule requires a practitioner to use telemedicine technologies to treat a patient if the practitioner, in his or her discretion determines that an in-person encounter is required.

APRNs: When prescribing to a patient via telemedicine, a telehealth provider shall prescribe within the prescriptive authority of the provider’s profession in the state of West Virginia pursuant to qualified advanced practice registered nurses to prescribe prescription drugs in accordance with the provisions of W. Va. Code § 60A-9-5a and the requirements set forth in §30-7-15a, 15b, and 15c and 19 CSR 08.

A telehealth provider may not, based solely upon a telemedicine encounter, prescribe any drug with the intent of causing an abortion.

See rule for requirements for controlled substances.

SOURCE: WV Admin Law 19-16-6, 7, 8. (Accessed May 2024).

**Final Rule (Effective until August 1st, 2027) – Board of Osteopathic Medicine

A provider-patient relationship may be established through:

The provider-patient relationship may not be established through text-based communications such as email, internet questionnaires, text-based messaging, or other written forms of communication. After a provider-patient relationship has been established, a provider may utilize any telemedicine technology that meets the standard of care and is appropriate for the patient presentation.

It is the standard of care in this state for health care practitioners to complete an appropriate controlled substance prescribing course prior to prescribing controlled substances to patients located in West Virginia. The Board maintains a list of Board-approved courses in drug diversion training and best practice prescribing controlled substances training on its website. Registrants may comply with the standard of care by completing a Board-approved course or a controlled substance continuing education course required by the registrant’s state of licensure.

When prescribing to a patient via telemedicine, a telehealth provider shall prescribe within the prescriptive authority of the provider’s profession in this state.

A telehealth provider who provides health care to a patient solely through the use of telemedicine technologies is prohibited from prescribing a controlled substance listed in Schedule II of the Uniform Controlled Substance Act except under the following circumstances:

See additional requirements for providers who prescribe controlled substances.

A telehealth provider may not, based solely upon a telemedicine encounter, prescribe any drug with the intent of causing an abortion.

SOURCE: WV Admin Law 24-10-6, 7, 8. (Accessed May 2024).

Final Rule (Effective until August 1, 2030) – Social Workers

The practitioner-client relationship is established at the time informed consent is obtained.

SOURCE: WV Admin Law 25-1-5. (Accessed May 2024).

Final Rule (Effective until August 1, 2030) – Speech Language Pathology and Audiology

Established patient means a patient who has, within the last three years, received professional services, face-to-face, from the physician, qualified health care professional, or another physician or qualified health care professional of the exact same specialty and subspecialty who belongs to the same group practice.

The standard of care requires that with respect to the established patient, the patient shall visit an in-person health care practitioner within 12 months of using the initial telepractice service or the telepractice service shall no longer be available to the patient until an in-person visit is obtained. This requirement may be suspended, in the discretion of the health care practitioner, on a case-by-case basis, but it does not apply to the following services: acute inpatient care, post-operative follow-up checks, behavioral medicine, addiction medicine, or palliative care.

SOURCE: WV Rule 29-01-16. (Accessed May 2024).

Final Rule (Effective until August 1, 2028) – Optometrists

No person shall deliver optometric telehealth services unless a bona fide optometrist-patient relationship is established. A bona fide optometrist-patient relationship shall exist if the optometrist has:

In cases in which an optometrist is providing telehealth, the examination required shall not be required if the patient has been examined in person by an optometrist licensed by the Board within the 12 months prior to the initiation of telehealth and the patient’s records of such examination have been reviewed by the optometrist providing telehealth.

The standard of care for providing optometric care in the State of West Virginia via telehealth services by a registrant or licensed optometrist shall be the same as for in-person care.

A telehealth provider’s selection of telemedicine technologies for a patient encounter must permit the provider to meet the standard of care for the patient’s particular health issue and presentation. Treatment, including issuing a prescription, based solely on an online questionnaire, does not conform to the standard of care.

Nothing in this rule requires a practitioner to use telemedicine technologies to treat a patient if the practitioner, in his or her discretion determines that an in-person encounter is required.

A registrant shall not prescribe any controlled substance listed in Schedule II of the Uniform Controlled Substance Act via interstate telehealth services.

Nothing in this section shall be construed to invalidate §30-8A-3 or to permit use of any automated refractor or other automated or remote testing device to generate refractive data.

SOURCE: WV Admin Law 14-12-3, 5. (Accessed May 2024).

Emergency Rule (Effective until August 1st, 2029) – Professional Counselors & Marriage and Family Therapists

An interstate telehealth registration does not authorize a LPC or LMFT to establish a new client relationship.

SOURCE: WV Admin Law 27-14-3. (Accessed May 2024).

Final Rule (Effective until August 1, 2029) – Dietitians

A practitioner-patient relationship may be established through video, audio or written forms of communication, such as e-mail or text-based messaging, or any combination thereof.

If an existing practitioner-patient relationship is not present prior to the utilization of telehealth technologies, or if services are rendered solely through telehealth technologies, a practitioner-patient relationship may only be established through the use of telehealth technologies which incorporate interactive audio using store and forward technology, real-time videoconferencing, or similar secure video services during the initial patient evaluation.

Once a practitioner-patient relationship has been established, either through an in-person encounter or in accordance with section 4.2 of this rule, the practitioner may utilize any telehealth technology that meets the standard of care and is appropriate for the patient.

SOURCE: WV Rule 31-7-4. (Accessed May 2024).

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Wisconsin

Last updated 08/13/2024

A physician-patient relationship may be established through telemedicine.

SOURCE: WI …

A physician-patient relationship may be established through telemedicine.

SOURCE: WI Admin. Code MED Ch. 24.03 (Accessed Aug. 2024).

When a physician uses a website to communicate to a patient located in this state, the physician may not provide treatment recommendations, including issuing a prescription, unless the following requirements are met:

Providing treatment recommendations, including issuing a prescription, based only on a static electronic questionnaire does not meet the standard of minimally competent medical practice.

SOURCE: WI Admin. Code MED Ch. 24.07 (Accessed Aug. 2024).

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