Telehealth

In response to the COVID-19 public health emergency, states have taken measures to alleviate the occupational licensure policy burdens that impede state response efforts and which are counterintuitive to social distancing practices. The following information presents a collection of policy actions states have implemented to expand telehealth services.

The enhanced use of telehealth/telemedicine services allows states to augment the availability of health care services while promoting social distancing. Several states have taken actions that reduce regulations associated with telehealth, including allowing practitioners (including those out of state) not normally authorized to deliver telehealth services to do so and modifying in-person examination requirements which are a pre-requisite for telehealth services.

Click to view each state’s actions

Alaska

• • • Senate Bill 241 – Allows the Commissioner of the Department of Commerce, Community, and Economic Development may take actions regulating the scope and duration of any license, permit, or certificate issued under the applicable section of the legislation

Arkansas

• • • Executive Order 20-05 – Allows Arkansas-licensed mental health providers to use any appropriate communication technology to reach patients within the state.

California

• • • Executive Order N-43-20 – Suspends numerous statutory and regulatory requirements relating to patient confidentiality and consent in telehealth administration, for both mental health and medical practitioners.

Colorado

• • • EO 2020-020 – Suspends the statutory definition of “telehealth” to broaden the range of acceptable technologies and services, mandates insurer coverage of telehealth, suspends limitations on out-of-state mental health professionals’ ability to practice in Colorado; allows veterinary telemedicine without an existing vet-client relationship.
    • EO 2020 046 (Extends EO 2020 020) – Temporaily suspends certain statutes relating to telehealth to increase its use.
    • EO 2020 082 and 2020 116 – Extend Executive Orders 2020 020 and 2020 046 Concerning the Temporary Suspension of Certain Statutes to Expand the Use of Telehealth Services Due to the Presence of COVID-19.

Connecticut

• • • Executive Order 7DD – Expands the range of professions allowed to provide telehealth services to include dentists, behavior analysts, genetic counselors, music therapists, art therapists, and veterinarians; allows for telehealth services via audio-only telephone; suspends certification requirements for telehealth providers; loosens privacy and record-keeping requirements for telehealth; and mandates that un- or under-insured telehealth patients be billed at the Medicaid rate, with financial assistance available.
    • Executive Order 7FF – Allows Medicaid-enrolled providers to provide telehealth services to new or established Medicaid patients through audio-only telephone.
      

Delaware

• • • Second Modification of the Declaration of Emergency Due to a Public Health Threat – Allows out-of-state medical providers to practice in Delaware via telehealth if their profession is telehealth-eligible within the state. Suspends the Delaware medical board’s Regulation 19 governing the use of telehealth.
    • Eighth Modification of the Declaration of Emergency Due to a Public Health Threat – Suspends any remaining restrictions on telehealth so that no in-person contact between provider and patient is required before or during telehealth service.

    • House Bill 348/1 (July 17) – Continues the suspension of statutory requirements restricting the use of telemedicine but specifies that the requirement that a patient present in-person prior to the delivery of telemedicine services is excused under circumstances which make in-person presentation impractical.

Georgia

• • • EO 03.20.20.02 – Directs Georgia Composite Medical Board to immediately adopt emergency rules to provide telehealth licenses.

    • EOs 04.08.20.02, 04.30.20.1, 05.28.20.01, and 06.29.20.01 – Extend the Public Health State of Emergency declared by Executive Order 03.14.20.01 that provides for telemedicine licenses.

Hawaii

• • • Executive Order 20-02 – Allows currently or formerly licensed out-of-state physicians and physician assistants to engage in telehealth services without an existing patient-provider relationship or Hawaii license

Idaho

• • • Proclamation (April 2) – Suspends requirement for an existing patient-provider relationship to practice telehealth, allows prescription of controlled substances via telehealth.

       

    • Proclamation (April 23) – Suspends statutory definitions related to telehealth and suspends disciplinary provisions associated with improper use of telehealth.

 Indiana

• • • Executive Order 2020-05 – Authorizes use of telehealth by mental health professionals.

 Iowa

• • • Proclamation of Disaster Emergency – Authorizes out-of-state mental health professionals to use telehealth to reach Iowa patients.
    • Proclamation of Disaster Emergency (April 2) – allows for remote mental health services by out-of-state mental health professionals and modifies the definition of telehealth to include audio-only telephone transmission.
    • Proclamation of Disaster Emergency (April 24) – Allows for licensed out-of-state telehealth providers to be licensed in Iowa.
    • Proclamations of Disaster Emergency (May 26, June 25, and July 24) – Extend 3/22 and 4/2 proclamations including the allowance of remote mental health services by out-of-state mental health professionals.

Kansas

• • • EO 20-35 – Allows out-of-state physicians to utilize telemedicine when treating patients within the state without the necessity of securing a license to practice medicine in the state, provided the out of state physician advises the Board of the physician’s practice in writing. These provisions may be extended to other healthcare professionals.

    • House Bill 2016a (June 8) – Allows a physician holding a license issued by another state to practice telemedicine to treat patients in Kansas. Also allows the state board of healing arts to extend the provisions of this subsection to other healthcare professionals licensed and regulated by the board.

Kentucky

• • • Division of Community Alternatives, Dept. for Medicaid Services, Letter to 1915(c) Home and Community Based Services Waiver Providers – Allows case managers to conduct visits with Home and Community Based Waiver participants via telehealth, if compliant with HIPAA.

• • • Dept. for Medicaid Services Letter to Behavioral Health Providers – Expands range of behavioral telehealth services covered by Medicaid; creates new billing codes for brief telecommunications with established patients.

Louisiana

• • • Proclamations JBE 2020-52, JBE 2020-59, JBE 2020-75, JBE 2020-84, JBE 2020-97, and JBE 2020-102 – Extend all prior proclamations, including those expanding access to telemedicine and the way it may be delivered, and extends state of emergency.

    • House Bill 449 (June 11) – Allows for the licensed delivery of behavioral health services through telehealth.

Maine

• • • Executive Order 16 – Authorizes use of telehealth by in-state and out-of-state physicians, physician assistants and registered nurses via any telecommunication technology; suspends any patient confidentiality requirements that may conflict with telehealth delivery.
    • Executive Order 35 – Authorizes use of telehealth by all other in-state and out-of-state medical professionals, including veterinary, via any telecommunication technology suspends any patient confidentiality requirements that may conflict with telehealth delivery.

Maryland

• • • Executive Order 20-04-01-01 – Authorizes Secretary of Health to issue guidance allowing healthcare practitioners to deliver services via telehealth, including audio-only technologies. Allows the establishment of new patient-provider relationships via telehealth.

Michigan

• • • EO 2020-86 – All health care providers are authorized and encouraged to use telehealth services when medically appropriate and upon obtaining patient consent.
    • EO 2020-138 – Modifies Executive Order 2020-86 to only include necessary provisions. Extends telehealth authorizations.

 Minnesota

• • • Emergency Executive Order 20-28 – Authorizes telehealth practice in Minnesota by both in-state and out-of-state practitioners.

    • House Bill 105b (June 23) – Extends the expiration of Executive Order 20-28 relating to use of telemedicine.

 Mississippi

• • • Proclamation of the State Board of Medical Licensure (March 15) – Allows out-of-state licensed physicians to reach patients in Mississippi via telehealth; suspends requirements for in-person examinations prior to issuance of prescriptions.

 Missouri

• • • Executive Order 20-04 – Suspends requirements for an existing patient-provider relationship and an in-person physical examination as conditions for telehealth practice; eases certain record-keeping requirements for telehealth.

Montana

• • • Directive Implementing Executive Orders 2-2020 and 3-2020 and providing for expanded telehealth – Authorizes use of all modes of telehealth, including audio-only, and waives strict compliance with the respective telehealth requirements of the boards of medical examiners, psychologists, and speech-language pathologists.
    • Directive (April 21) – Implements Executive Orders 2 and 3 and allows healthcare professionals to utilize telehealth.
    • Directive (April 21) – Further expands previous telehealth directive on 3/20. Suspends rules limiting telehealth usage and requiring face-to-face interactions. Requires insurance coverage parity between telehealth and in-person services.

Nebraska

• • • Executive Order 20-12 – Directs state Dept. of Heath and Human Services to issue guidance for use of telehealth by licensed practitioners; allows healthcare workers not specifically certified by law to accept treatment orders by phone or verbally.

New Hampshire

• • • Emergency Order #15 Pursuant to Executive Order 2020-04 – Allows out-of-state medical practitioners to practice in New Hampshire, including via telehealth as necessary.

New York

• • • Executive Order 202.18 – Allows pharmacists and pharmacy technicians to practice remotely as long as patient confidentiality is maintained.

North Dakota

• • • Executive Order 2020-05.1 – State statutes related to telehealth are suspended, including requirements for a secure connection and the prohibition on audio-only technologies; also requires insurers to cover telehealth services in full, without restrictions.

Ohio

• • • State Medical Board Guidance (March 18) – Suspends Medical Board’s enforcement of telehealth-related laws and regulations for duration of emergency, provided that practitioners must document their use of telehealth and meet minimal standards of care.

Oklahoma

• • • Executive Order 2020-07 – Directs medical professionals to utilize telehealth to the maximum possible extent. 

Oregon

• • • Oregon Health Authority Temporary Administrative Order (March 14) – Clarifies billing procedures for telehealth, including ensuring that telehealth services are covered equivalently to in-person services.

    • House Bill 4212 (June 26) – Authorizes physician assistants to practice telehealth across state lines.

Pennsylvania

• • • Department of State Telemedicine Guidance (March 18) – Authorizes telehealth practice by all professions regulated by the state’s medical, behavioral health, physical therapy, and veterinary licensing boards, including by out-of-state practitioners.
    • Department of State Waiver (March 26) – Allows for clinical social workers, marriage and family therapists, professional counselors, and psychologists who are receiving supervision for clinical experience to provide teletherapy services if their supervisor complies with all required regulations.

Rhode Island

• • • EO 20-06 – Suspends statutory limits on telehealth practice, including prohibition of audio-only technologies, restrictions on the location of the patient, and provisions allowing insurers to limit telehealth access.

    • EO 20-43 – Directs the Department of Health to “take immediate actions to … sustain positive enhancements associated with the COVID-19 crisis, such as the expansion of telehealth”.

South Dakota

• • • Executive Order 2020-07 – Suspends statutes and regulations limiting provision of telemedicine and requiring face-to-face visits.

    • Executive Order 2020-16 – Suspends statutes requiring a prior patient-provider relationship, limiting virtual prescription of certain medication, and requiring real-time visual communication technology or prohibiting audio-only telehealth service.

Tennessee

• • • EO 24 – Authorizes the Commissioner of Health to allow persons who have completed postgraduate training in behavioral or mental health to provide services in Tennessee without a license, including through the use of telehealth technology.
    • EO 36 – Allows all licensed in-state and out-of-state healthcare providers to practice in Tennessee via telehealth; urges insurers to remove any restrictions on telehealth services.

Texas

• • • Governor’s Directive (March 14) – Directs the Texas Medical Board and Board of Nursing to allow telehealth practice by licensed in-state and out-of-state providers.
    • Medical Board Guidance (March 14) – Allows patient-provider relationship to be established via telehealth, including audio-only.
    • Department of Insurance Emergency Rule (March 17) – Requires telehealth visits for patients with state-regulated plans to be billed the same as in-office visits for insurance purposes.
    • Press Release (March 20) – Allows pharmacists to conduct telephonic consultations.
    • Press Release (April 7) – Allows pharmacy technicians to accept prescription orders over the phone and to send or receive a transfer of original prescription information on behalf of patients.
    • Press Release (April 9) – Waives certain telehealth restrictions to allow for use of a smart phone or any audio-visual, real-time, or two-way interactive communication system in remote practice by speech pathologists, audiologists, behavior analysts, hearing aid fitters, and dyslexia therapists.
    • Medical Board Emergency Rule §174.5 (June 19) – Modifies telehealth rules for chronic pain treatment to allow physicians to renew prescriptions of scheduled pain medications via telehealth (but not to issue new prescriptions).
    • Texas Board of Nursing Emergency Rule §217.24 (July 7) – Modifies telehealth rules for chronic pain treatment to allow advanced practice RNs to renew prescriptions of scheduled pain medications via telehealth (but not to issue new prescriptions).

Utah

• • • Executive Order 2020-07 (Renewed by E.O. 2020-23) – Suspends portions of the Utah Telehealth Act, including provisions for patient privacy and the requirement that a telehealth provider comply with applicable laws & rule regarding the provider’s licensed practice.

Vermont

• • • House Bill 742 – Allows retired, out-of-state, and recently graduated healthcare professionals to provide care in Vermont, including via telehealth; requires insurers to provide the same reimbursement rate for telehealth as for in-person care and prohibits insurers from limiting patient access to telehealth services.

Virginia

• • • EO 57 – Allows-of-state providers to reach existing patients via telehealth and permits the use of any private communication technology.

    • Board of Pharmacy Waivers (Revised May 5) – Allows licensed out-of-state pharmacists and pharmacy technicians to practice in Virginia, allows pharmacy technicians to perform certain services remotely, and extends the length of time pharmacy technicians may practice without a license while waiting to take the licensure exam.

Washington

• • • Senate Bill 5385 (March 19) – Requires insurers to reimburse telehealth services at the same rate as if the services were provided in person (payment parity).
    • Proclamation 20-29 – Provides for provisions of Senate Bill 5385 (payment parity for telehealth) to take effect immediately rather than on Jan. 1, 2021.

West Virginia

• • • EO 10-20 – Allows telehealth practice by licensed in-state and out-of-state practitioners and permits use of non-video technologies.
    • EO 17-20 – Suspends statutory provisions requiring in-person examinations to refill a schedule II opioid prescription.
    • EO 31-20 – Suspends requirement that a speech-language pathologist or audiologist must be licensed by the State Board for Speech-Language Pathology and Audiology in order to telepractice and allows ASLPs licensed by the Department of Education to telepractice.

Wisconsin

• • • Emergency Order 16 – Allows any physician licensed in Wisconsin, another state, or Canada, to reach Wisconsin patients via telehealth
    • Emergency Order 35 – Authorizes provision of outpatient mental health services via telehealth; allows telehealth practice by occupational therapists.

MODIFICATION OF LICENSING REQUIREMENTS

TEMPORARY LICENSURE

TELEHEALTH

SCOPE OF PRACTICE

INTERSTATE COMPACTS

All Actions

The executive orders, administrative orders and legislation included in this web resource represent a sample of the actions states have enacted in response to COVID-19. Therefore, this resource is not intended to be represented as an exhaustive list of state actions, but rather used to review the variances in strategies states have implemented through occupational licensing policy to effectuate response efforts. The descriptions of the policy actions have been summarized to include relevant detail but should be viewed in full for their entire context. CSG will continue to update the list of policy actions throughout the duration of the state public health emergency response and recovery efforts.