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Interstate Licensure for Providers Using Telemedicine

In order to deliver telemedicine services, providers must have a license issued to them by the state in which the patient receiving the telemedicine resides. Thus, providers offering telemedicine may have to get licensed in multiple states depending on where their patients live. Obtaining multiple licenses to practice interstate telemedicine is timely and costly, which may deter providers from using telemedicine; this is an issue for rural and underserved areas who rely on telemedicine for access to healthcare.

The TELE-MED Act of 2015 was intended to reduce licensing barriers for interstate telemedicine by making Medicare coverage and reimbursement available for interstate telemedicine services. However, the Act failed to get congressional approval when it was introduced three years ago. Its purpose was to amend title XVIII of the Social Security Act so that Medicare participating providers could provide interstate telemedicine services to Medicare beneficiaries without having to get licensed in multiple states. This would have significantly aided Medicare beneficiaries who need telemedicine from providers out of state.

Though the TELE-MED Act did not pass, the Interstate Medical Licensure Compact (IMLC) may still reduce the burden for providers wanting to use interstate telemedicine. Acknowledging the burden of applying to for a license in other states, especially when providers have patients across multiple states, the IMLC has created an expedited pathway for interstate licensure. The IMLC formed a Commission made up of two representatives from each adopting state, and the Commission reviews the applicants and determines whether they should be issued a license or not. The IMLC is an agreement with 24 states, 1 territory, and the 31 Medical and Osteopathic Boards in those states and territory. IMLC is streamlining the licensing process, but it is still expensive and does not solve the problem that physicians using telemedicine must be licensed wherever their patients are located.

The U.S. Department of Veterans Affairs (VA) has recently expanded telemedicine by allowing VA health care providers to treat patients across state lines.  This was a result of the 2016 “Anywhere to Anywhere” healthcare initiative. The initiative’s goal was to enable VA doctors to treat interstate VA patients via telemedicine, regardless of whether the doctor is licensed in the state the patient resides. In the past, VA providers had to abide by the licensing restrictions and state-specific telemedicine laws, but the new federal rule preempts those restrictions.

The VA has accomplished what the TELE-MED Act was trying to achieve. No current advisory opinion or report by the OIG explains future developments in regards to Medicare undertaking the interstate licensure restrictions again. However, the OIG has a work plan on Medicaid and telemedicine, “Review of Medicaid Services Delivered Using Telecommunication Systems,” where the OIG is reviewing compliancy of providers who use telemedicine. Although not directly stated in the work plan, the OIG may release some guidance on interstate licensure in the future.

For over 30 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, including telemedicine licensure. If you or your healthcare entity has any questions about the IMLC, how to apply for a license, or any other health care regulatory compliance questions, please contact an experienced healthcare attorney at (248) 544-0888, or via email at You may also subscribe to our health law blog by adding your email at the top right of this page.

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