Practicing Telemedicine? You Should Be Licensed in These States.

Becoming a telemedicine provider can offer flexibility in your practice, expand your patient pool and open the door to new experiences. However, almost all states require you to be licensed in the state where the patient is located - so to make the most out of a telehealth practice, many healthcare providers have multiple state licenses. 

Multi-state licensing, although important for expanding patient reach, can be a time-consuming and burdensome process. So, if you are considering practicing telemedicine across state lines you might be wondering - what are the best states to be licensed in? Or if you are working towards becoming licensed in all 50 states, which ones should you prioritize? 

There are a variety of things to consider when strategically expanding your licensure to additional states. Influencing factors to consider could include:

• The adoption rate of telehealth in each state

• Modality neutrality

• What mode the state allows patients to start telehealth 

• Pay parity laws 

• Independent practice requirements (if you are a nurse practitioner) 

By considering these factors, you can make the most out of your licensure and effectively expand your patient reach. 

Adoption Rate of Telehealth

When the COVID-19 pandemic hit, both patients and care providers alike flocked to telehealth. However, since the height of the pandemic in 2020, the number of telehealth users have shifted. The National Library of Medicine completed a study of the use of telemedicine in the United States between 2021 and 2022 and found that the highest usage of telehealth were in the following states:

• California

• Oregon

• Massachusetts

• New Mexico

• Arizona 

• Washington 

• District of Columbia

• Vermont

• New York

• Florida

Being licensed in a state with a high telehealth adoption rate can offer healthcare providers significant advantages. High usage of telehealth typically means increased patient demand and more reimbursement opportunities. It can also mean ease of compliance as states with high telehealth adoption often have better defined regulations and guidelines for telehealth.

Modality Neutrality

Modality neutrality is another aspect to evaluate when determining what states to become licensed in. Modality neutrality in this context, refers to how neutral the state is when it defines telehealth in terms of models. A model neutral definition of telehealth means state law defines telehealth as a mode of delivery of health care services using telecommunication technologies, including but not limited to asynchronous, synchronous and remote patient monitoring by a clinician at a different physical location than the health care practitioner. 

States with laws that use this definition (or similar) of telehealth do not limit delivery of telehealth services to a specific type of model (such as synchronous video only). When states operate with modality neutrality it gives both patients and provides range on how to provide/receive their healthcare, making telemedicine more accessible to deliver/receive. 

The following states allow many methods of telehealth and are considered model neutral or have a broad enough definition of telehealth to be considered model neutral:

• Minnesota

• South Dakota

• Nebraska

• Oklahoma

• Arkansas

• Lousianna

• Illinois

• Indiana

• Kentucky

• Mississippi

• Maryland 

• Rhoad island

• Massachusetts

• New hampshire

• Florida

• Connecticut

• Delaware

• Idaho

• Utah

• Colorado

• Arizona

• New Mexico

• Hawaii

Starting Telehealth by Any Mode

Another factor to consider is the mode in which states allow patients to begin using telehealth. Some states allow patients to start seeing a telehealth provider by any mode of delivery (synchronous, asynchronous, remote patient monitoring, etc.) while others limit how a patient starts their telehealth journey. For example, New Mexico doesn’t allow patients to begin telehealth asynchronously. 

When states allow patients to begin telehealth by any mode they prioritize patient choice and accessibility, leading to improved access to care, patient-centered interactions and reduced technological barriers. These states support equitable healthcare access and can enhance the overall patient experience, making them advantageous for both healthcare providers and patients. 

The following states allow patients to begin telehealth by any mode:

• California

• Nevada

• Arizona

• Hawaii

• Montana

• Wyoming

• Colorado

• Texas

• South Dakota

• Nebraska

• Oklahoma

• Texas

• Iowa

• Missouri

• Wisconsin

• Illinois

• Michigan

• Indiana

• Kentucky

• Tennessee

• Ohio

• Alabama

• Florida

• Georgia

• North Carolina

• Maryland

• Delaware

• Pennsylvania

• New York

• Connecticut

• New Hampshire

• Maine

Pay Parity Laws

Being licensed in states with telehealth pay parity laws is extremely beneficial to clinicians as it guarantees their telehealth services will be covered by insurance - in some cases reimbursed at the same rate.

There are two types of pay parity laws, payment parity for telehealth and telehealth service/coverage parity. Payment parity for telehealth requires that telehealth visits be reimbursed at the same rate as if the visit had been delivered in-person. While service/coverage parity requires the same telehealth services to be covered as if they were delivered in-person. Coverage/service parity does not guarantee the same payment rate. 

As of May 1, 2023 the following states have both payment parity and service/coverage parity laws:

• Washington

• Oregan

• California

• Nevada

• Arizona

• Utah

• New Mexico

• Nebraska

• Oklahoma

• Minnesota

• Iowa

• Illinois

• Oklahoma

• Kentucky

• Georgia

• West Virginia

• New York

• Vermont

• Massachusetts

• Rhode Island

• Connecticut

• Delaware

• Maryland

• Virginia

Pay parity laws for telehealth services promote fairness, equity and the continued growth of telehealth as a viable healthcare delivery method. They benefit both healthcare providers and patients by incentivizing telehealth adoption, improving access to care and ensuring that providers are fairly compensated for their virtual services.

Independent Practice Requirements 

Lastly, if you are a Nurse Practitioner, you may want to prioritize becoming licensed in states that allow independent practice. States vary on whether they allow nurse practitioners (NPs) to practice independently without a doctor providing oversight or co-signing their work. 

When states allow NPs to practice independently this helps increase access to care, especially amid the ever-growing healthcare professional shortage, and reduce costs without compromising quality of care. 

The following states allow NPs to practice independently without a collaborative practice agreement or supervision from a physician to provide medical services:

• Washington

• Oregan

• Nevada

• Arizona

• Idaho

• Utah

• Hawaii

• Montana

• Wyoming

• New Mexico

• North Dakota

• Alaska

• Kansas

• Iowa

• Kentucky

• West Virginia

• New Hampshire

• Massachusetts

• Delaware

• West Virginia

• Kentucky

Powering Telehealth Clinicians

Considering all the factors mentioned above can help you strategically expand your licensure and ensure you make the most of your time and telehealth practice. However, please note that telehealth policies can change and to confirm state laws during your evaluation process. 

Speaking of telehealth and digital health solutions, meet OpenLoop! We thoughtfully pair our network of clinicians with innovative healthcare organizations providing virtual and in-person care, in all 50 states. 

Our easy-to-use, HIPAA compliant technology was designed with clinicians top-of-mind for seamless scheduling, patient visits and note charting. With 6,000+ providers already in our clinician network, you can tap into the OpenLoop advantage too with:

• Nationwide connections

• Sync & async options

• Flexible scheduling

• Competitive pay

• Dedicated provider support

Interested in expanding your reach as a provider? Apply to our clinician network!