Legislation Affecting Telemedicine Licensure (1995-1997)

Legislation Affecting Telemedicine Licensure (1995-1997)

Alabama: 3-year, special purpose licenses must be granted to nonresident doctors and osteopaths practicing medicine across state lines. Defines "practice of medicine" to include treatment rendered as a result of the transmission of data by electronic or other means. Excludes informal, uncompensated and undocumented consultations. Holding the special purpose license subjects the licensee to the jurisdiction of Alabama's medical board. Reciprocal, telemedicine licenses must also be issued to Alabama physicians. (S 341; enacted 4/8/97)

Arkansas: Physicians physically located outside the state but practicing within the state must obtain licensure. The "practice of medicine" is defined as a physician who, through use of an electronic or other medium, performs an act that is part of a patient care service initiated in this state, including performance or interpretation of x-rays or pathological materials. Nonresident physicians episodically consulting with state physicians or medical schools, providing services unavailable in Arkansas, or physically traveling to Arkansas to see patients are exempted. (H 2023; enacted 4/14/97)

Arizona: Defines "telemedicine" as the practice of health care delivery, diagnosis, treatment and transfer of medical data through interactive audio, video or data communications that occurs in the physical presence of the patient. Includes electronic communications sent to a provider for multiple or frequent consultations. The provider must obtain licensure in Arizona as well as verbal or written consent prior to the delivery of telemedicine. The telemedical transaction becomes part of the patient's record. (H 2224; enacted 4/11/97)

In 1996, the definition of "practice of medicine" was amended to include treatment "by any means, methods, devices or instrumentalities" (AZ Rev. Stat. 32-1401). Out-of-state physicians were exempted from licensure if providing "single or infrequent" consultations (AZ Rev. Stat. 32-1421). This legislation was further refined in 1997.

California: The Telemedicine Development Act of 1996 allows for teleconsulation without a license if the out-of-state physician does not have ultimate authority over the care of the patient. All medical information transmitted electronically becomes part of the patient's medical record, which resides with the resident, primary care physician. Requires physicians and surgeons to obtain the verbal and written consent of the patient prior to the delivery of telemedical care. As of July 1, 1997, all private insurers and the Medi-Cal program must establish a reimbursement policy for telemedicine. (S 1665; effective 9/24/96)

The following year, the definition "telemedicine" was amended to exclude telephone conversations and electronic mail messages between a practitioner and patient. (S 922; enacted 8/2/97)

Colorado: CO Rev. Stat. 12-36-106 states that physicians lawfully practicing medicine in another state or territory do not have to obtain licensure in Colorado unless they do not limit their services to an occasional case, they establish or regularly use hospital connections in Colorado, or they maintain or are provided with an office in Colorado for their regular use. The "practice of medicine" is defined as holding oneself to the public as being able to diagnose, treat, prescribe for, palliate, or prevent any human ailment by any physical, mechanical or other means whatsoever. (1996)

Connecticut: Physicians who perform services in the state on a regular basis through electronic communications must be licensed in Connecticut. Exceptions include consultations and emergencies. (S 225; enacted 5/6/96)

Florida: Only a physician licensed in this state or otherwise authorized to practice medicine in this state may order, from a person located outside this state, electronic-communications diagnostic-imaging or treatment services for a person located in this state. (effective 7/1/95)

Georgia: Requires full licensure of nonresident physicians practicing medicine in Georgia, excluding consultations or demonstrations. The "practice of medicine" is defined as performing an act that is part of a patient care service located in the state, through use of any means, including electronic, radiographic, or telecommunications. Includes initiation of imaging procedures or the preparation of pathological materials. Telepractitioners can be disciplined by Georgia's state medical board. (S 107; effective 7/1/97)

Hawaii: HI Rev. Stat. 453-2 states out-of-state physicians practicing medicine in Hawaii must obtain licensure if they are the physician primarily responsible for the patient's care, if they open an office in the state, appoint a place to meet patients or receive calls in Hawaii. Telepractitioners are exempted if a physician licensed in Hawaii maintains primary control over the patient's care. (1997)

Limited, 3-month licenses must be granted to licensed, nonresident physicians substituting for Hawaiian doctors due to illness, vacation or training. Military medics and nonresident, consulting practitioners are excluded. (S. 512; 1997)

Idaho: ID Code 54-1803(1)(a) amended the definition of practice of medicine to read: "to investigate, diagnose, treat, correct, or prescribe for any human disease, ailment, injury, infirmity, deformity, or other condition, physical or mental, by any means or instrumentality." ID Code 54-1804(1)(b) allows out-of-state physicians to practice medicine in the state without obtaining licensure for consultations, demonstrations, lectures or clinics. The physician cannot open an office, appoint a place to meet patients or receive calls in the state. (effective 3/10/96)

Illinois: Nonresident doctors delivering care via electronic means to Illinois residents must be fully licensed, unless they are providing consultations, second opinions or follow up care. Amends the definition of telemedicine to include the rendering of written or oral opinions concerning the diagnosis or treatment of a patient in Illinois by a person outside the state through telephonic, electronic, or other means. Out-of-state physicians practicing telemedicine must subject themselves to the jurisdiction of Illinois courts. (S 314; enacted 7/11/97)

Indiana: "Practice of medicine" was amended to include "providing diagnostic or treatment services to a person in Indiana when the diagnostic or treatment services (a) are transmitted through electronic communications; and (b) are on a regular, routine and non-episodic basis." Consultation exceptions were not modified. (effective 1996)

Kansas: Kansas Register 100-26-1 states that physicians, regardless of their location, who perform acts constituting the "practice of medicine" in Kansas must be licensed by the state board of healing arts. Exceptions exist for out-of-state physicians called into the state on consultations, or physicians in bordering states, unless they open an office, appoint a place to meet patients, or receive calls in the state. (enacted 1996)

Mississippi: Requires full licensure of nonresident physicians practicing medicine across state lines, unless a resident physician requests their services. The resident physician must have a prior relationship with the patient being treated via telemedicine. (S 2389; effective 7/1/97)

Nebraska: Nonresident physicians practicing across state lines must be fully licensed, excluding consultations. The "practice of medicine" is amended to include persons physically located in another state who, through electronic or other means, perform any service that constitutes the healing arts and that affects the diagnosis and treatment of an individual in Nebraska. (L 452; enacted 5/9/97)

Nevada: The "practice of medicine" is amended to include the diagnosis or treatment of human illnesses and diseases "by using equipment that transfers information concerning the medical condition of the patient electronically, telephonically or by fiber optics." (effective 1995)

North Carolina: Requires nonresident physicians who treat patients in the state via electronic means to be licensed in the state and be subject to reasonable regulations by the North Carolina Medical Board. Exceptions are granted for infrequent consultations, educational training or physicians in bordering states who regularly practice in North Carolina. Allows residents to bring malpractice claims against nonresident practitioners into state courts. (S 780; enacted 9/17/97)

Oklahoma: The "Oklahoma Telemedicine Act" defines telemedicine as "the practice of health care delivery, diagnosis, consultation, treatment, transfer of medical data, or exchange of medical education information by means of audio, video or data communications." Requires health care service plans, disability insurer programs or state Medicaid contracts issued, amended or renewed on or after 1/1/98 to eliminate person-to-person contact as a provision for reimbursement. The primary care physician must obtain verbal and written informed consent from the patient before delivering telecare. (S 48; effective 7/1/97)

In 1995, licensure was required for out-of-state physicians who provide services to residents on an ongoing, regular basis through electronic communications. Exceptions were granted for brief consultations with a physician licensed in Oklahoma. Individuals performing these functions were considered to have submitted to the jurisdiction of the Oklahoma courts for any causes of actions resulting from these services. (OK Stat. Ann. tit. 59, 492(c)(3)(b); effective 5/95)

South Dakota: "Any nonresident physician or osteopath who, while located outside of this state, provides diagnostic or treatment services through electronic means to a person located in this state...is engaged in the practice of medicine or osteopathy in this state." (effective 3/3/95)

Tennessee: "The board has the authority to issue restricted licenses and special licenses based upon licensure to another state for the limited purpose of authorizing the practice of telemedicine to current applicants or current licensees or both as it deems necessary." (effective 5/15/96)

Texas: "A person who is physically located in another jurisdiction who, through the use of any medium, including an electronic medium, performs an act that is part of a patient care service initiated in this state, including the taking of an x-ray examination or the preparation of pathological material for examination, and that would affect the diagnosis or treatment of the patient, is engaged in the practice of medicine in this state." Out-of-state physicians practicing medicine in Texas must obtain licensure in the state, unless they are providing episodic consultations to a Texas physician, at his or her request, or consultation services to an educational institution. (effective 6/16/95)

In 1997, the definition of telemedicine was amended to exclude telephone or fax communications (H 2033; effective 9/1/97)

Utah: Utah Code Ann. 58-67-102 defines the practice of medicine as follows: "to diagnose, treat, correct, or prescribe for any human...ailment...by any means or instrumentality, and by an individual in Utah or outside the state upon or for any human within the state." Anyone practicing medicine in Utah must obtain a license, including telepractitioners. Exceptions are made for consultations, demonstrations and emergencies. (effective 7/1/96)