Which States Allow Telehealth Across State Lines?

Telehealth has transformed healthcare delivery, but state licensing requirements historically created barriers to cross-state practice. The landscape has shifted dramatically over the past five years, with most states adopting frameworks that allow providers to serve patients across state lines. Understanding which states participate in these agreements and what restrictions apply is essential for patients seeking remote care and providers expanding their practice.

The primary mechanism enabling interstate telehealth is the Interstate Medical Licensure Compact, a voluntary agreement that has fundamentally changed how physicians can practice remotely. This framework, combined with state-specific policies and federal regulations, now permits cross-state care delivery for most medical services, though important exceptions remain.

What is the Interstate Medical Licensure Compact and how does it work?

The Interstate Medical Licensure Compact, established in 2015, creates a pathway for physicians to obtain expedited licensure in multiple states through a centralized application process. Rather than applying separately to each state medical board, IMLC-member physicians can practice across participating states with a single, streamlined application. This compact applies to MDs and DOs and has become the gold standard for enabling interstate telehealth practice.

Which states are currently members of the Interstate Medical Licensure Compact?

IMLC membership includes major population centers and geographically diverse states spanning all regions. Member states represent approximately 60% of the U.S. population, making the compact the dominant framework for interstate medical practice. States continue joining regularly, with the most recent additions occurring throughout 2023-2024. The healthcare interoperability benefits of widespread IMLC adoption have accelerated state adoption rates.

For current membership status, the IMLC official website maintains an updated list of participating states and their implementation dates.

What states do NOT allow telehealth across state lines?

Approximately 20 states have not yet joined the IMLC, though many have adopted alternative reciprocal agreements or modified their regulations to permit cross-state telehealth under specific conditions. These non-member states typically require providers to obtain individual state licenses or temporary permits to practice telehealth with in-state patients. Some states allow telehealth for established patients or specific medical conditions, creating a patchwork of regulations.

Are there restrictions on which medical services can be provided across state lines via telehealth?

Federal and state regulations impose specific limitations on interstate telehealth services. Prescribing controlled substances across state lines faces particular scrutiny under the DEA’s regulations, requiring in-person evaluations in many cases. Mental health crisis interventions and emergency psychiatric services often require providers to be licensed in the patient’s state. However, routine consultations, follow-up care, chronic disease management, and preventive services are generally permitted across state lines for IMLC-member providers.

What are the requirements for providers to practice telehealth across state lines?

To practice telehealth across state lines, physicians must meet several prerequisites. First, they require an active, unrestricted medical license in their primary state of residence. Second, they must be eligible for IMLC membership, which involves background checks, medical education verification, and board certification requirements. Third, malpractice insurance must explicitly cover multi-state telehealth practice, as standard policies may exclude cross-state care. Finally, providers must understand and comply with individual state regulations regarding patient location verification, informed consent requirements, and record-keeping standards. Telehealth fraud prevention measures also require providers to maintain proper documentation of patient interactions.

How do telehealth regulations differ between states for out-of-state providers?

State-by-state variations in telehealth regulations create complexity for multi-state providers. Some states require providers to verify that patients are physically located within state boundaries during telehealth appointments, while others do not. Informed consent requirements range from simple verbal acknowledgment to detailed written agreements. Medical record standards differ regarding where records must be maintained and how long they must be retained. Additionally, some states require an established patient relationship or prior in-person visit before telehealth consultations, while others permit telehealth for new patients. Understanding these nuances is essential for compliance and optimizing patient access to online medical services.

What recent changes have been made to interstate telehealth policies?

The COVID-19 pandemic accelerated interstate telehealth adoption, and many temporary flexibilities have become permanent policy. Medicare expanded telehealth services across state lines and removed geographic restrictions for certain services. State legislatures have enacted permanent telehealth laws replacing emergency orders, and additional states have joined or are preparing to join the IMLC. The healthcare digital transformation momentum continues, with regulatory bodies increasingly recognizing telehealth as standard practice rather than an emergency measure.

For current information on federal telehealth policy, consult the CMS telehealth services page.

Frequently Asked Questions

Can I see a doctor from another state via telehealth?

The ability to access out-of-state providers depends on your location and the provider’s licensing status. If both your state and the provider’s state are IMLC members, telehealth consultations are permitted for most services. Check your state’s medical board website to confirm IMLC membership status.

Do I need to be an established patient for out-of-state telehealth visits?

State regulations differ significantly on this point. Many IMLC states permit new patient telehealth consultations, while others require established relationships. Contact your provider’s office or your state medical board for specific requirements.

Can I get prescriptions from an out-of-state telehealth provider?

Out-of-state providers can prescribe most medications via telehealth in IMLC states. However, controlled substances require additional scrutiny and may need in-person evaluation. Non-controlled medications are generally permitted across state lines for established or new patients, depending on state law.