Telehealth, patient portals, electronic prescribing, and mobile communication allow clinicians to remain connected with patients who are traveling or temporarily living in another state. However, providing patient-specific advice across state lines may create licensure, legal, privacy, prescribing, and patient safety obligations.

Before delivering care, clinicians should verify where the patient is located, determine whether they are legally authorized to practice in that state, and ensure they can meet the applicable standard of care through the chosen communication method.

Key Takeaways

• Medical care is generally considered to occur where the patient is physically located.
• Cross-state care may require a license, registration, reciprocity, or compact participation.
• Telephone calls, portal messages, emails, and prescription decisions may constitute medical care.
• Clinicians should verify both licensure authority and professional liability coverage.
• Telehealth encounters remain subject to privacy, consent, and documentation requirements.
• Practices should have emergency procedures for patients located in another state.

When is a clinician considered to be practicing medicine in another state?

Medical care generally is considered to occur where the patient is physically located. A clinician who evaluates, diagnoses, treats, prescribes for, or provides individualized medical advice to a patient in another state may therefore be practicing in that state. Before providing care, the practice should verify and document the patient's current location and determine whether the clinician is legally authorized to practice there.

This concern is not limited to scheduled video visits. Telephone calls, portal messages, emails, medication adjustments, test-result discussions, or reviews of patient-submitted photographs may constitute medical care when they involve individualized clinical decisions.

What licensure requirements apply to cross-state medical care?

Depending on the state, authorization may require:

• A full license
• Telehealth registration
• Temporary-practice authority
• Reciprocity
• Participation in a professional licensure compact

Some states provide limited exceptions for emergencies, consultations with locally licensed clinicians, or follow-up care for established patients who are temporarily traveling. Because these exceptions differ substantially, clinicians should confirm the applicable requirements before relying on them.

Do licensure compacts allow physicians to practice anywhere in the United States?

Not necessarily. Licensure compacts can expedite multistate practice but do not necessarily create one national license. For example, eligible MD and DO physicians using the Interstate Medical Licensure Compact still receive separate licenses from participating states.

Healthcare professionals should consult their own profession-specific licensing boards regarding compact participation and multistate practice requirements.

Does malpractice insurance automatically cover care provided in another state?

No. Clinicians should confirm that their professional liability insurance covers services provided to patients located in other states. Authorization to practice does not automatically establish insurance coverage or payer reimbursement. Cross-state care may also create jurisdictional considerations. If a malpractice claim arises from care provided to a patient located in another state, the claim may potentially be brought in that state because that is where the patient received care and where the alleged injury occurred. In some situations, another state's laws and standards of care may apply.

Clinicians should be aware that providing care across state lines may expose them to legal proceedings outside their home state. Before providing cross-state care, practices should verify coverage with their insurance carrier and confirm any applicable requirements.

What should clinicians consider before prescribing across state lines?

Cross-state prescribing must comply with:

• The patient's state laws
• Professional-board rules
• Federal law
• Prescription-monitoring requirements
• Applicable pharmacy regulations

Clinicians should determine whether a sufficient practitioner-patient relationship exists and whether an in-person examination is required.

Additional restrictions apply to controlled substances.

Federal telemedicine flexibilities currently permit qualifying DEA-registered practitioners to prescribe certain controlled medications without a prior in-person evaluation when specified requirements are met. These temporary flexibilities extend through December 31, 2026.

However, these flexibilities do not override state licensure requirements or more restrictive state prescribing laws.

Is telehealth always clinically appropriate for patients in another state?

Legal authority to provide care does not necessarily mean remote treatment is clinically appropriate. The applicable standard of care remains in effect regardless of whether communication occurs by video, telephone, email, or patient portal. Before proceeding, the clinician should determine whether the available technology permits:

• An adequate history and examination
• Access to relevant records
• Necessary testing
• Identification of local referral resources
• Appropriate follow-up
• Timely response if the patient's condition becomes urgent

When remote communication cannot support an adequate assessment, the patient should be directed to an appropriate local clinician or emergency facility.

What emergency planning should practices have for cross-state patients?

Practices should maintain cross-state emergency procedures. Each encounter should include:

• Verification of the patient's exact location
• Identification of a local emergency contact when appropriate
• Identification of a local emergency medical service when appropriate
• Identification of a nearby hospital when appropriate

Planning ahead helps ensure appropriate emergency response if a patient's condition deteriorates during a telehealth or remote-care encounter.

What consent and privacy requirements apply to cross-state telehealth care?

Some states require telehealth-specific consent or disclosures regarding:

• Limitations of remote care
• Available alternatives
• Privacy risks
• Emergency procedures

Telehealth visits and related communications remain subject to HIPAA when provided by covered entities. Practices should use:

• Secure platforms
• Encrypted communications
• Vendors willing to enter into business associate agreements when required

Patients should be encouraged to use secure portals rather than ordinary email, text messaging, or social media when sharing sensitive clinical information.

What should be documented during cross-state encounters?

The medical record should document:

• The patient's location
• The communication method used
• Consent
• Relevant findings
• Limitations of the remote examination
• Assessment
• Treatment plan
• Prescriptions
• Referrals
• Follow-up instructions
• Emergency instructions

Thorough documentation helps demonstrate compliance with legal, clinical, and risk management requirements.

What is the risk management takeaway for clinicians providing cross-state care?

Before providing cross-state care, clinicians should ask:

• Where is the patient?
• Am I authorized to provide care there?
• Am I insured to provide care there?
• Can I meet the applicable standard of care through this communication method?

Because requirements change frequently, practices should verify current rules with the applicable state licensing board, payer, professional liability carrier, and legal counsel before providing cross-state care.

FAQs

Can a physician treat a patient who is temporarily visiting another state?

Possibly. The answer depends on the laws of the state where the patient is physically located and whether an applicable exception or authorization exists.

Do telephone calls and portal messages count as medical care?

They may. Telephone calls, patient portal messages, emails, medication adjustments, and other individualized clinical communications can constitute medical care.

Can a physician prescribe medication for a patient located in another state?

Potentially, but prescribing must comply with state and federal requirements, including any applicable licensure and telemedicine rules.

Does HIPAA apply to telehealth and cross-state communications?

Yes. Telehealth visits and related communications remain subject to HIPAA when provided by covered entities.

Should a patient's location be documented during a telehealth encounter?

Yes. The patient's physical location should be verified and documented as part of the encounter record.

Looking for more guidance? Explore our risk management resources. If you're not currently insured with OUM, fill out our online form to receive a free, no-obligation quote.  

References

1. HHS, Licensing Across State Lines.
2. Federation of State Medical Boards, Telemedicine Policies: Board-by-Board Overview.
3. Federation of State Medical Boards, States with Episodic and Follow-Up Care Licensure Exceptions.
4. Interstate Medical Licensure Compact Commission, General FAQs.
5. DEA, Extension of Telemedicine Prescribing Flexibilities Through 2026.
6. HHS, Obtaining Informed Consent.
7. HHS, HIPAA Rules for Telehealth Technology.

Disclaimer: “OUM” and “OUM Chiropractor Program” do not refer to a legal entity or insurance company but to a program or symbol of a program underwritten, insured, and administered by ProAssurance Insurance Company of America. The information contained on the OUM Chiropractor Blog does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only. We encourage all blog visitors to consult with their personal attorneys for legal advice, as specific legal requirements may vary from state to state. Links or references to organizations, websites, or other information is for reference use only and do not constitute the rendering of legal, financial, or other professional advice or recommendations. In the event any of the information presented conflicts with the terms and conditions of any policy of insurance offered by ProAssurance Insurance Company of America, the terms and conditions of the actual policy will apply. All information contained on the blog is subject to change.