The expansion of telehealth has a number of positive implications for nurse practitioners. It can mean the ability to work from home, providing patient care from a computer screen. Telehealth helps nurse practitioners interact with patients who may have barriers to receiving care in the traditional clinic or hospital setting. Technically, the technology opens up a much wider patient population to the nurse practitioner, as close geographic proximity is not required to interact with the patient. But, is it legal for NP to treat out-of-state patients on telehealth platforms?
Before you get too excited about the ability to expand your practice by taking communication to the virtual realm, a review of state rules and regulations is in order. While technology that would allow providers to treat patient nationally, and even globally, exists, in most cases laws make it difficult for nurse practitioners to do so.
Scope of Practice Conflict
State laws regulate the way healthcare providers, including nurse practitioners, must practice. Telehealth makes it possible for providers to treat patients across state lines. So, which state laws must the provider adhere to in treating the patient – those in the state where the provider is located, or those in the state where the patient is located?
When it comes to telehealth, the location of the patient is considered by federal law to be the ‘place of service’. The provider, regardless of location, must at minimum follow the rules of the regulations of the state where the patient is located.
The issue of state licensure also arises in telehealth. Should the nurse practitioner obtain a license to practice in the state where he/she is physically located, or in the state where the patient is located? In most cases, the answer is both.
States require that healthcare providers practicing within their boarders are appropriately licensed. This means that nurse practitioners must be licensed in the state where they are physically located, and adhere to corresponding scope of practice guidelines. Most states also required that healthcare providers have a license to practice if they are treating patients within that state. For example, a nurse practitioner located in Virginia, but treating a patient in Connecticut, would be required to hold a license to practice in both Virginia and Connecticut.
Licensing regulations restrict the growth and utility of telehealth. While nurse practitioners may theoretically provide care to patients across the country, obtaining a license to practice in a large number of states is impractical. Federal legislation could change this.
In coming years, we may see the federal government redefine the ‘place of service’ as the location of the provider delivering care, rather than the location of the patient. This would mean that practitioners providing telehealth services must hold a license only in the state where the provider is located, rather than that of the patient and provider.
Providing care across state lines can be a complicated matter. Nurse practitioners interested in implementing telehealth technology must carefully examine the laws regulating telehealth not only in the state where they are located, but also in the state(s) of the patients they treat.
Would you consider treating patients via telehealth?
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